CID BENEDICT D. PABALAN's COPY
Chapter I
GENERAL CONSIDERATION
^EGALM^DIClNllis a branch of medicine which deals with the
application of medical knowledge to the purposes of law and in the
administration of justice. It is the application of basic and clinical,
medical and paramedical sciences to elucidate legal matters.
Originally the terms legal medicine, forensic medicine and medical
jurisprudence are synonymous and in common practice are used
interchangeably. This concept prevailed among countries under the
Anglo-American influence.
The concept and practice of legal medicine in the Philippines is
of Spanish origin. In modern times, especially in continental European countries, legal medicine has a similar meaning as the term
forensic medicine, although, strictly speaking, legal medicine is
primarily the application of medicine to legal eases while forensic
medicine concerns with the application of medical science to elucidate legal problems. On the other hand, .medical jurisprudence
(j'uris-law, prudentia-knowledge) denotes knowledge"of lawT in relation to the practice of medicine. It concerns with the study of the
rights, duties and obligations of a medical practitioner with particular reference to those arising from doctor-patient relationship.
According to the Rules of Court (Sec. 5, Rule 138) Medical
Jurisprudence is one of the subjects in the law course before admission to the bar examination. This is based on the original concept
but actually it must be the study of legal medicine as it was the
intention and practice in the past.
v Scope of Legal Medicine:
The scope of legal medicine is quite broad and encompassing. It
is the application of medical and paramedical sciences as demanded
by law and administration of justice. The knowledge of the nature
and extent of wounds has been acquired in surgery, abortion in
gynecology, sudden death and effects of trauma in pathology, etc.
aside from having knowledge of the basic medical sciences, like
anatomy, physiology, biochemistry, physics and other allied sciences.
^Nature of the Study of Legal Medicine:
A knowlege of legal medicine means the ability to acquire facts,
the power to arrange those facts in their logical order, and to draw a
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LEGAL MEDICINE
conclusion from the facts which may be useful in the administration
of justice.
Aside from being a perceptor of fact, he must possess the power to
impart to others verbally or in writing all those he has observed.
A physician who specializes or is involved primarily with medicolegal duties is known as medical jurist, (meoical examiner, medicolegal officer, medico-legal expert). Inasmuch as administration of
justice is primarily a function of the state, physicians whose duties
are mainly medico-legal in nature are mostly in the service of the
government.
/
Health officers, medical officers of Jaw enforcement agencies and
members of the medical staff of accredited hospital are authorized
by law to perform autopsies (Sec. 95, P.D. 856, Code of Sanitation).
However, "it is the duty of every physician, when called upon by the
judicial authorities, to assist in the administration of justice on
matters which are medico-legal in character" (Sec. 2, Art. Ill, Code
of Medical Ethics of the Medical Profession of the Philippines).
To be involved in medico-legal duties, a physician must possess
sufficient knowledge of pathology, surgery, gynecology, toxicology
and such other branches of medicine germane to the issues involved.
/Distinction Between an Ordinary Physician and a Medical Jurist:
1. An ordinary physician sees an injury or disease on the point of
view of treatment, while a medico-jurist sees injury or disease on
the point of view of cause.
2. The purpose of an ordinary physician examining a patient is to
arrive at a definite diagnosis so that appropriate treatment can be
instituted, while the purpose of the medical jurist in examining a
patient is to include those bodily lesions in his report and testify
before the court or before an investigative body; thus giving
justice to whom it is due.
3. Minor or trivial injuries are usually ignored by an ordinary clinician
inasmuch as they do not require usual treatment. Superficial
abrasions, small contusion and other minor injuries will heal without medication. However, a medical jurist must record all bodily
injuries even if they are small or minor because these injuries may
be proofs to qualify the crime or to justify the act.
Examples: a. The presence of physical injuries of a victim of
sexual abuse may be presumptive proof that force
was applied in the commission thereof, hence the
crime committed must be rape.
GENERAL CONSIDERATION
b. The presence of physical injuries on the offender of
the crime of physical injuries may be a proof that the
victim acted in self-defense.
Other Definitions:
yjl. Law is a rule of conduct, just, obligatory, laid by legitimate power
for common observance and benefit. It is a science of moral laws
founded on the rational nature of man which regulates free activity
for the realization of his individual and social ends under the
aspect of mutual demandable independence. (1 S.R.)
The word "law" includes regulations and circulars which are
issued to implement a law and have, therefore, the effect of law.
^Characteristics of Law:
a. It is a rule of conduct;
b. It is dictated by legitimate power; and
c. Compulsory and obligatory to all (Civil Code by Padilla).
Forms of Law:
' a. Written or Statutory Law (Lex Scripta):
This is composed of laws which are produced by the country's
legislations and which are defined, codified and incorporated
by the law-making body.
/ Example: Laws of the Philippines,
^ b . Unwritten or Common Law (Lex non Scripta):
This is composed of the unwritten laws based on immemorial
customs and usages. It is sometimes referred to as case law,
common law, jurisprudence or customary law.
Example: Laws of England
2. Forensic:
It denotes anything belonging to the court of law or used in
court or legal proceedings or something fitted for legal or public
argumentations (Black's Law Dictionary, 4th ed.)
3. Medicine:
Medicine is a science and art dealing with prevention, cure and
alleviation of disease. It is that part of science and art of restoring
and preserving health.
The term medicine is also applied to a science and art of diagnosing, treating, curing and preventing disease, relieving pain,
and improving the health of a person,
z 4. Legal:
Legal is that which pertains to law, arising out of, by virtue of
or included in law. It also refers to anything conformable to the
letters or rules of law as it is administered by the court.
J
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LEGAL MEDICINE
5. Jurisprudence:
It is a practical science which investigates the nature, origin,
development and functions of law. It is a science of giving a wise
interpretation of the law and making just application of them to
all cases as they arise.
Judicial decisions applying or interpreting the laws shall form a
part of the Philippine jurisprudence. The decisions contemplated
are those rendered by the Supreme Court which is the final arbiter
on legal issues. However, the decisions of the Court of Appeals
may serve as precedent for inferior courts on points of facts.
Principle of Stare Decisis:
A principle that, when the court has once laid down a principle of
law or intepretation as applied to a certain state of facts, it will
adhere to and apply to all future cases where the facts are substantially the same.
The principle is one of policy, grounded on the theory that
security and certainty require that accepted and established legal
principles, under which right may accrue, be recognized and followed, though later found to be not legally sound, but whether
previous holding of court shall be adhered to, modified or overruled is within the court's discretion under the circumstance of the
case before it (Black's Law Dictionary, 4th ed.).
Branches of Law Where Legal Medicine may be Applied:
1. Civil Law — Civil law is a mass of precepts that determines and
regulates the relation of assistance, authority, and obedience
between members of a family and those which exist among
members of a society for the protection of private interest (Sanchez Roman).
Our civil laws are scientifically and systematically compiled in
the Civil Code of the Philippines (Republic Act No. 386).
In civil law, knowledge of legal medicine may be useful on the
following:
a. The determination and termination of civil personality (Art. 40
and 41),
b. The limitation or restriction of a natural person's capacity to
act (Art. 23 and 39);
c. The marriage and legal separation (Book I, Title III & IV);
d. The paternity and filiation
^Book I, Title VIII); and
e. The testimentary capacity of a person making a will (Book III,
Title IV).
GENERAL CONSIDERATION
5
2. Criminal Law — Criminal law is that branch or division of law
which defines crimes, treats of their nature and provides for their
punishment.
It is a body of specific rules regarding human conduct which have
been promulgated by political authority, which apply uniformly
to all members of the classes to which the rules refer, and which are
enforced by punishment administered by the state (SutherlandCressey, Criminology, 7th ed„ p. 4).
Penal laws and those of public security and safety shall be
obligatory upon all who live or sojourn in the Philippine territory,
subject to the principles of public international law and to treaty
stipulations (Art. 14 Civil Code).
The Philippine criminal law is codified in the Revised Penal
Code and may also be found in the penal provisions of the special
laws.
Legal medicine is applicable in the following provisions of the
penal code:
a. Circumstances affecting criminal liability (Title I);
b. Crimes against person (Title VIII), and
c. Crimes against chastity (Title XI).
3. Remedial Law — Remedial law is that branch or division of law
which deals with the rules concerning pleadings, practices and
procedures in all courts of the Philippines.
It is the law which gives a party a remedy for a wrong. It is
intended to afford a private remedy to a person injured by the
wrongful act. It is a designed law, which redresses an existing
grievance or introduces regulation conducive to public good
(Black's Law Dictionary, 4th ed.).
Our remedial law is embodied in the Rules of Court of the
Philippines and also in the remedial provision of Special Laws.
Legal Medicine may be applied in the following provisions of
the Rules of Court:
a. Physical and mental examination of a person (Rule 28);
b. Proceedings for hospitalization of an insane person (Rule 101);
and
c. Rules on evidences (Part IV).
4. Special Laws:
a. Dangerous Drug Act (R.A. 6425, as amended)
b. Youth and Child Welfare Code (P.D. 603)
c. Insurance Law (Act No. 2427 as amended)
d. Code of Sanitation (P.D. 856)
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LEGAL MEDICINE
e. Labor Code (P.D. 442)
f. Employee's Compensation Law
Some Bask Principles Governing Application and Effects of Laws:
1. Ignorance of the law excuses no one from compliance therewith
or "ignorantia legis nominem excusat" (Art 3, Civil Code):
The main reason for the provision is to prevent ignorance of
the law as a means of defense for violation of the law. The provision refers to all kinds of domestic laws on grounds of expediency, policy and necessity.
"Ignorance of the law" may refer to the literal wordings of the
law and also to the meaning or interpretation given to the law.
But the rule is not inflexible. It may only be applied when it is
clearly manifested and inexcusably ignorant of the law.
Mere ignorance of the facts of the law would furnish immunity
from the punishment for violation of the penal code and immunity
from the liability for actual loss for violation of personal or property right.
2. Laws shall have no retroactive effect, unless the contrary is provided (Art. 4, Civil Code):
A law can only be applied to cases after its promulgation arid
must not be given retroactive application.
A law, however, may be given retroactive effects in the following instances:
a. When the law provides the contrary (Art. 4, Civil Code).
b. Penal laws shall be given retroactive effect if favorable to the
accused who is not habitually delinquent (Art. 22, Revised
Penal Code).
c. When the statute is remedial in nature because there is no vested
right in the rules of procedure.
d. When the law creates a new substantive right.
3. Rights may be waived, unless the waiver is contrary to law, public
order, public policy, morals or good customs, or prejudicial to a
third person with a right recognized by law (Art. 6, Civil Code):
A right is the power, privilege, faculty which entitles a man to
have, or to do, or to receive from another within the limits
prescribed by law. Waiving is the intentional or voluntary relinquishment, abandonment or throwing away, renunciation, surrendering of a known right.
The rights granted to a person by law may be waived but in the
following cases, the law does not allow such waiver:
a. When such waiver will be contrary to the existing law.
GENERAL CONSIDERATION
7
b. When it is against public order, public policy, morals and good
customs.
c. When in so waiving it is prejudicial 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 (Art. 11, Civil Code). A custom must
be proved as a fact according to the rules of evidence (Sec. 12,
Civil Code):
Custom is a usage or practice of the people, which by common
adoption and acquiescence and by long and unvarying habit, has
become compulsory and has acquired the force of a law with
respect to the place and subject-matter to which it relates (Black's
Law Dictionary, 4th ed.).
Customs constitute sources of supplementary law in default of
specific legislation.
However, if the custom is contrary to the existing law or to
' public order and policy, the law must prevail.
5. Laws are repealed only by subsequent ones, and their violation or
non-observance shall not be excused by disuse, custom or practice
to the contrary.
When the court declares a law to be inconsistent with the constitution, the former shall be void and the latter shall govern.
Administrative or executive acts, orders and regulations shall
be valid only when they are not contrary to the laws or the constitution (Art. 7, Civil Code):
The constitution is the fundamental law of the land. All acts,
administrative or executive orders contrary to the provision of
the constitution shall be deemed void.
Any existing law which is inconsistent with a subsequent law
is deemed repealed by the latter law.
Administrative or executive acts, orders and regulations are considered valid when they are not in contravention with the existing
laws.
BRIEF HISTORY OF LEGAL MEDICINE
1. IN WORLDWIDE SCALE:
The earliest recorded medico-legal expert was Imhotep (2980
B.C.). He was the chief physician and architect of King Zoser of
the third dynasty in Egypt and the builder of the first pyramid.
That time was the first recorded report of a murder trial written
on clay tablet.
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LEGAL MEDICINE
The Code of Hammurabi, the oldest code of law (2200 B.C.)
included legislation on adultery, rape, divorce, incest, abortion and
violence.
Hippocrates (460-355 B.C.) in Greece discussed the lethality
of wounds. Aristotle (384-322 B.C.) fixed animation of fetus at
the 40th day after conception.
About 300 B.C. the Chinese materia medica gave information
on poison including aconite, arsenic and opium. Hashish was said
to have been used as a narcotic in surgery about 200 B.C.
That bodies of all women dying during confinement should
immediately be opened in order to save the child's life was promulgated during the reign of Numa Pompilius in Rome (600
B.C.).
The first "police surgeon" or forensic pathologist was Antistius. Julius Caesar (100-44 B.C.) was murdered and his body was
exposed in the forum and Antistius performed the autopsy. He
found out that Julius Caesar suffered from twenty-three wounds
and only one penetrated the chest cavity through the space between the first and second ribs.
Justinian (483-565 A.D.), in his Digest, made mention that a
physician is not an ordinary witness and that a physician gives
judgment rather than testimony. This led to the recognition of
expert witness in court.
The first textbook in legal medicine was included in the Constitute Criminalis Carolina which was promulgated in 1532 during
the reign of Emperor Charles V in Germany.
Pope Innocent III (1209) issued an edict providing for the
appointment of doctors to the courts for the determination of the
nature of wounds.
Pope Gregory IX, in 1234, caused the preparation of Nova
Compilatio Decretalium which concerned medical evidence, marriage, nullity, impotence, delivery, caesarian section, legitimacy,
sexual offenses, crime against persons and witchcraft.
In the 14th century, Pope John XXII expressed the need of
experts in the ecclesiastical courts, in the diagnosis of leprosy and
many medico-legal documents.
In China, the Hsi Yuan Lu (Instructions to Coroner) was published. It is a five volume book dealing with inquest, criminal
abortion, infanticide, signs of death, assault, suicide, hanging,
strangling, drowning, burning, poisoning and antidotes, and
examination of the dead.
GENERAL CONSIDERATION
9
In 1575, Ambroise Pare considered legal medicine as a separate
discipline and he'discussed in his book, abortion, infanticide,
death by lightning, hanging, drowning, feign diseases, distinction
between ante-mortem and post-mortem wound and poisoning by
carbon monoxide and by corrosives.
Paulus Zacchias (1584-1659), a papal physician, is regarded as
the "father of forensic medicine." He published Questiones
Medico-legales which dealt with the legal aspects of wounds and
the first two chapter dealt with the detection of secret homicide.
In 1598, Severin Pineau published in Paris a work on virginity
and defloration. He confirmed the existence of the hymen and
that it may not rupture during sexual intercourse.
Orfila (1787-1853) introduced chemical methods in toxicology.
In his Traite' des Poison, he mentioned mineral, vegetable and
animal poison in relation with physiology, pathology and legal
medicine. He was considered later as the founder of modern
toxicology.
The period thereafter is characterized by an appreciable increase in available publication on the subject dealing with modem
innovative findings and procedures related to medical progress and
changes in the laws.
2. IN THE PHILIPPINES:
In 1858, the first medical textbook printed including pertinent instructions related to medico-legal practice by Spanish
physician, Dr. Rafael Genard y Mas, Chief Army Physician,
entitled "Manual de Medicina Domestica."
In 1871, teaching of legal medicine, included as an academic
subject in the foundation of the School of Medicine of the Real
y Pontifica Universidad de Santo Tomas.
On March 31, 1876 by virtue of the Royal Decree No. 188, of
the King of Spain, the position of "Medico Titulares" was created
and made in charge of public sanitation and at the same time
medico-legal aid in the administration of justice.
In 1894, rules regulating the services of those "Medico Titular
y Forences" was published.
In 1895, medico-legal laboratory was established in the City of
Manila and extended at the same time its services to the provinces.
In 1898, American Civil Government preserved the Spanish
forensic medicine system.
In 1901, Philippine Commission created the provincial, insular
and municipal Board of Health (Act Nos. 157, 307 and 308) in
the Philippines and assigned to the respective inspectors and pres-
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LEGAL MEDICINE
idents of the same, medico-legal duties of the "Medico Titulares"
of the Spanish regime. The Philippine Legislature maintained the
pre-existing medico-legal system in full force in the Administrative
Code.
In 1908, the Philippine Medical School incorporated the teaching of Legal Medicine, one hour a week to the fifth year medical
students.
In 1919, the University of the Philippines created the Department of Legal Medicine and Ethics with the head having the salary
of 4,000.00 pesos per annum, half-time basis, with Dr. Sixto de
los Angeles as the chief.
On January 10, 1922, the head of the Department of Legal
Medicine and Ethics became the Chief of the Medico-Legal Department of the Philippine General Hospital without pay.
On March 10, 1922,-the Philippine Legislature enacted Act. No.
1043 which became incorporated in the Administrative Code as
Section 2465 and provided that the Department of Legal Medicine,
University of -the Philippines, became a branch of the Department
of Justice.
On December 10, 1937, Commonwealth Act. No. 181 was
passed creating the Division of Investigation under the Department
of Justice. The Medico-Legal Section was made as an integral part
of the Division with Dr. Gregorio T. Lantin as the chief.
On March 3, 1939, the Department of Legal Medicine of the
College of Medicine, University of the Philippines was abolished
and its functions were transferred to the Medico-Legal Section of
the Division of Investigation under the Department of Justice.
On July 4, 1942, President Jose P. Laurel consolidated by
executive order all the different law-enforcing agencies and created
the Bureau of Investigation on July 8,1944.
In 1945 immediately after liberation of the City of Manila, the
Provost Marshal of the United States Army created the Criminal
Investigation Laboratory with the Office of the Medical Examiner
as an integral part and with Dr. Mariano Lara as Chief Medical
Examiner.
On June 28, 1945, the Division of Investigation, under the
Department of Justice was reactivated.
On June 19, 1947, Republic Act. No. 157 creating the Bureau
of Investigation was passed. The Bureau of Investigation was
created by virtue of an executive order of the President of the
Philippines. Under the bureau, a Medico-Legal Division was created
with Dr. Enrique V. de los Santos as the Chief.
GENERAL CONSIDERATION
11
There exists a Medico-Legal Division in the Criminal Laboratory
Branch of the G-2 of the Philippine Constabulary. All provincial,
municipal and city health officers, physicians of hospitals, health
centers, asylums, penitentiaries and colonies are ex-officio medicolegal officers.
In remote places where the services of a registered physician was
not available, a "Cirujano Ministrante" may perform medico-legal
work. However, after the approval of Republic Act 1982 on
June 15, 1954 which provided for the creation of rural health
unit to each municipality composed of municipal health officer, a
public nurse, a midwife and a sanitary inspector virtually abolished
the appointment of Cirujano Ministrante thereby making qualified
physicians to perform medico-legal functions.
June 18, 1949, Republic Act 409 which was later amended by
Republic Act 1934 provides (Sec. 38) for the creation of the office of the Medical Examiners and Criminal Investigation Laboratory under thej^jice Department of the City of Manila.
On December 23, 1975, Presidential Decree 856 was promulgated and Sec. 95 provides:
A. Persons authorized to perform autopsies:
1. Health officers
2. Medical officers of law enforcement agencies
3. Members of the medical staff of accredited hospitals
B. Autopsies shall be performed in the following cases:
1. Whenever required by special laws;
2. Upon order of a competent court, a mayor and a provincial or city fiscal;
3. Upon written request of police authorities,
4. Whenever the Solicitor General, provincial or city fiscal
deem it necessary to disinter and take possession of the
remains for examination to determine the cause of death;
and
5. Whenever the nearest kin shall request in writing the
authorities concerned to ascertain the cause of death.
V MEDICAL EVIDENCE
Evidence is the means, sanctioned by the Rules of Court, of
ascertaining in a judicial proceeding the truth respecting a matter of
fact (Sec. 1, Rule 128, Rules of Court).
It is the species of proof, or probative matter, legally presented at
the trial of an issue by the act of the parties and through the medium
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LEGAL MEDICINE
of witnesses, records, documents, concrete objects, etc., for the purpose of inducing belief in the minds of the court as to their contenti o n (Black's Law Dictionary, 4th ed.).
If the means employed to prove a fact is medical in nature then it
becomes a medical evidence.
Same rules in all cases — The rules of evidence shall be the same in
all courts and on all trials and hearings, whether civil or criminal
(Sec. 2, Rule 128, Rules of Court).
Admissibility of evidence — Evidence is admissible when it is
relevant to the issue and is not excluded by these rules (Sec. 3, Rule
128, Rules of Court).
It is considered relevant when it has the tendency to prove any
matter of fact. It is something which by the process of logic, an
inference may be made as to the existence or non-existence of a fact
at issue.
Relevancy of evidence (collateral matters) — Evidence must have
such a relation to the fact in issue as to induce belief in its existence
or non-existence; therefore, collateral matters shall not be allowed,
except when they tend in any reasonable degree to establish the
probability or improbability of the fact at issue (Sec. 4, Rule 130,
Rules of Court).
Collateral matters are those different from those or do not correspond with the matters in issue.
Types of Medical Evidence:
. /I. Autoptic or Real Evidence:
This is an evidence made known or addressed to the senses of the
court. It is not limited to that which is known through the sense
of vision but is extended to what the sense of hearing, taste, smell
and touch is perceived.
Sec. 1, Rule 130, Rules of Court — View of an object — Whenever an object has such a relation to the fact in issue as to afford
reasonable ground of belief respecting the latter, such object may
be exhibited to or viewed by the court, or its existence, situation,
condition, or character proved by witnesses, as the court in its
discretion may determine.
The court may require the physician to present the skeleton of
the victim of a criminal act exhumed and examined for the judge
to see the presence and degree of the ante-mortem fracture.
Limitations to the Presentation of Autoptic Evidence:
a. Indecency and Impropriety — Presentation of an evidence may
be necessary to serve the best interest of justice but the notion
of decency and delicacy may cause inhibition of its presentation.
GENERAL CONSIDERATION
13
The court may not allow exposure of the genitalia of an
alleged victim of sexual offense to show the presence and degree
of the genital and extra-genital injuries suffered by the victim.
There are other ways for the court to know the facts other than
actual exhibition.
b. Repulsive Objects and those Offensive to Sensibilities — Foul
smelling objects, persons suffering from highly infectious and
communicable disease, or objects which when touch may mean
potential danger to the life and health of the judge may not be
presented.
However, if such evidence is necessary in the adjudication of
the case, the question of indecency and impropriety or the fact
that such evidence is repulsive or offensive to sensibilities, it
may be presented. This will depend on the sound discretion of
the court.
-2. Testimonial Evidence:
A physician may be commanded to appear before a court to
give his testimony. While in the witness stand, he is obliged to
answer questions propounded by counsel and presiding officer of
the court. His testimony must be given orally and under oath or
affirmation.
A physician may be presented in court as an ordinary witness
and/or as an expert witness:
a. Ordinary Witness:
A physician who testifies in court on matters he perceived
from his patient in the course of physician-patient relationship
is considered as an ordinary witness.
Sec. 18, Rule 130, Rules of Court — Witnesses. Their qualification — Except as provided in the next succeeding section,
all persons who, having organs of sense, can perceive, and perceiving, can make known their perception to others, may be
witnesses. Neither parties nor other persons interested in the
outcome of a case shall be excluded; nor those who have been
convicted of crime; nor any person on account of his opinion
on matters of religious belief.
One of the^exceptions to the ordinary witness rule is the
privilege j>fcommunication (confidential) between physician
and patient.
Although the physician perceived something
through his organ of sense and has the power to transmit to
others what he perceived, he is not allowed to disclose those
informations to others as regards to matters he perceived from
his patient during the physician-patient relationship.
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LEGAL MEDICINE
Sec. 21(c), Rule 130, Rules of Court — Privileged communication — A person authorized to practice medicine, surgery or
obstetrics cannot in a civil case, without the consent of the
patient, be examined as to any information which he may have
acquired in attending such patient in a professional capacity,
which information was necessary to enable him to act in that
capacity, and which would blacken the character of the patient.
A medical witness can only testify on matters derived by his
own perception. Hearsay informations are as a rule not admissible in court. Hearsay evidences are those not proceeding
from the personal knowledge of the witness but from mere
repetition of what he has heard others say. It is a, "second
hand" evidence which rest mainly on the veffdty and competence of its source.
Sec. 30, Rule 130, Rules of Court — Testimony generally
confined to personal knowledge — A witness can testify only
to those facts which he knows of his own knowledge; that is,
which are derived from his own perception, except as otherwise provided in these ruje:
One of the exceptions to the non-admissibility of hearsay
evidence is dying declaration. The declaration of a dying person
under the consciousness of his impending death as regards
circumstance regarding his impending death is admissible in
spite of the fact that it is a hearsay, it is made so because of
necessity and it is trustworthy.
Exceptions to the hearsay rule. Sec. 31, Rule 130, Dying
declaration — The declaration of a dying person, made under a
consciousness of an impending death, may be received in a
criminal case wherein his death is the subject of inquiry, as
evidence of the cause and surrounding circumstances of such
death.
Physicians are frequent recipients of dying declaration in the
medical clinics and emergency rooms of hospitals. To be admissible it must be shown that the declarant was conscious of
his impending death, that the declaration must be with regards
to his impending death; that the declarant was in full possession
of his mental faculties when he made the declaration; and that
such evidence is presented in court in a case of homicide,
murder or parricide wherein the declarant was the victim,
b. Expert Witness:
A physician on account of his training and experience can
give his opinion on a set of medical facts. He can deduce or
GENERAL CONSIDERATION
15
infer something, determine the cause of death, or render opinion
pertinent to the issue and medical in nature.
Sec. 42, Rule 130, Rulesof^Court — Opinion Rule — General
Rule — The opinion of^witness is not admissible, except as
indicated in the following section.
Sec. 43, Rule 130, Rules of Court — Expert Evidence — The
opinion of a witness regarding a question of science, art or
trade, when he is skilled therein, may be received in evidence.
The probative value of the expert medical testimony depends
upon the degree of learning and experience on the line of what
the medical expert is testifying, the basis and logic of his conclusion, and other evidences tending to show the veracity or
falsity of his testimony.
3. Experimental Evidence:
A medical witness may be allowed by the court to confirm his
allegation or as a corroborated proof to an opinion he previously
stated.
The issue as to how long a person can survive, after the administration of lethal dose of poison can be shown by the administration of the said poison to experimental animals within
the view of the court.
4. Documentary Evidence:
A document is an instrument on which is recorded by means of
letters, figures, or marks intended to be used for the purpose of
recording that matter which may be evidentially used. The term
applies to writings, to words printed, lithographed or photographed; to seals, plates or stones on which inscriptions are cut
or engraved; to photographs and pictures; to maps or plans
(Black's Law Dictionary, 4th ed.).
Medical Documentary Evidence may be:
a. Medical Certification or Report on:
(1) Medical examination.
(2) Physical examination.
(3) Necropsy (autopsy).
(4) Laboratory.
(5) Exhumation.
(6) Birth.
(7) Death.
b. Medical Expert Opinion.
c. Deposition — A deposition is a written record of evidence
given orally and transcribed in writing in the form of questions
16
LEGAL MEDICINE
by the interrogator and the answer of the deponent and signed
by the latter.
5. Physical Evidence:
These are articles and materials which are found in connection
with the investigation and which aid in establishing the identity
of the perpetrator or the circumstances under which the crime was
committed, or in general assist in the prosecution of a criminal.
The identification, collection, preservation and mode of presentation of physical evidence is known in modern parlance as
criminalistics. Criminalistics is the application of sciences such
as physics, chemistry, medicine and other biological sciences in
crime detection and investigation.
On the investigator's viewpoint, the following are the different
types of physical evidences:
a. Corpus Delicti Evidence — Objects or substances which may be
a part of the body of the crime. The body of the victim of
murder, prohibited drugs recovered from a person, dagger with
blood stains or fingerprints of the suspect, stolen motor
vehicle identified by plate number and by body or engine
serial numbers are examples of corpus delicti evidence.
b. Associative Evidence — These are physical evidences which link a
suspect to the crime. The offender may leave clues at the scene
such as weapon, tools, garments, fingerprints or foot impression.
Broken headlights glass found at the crime scene in "hit and
run" homicide may be associated with the car found in the
repair shop. Wearing apparel of the offender and other articles
of value may be recovered where the crime of rape was committed.
c. Tracing Evidence —These are physical evidences which may assist
the investigator in locating the suspect. Aircraft or ship manifest,
physician's clinical record showing medical treatment of suspect
for injuries sustained in an encounter; blood stains recovered
from the area traversed by the wounded suspect infer direction
of the movement are examples of tracing evidence.
Preservation of Evidences:
The physical evidences recovered during medico-legal investigation must be preserved to maintain their value when presented as
exhibits in court. Most medical evidences are easily destroyed or
physically or chemically altered unless appropriate preservation
procedure are applied. This problem is further compounded by the
long space of time the evidence was recovered and its presentation in
court. From its recovery and from becoming a part of the inves-
GENERAL CONSIDERATION
17
tigation report, a preliminary investigation will be made by the
prosecuting fiscal to prove that there is a prima facie evidence to
warrant filing of the case in court. While in court, the case further
suffers delays because of postponement of the hearings, preferential
trials of other cases, raising of prejudicial issues to higher courts, etc.
Preservation of evidence is indeed vital in medico-legal investigation.
-Methods of Preserving Evidences:
1. Photographs, audio and/or video tape, micro-film, photostat,
xerox, voice tracing, etc.
Photography is considered to be the most practical, useful and
reliable means of preservation.
a. Photo-camera are available in many places.
b. The object preserved is reduced in size in the picture proportionately with other objects adjacent or near it.
c. An unlimited number of copies can be reproduced, each of
which is identical to one another.
In colored photographs variation may occur in the choice
of the kind of film and printing paper used.
Identification of voice from the recording instrument may
sometimes be difficult. Audio-recording may be dependent on
the speed, volume, pitch and timbre which may be changed by
the instrument used in the recording and replaying.
2. Sketching — If no scientific apparatus to preserve evidence is available then a rough drawing of the scene or object to be preserve is
done. It must be simple, identifying significant items and with
exact measurement.
-Kinds of Sketch:
a. Rough Sketch — This is made at the crime scene or during
examination of living or dead body. On the latter, an anatomic
figure of the front, back and side part of the body must be
made and the bodily lesions indicated.
b. Finished Sketch — A sketch prepared from the rough sketch for
court presentation.
J Essential Elements to be Included in a Sketch:
a. Measurement must be accurate.
b. Compass direction must always be indicated to facilitate proper
orientation in the case of crime scene.
A
c. Essential item which has a bearing in the investigation mus. oe
included.
d. Scale and proportion must be stated by mere estimation.
18
LEGAL MEDICINE
e. There must be a title and legend to tell what it is and the meaning of certain marks indicated therein.
3. Description — This is putting into words the person or thing to be
preserved. Describing a thing requires keen observation and a
good power of attention, perception, intelligence and experience.
It must cause a vivid impression on the mind of the reader, a true
picture of the thing described.
The following are the minimum standard requirements which
must be satisfied in the description of the person or thing to make
it complete:
a. Skin Lesion — kind, measurement, other descriptive information of the lesion itself, location, orientation.
b. Penetrating Wound (Punctured, Stab or Gunshot) — kind,
shape, other information from the wound itself, location,
orientation, direction, other structures involved, complications
and foreign elements that may be present.
c. Hymenal laceration — location, degree, duration, complication.
d. Person — those requirement in portrait parle (see p. 53 supra).
4. Manikin Method — In a miniature model of a scene or of a human
body indicating marks of the various aspects of the things to be
preserved. An anatomical model or statuette may be used and
injuries are indicated with their appropriate legends. Although it
may not indicate the full detail of the lesion, it is quite impressive
to the viewer as to the nature and severity of the trauma.
5. Preservation in the Mind of the Witness — A person who perceived
something relevant for proper adjudication of a case may be a
witness in court if he has the power to transmit to others what he
perceived. He would just have to make a recital of his collection.
Principal drawbacks of preserving evidence in the mind of the
witness:
a. The capacity of a person to remember time, place and event
may be destroyed or modified by the length of time, age of the
witness, confusion with other evidences, trauma or disease,
thereby making the recollection not reliable.
b. The preservation is co-terminus with the life of the witness. If
the witness dies, then the evidence is lost.
c. Human mind can easily be subjected to too many extraneous
factors that may cause distortion of the truth. Other persons
./£may influence a witness to serve the interest of another or state
untruthful facts to justify an end.
6. Special Methods — Special way of treating certain type of evidence
may be necessary. Preservation may be essential from the time it
GENERAL CONSIDERATION
19
is recovered to make the condition unchanged up to the period it
reaches the criminal laboratory for appropriate examination.
Preservation may be needed for the remaining portion of the
evidence submitted for future verification and/or court presentation.
Some of the Special Ways of Preservation are:
a. Whole human body — embalming.
b. Soft tissues (skin, muscles, visceral organs) — 10% formalin
solution.
c. Blood — refrigeration, sealed bottle container, addition of
chemical preservatives.
d. Stains (blood, semen) — drying, placing in sealed container.
e. Poison — sealed container.
Kinds of Evidence Necessary for Conviction:
1. Direct Evidence:
That which proves the fact in dispute without the aid of any
inference or presumption. The evidence presented corresponds to
to the precise or actual point at issue.
2. Circumstantial Evidence:
The proof of fact or facts from which, taken either singly or
collectively, the existence of a particular fact in dispute may be
inferred as a necessary or probable consequence.
When is circumstantial evidence sufficient to produce conviction?
a. When there is more than one circumstance;
b. When the facts from which the inferences are derived are
proven; and
c. When the combination of all the circumstances is such as to
produce a conviction beyond reasonable doubt (Sec. 4, Rule
123, Rules of Court).
Weight and Sufficiency of Evidence:
Rule 133, Rules of Court:
Section 1. Preponderance of evidence, how determined. — In
civil cases, the party having the burden of proof must establish his
case by a preponderance of evidence. In determining where the
preponderance or superior weight of evidence on the issues involved
lies, the court may consider all the facts and circumstances of the
case, the witnesses' manner of testifying, their intelligence, their
means and opportunity of knowing the facts to which they tire
testifying, the nature of the facts to which they testify, the proba
20
LEGAL MEDICINE
bility or improbability of their testimony, their interest or want of
interest, and also their personal credibility so far as the same may
legitimately appear upon the trial. The court may also consider the
number of witnesses, though the preponderance is not necessarily
with the greatest number.
From the foregoing provision of the Rules of Court, the following
factors must be considered which party's evidence preponderate.
a. All the facts and circumstances of the case.
b. The witnesses' manner of testifying, their intelligence, their
means and opportunities of knowing the facts to which they are
' testifying.
c. The nature of the facts to which the witnesses testify.
d. The probability and improbability of the witnesses' testimony.
e. The interest or want of interest of the witnesses.
f. Credibility of the witness so far as the same may legitimately
appear upon the trial.
g. The number of witnesses presented, although preponderance is
not necessarily with the greatest number.
Section 2 — Proof beyond reasonable doubt — In a criminal case,
the defendant is entitled to an acquittal, unless his guilt is shown
beyond reasonable doubt. Proof beyond reasonable doubt does not
mean such a degree of proof as, excluding possibility of error,
produces absolute certainty. Moral certainty only is required, or that
degree of proof which produces conviction in an unprejudiced mind.
It is presumed that a person is innocent of a crime until the contrary is proven beyond reasonable doubt. The doubt, the benefit of
which an accused is entitled in a criminal case, is a reasonable doubt,
and not a whimsical or fanciful doubt, based on imagined and wholly
improbable possibilities and unsupported by evidence.
Chapter II
^'fjECEPTION DETECTION
The knowledge of the truth is an essential requirement for the
administration of criminal justice. The success or failure in making
decisions may rest solely on the ability to evaluate the truth or
falsity of the statement given by the suspect or witness. The task
for its determination initially lies on the hand of the investigator.
Modern scientific methods have been devised utilizing knowledge
of physiology, psychology, pharmacology, toxicology, etc. in determining whether a subject is telling the truth or not. Although the
scientific methods of deception detection have not yet attained
legal recognition to have their results admissible as an evidence in
court, they have been considered very useful as aids in criminal
investigation.
1
Methods of deception detection which are currently being used or
applied by law enforcement agencies may be classified as follows:
1. Devices which record the psycho-physiological response:
a. Use of a polygraph or a lie detector machine
b. Use of the word association test
c. Use of the psychological stress evaluator
Use of drugs that try to "inhibit the inhibitor":
a. Administration of "truth serum''
b^Narcoanalysis or narcosynthesis
c. Intoxication
3. Hypnotism
4. By observation
5. Scientific interrogation
jo. Confession
i I. RECORDING OF THE PSYCHO-PHYSIOLOGICAL RESPONSE
The nervous control of the human body includes the central
nervous system (the brain and the spinal cord) and the autonomic
or regulating nervous system (sympathetic and parasympathetic).
The central nervous system primarily controls the motor and sensory
functions that occur at or above the threshold. It may be voluntary.
The autonomic nervous system acts as a self-regulating autonomic
response of the body.
21
22
LEGAL MEDICINE
The autonomic nervous system is composed of two complimentary
branches: the sympathetic and the parasympathetic nervous system,
acting opposite each other. The fibers of both enervate are all organs where self-regulation is essential.
When a person is under the influence of physical (exertion) or
emotional (anger, excitement, fear, lie detection, etc.) stimuli, the
sympathetic will dominate and over-ride the parasympathetic, thus,
there will be changes in the heart rate, pulse rate, blood pressure,
respiratory tracing, psychogalvanic reflexes, time of response to
question, voice tracing, etc. The parasympathetic nervous system
works to restore things to normal when the conditions of stress have
been removed. It is the dominant branch when the condition is
normal and the subject is calm, contented and relaxed.
«/ The recording of some of the psycho-physiological reaction of a
subject when he is subjected to a series of questions, and the scientific interpretation by trained experts are the basis of the tests.
A. Use of a Lie Detector or Polygraph:
It is not appropriate to call a lie detector a polygraph. A lie
detector records physiological changss that occur in association
with lying in a polygraph. It is the fear of detection of the subject
which allows the determination. The fear of the subject when not
telling the truth activates the sympathetic nervous system to a
series of automatic and involuntary physiological changes which
are recorded by the instrument.
The instrument (lie detector) is like an electrocardiogram or
electroencephalogram with recording stylets making tracings on
moving paper at the rate of 6 inches per minute.
The test must be made in a room especially built for the purpose. It must be quiet, private, sound-proof and free from any
disturbances and distractions. Extrenuous noises, like blowing of
horns, ringing of bells or telephone and loud conversations of
persons must be avoided.
The subject is seated on a chair beside a table where the instrument is located. The pneumograph tubes are placed around the
chest and abdomen, the blood pressure cuff around the upper
right arm, and the electrodes are attached to the two fingers of
the other hand. The back of the chair is equipped with an inflatable rubber bladder for the purpose of recording the muscular
contraction and pressure. All the gadgets attached are connected
to the recording instrument. The subject must be placed in. a
position so that he looks straight ahead.
The subject is instructed to remain as quiet as possible, to
answer all questions by "yes ' or "no", and to refrain from other
DECEPTION DETECTION
23
verbal responses during the test. If any explanations are to be
made, the subject is instructed to wait until the termination of
the test.
Phases of the Examination:
1. Pre-test interview
2. Actual interrogation and recording through the instrument
3. Post-test interrogation
1. Pre-test interview:
Before the actual testing is done, the examiner must first
make an informal interview of the subject which may last from
20 to 30 minutes,
a. Purpose of the interview:
(1) To determine whether the subject has any medical or
psychiatric condition or has used drugs that will prevent
the testing;
(2) To explain to the subject the purpose of the examination;
(3) To develop the test questions, particularly those of the
types to be asked;
(4) To relieve the truthful subject of any apprehension as
well as to satisfy the deceptive subject as to the efficiency
of the technique;
(5) To know any anti-social activity or criminal record of
the subject.
2. Actual interrogation and recording:
With all the gadgets attached to the body of the subject, the
instrument will start running by applying pressure on a button.
The subject then will be asked to answer the following standard
test questions:
a. Irrelevant questions — These are questions which have no
bearing to the case under investigation. The question may
refer to the subject's age, educational attainment, marital
status, citizenship, occupation, etc. The examiner asks these
types of questions to ascertain the subject's normal pattern
of response by eliminating the feeling of apprehension.
b. Relevant questions — These are questions pertaining to the
issue under investigation.
They must be unambiguous,
unequivocal and understandable to the subject. They must
all be related to one issue or one criminal act. It is equally
important to limit the number of relevant questions to avoid
discomfort to the subject. Relevant questions must be very
specific to obtain an accurate result.
24
LEGAL MEDICINE
Examples of relevant questions are "Did you shoot to
death Mr. "X''? "Did you take the ring, wrist watch, and
wallet of Mr. "X" after his death? "
c. Control questions — These are questions which are unrelated
to the matter under investigation but are of similar nature
although less serious as compared to those relevant questions
under investigation.
If someone is being investigated for murder by shooting,
the control questions may be "Have you ever used or fired
a gun? ", "Do you have a gun? ", "Have you killed someone
with a gun? ", etc.
In practice, the relevant — irrelevant question technique is
used. The responses to the two types of questions are compared, if there is no significant difference between the relevant
and irrelevant questions, the subject is reported to be truthful.
However, if the subject responds more to the relevant questions,
he is considered as not telling the truth.
The use of control questions is considered by many polygraphists to be the most reliable and effective questioning technique. These are usually asked if there is doubt in the interpretation of the subject's response to relevant and irrelevant
questions.
3. Post-test interrogation:
The purposes of further questioning after the test are:
a. To clarify the findings;
b. To learn if there are any other reasons for the subject's
responding to a relevant question, other than the knowledge
of the crime;
c. To obtain additional information and an admission for law
enforcement purposes, if the results suggest deception.
4. Supplementary tests:
Aside from the standard tests described above, the following
special tests may be performed and incorporated as a part of the
standard procedure or may be used as supplementary tests
depending upon the result of the standard test in order to draw
a better conclusion.
a. Peak-of-tension test — The subject may be given this test if
he is not yet informed of the details of the offense for which
he is being interrogated by the investigator, or by other
persons or from other sources like the print media.
The examiner will prepare several questions, about seven,
and one of them has a specific bearing on the matter under
investigation. The specific question must refer to some
DECEPTION DETECTION
25
details of the incident which could not have been known to
the subject.
A truthful subject, not aware of any question referrable
to the subject of investigation, will respond by not building
up tension. However, when the question which refers to a
detail of the incident is asked, a guilty subject will develop
a ''peak of tension'' which will be recorded in the tracing.
b. Guilt complex test — This test is applied when the response
to relevant and control questions are similar in degree and
consistency and in a way that the examiner cannot determine
whether the subject is telling the truth or not.
The subject is asked questions aside from the irrelevant,
relevant and controlled questions; a new series of relevant
questions dealing with a real incident and that which the
subject could not have committed. If the subject does not
respond to the added relevant questions, it indicates that the
subject was being deceptive as to the primary issue under
investigation. However, no conclusion can be drawn if the
response to the added guilt complex question is similar to
the real issue questions.
c. Silent answer test — This test is conducted in the same
manner as when relevant, irrelevant and control questions
are asked, but the subject is instructed to answer the questions silently, to himself, without making any verbal response. This test is effective when the subject's verbal
response causes distortion in the tracing such as sniff or
clearing of the throat. (Modern Legal Medicine, Psychiatry
and Forensic Sciences by William Curran, Louis McGarry
& Charles Petty, F. A. Davis Company, Philadelphia, 1980
p. 1187-1205).
Reasons for the Inadmissibility To the Court of the Result of
Polygraph Examination:
1. The polygraph techniques are still in the experimental stage and
have not received the degree of standardization of acceptance
among scientists.
In a series of decisions of the state supreme courts in the
United States (Fyre v. U.S., State v. Bonner (Wis.), People v.
Becker (Mich.), People v. Forte, State v. Cole (Mich., (Beech v.
State (Neb.), People v. Wechnick (Calif.), etc.), non-admissibility of the lie detector test was uniformly ruled. The common reason given was that, according to physiological and
psychological authorities, the test has not gained a degree of
development beyond the experimental stage. Until it is es-
2«
LEGAL MEDICINE
tablished that reasonable certainty follows from such a test, it
would be an error to admit the results as evidence. The test
is useful in the investigation of a crime but it has no place In
the courtroom.
2. The trier of fact is apt to give almost conclusive weight to the
polygraph expert's opinion.
3. There is no way to assure that a qualified examiner administered the test. The polygraph is capable of a high degree of
accuracy only when conducted under controlled conditions by
an examiner who is highly qualified due to his ability, experience, education and integrity.
"The important areas that may affect the accuracy of the
reported test result. . . .would be (1) his polygraphy training
(2) the extent of his experience with respect to the years and
number of tests he has conducted, (3) the operation of the
polygraphy instrument itself (4) the accuracy of the polygraph
technique. In addition, special consideration should be given
to the number of tests and the number of questions asked
during the test. . . (Modern Legal Medicine, Psychiatry and
Forensic Sciences, by Curran, et. al, p. 1203).
4. Since the polygraph involves a certain unconscious quality of
the examinee, he may unwittingly waive his or her right against
self-incrimination.
It becomes necessary to determine the
scope of the defendant's waiver if he voluntarily submits to
the test. (Am. J. of Trial Advocacy, Vol. 4, p.593).
5. The test itself cannot be relied upon because it has many errors.
The factors that are responsible for the 26% errors of the lie
detector are as follows:
1. Nervousness or extreme emotional tension experienced by a
subject who is telling the truth regarding the offense in question but who is nevertheless affected by:
a. Apprehension induced by the mere fact that suspicion or
accusation has been directed against him;
b. Apprehension over the possibility of an inaccurate liedetector test result;
c. Over-anxiety to cooperate in order to assure an accurate
test result;
d. Apprehension concerning possible physical hurt from the
instrument;
e. Anger resentment over having to take a lie-detector test;
f. Over-anxiety regarding serious personal problems unrelated
to the offense under investigation;
DECEPTION DETECTION
27
g. Previous extensive interrogation, especially when accompanied by physical abuse; and
h. A guilt-complex or fear of detection regarding some other
offense which he had committed.
2. Physiological abnormalities such as:
a. Excessively high or excessively low blood pressure;
b. Diseases of the heart; and
c. Respiratory disorder.
3. Mental abnormalities such as:
a. Feeblemindedness, as in idiots, imbeciles and morons;
b. Psychosis or insanities, as in manic-depressives, paranoids,
schizophrenics, paretics, etc.
c. Psychoneurosis and psychopathia, as among the so-called
"peculiar" or "emotionally stable" persons — Those who
are neither psychotic or normal, and those from the borderline between these two groups.
4. Unresponsiveness in a living or guilty subject, because of:
a. No fear of detection;
b. Apparent inability to consciously control response by means
of certain mental sets of attitudes;
c. A condition of "sub-shock" or "adrenal exhaustion" at the
time of the test;
d. Rationalization of the crime in advance of the test to such an
extent that lying about the offense arouses little or no emotional disturbance.
e. Extensive interrogation prior to the test.
5. Attempt to "beat the machine" by controlled breathing or by
muscular flexing.
6. Unobserved application of muscular pressure which produces
ambiguities and misleading indications in the blood pressure
tracing (Lie Detection and'Criminal Interrogation by Fred
Imbau and John Reid, The Williams & Wilkins Co., p. 65).
However, the results of the lie detector test may be admissible if
there is a stipulation of the parties and counsels that they will
accept said results. The reason is that if the defendant agrees to
the admission of the polygraph result, then he should not be able
to object if the subsequent result turns out to be unfavorable to
him (State v. Valdez, 91 Ariz. 274, 371 p. 2d 894 (1962). The
judge may have the discretion as to whether it is to be admitted or
not. For example, it may not be admitted if done by an incompetent polygrapher.
Can a person be compelled to be subjected to the lie-detector
test?
28
LEGAL MEDICINE
Inasmuch as the test requires the subject to answer the questions either by "yes" or "no", it infers the use of intelligence and
attention or other mental faculties which is self-incriminatory.
Therefore, a person cannot be compelled to be subjected to the
test.
B. Use of the Word Association Test:
A list of stimulus and non-stimulus words are read to the subject who is instructed to answer as quickly as possible. The
answers to the questions may be a "yes" or a "no". Unlike the
lie detector, the time interval between the words uttered by the
examiner and the answer of the subject is recorded.
When the subject is asked questions with reference to his name,
address, civil status, nationality, etc. which has no relation to the
subject-matter of the investigation, the tendency is to answer
quickly. But when questions bear some words which have to do
with the criminal act the subject allegedly committed, like knife,
gun or hammer which was used in the killing, the tendency is to
delay the answer.
The test is not concerned, with the answer, be it a "yes" or
"no". The important factor) is the time of response in relation
to stimulus or non-stimulus words.
Like the use of the lie detector, the subject cannot be compelled to be subjected to the test without his consent.
C. Use of the Psychological Stress Evaluator (PSE):
When a person speaks, there are audible voice frequencies, and
superimposed on these are the inaudible frequency modulations
which are products of minute oscillation of the muscles of the
voice mechanism. Such oscillations of the muscles or micro tremor occur at the rate of 8 to 14 cycles per second and controlled
by the central nervous system.
When a person is under stress as when he is lying, the microtremor in the voice utterance is moderately or completely suppressed. The degree of suppression varies inversely to the degree
of psychologic stress in the speaker.
The psychological stress evaluator (PSE) detects, measures, and
graphically displays the voice modulations that we cannot hear.
/ When a person is relaxed and responding honestly to the questions, those inaudible frequencies are registered clearly on the instrument. But when a person is under stress, as when he is lying,
these frequencies tend to disappear.
DECEPTION DETECTION
29
1. Procedure:
a. The examiner meets the requesting party to determine the
specific purpose of the examination and to begin formulation of relevant questions.
b. A pre-test interview is conducted with the subject to help
him or her feel at ease with the examiner, to provide an
opportunity to specify matters, to eliminate outside issues,
and to review questions that will be asked.
c. An oral test of about 12 to 15 "yes* or "no" questions is
given which is recorded on a tape recorder. The questions
are a mixture of relevant and irrelevant questions.
d. Immediately following the test or at a later time, the tape is
processed through the Psychological Stress Evaluator for
analysis of the answers.
e. If stress is indicated, the subject is given opportunity to
provide additional clarification. A retest is given to verify
correction and clarification (Legal Medicine 1980, Cyril
Wecht, ed. p. 58).
2. Advantages of Psychological Stress Evaluator over the Lie
Detector Machine:
a. It does not require the attachment of sensors to the person
being tested.
b. The testing situation need not be carefully controlled to
eliminate outside distraction; and
c. Normal body movement is not restricted.
/ II. USE OF DRUGS THAT "INHIBIT THE INHIBITOR"
A. Administration of Truth Serum:
The term "truth serum" is a misnomer. The procedure does not
make someone tell the truth and the thing administered is not a
serum but is actually a drug.
In the test, hyoscine hydrobromide is given hypodermically in
repeated doses until a state of delirium is induced. When the
proper point is reached, the questioning begins and the subject
feels a compulsion to answer the questions truthfully. He forgets
his alibi which he may have built up to cover his guilt. He may
give details of his acts or may even implicate others.
j The drug acts as depressant on the nervous system. Clinical
evidence indicates that various segments of the brain particularly
the cortex and diencephalon are selectively depressed in the
reversed order of their evolutionary development.
The use of drugs for the purpose is not without the element of
danger and should not be attempted except by a physician who
30
LEGAL MEDICINE
has had experience in using the drug. Scopolamine may sometime
cause psychotic reactions.
Statements taken from the subject while under the influence of
truth serum are evolutionarily obtained hence they are not admissible as evidence. Because of the potential risks involved in the application of the procedure, it is seldom used by law-enforcement
agencies.
B. Narcoanalysis or Narcosynthesis:
This method of deception detection is practically the same as
that of administration of truth serum. The only difference is the
drug used. Psychiatric sodium amytal or sodium p'enthotal is
administered to the subject. When the effects appear, questioning
starts. It is claimed that the drug causes depression of the inhibitory mechanism of the brain and the subject talks freely.
The administration of the drug and subsequent interrogation
must be done by a psychiatrist with a long experience on the line.
Like the administration of truth serum, the result of the test is
not admissible in court.
I
C. Intoxication with alcohol:
The apparent stimulation effect of alcohol is really the result of
the control mechanism of the brain, so alcohol, like truth serum,
and narcoanalytic drugs "inhibit the inhibitor".
The ability of alcohol to reveal the real person behind the
mask which all of us are said to wear ("mask of sanity") is reflected in the age-old maxim, "In vino Veritas" ("In wine there is
truth"). (Pathology of Homicide by Lester Adelson, Charles
Thomas, 1974, p. 895).
The person whose statement is to be taken is allowed to take
alcoholic beverages to almost intoxication. At this point the power
to control diminishes and the investigator starts pounding questions and recording answers.
The questioning must start during the excitatory state when the
subject has the sensation of his well-being and when his action,
speech and emotions are less strained due to the lowering of the
inhibition normally exercised by the higher brain centers. When
the subject is already in the depressive state due to the effect of
alcohol, he will no longer be able to answer any question.
Confessions made by the subject while under the influence of
alcohol may be admissible if he is physically capable to recollect
the facts that he has uttered after the effects of alcohol have
disappeared. 3ut in most instances, the subject cannot recall
everything that he had mentioned or he may refuse to admit
the truth of the statement given.
DECEPTION DETECTION
31
III. HYPNOSIS
Hypnosis is the alteration of consciousness ^nd concentration in
which the subject manifests a heightened of suggestibility while
awareness is maintained.
Not all persons are susceptible to hypnotic induction. Subjects
who are compulsive-depressive type, strong-willed like lawyers,
accountants, physicians and other professionals are usually nonhypnotizable.
Reasons Why Deception Detection Obtained Through Hypnosis Is
Not Admissible in Court:
1. It lacks the general scientific acceptance of the reliability of
hypnosis per se in ascertaining the truth from falsity;
2. The fear that the trier of fact will give uncritical and absolute
reliability to a scientific device without consideration of its flaw
in ascertaining veracity.
3. The possibility that the hypnotized subject will deliberately
fabricate;
4. The prospect that the state of heightened suggestibility in which
the hypnotized subject is suspended will produce distortion of the
fact rather than the truth; and
5. The state of the mind, skill and professionalism of the examiner
are too subjective to permit admissibility of the expert testimony
(Am. J. of Trial Advocacy, 1981, p. 603).
Confession while under hypnotic spell is not admissible as
evidence because such "psychiatric treatment" is involuntary and
mentally coersive (Leyra v. Demro, 347 U.S. 556, 74 S. Ct. 716,
98, 948 (1954).
Although hypnosis may not yield admissible evidence it may be
of some use during investigation as a discovery procedure.
IV.^SERVATION
A good criminal investigator must be a keen observer and a good
psychologist. A subject under stress on account of the stimulation of
the sympathetic nervous system may exhibit changes which may be
used as a potential clue of deception. And since just one or a combination of the following signs and symptoms is not conclusive or a
reliable proof of guilt of the subject, their presence infers further
investigation to ascertain the truth of the impression.
Physiological and Psychological Signs and Symptoms of Guilt:
1. Sweating — Sweating accompanied with a flushed face indicate
anger, embarrassment or extreme nervousness. Sweating with a
LEGAL MEDICINE
32
pallid face may indicate shock or fear. Sweating hands indicate
tension.
2. Color cnange — If the face is flushed, it may indicate anger, embarrassment or shame. A pale face is a more common sign of
guilt.
3. Dryness of the mouth — Nervous tension causes reflex inhibition
of salivary secretion and consequently dryness of the mouth.
This causes continuous swallowing and licking of the lips.
4. Excessive activity of the Adam's apple — On account of the dryness of the throat aside from the mouth, the subject will swallow
saliva from the mouth and this causes the frequent upward and
downward movement of the Adam's apple. This is observed in
many guilty subjects.
5. Fidgeting — Subject is constantly moving about in the chair,
pulling his ears, rubbing his face, picking and tweaking the nose,
crossing or uncrossing the legs, rubbing the hair, eyes, eyebrows,
biting or snapping of fingernails, etc. These are indicative of
nervous tension.
6. "Peculiar feeling inside" — There is a sensation of lightness of
the head and the subject is confused. This is the result of his
troubled conscience.
7. Swearing to the truthfulness of his assertion — Usually a guilty
subject frequently utters such expression. "I swear to God I am
telling the truth" or "I hope my mother drops dead if I am
lying", "I swear to God". . . etc. Such expressions are made to
make forceful and convincing his assertion of innocence.
8. "Spotless past record" — "Religious man" — The subject may
assert that it is not possible for him to do "anything like that"
inasmuch as he is a religious man and that he has a spotless record.
9. Inability to look at the investigator "straight in the eye" — The
subject does not like to look at the investigator for fear that his
guilt may be seen in his eyes. He will rather look at the floor or
ceiling.
10. "A or that I remember" expression — The subject will resort to
the use of "not that I remember" expression when answering to
be evasive or to avoid committing something prejudicial to him.
r
V. SCIENTIFIC INTERROGATION
Interrogation is the questioning of a person suspected of having
committed an offense or of persons who are reluctant to make a full
disclosure of information in his possession which is pertinent to the
investigation. It may be done on a suspect or a witness.
DECEPTION DETECTION
33
1. A suspect is a person whose guilt is considered on reasonable
ground to be a practical possibility.
2. A witness is a person, other than the suspect, who is requested to
give information concerning the incident. He may be a victim
a complainant, an accuser, a source of information, an observer
of the occurrence, a scientific specialist who has examined physical
evidence or a custodian of official document.
Attitude and Conduct of an Investigator:
In the course of an interrogation of a suspect or witness, the interrogator must observe the following:
1. The interrogator should avoid creating an impression that he is an
investigator seeking a confession or conviction. It is better for him
to appear in the role of one who is merely seeking the truth.
2. Such realistic words or expressions as "kill", "steal", "confess"
your crime, etc. should not be used by the interrogator. It is more
desirable, from the psychological standpoint, to employ a milder
terminology like "shoot", "take", "tell the truth", etc.
3. The interrogator should sit fairly close to the subject and between
the two, there should not be a table or other pieces of furniture.
4. The interrogator should avoid pacing about the room. To give an
undiverted attention to the person being interrogated, make it as
such that will be more difficult for him to evade detection of
deception or conceal his guilt5. The interrogator should avoid or at least minimize smoking, and
he should also refrain from fumbling with a pencil, pen or other
room accessories, for all these tend to create an impression of lack
of interest or confidence.
6. The interrogator should adapt his language to that used and understood by the subject himself. In dealing with an uneducated and
ignorant subject, the interrogator should use simple words and
sentences.
7. Since the interrogator should always occupy a fearless position
with regards to his subject and to the condition and circumstances
attending the interview, the subject should not be handcuffed or
shackled during his presence in the interrogation room. The
interrogator should face the subject as "man to man" and not as
policeman to prisoner.
For Purposes of Investigation the Following are the Different Types
of Criminal Offenders:
1. Based on behavioral attitude:
a. Active aggressive offenders — They are persons who commit
crime in an impulsive manner usually on account of their
34
LEGAL MEDICINE
aggressive behavior. Such attitude is clearly shown in crimes of
passion, revenge or resentments,
b. Passive inadequate offenders — Persons who commit crimes
because of inducement, promise or reward. They are gullible
and easily persuaded to perform acts in violation of the penal
laws.
2. Based on the state of mind:
a. Rational offenders — Those who commit crime with motive or
intention and with full possession of their mental faculties.
Example: Killing with evident premeditation.
b. Irrational offenders — They commit crime without knowing
the nature and quality of his act.
Example: Mad killer.
3. Based on proficiency:
a. Ordinary offenders — These are the lowest form of criminal
career. They are only engaged in crimes which require limited
skill. They lack the capacity to avoid arrest and conviction.
a. Professional offenders — They are highly skilled and able to
perform criminal acts with the least chance of being detected.
They commit crimes which require special skill rather than
violence.
Example: Pick-pocketing, shop-lifting.
4. Psychological classification:
a. Emotional offenders— These are persons who commit crimes
in the heat of passion, anger, or revenge, and also who commit
offenses of accidental nature. Emotional offenders usually have
feeling of remorse, mental anguish or compunction as a result of
their acts. They have the sense of moral guilt. Their conscience
"bother" them and they have difficulty resting or sleeping
because of their feeling of guilt. The most effective interrogation approach to use for them is based upon sympathetic
consideration regarding their offense and present difficulty.
b. Non-emotional offenders — These are persons who commit
crimes for financial gain and are usually recidivist or repeaters.
Sympathetic approach is not effective. The interrogator should
make a factual analysis of the suspect's predicament and appeal
to his common sense and reasoning rather than to his emotion.
Requirement for the Admissibility of Evidence Obtained Through
Interrogation:
Sec. 20 Art. IV, Bill of Rights, Philippine Constitution:
No person shall be compelled to be a witness against himself.
Any person under investigation for the commission of an offense
DECEPTION DETECTION
35
shall have the right to remain silent and to counsel, and be informed
of such right. No force, violence, threat, intimidation, or any other
means which vitiates the free will shall be used against him. Any
confession obtained in violation of this section shall be inadmissible
in evidence.
In compliance with the above provision of the constitution and
the decision of the U.S. Supreme Court, in Miranda v. Arizona, 384
U.S. 436 (1966) safeguards were established for the interrogation of
suspected (accused) person. If a person is to be interrogated, he
must first be warned and advised that:
a. He has the right to remain silent;
b. Anything he says can be used against him in court of law;
c. He has the right to consult with an attorney and to have the
attorney present during the questioning; and
d. If he cannot afford an attorney, one will be appointed for him
prior to any questioning if he so desires.
After such warning and in order to secure a waiver, the following
questions should be asked. An affirmative answer to each question
constitutes a waiver to the rights:
a. Do you understand each of these rights I have explained to
you?
b. Having these rights in mind, do you wish to talk to us now?
Some Techniques of Interrogation:
The choices of methods of questioning depend on the personal
and psychological evaluation of the subject by the interrogator, the
nature of the crime under investigation, previous criminal record, and
the social and educational background of the subject.
1. Emotional appeal — The interrogator must create a mood that is
conducive to confession. He may be sympathetic and friendly to
the subject. The subject may be willing to disclose more information if he is treated in a kind spirit.
2. Mutt and Jeff technique — In this technique there must be at least
two investigators with opposite character; one (Mutt) who is
arrogant and relentless who knows the subject to be guilty and
will not waste time in the interrogation, and the other (Jeff) who
is friendly, sympathetic and kind. When Mutt is not present Jeff
will advice the subject to make a quick decision and plea for
cooperation.
3. Bluff on split-pair technique — This is applicable where there are
two or more persons who allegedly participated in the commission
of a crime. All of them are interrogated separately and the results
of their individual statements are not known to one another.
While one of them is under interrogation, the interrogator may
36
LEGAL MEDICINE
claim that the subject was implicated by the author and that there
is no use for him to deny participation.
4. Stern approach — The questions must oe answered clearly, and the
interrogator utilizes harsh language. Immediate response from the
subject is demanded.
5. The subject is given the opportunity to make a lengthy, timeconsuming narration. There may be a moment when the subject
becomes confused and desists from making further statement for
fear of contradicting his previous statement.
Basis of the Investigator's Inference that the Subject is Not Telling
the Truth:
1. The subject's statement have many improbabilities and gaps on
its substantial parts.
2. The subject's statements are inconsistent with the material facts.
3. The subject's statements are incoherent, conflicting with one
another.
VI. CONFESSION
Confession is an expressed acknowledgment by the accused in
a criminal case of the truth of his guilt as to the crime charged, or of
some essentials thereof.
Confession is different from admission, although admission includes, as one of its species, confession. Confession is a statement of
guilt while admission is usually a statement of fact by the accused
which does not directly involve an acknowledgement of guilt of the
accused.
The defendant stated in the preliminary investigation that he
had inflicted upon the deceased the wounds -in question. It was
held that such statement was not a confession of guilt but only an
admission, inasmuch as the defendant might have inflicted the
wound in self-defense (U.S. v. Team, 23 Phil. 64).
An admission by one accused of rape that he had carnal intercourse with the complaining witness at the time and place mentioned in the information is not a confession of guilt of the crime
charged unless he further admits that he cohabited with the
woman without her consent, or by the use of force or threat
(U.S. v. Flores, 26 Phil. 262).
Kinds of Confession:
1. Extra-judicial Confession:
This is a confession made outside of the court prior to the
trial of the case.
LEGAL MEDICINE
37
Sec. 3, Rule 133, Rules of Court — Extra-judicial confession, not
sufficient ground for conviction:
An extra-judicial confession made by an accused, shall not be
sufficient ground for conviction, unless corroborated by evidence
of corpus delicti.
Qbrpus delicti means the body of the crime or fact of specific
loss or injury sustained. It may not necessarily be the body of
the crime but may consist of facts and circumstances tending to
corroborate the confession.
The reason for the above rule is to guard against conviction
based upon false confession of guilt. It is possible that a person
might have confessed his guilt regarding an offense which someone has committed and when asked of his victim on the nature of
the injuries inflicted by him, it does not coincide with the identity
or nature of the injuries received by the victim.
a. Extra-judicial confession may be:
/ ( l ) Voluntary extra-judicial confession:
The confession is voluntary when the accused speaks on
his free will and accord, without inducement of any kind,
and with a full and complete knowledge of the nature and
consequence of the confession, and when the speaking is
so free from influences affecting the will of the accused, at
the time the confession was made that it renders it admissible in evidence against him.
(2) Involuntary extra-judicial confession:
lA ^ C A W * * A M '
Confessions obtained through force, threat, intimidation, duress or anything influencing the voluntary act of
the confessor.
Confessions obtained from the defendant by means of
force and violence is null and void, and cannot be used
against him at the trial. (U.S. v. Lozada, 4 Phil. 266; U.S.
v. Felipe, 5 Phil. 333).
If a confession was made when a threat or promise was
made by, in the presence of a person in authority, who has,
or is supposed by the accused to have power or opportunity
to fulfill the threat or promise, then the confession of the
accused will be presumed to be the exclusive effect of
inducement and therefore inadmissible (Early v. Com., 86
Va. 921).
A confession made under the influence of spiritual advice
or exhortation is not admissible.
L
V
?
38
LEGAL MEDICINE
A confession made under the influence of parental
sentiment is not admissible (People v. Martinez, 42 Phil.
853).
In confession through a "third degree", the duty of the
physician is to determine the presence and extent of physical injuries on the subject.
A physician must be cautious concluding that if physical
injuries are present, they were inflicted in the course of a
"third degree". It could be possible that the subject has
self-inflicted those wounds in the guise that the confession
was not voluntary.
Maltreatment of Prisoners for the Purpose of Exhorting Confession
or To Obtain Some Information is a Crime.
Art. 235, Revised Penal Code — Maltreatment of prisoners:
The penalty of arresto mayor in its medium period to prision
correccional in its minimum period, in addition to his liability for the
physical injuries or damaged caused, shall be imposed upon any public
officer or employee who shall overdo himself in the correction or
handling of a prisoner or detention of a prisoner under his charge, by
the imposition of punishments not authorized by the regulations, or
by inflicting such punishments in a cruel and humiliating manner.
If the purpose of the maltreatment is to extort a confession, or to
obtain some information from the prisoner, the offender shall be
punished by prision correccional in its minimum period, temporary
special disqualification, and a fine not exceeding 500 pesos, in
addition to his liability for the physical injuries or damage caused.
Elements of the crime:
1. The offender is a public officer or employee;
2. The offender has under his charge a (convicted) prisoner or a detention prisoner;
3. The offender maltreats the prisoner in any of the following way:
a. By overdoing in the correction or handling of prisoner, either
by (1) imposition of punishment not authorized by the regulation, or (2) by inflicting such punishment in a cruel and humiliating manner; or
b. By maltreating such prisoner to extort a confession or to
obtain some information from the prisoner.
THE TOKYO DECLARATION
The Tokyo Declaration which was endorsed by the World Medical
Association in 1975 contains guidelines to be observed by physicians
concerning torture and other cruel, inhuman, and degrading treatment or punishment in relation to detention and imprisonment.
DECEPTION DETECTION
39
Preamble
It is the privilege of the medical doctor to practice medicine in
the service of humanity, to preserve and restore bodily and mental
health without distinction as to persons, to comfort and ease the
suffering of his or her patients. The utmost respect for human life is
to be maintained even under threat, and no use made of any medical
knowledge contrary to the laws of humanity.
For the purpose of this Declaration torture is defined as the
deliberate, systematic or wanton infliction of physical or mental
suffering by one or more persons acting alone or on the orders of
any authority, to force another person to yield information, to make
a confession, or for any other reason.
Declaration
1. The doctor shall not countenance, condone or participate in the
practice of torture or other forms of cruel inhuman or degrading
procedures, whatever the offense of which the victim of such
procedures is suspected, accused or guilty, and whatever the
victim's beliefs for motives, and all the situations, including
armed conflict and civil strife.
2. The doctor shall not provide any premises, instruments, substances
or knowledge to facilitate the practice of torture or other forms
of cruel, inhuman or degrading treatment or to diminish the
ability of the victim to resist such treatment.
3. The doctor shall not be present during any procedure during
which torture or other forms of cruel, inhuman or degrading
treatment is used or threatened.
4. A doctor must have complete clinical independence in deciding
upon the care for a person for whom he or she is medically responsible.
The doctor's fundamental role is to alleviate the distress of his
or her fellow men, and no motive — whether personal, collective
or political — shall prevail against his higher purpose.
5. Where a prisoner refuses nourishment and is considered by the
doctor as capable of forming an unimpaired and rational judgment
concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the
capacity of the prisoner to form such a judgement should be
confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the
doctor to the prisoner.
6. The World Medical Association will support, and should encourage
the international community, the national medical associations
and fellow doctors, to support the doctor and his or her family in
40
LEGAL MEDICINE
the face of threats or reprisals resulting from a refusal to condone
the use of torture and other forms of cruel, inhuman or degrading
treatment.
(The New Police Surgeon by S.H. Burgress, pp. 134-136; JAMA Vol.
255, No. 20 May 23,1986, p. 2800)
2. Judicial Confession:
This is the confession of an accused in court. It is conclusive
upon the court and may be considered to be a mitigating circumstance to criminal liability.
A plea of guilty when formally entered on arraignment is
sufficient to sustain a conviction of any offense, even a capital
one, without further proof.
Sec. 2, Rule 129, Rule of Court — Judicial admissions:
Admissions made by the parties in the pleadings, or in the
course of the trial or other proceedings do not require proof and
can not be contradicted unless previously shown to have been
made through palpable mistake.
Chapter III
MEI31G0-LEGAL ASPECTS OF IDENTIFICATION
- identification is the determination of
or thing.
t h e i n d i v i d u a l i t y nt
ajTimn
importance of Identification of Person:
1. In the prosecution of the criminal offense, the identity of the
offender and that of the victim must be established, otherwise it
will be a ground for the dismissal of the charge or acquital of the
accused.
2. The identification of a person missing or presumed dead will
facilitate settlement of the estate, retirement, insurance and other
social benefits. It vests on the heirs the right over the properties
of the identified person.
If identity cannot be established, then the law on presumption
of death (Art. 390, Civil Code) must be applied which requires the
lapse of seven years before a person can be presumed dead. In
special instances, the seven years period may be reduced to four
years (Art. 391, Civil Code).
3. Identification resolves the anxiety of the next-of-kin, other relatives and friends as to the whereabouts of a missing person or
victim of calamity or criminal act.
4. Identification may be needed in some transactions, like cashing of
check, entering a premise, delivery of parcels or registered mail in
post office, sale of property, release of dead bodies to relatives,
parties to a contract, etc.
Rules in Personal Identification:
1. The greater the number of points of similarities and dissimilarities
of two persons compared, the greater is the probability for the
conclusion to be correct. This is known as the TJIW of Multiplicity of Evidence in Identification.
2. The value of the different points of identification varies in the
formulation of conclusion. In a fresh cadaver, if the fingerprints
on file are the same as those recovered from the crime scene, they
will positively establish the identity of the person while bodily
marks, like moles, scars, complexion, shape of nose, etc. are
merely corroborative. Visual recognition by relative or friends
may be of lesser value as compared with fingerprints or dental
comparison.
41
42
LEGAL MEDICINE
3. The longer the interval between the death and the examination
of the remains for purposes of identification, the greater is the
need for experts in establishing identity. The process of taking
fingerprints and its examination under a magnifying lens requires
the services of an expert. When putrefaction has set in, the external bodily marks useful in identification might be destroyed
so that it is necessary to resort to an anatomical or a structural
examination of the body which requires knowledge of medicine'
and dentistry.
4. Inasmuch as the object to be identified is highly perishable, it is
necessary for the team to act in the shortest possible time specially in cases of mass disaster.
5. There is no rigid rule to be observed in the procedure of identification of persons.
Methods of Identification:
l.By comparison — Identification criteria recovered during investigation are compared with records available in the file, or postmortem finding are compared with ante-mortem records.
Examples:
a. Latent fingerprints recovered from the crime scene are compared with the fingerprints on file of an investigating agency.
b. Dental findings on the skeletal remains are compared with the
dental record of the person in possession of the dentist.
2. By exclusion — If two or more persons have to be identified and
all but one is not yet identified, then the one whose identity has
not been established may be known by the process of elimination.
/
IDENTIFICATION OF PERSONS
The bases of human identification may be classified as:
X- Those which laymen used to prove identity — No special training
or skill is required of the identifier and nc instrument or procedure is demanded.
2 JPhose which are based on scientific knowledge — Identification is
made by trained men, well-seasoned by experience and observation, and primarily based on comparison or exclusion.
<
V L ORDINARY METHODS OF IDENTIFICATION
Points of Identification Applicable to the Living Person Only:
1. Characteristics which may easily be changed:
(j^ Growth of hair, beard or mustache — This may easily be shaved
or grown within a short time. Arrangement may be changed.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
artificial hair may be worn or ornamentation may be placed to
changed its natural condition.
^b^Clothing — A person may have special preference for certain
form, texture, or style. Certain groups of people are required
to have specific cut, color or design, as in uniforms, worn by
students, employees of commercial or industrial establishment,
or groups of professionals.
/c.^'requent place of visit — A person may have a special desire or
^ " n a b i t to be in a place if ever he has the opportunity to do so.
"Sari-sari" stores, barber shops, coffee shops, beer gardens and
recreation halls are common venues of visit of certain class of
people. A wanted criminal may suddenly prevent himself from
going to the place he used to visit for fear that he may be
apprehended.
^^Grade of profession — A medical student of the upper clinical
year may be recognized by the stethoscope; a graduate or
student nurse by her cap, a mechanic by his tools, a clergyman
by his robe, etc. A change of grade, trade, vocation or profession may be resorted to as a means of concealing identity.
(eJBody ornamentations — Earrings, necklaces, rings, pins, etc.
^-^usually worn by persons may be points to identify a person
from the rest.
2.\£haracteristics that may not easily be changed:
a. Mental memory — A recollection of time, place and events
may be a clue in identification. Remembering names, faces
and subjects of common interest may be initiated during interview to see how knowledgeable a person is.
b. Speech — A person may stammer, stutter or lisp. However,
if the manner of talking is due to some physical defects, like
harelip and cleft palate, that have been corrected by surgery,
there may be a change in his manner of speech.
The manner of talking and the quality of the voice are
dependent on the vocal cavities (throat, mouth, nose and
•inuses) and his manner of manipulating the lips, teeth, tongue,
soft palate, and jaw muscles. The chances of two or more
persons having the same size of vocal cavities and the same
manner of articulation are remote and unlikely. Whispering,
muffling and nose-holding do not change the speech characteristic. The speech may be recorded and preserved in a good
tape recorder. A known standard may also be recorded for
purposes of comparison. Identification can be achieved through
the sound spectrographs analysis.
LEGAL MEDICINE
c. Gait — A person, on account of disease or some inborn traits,
may show a characteristic manner of walking.
(1) Ataxic gait — A gait in which the foot is raised high, thrown
forward and brought down suddenly is seen in persons
suffering from tabes dorsalis.
(2) Cerebellar gait — A gait associated with staggering movement is seen in cerebellar diseases.
(3) Cow's gait — A swaying movement due to knock-knee.
(4) Paretic gait — Gait in which the steps are short, the feet are
dragged and the legs are held more or less widely apart.
(5) Spastic gait — A gait in which the legs are held together and
move in a stiff manner and the toes dragged.
(6) Festinating gait — Involuntary movement in short accelerating steps.
(7) Frog gait — A hopping gait resulting from infantile paralysis.
(8) Waddling gait — Exaggerated alternation of lateral trunk
movement similar to the movement of the duck.
In the normal process of walking the rear portion of the
heel is placed on the ground. This is subsequently followed by
the other parts of the heel and the sole of the foot is pressed on
the ground. The toes are the last to be pressed followed by the
lifting of the foot making another step forward. The pressure at
the rear portion of the heel and in the region of the toes is the
most forceful, hence the impression is the most.
During the process of running the foot marks are less distinct because of the slipping of the foot and the sand or soil
thrown into the marks by the pressure of the tip of the toes.
Gait Patterns:
A scientific investigation of the gait pattern may be useful
for purposes of identification and investigation of the crime
scene. Gait pattern is the series of foot marks by a person
walking or running. Examination of the gait includes the
direction line, gait line, foot angle, principal angle and the
length and breadth of the steps.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
45
at..
Gait pattern. A: direction line; B: gait line; C: foot line; D: foot angles;
E: principal angle; F: length of step; G: breadth of step.
(A) Direction line — Expresses the path of the individual.
(B) Gait line — The straight line connecting the center of the
succeeding steps. It is more or less in zigzag fashion especially when the legs are far apart while walking. Stout,
elderly people and those who want stability while walking
have a more zigzag gait line.
(C) Foot line — The longitudinal line drawn on each foot mark.
There may be a difference in the foot line of the left and
right foot.
(D)Foot angle — The angle formed by the foot line and the
direction line. In normal walking the foot angle is very
characteristic of a person and cannot be altered immediately. However, it may be altered when a person is running,
carrying a heavy weight or moving on a rugged terrain.
(E) Principal angle — The angle between the two succeeding
foot angles.
(F) Length of step — When the distance between the center
points in two successive heel prints of the two feet exceeds
40 inches, there is a strong presumption that the person
is running.
(G) Breadth of step — The distance between the outer contours
of two succeeding foot marks or steps. The more apart the
legs are while walking, the greater is the breadth of the step.
(Crime Detection by Ame Svensson & Otto Wendel, p. 58)
dr.'Mannerism — Stereotype movement or habit peculiar to an
individual. It may be:
(1) Way of sitting.
(2) Movement of the hand.
(3) Movement of the body.
(4) Movement of the facial muscles.
(5) Expression of the mouth while articulating.
(6) Manner of leaning.
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LEGAL MEDICINE
e. Hands and feet — Size, shape and abnormalities of the hands
and feet may be the bases of identification. Some persons have
supernumerary fingers or toes far apart with bony prominence.
Some fingers or toes are with split nails.
Foot or hand marks found in the investigation of the crime
scene may be:
(1) Foot or hand impression — This develops when the foot or
hand is pressed on mouldable materials like mud, clay,
cement mixture, or other semi-solid mass. The impression
can be preserved by making a cast of it with plaster of Paris.
(2) Footprint or handprint — This is a footmark or handmark
on a hard base contaminated or smeared with foreign
matters like dust, flour, blood, etc.
t. Complexion — Complexion can be determined when the whole
body is exposed preferably to ordinary sunlight. Dark complexion may be found fair with the use of bleaching chemicals,
while fair complexion may temporarily be made dark with the
use of an ointment with a dark pigment. Exposed parts of the
body usually appear darker than those covered with clothing.
g. Changes in the eyes — A person identified because he is nearsighted, far-sighted, color blind, astigmatic, presbyopic, or crosseyed. The eye may have arcus senilis, artificial pupils, irregular
marks of the spectacles or cataract. Color of the iris, shape
of the eyes, deformity of the eyeball and the presence of
disease are useful bases of identification.
h. Facies — There are different kinds of facial expressions brought
about by disease or racial influence.
(1) Hippocratic facies— The nose is pinched, the temple hollow,
eyes sunken, ears cold, lips relaxed and skin livid. The
appearance of the face is indicative of approaching death.
(2) Mongolian facies — Almond eyes, pale complexion, prominence of cheek bones.
(3) Facies Leonine — A peculiar, deeply furrowed, lion-like
appearance of the face. This may be observed in leprosy,
elephantiasis and ,leontiasis ossia.
(4) Myxedemic facies — Pale face, edematous swelling which
does not pit on pressure, associated with dullness of intellect, slow monotonous speech, muscular weakness and
tremor.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
Base up
47
Base down
Triangular face
The face may be round, oval, triangular or slightly
square.
Distinct identifying marks may be present on the face,
such as, peculiarly attractive scars, moles, hair, nose and condition of the skin which an identifier may specially notice,
i. Left— or right-handedness — The preferential use of one hand
with skill to the other in voluntary motor acts. Ambidextrous
people can use their right and left hands with equal skill.
The best way to determine whether a person is left— or
right-handed or ambidextrous is to observe him during his
unguarded moments.
j. Degree of nutrition — The determination must be in relation
to the height and age. A person may be thin, normal or stout.
This point of identification easily changes by refraining from
/ intake of fatty foods. Some persons are inherently skinny
/ inspite of heavy intake of nutritive food.
^Points of Identification Applicable to Both Living and Dead before
-Ouaul of Lrecomposition:
l^Oeeupatirnttl Marfrff — Certain occupations may result in some
characteristic marks or identifying guides:
48
LEGAL MEDICINE
a. A shoemaker develops depressed sternum.
b. Painters have stains on the hands and fingernails.
c. Engineers and mechanics may have grease on their hands.
d. A dressmaker develops multiple punctured marks on finger
tips.
e. Baker and miller may have flour dust on their clothings and
on their bodies.
f. Mason have callosities on the palms of the hands.
g. Scars caused by burns produced by scales or sparks or red hot
iron may be seen at the back of the hands of blacksmiths.
h. Involuntary tattooing of particles of coal may be seen on the
hands of miners.
i. Chemical stains may be present on the hands of dyers, photographic developers and printers.
2. Race — In the living, race may be presumed in:
*^a. Color of the skin:
Caucasian — Fair
Malayan — Brown
Mongolian — Fair
Negro — Black
b. Feature of the face:
Caucasian — Prominent sharp nose
Malayan — Flat nose with round face
Mongolian — Almond eyes and prominent cheek bone
Negro — Thick lips and prominent eyes
c. Shape of the skull:
Caucasian — Elongated skull
Malayan — Hound head
Mongolian — Round head
Ked Indians and Eskimos — Flat head
d. Wearing apparel — Casual and customary wearing apparel
may indicate race as well as religion, nationality, region and
custom.
3.
Rtntiijp A person ceases to increase in height after the age of
"25. There is apparent shrinkage in height after a long standing
debilitating disease. There is actual shrinkage in old age on
account of the compression of the inter-vertebral and also the
curvature of the spinal column. The growth of a person rarely
exceeds five centimeters after the age of 18.
The rate of growth is variable but it is most active from 5 to
7 and from 13 to 16 years of-age. When the rate of growth is
increased, the horizontal growth is relatively retarded.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
Methods of Approximating the Height of a Person:
If the body is complete the height can be determined by actual
measurement. Sometimes some part of the body is missing and
the actual measurement may not be possible. The following are
the methods to be used to approximate the height:
a. 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.
b. Two times the length of one arm plus 12 inches from the
clavicle and 1.5 inches from the sternum is the approximate
height.
c. Two times the length from the vertex of the skull to the pubic
symphysis is the height.
d. The distance between the supra-sternal notch and the pubic
symphysis is about one-third of the height.
e. The distance from the base of the skull to the coccyx is about
44% of the height.
f. The length of the forearm measured from the tip of olecranon
process to the tip of the middle finger is 5/19 of the height.
g. Eight times the length of the head is approximately equal to
the height of the person.
4. Tattoo marks — Introduction of coloring pigments in the layers
of the skin by multiple puncture. Tattoo marks may be in the
form of initials, names, images or views.
_1,
Tattoo marks
so
l e g a l medicine
Importance of Tattoo Mark:
a. It may help in the identification of the person. The image
inscribed may reflect the name, date of birth, language spoken,
religion, name of spouse, etc.
b. It may indicate memorable events in his life.
c. It may indicate the social stratum to which the person belongs.
Generally, tattooing is practiced by the members of the lower
economic class.
d. Lately, the presence of tattoo implies previous commitment
in prison or membership in a criminal gang.
Factors Responsible for the Permanency of Tattoo:
a. Whether the punctures are superficial or deep to reach the true
skin;
b. Nature and solubility of the pigment used. Ordinary pen ink
disappears in a short time while carbon introduced to the true
skin layer is usually permanent. Soluble pigments easily disappear and may be seen in the lymph glands.
Methods of Removing Tattoos:
a. By surgical excision - Shallow tattoo may disappear by simple
rubbing or superficial incision and may leave no scar. Deepseated tattoo may be excised and usually leaves a scar.
b. By electrolysis — The needle is inserted into the tattoo mark in
a sufficient number of times using a current of 5 to 8 milliamperes. This forms a superficial eschar, which drops off in a
week or so taking the pigment with it and leaving a superficial
scar.
c. By application of caustic substance — The caustic substance is
applied to the tattoo mark and the pigment is removed with
the eschar after inflammatory reaction.
h.Wejghtr— This is not a good point of identification for it is
""""easily changed from time to time.
6. Deformities — Congenital or acquired — deformities may cause
^-Peculiar way -of walking, body movement, facial expression,
mannerisms, etc. Deformity like clubfoot, harelip, cleft palate,
cystic conditions, bony prominence, etc., may be corrected
surgically.
Acquired deformities in the form of amputation, improper
union of bones, depressed fracture, deforming scars may be
the bases for identification.
T_Birth marks — Birth marks may be a spot naevi, port wine, or a
Mongolianblue spot. They may be removed by carbon dioxide
snow, electrocautery, or by excision. The marks must be des-
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
cribed as to shape, location, dimension, color and degree of
pigmentation.
rnj»riv>fl leaving permanent results — Amputation, improper
union of fractured bones.
Q M o f g « — O r d i n a r i l y they are permanent but can be removed by
'""""electrolysis, by radium or by carbon dioxide snow.
10^Jfcgc--==--A-^maining mark after healing of the wound. The
fibrous tissue takes the place of the original tissue which has
been injured or destroyed. A scar is devoid of specialized tissues
so it does not contain pigment, sweat or sebaceous glands. Its
number, exact location, size and shape, and whether it is elevated
or depressed should be noted.
Faint scars may be made visible by making the surrounding
skin red upon applying friction with hand or by heat.
Scar which develops after a secondary infection is usually
marked.
Scar increases in size in proportion with the growth of the
person.
Age of the Scar — A recently formed scar is slightly elevated,
reddish or bluish in color, and tender to touch.
In a few weeks to two months, the scar has inflammatory
redness and it is soft and sensitive.
Two to six months later, it becomes brownish or coppery red
in color, free from contraction and corrugation, and soft.
When the scar is white, glistening, contracted and tough, it
is not less than six months.
The period of scar formation may be delayed by sepsis, poor
vascularity of the part involved, age, depth of the wound, mobility, presence of foreign body and health condition of the
victim. Scar may or may not develop if the wound is small,
superficial and healed by first intention.
Characteristics of the scar may show the cause of the previous
lesion:
a. Surgical operation — Regular form and situation with stitch
marks.
b. Bums and scald — Scars are large, irregular in shape, and may
be keloid. Scar of scald may show stippled surface.
c. Gunshot — Disc-like, depressed at center and may be adherent
to the underlying tissue.
d. Tuberculosis sinus — Irregular in shape furrowed, with edges
hardened and uneven.
LEGAL MEDICINE
52
e. Flogging — Fine white lines diagonally across back, depressed
small spot at interval.
f. Gumma — Depressed scar following loss of tissue.
g. Lupus — Bluish-white scar.
h. Venesection — At bend of elbow, on dorsum of foot, or on
temporal region.
i. Wet cupping — Short parallel scars on lower part of the back
and loin.
11. Tribal marks — Marks on the skin by tattooing or branding. In
CliiratrdtngTheated metal is pressed on the skin and during the
healing process a scar develops as a mark. The tribal marks are
placed in the exposed parts of the body and used to identify
person or membership of a tribe or social group.
12. Sexual orggjL=.Male organ may show previous circumcision. In
lale"the uterus and breasts may show signs of previous pregnancy. Previous gynecological operation may be seen in the
abdomen.
13. Blood examination — Blood type, disease, parasitic infection or
-to~xic substances piesent may be utilized to distinguish one person from another.
/ ^ I H R O P O M E T R V (Bertitton Systemy
Alphonse Bertillon, a French criminologist, devised a scheme
utilizing anthropometrical measurement of the human body as the
basis of identification.
Basjs'of the Bertillon System of Identification:
l.X'he' human skeleton is unchangeable after the twentieth year. The
igh bone continues to grow somewhat after the period, but this
'is compensated by the curving of the spine which takes place at
aboia the same age.
/
2. It/is impossible to find two Jjuman beings having bones exactly
like.
3/The necessary measurement can easily be taken with the aid of a
simple instrument.
Information Included in the System:
1. Descriptive data — Color of the hair, eyes and complexion, shape
„<of the nose, ear, etc;
Igdymarks — moles, scars, tattoo marks, deformities, etc.
3 .An thropoineti ivul
measu remen ts:
"a.~Sotfy Mrasuromentii
sitting height.
- Height^
width of outstretched arms, and
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
Side-view shapes of noses
f
b. Measurement of the head — Length and breadth of head, bizy—gouiatkal diameter, and length of the right ear.
"of the left foot, length of
the left middle and left little fingers, and length of left arm and
hand from the elbow to the tip of the oustretched middle
finger.
In many instances an investigator does not have a picture of the
wanted or missing person. The only way to have an idea of the
prominent physical features is for the witnesses or someone who has
knowjeiig£_af-±h*jdentity to tell him.
<^Portrait parte' (spoken picture) is a verbal, accurate and picturesqueoescTlptioii o t t h e person identified. „ Such information may be
given by the witness, relatives, or other persons who are acquainted
with the physical features of the person to be identified.
The following basic requirements must be included in the verbal
description:
1. General impression: type, personality, apparent social status
2. Age and sex
3. Race or color
4. Height
5. Weight
6. Built — Thin, slender, medium or stout
7. Posture — Erect, slouching, round shoulder
8. Head — size, shape
9. Hair — Color, length, baldness
10. Face — General impression
a. Forehead — High, low, bulging or receding
b. Eyebrows — Brushy or thin, shape
54
LEGAL MEDICINE
c. Mustache — Length, color, shape
d. Ears — Size, shape, size of lobe, angle of set
e. Eyes — Small, medium or large; color; eyeglasses
f. Cheeks — High, low or prominent medium cheek bones; flat or
sunken.
g. Nose — Short, medium or big; or long; straight, aquiline or
flat or pug.
h. Mouth — Wide, small or medium; general impression
i. Lips — Shape; thickness; color
j. Teeth — Shade, condition, defect; missing elements
k. Chin — Size, shape, general impression
1. Jaw — Length, shape, lean, heavy or medium
11. Neck — shape, thickness, length; Adam's apple
12. Shoulder — Width and shape
13. Wrist — Size, shape
14. Hands — Length; size; hair; condition of the palms
15. Fingers — Length; thickness; stains; shape of nails; condition
of the nails.
16. Arms — Long, medium or short; muscular; normal or thin;
thickness of the wrist.
17. Feet — Size, deformities
If a skilled investigative illustrator is available, a picture of the
person to be identified may be drawn or sketched. As a check to
the sketch or drawing made, it must be shown to the person(s) who
gave the information to see whether it tallies with the person to be
identified.
If available, the investigator may look at what is commonly
called rougue's galary or photographic files of wanted or missing
persons for comparison with the cartographic sketch.
EXTRINSIC FACTORS IN IDENTIFICATION
1. Ornamentations — Rings, bracelet, necklace, hairpin, earrings,
lapel pin, etc.
2. Personal belongings — Letters, wallet, driver's license, residence
certificate, personal cards, etc.
3. Wearing apparel — Tailor marks, laundry mark, printed name of
owner, size, style, and texture, footwear, socks.
4. Foreign bodies — Dust in clothings, cerumen in the ears, nail
scrapping may show occupation, place of residence or work, habit,
etc.
5. Identification by close friends and relatives.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
55
6. Identification records on file at the police department, immigration bureau, hospitals, etc.
7. Identification photograph.
LIGHT AS A FACTOR IN IDENTIFICATION
1. Clearest moonlight or starlight:
Experiments have shown that the best known person cannot be
recognized by the clearest moonlight at a distance greater than 16
to 17 yards and by starlight any further than 10 to 13 yards.
a. Broad daylight:
A person can hardly recognized another person at a distance
farther than one hundred yards if the person has never been
seen before, but persons who are almost strangers may be
recognized at a distance of twenty-five yards.
b. Flash of firearm:
Although by experiment, letters of two inches high can be
read with the aid of the flash of a caliber .22 firearm at a
distance of two feet it is hardly possible for a witness to see the
assailant in case of a hold-up or a murder because:
(1) Usually the assailant is hidden.
(2) The assault is unexpected and the attention of the person or
witness is at its minimum.
c. The flash of lighting produces sufficient light for the identification of an individual provided that the person's eye is focused towards the individual he wishes to identify during the
flash.
d. In case of artificial light, the identity is relative to the kind and
intensity of the light. Experiments may be made for every
particular artificial light concerned.
/ JH. SCIENTIFIC METHODS OF IDENTIFICATION
Aspects o t Identification Requiring Scientific Knowledge:
^printing
^jS^Denfal Identification
.^^Handwriting .
Dudentification of Skeleton
E<^5etefmination of Sex .
F/f5e^0rfmnation of Age ,
G^iaentiflcation of Blood and Blood Stains
H. Identification of Hair and Fibers
56
LEGAL MEDICINE
A. FINGERPRINTING
Fingerprinting is considered to be the most valuable method of
identification. It is universally used because:
1. There are no two identical fingerprints:
Fingerprints show unlimited and infinite varieties of form.
Two or more fingerprints may grossly appear to be seemingly
alike but under a microscope or the magnifying lens, the difference may be proven. The chances of two fingerprints being
the same are calculated to be 1 to 64,000,000,000 which is ten
times the number of fingers existing in the world.
2. Fingerprints are not changeable:
Fingerprints are formed in the fetus in the fourth month of
pregnancy. During the latter stage of pregnancy as well as after
birth, the pattern enlarges, but no changes take place in the number
and arrangement of the friction ridges.
The finger may be wounded or burned, but the whole pattern with
all its details will reappear when the wound heals. If the injury is
deep or beyond the layers of the skin and scar develops, it will not
deter identification. On the contrary, the scar will make a much
deeper impression of the pattern. It can be said that fingerprints
are an indelible signature which a person carries from the cradle to
the grave.
* Practical Uses of Fingerprints:
•fTHelp establish identity in cases of dead bodies and unknown
or missing persons.
2. Prints recovered from the crime scene associate person or weapon.
3. Prints on file are useful for comparative purposes and for the
knowledge of previous criminal records.
Among illiterates, right thumbprint is recognized as a substitute
for signature on legal documents. Countries differ as to which
finger is used for the purpose. India uses the left thumb, Spain
uses the right pointing finger.
^ / Dactylography is the art and study of recording fingerprints as a
means of identification.
f
Dactyloscopy is the art of identification by comparison of fingerprints. It is the study and utilization of fingerprints.
f
-^Poroscopy is the study of the pores found on the pappillary or
friction ridges of the skin for purposes of identification.
¥ f W > L f g A t ^ p e e r t of IOETWIC^TiON
57
Advantages of Using Fingerprinting as a Means of Identification:
1. Not much training is necessary for a person to take, classify and
compare fingerprints.
2. No expensive instrument is required in the operation.
3. The fingerprint itself is easy to classify.
4. Actual prints for comparative purposes are always available and
suspected errors can easily be checked.
Methods of Producing Impressions:
Jt. Plain method — The bulbs of the last phalanges of the fingers and
thumb are pressed on the surface of the paper after pressing them
/ o n an ink pad or ink plate with printing ink.
^
Rolled method — The bulbs of the thumb and other fingers are
rolled on the surface of the paper after being rolled on an ink pad
or ink plate with printing ink.
A Kinds of Impressions:
1. Real impression — Impression of the finger bulbs with the use of
^printing ink on the surface of the paper. Other coloring materials
may be used but they are less visible and indelible.
k 2. Chance impression — Fingerprints which are impressed by mere
chance without any intention to produce it. Chance impression
maybe:
r
o
A Fingerprint
LEGAL MEDICINE
58
a. Visible print — Impression made by chance and is visible without previous treatment. Impression made by the fingers smeared
with some colored substances, like black ink, vegetable juice,
may be visible immediately after impression.
b. Plastic print — Impression made by chance by pressing the
finger tips on melted paraffin, putty, resin, cellophane, plastic
tape, butter, soap, etc.
c. Latent print — Prints which are not visible after impression but
made visible by the addition of some substances. Latent prints
develop because the fingers are always covered with colorless
residue of oil and perspiration which when pressed on smooth
and non-absorbent material will cause the production of the
prints.
ir
How to Develop Latent Prints:
(1) Application of fine powder — The choice of substance to
be used to make the latent prints visible depends upon the
texture and color of the material where the suspicious prints
are located. The color of the substances to be used must be
in contrast with that material.
Characteristics of a good powder:
(a) It should be adhesive to the extent that it clings readily
to the edges of the fingerprints.
(b) It should not absorb water.
(c) It should provide good contrast to the place where the
latent print is impressed.
The following substances are commonly used to make
latent prints visible:
(a) Graphite for spraying
(b) Aluminum powder
(c) Plaster of Paris
(d) Copper powder for latent prints on leather
(e) Metallic antimony
(2) Chemical development by fuming and immersion:
Fuming by iodine or arsenic acid or immersion in a
solution of silver nitrate may develop latent prints.
How to Get Fingerprint Impressions on Dead Bodies:
In cases of fresh dead bodies, the fingers are unclenched and each
one is inked individually with the aid of a small rubber roller. The
paper where the print will be impressed will be placed in a spoonshaped piece of wood and slowly and evenly rolled over the pattern.
If the fist is too tightly clenched, a small incision may be made at
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
the base of the fingers. The contraction may also be overcome by
dipping the hands in hot water.
If the so-called washerwoman's skin is not too marked on the
fingerprints of dead bodies recovered shortly from bodies of water
(floaters), the fingers may be dried off with a towel and glycerin is
injected with a syringe under the skin of the finger tips in order to
smoothen the surface. The fingerprints are then taken like that of a
fresh dead body.
If the "floater" has been in a body of water for a longer time and
the friction ridges have disappeared, the skin of the fingertips is cut
away. This area of skin from each finger is placed in a small labelled
test tubes containing formaldehyde solution. If the papillary ridges
are still preserved on the outer surface, the person taking the prints
places a portion of the skin on his right index finger protected by a
rubber glove and then takes the print after inking the finger tip.
The same procedure as described may be applied to putrefied or
burned bodies according to circumstances.
^Fypes of Fingerprint Patterns:
1. Arches — The ridges go from one side of the pattern to another,
never turning back to make a loop.
a. Plain arches — The ridges on one side of the impression and
flow or tend to flow out the other side with rise or wave in the
center.
b. Tented arch — One or more ridges at the center to form a
definite angle of 90 degrees or less than 45 degrees from the
horizontal plane.
2. Loops — One or more ridges enter on either side, recurves and
terminate or tend to terminate on the same side from which it
entered.
a. Ulnar loop — Recurves towards the ulnar side of the hand or
little finger.
b. Radial loop — Recurves towards the radial side of the hand or
thumb.
3. Whorls — Patterns with two deltas and patterns too irregular in
form to classify:
a. Simple whorls — Consist of two deltas with a core consisting of
circles, ellipses, or spiral turning to the right or left.
b. Central pocket loop- — It is like simple loop but in the core, one
may find one ridge which forms a convex towards the opening
of the loop.
c. Lateral pocket loops — There are at least two loops opening at
the same side.
LEGAL MEDICINE
Four Primary Types of Fingerprint
> Whorl
4 Composite
d. Twin loop — There are at least two loops opening at the different sides.
e. Accidentals — There are no rules that can be made in this pattern. They are rare and often with more than two deltas.
/Poroscopy (Locard's method of identification):
Examination of the ridges of the hands and fingers reveal to be
studded with minute pores which are the openings of ducts or sweat
glands. These pores are permanent as the ridges are and differ in
number and shape in a given area in each person. Poroscopy, as a
means of identification, is applied when only a part of the fingerprint is available for proper means of identification.
Can fingerprints be effaced?
John Dillinger, a notorious gangster and a police character attempted to erase his fingerprints by burning them with acid, but as
time went by, the ridges were again restored to its "natural" feature.
The acid he applied temporarily destroyed the epidermis of the
bulbs of his fingers.
As long as the dermis of the bulbs of the finger is not completely
destroyed, the fingerprints will always remain unchanged and indestructible.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
61
Can fingerprints be forged?
There is a considerable controversy regarding the possibility of
forging fingerprints or making a simulated impression or a perfect
replica of impression of fingers. Various experiments were conducted by authorities and although they could almost make an
accurate reproduction, still there is no case on record known or
have been written that forgery of fingerprints has been a complete
success. The introduction of modern scientific equipment, new
techniques and up-to-date knowledge in crime detection will always
foil the attempt.
/
The role of the teeth iri human identification is important for the
following reasons:
1. The possibility of two persons to have the same dentition is quite
remote. An adult has 32 teeth and each tooth has five surfaces.
Some of the teeth may be missing, carious, with filling materials,
and with abnormality in shape and other peculiarities. This will
lead to several combinations with almost infinite in number of
dental characteristics.
2. The enamel of the teeth is the hardest substance of the human
body. It may outlast all other tissues during putrefaction or
physical destruction.
3. After death, the greater the degree of tissue destruction, the
greater is the importance of dental characteristics as a means of
identification.
4. The more recent the ante-mortem records of the person to be
identified, the more reliable is the comparative or exclusionary
mode of identification that can be done.
In order to make an accurate dental record available for purposes
of comparison with that of the person to be identified, Presidential
Decree No. 1575 was promulgated, requiring practitioners of dentistry to keep records of their patients. It provides the following:
"Whereas, the identification of persons is a necessary factor in
solving crimes and in settling disputes such as claims for damages,
insurance, and inheritance;
_
Whereas, in these cases where the identification of persons
cannot be established through the regular means, identification
through dentition has been proven to be necessary and effective;
Whereas, however, records of dentition of persons are often
not available due to the lack of systematic recording of dental
practitioners of the dental history of their patients.
62
LEGAL MEDICINE
NOW, THEREFORE, I, FERDINAND E. MARCOS, President
of the Philippines, by virtue of the powers vested in me by the
Constitution, do hereby order and decree the following:
Section 1. It shall be obligatory upon all practitioners of
dentistry to keep and maintain an accurate and complete record
of the dentition of all their patients which shall include a
history and description of the patient's dentition and the
treatment made thereon.
Section 2. Upon the lapse of ten years from the last entry,
dental practitioners shall turn over the dental records of their
patients to the National Bureau of Investigation for record
purposes: Provided, that the said practitioner may retain
copies thereof for their own files.
Section 3. Any violation of the provisions of this Decree
shall be punishable by a fine of not less than one hundred
pesos but not more than one thousand pesos.
Section 4. This Decree shall take effect immediately.
Done in the City of Manila, this 11th day of June, in the year of
Our Lord, nineteen hundred and seventy-eight."
However, the absence of dental records will not absolutely negate
dental identification. Members of the family, close associates and
friends may be witnesses to prove identity of dentition.
Causes of Unreliability of the Dental Records:
An ante-mortem dental record may be available but may be insufficient, and in some instances unreliable for purposes of comparison with the post-mortem findings because:
1. The dentist, in the course of diagnosis and treatment of the
patient, may only concern himself with the affected teeth and
may not care to have a detailed examination of the other teeth.
2. There may be no uniformity in nomenclature of the location and
condition in the charting of the teeth.
3. Although there may be a law obliging dentists to have a record of
their patient, the law does not mention the agency which will
enforce it.
4. The dentist may have a record but may no longer be reliable on
account of the lapse of time. There may be changes in the teeth
which are not seen by the dentist.
For purpose of uniformity, the following are the description of
location for dental identification:
1. Teeth position:
a. Anterior — From cuspid to cuspid inclusive (it includes cuspid,
lateral and central incissor).
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
b. Posterior — All bicuspid and molar teeth.
2. Surface:
Occlosal — O — Surface which is in contact with the opposing
teeth when jaws are in occlusion (closed).
Mesial
— M — Surface in direct contact with the adjacent
tooth towards the midline.
Distal
— D — Surface in direct contact with the adjacent
teeth away from the midline.
Buccal — B — Surface facing the lip or cheek.
Lingual — L — Inward directed surface of the teeth.
3. Restoration:
Amalgam (silver filling), gold inlay, gold foil, silicate, acrylic,
temporary cement, crown.
4. Prosthesis:
a. Fixed prosthesis — bridge
b. Removable prosthesis:
(1) Complete denture
(2) Partial denture
5. Root canal treatment (endodentia).
Dental Features Which May Be Included in the Description for
Identification:
1. Malposition, overlapping, crowding and spacing teeth.
2. Number and location of deciduous or permanent teeth.
3. Missing (unerupted or extracted) or supernumerary teeth.
4. Peculiar shape, size, direction of growth of individual teeth.
5. Missing piece or fragment due to decay or trauma.
6. Restoration, prosthesis (surface,
and material).
morphology, configuration
7. Root canal therapy on x-ray examination.
8. Bone pattern on x-ray examination.
9. Complete denture (type, shade and material).
10. Relationship of bite.
11. Oral pathology (tore, gingival hyperplasia, etc.).
LEGAL MEDICINE
64
Dental Chart
c
X
RF
AM
S
CG
—
—
—
—
Caries
Indicated for Extraction
Retained Root Fragment
Amalgam Filling
Silicate Filling
Gold Crown
AB
P
- Bridge Abutment
Pontic
Gold Clasp
Gl
- Gold Inlay
M
- Missing due to Extraction
U N - Unerupted
-
Other Aspects of Identification Which May Be Reflected in Dentition:
1. Personal, occupational and cultural traits:
a. Cigarette smokers may have smoke marks mainly on the lingual
surface of the anterior upper teeth.
b. Seamstress, carpenter, cobblers may hold pins or nails between
incissors and may cause formulation of groove.
c. Wind instrument musicians may have altered position of their
teeth due to mouth formation necessary for playing the instrument.
d. Pipe smokers may develop an oval-shape notch at the occlusal
surface or irregular gaps located at the angle of the mouth.
e. Sandblasters and stone mason may cause abrasions on the
labial or occlusal surface of their teeth.
f. Poor oral hygiene, with many decayed teeth and no restorations
infers individual of low economic status. Extracted teeth are
also not replaced by bridgework.
g. Excessive fruit juice drinker or carbonated drinks may cause
dissolution of the enamel structure of the front teeth.
h. Mutilation of teeth by filing or inlaying with precious metals
or stone, not done professionally, may indicate tribal customs
and cultural peculiarities.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
2. Age
9 yrs
11 yrs
12 permanent teeth (8 incisors and 4 molars).
20 permanent teeth (8 incisors, 8 premolar
and 4 molar).
13 yrs
28 permanent teeth and no deciduous teeth.
8 to 10 yrs
Calcification begin at the 3rd molar.
25 yrs
Root-ends of 3rd molar completely calcified.
Beyond 25 yrs. . . . Ends of the root of the 3rd molar have been
completely calcified.
After 30 yrs
Carries frequently develop at the cementum.
There may be gingival recession, decay attack
of the root surface.
3. Sex
Examination for the presence of Barr bodies from palatal
scrappings.
j
y/C. HANDWRITING
A person may be identified through his handwriting, handprinting
and handnumbering.
Sec. 23, Rule 132, Rules of Court — Handwriting, how proved:
The handwriting of a person may be proved by any witness who
believes it to be the handwriting of such person, and has seen the
person write, or has seen writing purporting to be his upon which
the witness has acted or been charged, and has thus acquired knowledge of the handwriting of such person. Evidence respecting the
handwriting may also be given by a comparison, made by the witness
or the court, with writings admitted or treated as genuine by the
party against whom the evidence is offered, or proved to be genuine
to the satisfaction of the judge.
The genuiness of any disputed writing may be proven by any of
the following ways:
JL. Acknowledgement of the alleged writer that he wrote it;
Statement of witness who saw the writing made and is able to
identify it as such;
By the opinion of persons who are familiar with the handwriting
of the alleged writer, or
4r^By the opinion of an expert who compares the questioned writing
with that of other writings which are admitted or treated to be
genuine by the party against whom the evidence is offered.
Sec. 44, Rule 130, Rules of Court — Opinion of ordinary witnesses:
The opinion of a witness regarding the identity of handwriting of
a person, when he has knowledge of the person or handwriting; the
opinion of a subscribing witness to a writing; the validity of which is
6 6
LEGAL MEDICINE
in dispute, respecting the mental sanity of the signer; and the opinion
of an intimate acquaintance respecting the mental sanity of a person,
the reason for the opinion being given, may be received as evidence.
In order for an ordinary witness to be qualified to express his
opinion, it must be shown that he has some familiarity with the
handwriting of the person in a way recognized by law.
Some Practical Uses of Handwriting Examination:
(^Financial crimes (bogus checks, cr'xlit card fraud, embezzlement).
/fjDeath investigation (suicide notes, hotel registration cards, letter
af explanation),
obberies (pawnshop notes, cashing of stolen checks),
idnapping with ransom (demand note, threatening letter).
'Anonymous threatening letters.
Falsification of documents (deeds of conveyance, receipts).
A
\Bibliotics is the science of handwriting analysis. It is the study of
documents and writing materials to determine its jgerqjineness or
authorship. One who had acquired special knowledge of the science
of handwriting for purposes of identification is known as JZibliotisl
or more commonly known as handwriting expert or qualified question document examiner.
<A Graphology is the study of handwriting for the purpose of determining the writer's personality, character and aptitude. It is a
pseudo-science and merely explains the characteristics of the handwriting reflecting the character, weakness, personal idiosyncracies,
mannerisms and ambition of the writer. It must not be confused
with bibliotics.
Handwriting is a complex interaction of nerves, memory and
muscular movement. It is influenced by several factors and may be
changed or modified during the life-span of a person.
Writing is a conscious act, but on account of a repeated act it
becomes habitual and unconscious. The writer concentrates more
on the subject-matter of the writing than on the way the letter are
formed which make up the writing.
.Worry, anxiety, anger, fegling of insecurity, age, and drunkenness
may cause variation of a person's handwriting.
~
k Movements in Writing:
1. Finger movement — The letters are made entirely by the action of
the thumb, the pointing and middle fingers. Such is found among
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
67
children, illiterates and those to whom writing is an unfamiliar
process.
2. Hand movement — The letters are produced by the action of the
hand as a whole with the wrist as the center of action and with some
action of the fingers. Most of the illegible, scratchy and angular
writings of women are produced by such movement.
3. Arm movement — The movement in writing is made by the hand
and arm supported with the elbow at the center of the lateral
swing. Many of the good writings are written in this manner.
There is more speed, rhythm and freedom in this way of writing.
4. Whole arm movement — The action is produced by the entire
arm without any rest. The source of motion comes from the
shoulder. Writing on a blackboard is a good example of whole
arm movement.
The Form, Style and Characteristics of the Handwriting of a Person
are Basically Determined By:
A.Primary factors:
1. Survival of the letters are formed when a person begins to write.
Children who were under the same tutelage during their initial
period of learning how to write have the tendency to develop
similar writing habits.
2. Inclusion of some characteristics due to admiration of a peculiar
design in writing.
3. Identifying characteristics may be the result of the great volume
of writing done.
4. The presence or absence of physical abnormalities or defects
originating from illness, injury, psychological variations and
other similar conditions.
B. Secondary factors:
1. The position of the writer, e.g. sitting, standing, lying, arm
high or low, and other similar variations not normally observed in his ordinary writing habit.
2. Temporary physical or psychological disturbances, such as
excitement, fear, pain, exhaustion, injury to thd hand or arm,
etc.
3. Other external temporary variables, such as writing without
glasses, bad lighting, irregular surface, external interference.
4. Physical and chemical factors:
a. Writing instrument:
(1) Ballpen — It. usually leaves rounded line showing no tip
separation even when pressed heavily. Smudge may be
deposited on the line. The ink, not being a true liquid,
LEGAL MEDICINE
does not flow into the fibers and spread in the same way
as fluid ink does.
(2) Fountain pen — The lines are more or less round but
when pressure is increased there is separation of the nib
which is easily detected. There is evenness in the flow
of ink.
(3) Steel pen — There is unevenness in the flow of ink and
leaves a scratchy appearance.
(4) Pencil — Lead of pencils is compose of graphite and
clay with kaolin as binder. Soft pencils have greater
proportion of graphite while hard ones have relatively
more clay. Cheap quality pencils have frequently gritty
impurities which scratch the paper, while high-grade
pencils are free from such grit.
Paper:
(1) Color — Color can be well appreciated with a good light.
Dirt, stain or fading condition may not show the true
color of the paper.
(2) Surface appearance — It may be smooth or rough. The
surface may be damaged or wrinkled.
(3) Watermarks - Exposure of the paper to a strong light may
reveal the watermarks of the manufacturer or the type of
paper.
(4) Weight and thickness — The thickness may be measured
by means of the paper micrometer. Papers are designated
in weight which is in turn related to the thickness of the
sheet.
Ink:
(1) Iron gallotannate ink — Commonly used in "blue-black"
ink and still the basis of the greatest number of commercial ink. The changes in the paper may provide some
indications of the age of the writing.
(2) It may be a solution of a single or a mixture of dyes.
This is a common constituent of "washable" inks.
(3) Logwood ink — Made of logwood extract with salts of
iron, copper, or chromium.
(4) Carbon ink — It is a fine suspension in water of carbon
with stabilizing agent. India ink is an example of this
type of ink.
(5) Ballpoint ink — A thick suspension of dye in a liquid
which is usually a drying oil (Crime Investigation, Physical Evidence and the Police Laboratory by Paul L. Kirk,
p. 446).
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
69
Instruments Necessary in Questioned Document Examination:
l j Photographic instruments are primarily used to view the writing
in sufficient magnification for detail examination and preparation
of evidence for presentation in an investigative or judicial body.
2^Magnifying lens and stereoscopic binocular microscope — These
two instruments are useful to determine line quality, quaver,
uncertainty, patching, over-writing, crowding, and other unusual
appearances of writing. Presence of obvious obliteration, erasure
or alteration may become more visible.
3JUltraviolet lamp and infra-red radiaton — Chemical erasures may
be made visible, invisible ink, writing may be made legible, identification of paper and resealing of the envelopes with different
mucilage can be seen through these instruments,
feasuring caliper,
lighting facilities.
>se of Handwriting Examination:
LUWhether the document was written by the suspect.
[2) Whether the document was written by the person whose signature
it bears.
3JWhether the writing contains additions or deletions.
^ W h e t h e r the document such as bills, receipts, suicide notes or
checks are genuine or a forgery.
Points to be Considered in Questioned Document Examination:
Size, slant, spacing, proportion of the letters, speed and rhythm in
writing, shading and change of position in pen hold, pressure, penlift, initial and terminal strokes, alignment, etc.
Inasmuch as handwriting examination is basically comparative,
the standard for such comparison must be suitable and sufficient.
The greater the variation in a way of writing, the greater is the
amount of standard writing needed to form a reliable impression.
Handwriting examination done by comparison with known standards:
To determine whether a certain instrument or document has been
written by a certain person, it is necessary to compare the writings
on such instrument or document with some standard writings of
the same person for the purpose of comparison and determine the
similarities.
The standard (exemplar) writings with which the questioned
writing has to be compared are of two types:
1. Collected (procured) standards — These consist of handwriting
by the person who is suspected to have written the questioned
document. It may be found in the private or public records of
LEGAL MEDICINE
the person or from other possible sources. Provided it is clear
and sufficient, it is the most appropriate standard.
2. Requested standard — These are standards made by the alleged
writer of the document in question upon request of the examiner
or the persons interested in the examination. Inasmuch as one
of the characteristics of good exemplar is that it must be contemporaneous with the date the questioned document was made,
the use of the requested standards is applicable only to recently
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
written questioned documents, like extortion letter, "poison"
notes, letter of threat or ransom, etc.
Considering that it is a request from a suspected maker of the
questioned document, there is a strong possibility for it to be
written in a disguised way.
Steps to be Undertaken to Minimize Conscious Efforts to Disguise
the Requested Standard:
1. The writer should be allowed to write sitting comfortably at a
desk or table and without distraction.
2. The suspect should not, under any condition, be shown the
questioned document or be provided with instructions on how
to spell certain words or what punctuation to use.
3. The suspect should be furnished with a pen and a paper similar
to those used in the questioned document.
4. The dictated text may be the same as the contents of the questioned document, or at least should contain many of the same
words, phrases, and letter combinations found in the document.
In handwriting cases, the suspect must not be given any instruction
on whether to use upper-case (capital) or lower-case lettering.
5. Dictation of the test should take place at least three times. If the
writer is making a deliberate effort to disguise his writing, noticeable variations should appear between the three repetitions. Discovering this, the investigator must insist upon continued repetitive dictation of the text.
6. Signature exemplars can best be obtained when the suspect is
required to combine other writings with a signature. For example,
instead of compiling a set of signatures alone, the writer must be
asked to completely fill out twenty to thirty separate checks or
receipts, each of which includes a signature.
7. Before requested exemplars are taken from the suspect, a document examiner should be consulted and shown the questioned
specimens (Criminalistics by Richard Saferstein, p. 336).
Handwriting Characteristics of Illiterates:
1. They seldom follow any rule or baseline although at the beginning
a position above the baseline is taken which continues in an
ascending or descending course. Baseline is the ruled or imaginary line upon which the writing rests.
2. The tendency of the writing is to be raised involuntarily in the
last letters of the word made by the extension of the fingers
while the hand is being held in a fixed position.
3. The loop letters are often slanted too much because the upstrokes are made too long or nearly straight.
72
LEGAL MEDICINE
4. Very unlikely to produce facsimile signatures in size, arrangement and proportion of parts.
5. The writing is not rhythmic, but made up of disconnected unskilled movement impulses which are not likely to be related in
an exactly identical way.
6. Tremor or involuntary trembling is seen due to inability to
control the pen in motion because of not being familiar with and
self-conscious to the process of writing.
7. Formation and angle of letters are irregular and definitely show
lack of knowledge of size and proportion.
8. Same speed is utilized from beginning to end and seldom is the
pen raised to get a new adjustment.
9. Illiterate pencil-writing is usually produced with much pressure
and may show the habit of wetting the pencil lead frequently.
10. In anonymous writing, illiteracy is indicated by faulty arrangement of words, lines, paragraphs and pages.
11. Combination of script forms and Roman capitals, or pen or
pencil printing, containing freak forms, abbreviations or punctuation marks are individual creations.
Handwriting Characteristics of Old Aged Persons:
X^Due to lack of muscular control, the handwriting will not usually
show fine lines continuously but the strokes are mostly rough
and made with considerable pressure.
2^With the presence of tremor, the changes of direction are numerous and omission of parts of letters of strokes are common.
Z. The concluding parts are often made with a nervous haste and
carelessness and they may be much distorted.
A\ Even with much tremor, the handwriting will usually show free
connecting and terminal strokes made by the momentum of the
hand.
J£ Often shows very uneven alignment and may disregard entirely a
line near which they are written.
-o. Usually shows an unusual and erratic departure from its intended
movement, particularly in the downward strokes.
"7. There is a loss of individual departure from its intended movement, particularly in the downward strokes.
,-8TThere is a loss of individual rhythm as indicated by malformation
and irregularity of speed in the writing of small letters.
Disguised Writing:
Disguised writing is the deliberate attempt on the part of the
writer to alter his writing habit by endeavoring to invent a new writing
style or by imitating the writing of another person.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
73
Physical Methods of Disguising Handwriting:
a. By changing the direction of the slant. The forger may employ
a backhand slant, instead of the usual forehand slant.
b. By increasing or decreasing the speed in writing.
c. By deliberate carelessness that will produce inferior style of
writing.
d. By making the letters unusually large or small.
e. The forger may use the left hand instead of the right hand.
f. Hand printing may be substituted for script.
Characteristics of Disguised Writing:
a. Inconsistent slant
b. Inconsistent letter formation
c. Change of capital letters
d. Lack of free-flowing movement
e. Lack of rhythm
f. Unnatural starts and stops
g. Irregular spacing
h. Writing with unaccustomed hand (Criminalistics by Richard
Saferstein, p. 692).
Signature forgery:
Signature forgery examination is the most common activity of a
questioned document examiner. A signature may be found on a
document which appears that a person has participated in its execution and the person denied that he had signed it. Such signature
may be found in checks, deeds of conveyance, anonymous letters,
receipts, etc.
Classification of Signature Forgery:
a. Traced forgery — The outlining of a genuine signature from one
document onto another where the forger wishes it to appear.
Traced forgery is basically drawing and consequently lacks free
natural movement inherent in a person's normal writing.
Ways of Achieving Traced Forgery *
(1) The paper wherein the signature is to be copied is placed
on top of the document containing the signature. By means
of a strong light underneath, the forged signature is traced
from the genuine, either directly or lightly by a pencil
outline and then over-writing the pencil outline.
(2) By placing the paper to receive the signature tracing underneath the document bearing the genuine signature and by
indented outline on the underneath page, or by interweaving the documents with carbon paper to produce a
carbon outline on the forged paper.
74
LEGAL MEDICINE
b. Simulated forgery — An attempt to copy in a freehand manner
the characteristics of a genuine signature either from memory of
the signature or from a model. It is accomplished without
outline.
The quality of the simulated signature varies with the writer's
skill as a penman, the difficulty of the signature being imitated,
the writer's ability to recognize and incorporate the details, his
ability to concentrate on the important feature of the signature
and his ability to discard all of his own natural habit of writing.
c. Spurious forgery — One prepared primarily in the forger's own
handwriting wherein little or no attempt has been made to copy
the characteristics of the genuine writing.
(Modern Legal Medicine, Psychiatry and Forensic Medicine by
W. Curran et ai, p. 1235).
The principle of identification of handwriting is also applicable to
handprinting and handnumbering.
Typewriter Identification:
The identification of the typing machine used in a questioned
document, like that in ballistics examination, may be on the basis of:
1. Class characteristics — those characteristics which serve to distinguish it from any other machine, such as:
a. Manufacturer's characteristics
b. Size and design of the type
c. Line and letter spacing
2. Individual characteristics:
a. Defects in the type face — Unusual manner of letter formation
due to factory defect, misuse of the machine or wear and tear.
b. Defects in the alignment — Malpositioning, spacing and alignment may be modified by loosening of the hinges and positioning of the letters on account of wear and tear and changes in
the spring pressure.
c. Other machine defects:
(1) Skipping space
(2) Irregular margin stops
(3) Improper letter spacing
(4) Improper ribbon actions
A typewriter has 44 keys with 88 characters, each operating
independently of one another and each being capable of damage or
having inherent defects. Consequently, a variety of combinations of
these defects may be the basis of typewriter identification.
The questioned document may be compared with those made by
the suspected typewriters.
Examination of Bones — Complete lay-out of the bones to determine duplicity
i
and missing ones.
V D. IDENTIFICATION OF THE SKELETON
Occasionally, before a physician is called to examine a dead body,
the soft tissues have already disappeared and only the skeletal system
remains. Ail the external identifications have already disappeared.
In this particular case we resort to the study of bones.
hi the examination of bones, the following points can be determined
approximately:
1. Whether the remains are of human origin or not.
2. Whether the remains belong to a single person or not.
3. Height.
4. Sex.
5. Race.
6. Age.
7. Length of interment or length of time from date of death.
8. Presence or absence of ante-mortem or post-mortem bone injuries.
9. Congenital deformities and acquired injuries on the hard tissues
causing permanent deformities.
How to Determine Whether the Remains Are of Human Origin or
Not:
The shape, size and general nature of the remains, especially that
of the head, must be studied. The oval or round shape of the skull
and the less prominent lower jaw and nasal bone are suggestive of
76
LEGAL MEDICINE
human remains. A complete lay-out of the whole bones found and
placing each of them on their corresponding places in the human
body will be helpful. The presence of dental fixtures, rings on the
fingers, earrings in the case of women, hair and other wearing apparels, together with the remains are strong presumption of human
remains.
How to Determine Whether the Remains Comes from a Single
Individual or Not:
A complete lay-out of the bones on a table in their exact locations
in the human body is necessary. Any plurality or excess of the bones
after a complete lay-out denotes that the remains belong to more
than one person. However, congenital deformities as supernumery
fingers and toes must not be forgotten. The unequality in sizes,
especially of the limbs may be ante-mortem.
Height:
Several formulae using different constants have been forwarded in
the approximation of the height of a person by measuring the long
bones of the body.
A. Actual measurement of the skeleton — To the actual length of the
skeleton add 1 to 1-1/2 in. for the soft tissue.
•,
B. Pearson's Formulae for the reconstruction of the living stature of
long bones, whose animal matters have disappeared and which are
in a dry state.
Males
Females
S = 81.306 plus 1.880 F
S = 72.844 plus 1 . 9 4 5 F
= 70.641 plus 2.894 H
= 71.475 DIUS 2 . 7 5 4 H
= 78.664 plus 2.376 T
= 74.774 plus 2 . 3 5 2 T
= 89.925 plus 3.271 R
= 81.224 plus 3 . 3 4 3 R
S = Stature
F = Femur
H = Humerus
T = Tibia
R = Radius
Remarks:
1. The femur is measured from the head to the apex of the inner
condyle. If the femur has been measured in the oblique position
and not straight, add 0.23 for male and 0 . 3 3 for female to the
length before using the above formulae.
2. The tibia is measured from the upper articular surface to the tip of
the malleolus. If the tiDia has been measured with, and not without, the spine, subtract 0.96 for male, and 0 . 8 7 cm. for female,
from the length before using the above formulae.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
77
3. The humerus and radius are measured in their greatest length.
(Taylor's Principles and Practices of Medical Jurisprudence, S.
Smith, 10th ed., Vol 1, p. 155).
4. Inasmuch as the formulae for male and female skeletons are
different, it is necessary to determine the sex of the skeleton
before the formulae may be applied.
C. Stature from bone:
Dupertuis and Hadden's General Formulae For Reconstruction of
Stature From Lengths of Dry Long Bones Without Cartilage (Constant Terms in Metric and Adapted to English System)
Constant term to be
added after calculations
in previous column
armula
Stature-bone length
coefficient(s)
Centimeters
Inches
69.089
81.688
73.570
80.405
69.294
71.429
66.544
66.400
64.505
27.200
32.161
28.965
31.655
27.281
28.112
26.198
26.142
25.396
56.006
22.050
61.412
72.572
64.977
73.502
65.213
55.729
59.259
60.344
57.600
24.178
28.572
25.581
28.938
25.674
21.941
23.330
23.757
22.677
57.495
22.636
Male
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(k)
2.238 (femur)
2.392 (tibia)
2.970 (humerus)
3.650 (radius)
1.255 (femur + tibia)
1.728 (humerus + radius)
1.422 (femur) + 1.062 (tibia)
1.789 (humerus) + 1.841 (radius)
1.928 (femur) + 0.568 (humerus)
1.442 (femur) + 0.931 (tibia)
+ 0.083 (humerus)
+ 0.480 (radius)
Female
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(k)
2.317 (femur)
2.533 (tibia)
3.144 (humerus)
3.876 (radius)
1.233 (femur + tibia)
1.984 (humerus + radius)
1.657 (femur) + 0.879 (tibia)
2.164 (humerus) + 1.525 (radius)
2.009 (femur) + 0.566 (humerus)
1.644 (femur) + 0.764 (tibia)
+ 0.126 (humerus)
+ 0.296 (radius)
78
LEGAL MEDICINE
(From: Forensic Medicine by Keith Simpson, 7th ed., p. 25.)
D.Topinard and Rollet, two French anatomists devised a formula fo'
the determination of the height for males and females.
Male
Female
Length of Femur
x 3.66 or 3.71 equals height
Length of Humerus x 5.06 or 5.22 equals height
Length of Tibia
x 4.53 or 4.61 equals height
Length of Radius x 6.86 or 7.16 equals height
(These formulae do not hold good in mixture of races.)
E. Humphrey's Table:
Humphrey made a table of the different height of bones for
different ages and their corresponding statures.
F. Lacassagne made the following coefficient for the determination
of height:
Bone
Male
Female
Femur
3.66
3.71
Tibia
4.53
4.61
Fibula
4.58
4.66
Humerus
5.06
5.22
Radius
6.86
7.16
Ulna
6.41
6.66
E.Manouvrier made a formulae based on length of tibia, fibula,
radius and ulna for the determination of height.
MANOUVRIER'S STATURE TABLE FOR FEMALES
ftbula Tibia Femur Cadaver Humerus Radius Ulna
Length
Mm. Mm. Mm.
Cm.
Mm.
Mm. Mm.
283
284
363 / 140.0
263
193
203
288
289
368^
142.0
195
266
206
293
294 , 373
144.0
270
197
209
298
299
378
145.5
199
273
212
303
304
383
147.0
201
276
215
307
309
388
148.8
279
203
217
311
314
393
149.7
282
205
219
316
319
398
151.3
285
207
222
320
324
403
152.8
289
209
225
325
329
408
154.3
292
211
228
330
334
415
155.6
214
297
231
336
340
422
156.8
302
235
218
341
346
429
158.2
307
222
239
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
346
351
356
361
366
371
376
352
358
364
370
376
382
388
436
443
450
457
464
471
478
159.5
161.2
163.0
165.0
167.0
169.2
171.5
313
318
324
329
334
339
344
226
230
234
238
242
246
250
243
247
251
254
258
261
264
Coefficients for smaller bone lengths than given above.
x4.88 x4.85 x3.87
x5.41 x7.44 x7.00
Coefficients for greater bone lengths than given above.
x4.52 x4.42 x3.58
x4.98
x7.00 x6.49
MANOUVRIER'S STATURE TABLE FOR MALES
Fibula Tibia Femur Cadaver Humerus Radius Ulna
Length
Mm. Mm. Mm.
Cm.
Mm.
Mm. Mm.
153.0
295
318
319
392
213
227
323
324
398
155.2
298
216
231
328
330
404
157.0
302
219
235
333
335
410
159.0
306
222
239
338
340
416
160.5
309
225
243
344
346
422
162.5
313
229
246
349
351
428
'232
249
163.4
316
353
357
434
164.4
320
236
253
358
362
440
165.4
324
239
257
363
368
446
166.6
328
243
260
368
373
453
167.7
332
246
263
373
460
336
249
266
378
168.6
378
383
467
169.7
340
252
270
383
389
475
344
255
273
171.6
388
394
482
173.0
348
258
276
393
400
490
175.4
352
261
280
398
405
497
176.7
356
264
283
403
410
504
178.5
360
267
287
408
415
512
181.2
364
270
290
413
420
519
183.0
368
273
293
Coefficient for smaller bone lengths than given above.
x4.82 x4.80 X3.92
...
x5.25 x7.11 x6.66
Coefficients for greater bone lengths than given above.
x4.37 x4.32 x3.53
. ..
x4.93 x6.70 x6.26
(From: Medical Jurisprudence by Gordon, Turner and Price, 3rd ed.,
pp. 354-355.)
80
LEGAL MEDICINE
F. Estimations of Total Foetal Length from One or More Bones (C.H.
length)
Diaphysis of femur
x
6.71 = Total height
Diaphysis of tibia
x 7.63 = Total height
Diaphysis of humerus x
7.6 = Total height
Diaphysis of radius
x
9.2 = Total height
Diaphysis of clavicle
x 11.3 = Total height
Diaphysis of lower jaw x 10.0 = Total height
(The lower jaw is measured from the symphysis menti to the
tip of the condyle, the whole breadth of the mandibular symphyseal surface placed flat along the blade of the calipers; Smith,
1943).
These ratios have been checked against the material recently
obtained and have been found useful; they are not accurate during
the early stage of embryonic life (Practical Forensic Medicine by
Camp and Purchase, 1957, p. 29).
Determination of the Sex of the Skeleton:
In determining the sex of the skeleton, the following bones must
be studied:
A. Pelvis
D. Femur
B. Skull
E. Humerus
C. Sternum
A. Pelvis:
Differences Between a Male and a Female Pelvis:
Male
Female
1. Heavier construction wall
1. Lighter construction wall less
more pronounced.
pronounced.
2. Height greater and flays off
2. Height lesser and flays off its
its wall more pronounced.
wall less pronounced.
3. Pubic arch narrow and less
3. Pubic
arch
wider and
round.
rounder.
4. Diameter of the true pelvis
4. Diameter of the true pelvis
less.
greater.
5. Curve of the iliac crest
5. Curve of the iliac crest is of
reaches a higher level.
the lower level.
6. Narrow greater sciatic notch.
6. Wide greater sciatic notch.
7. Body of the pubis narrow.
7. Body of the pubis wider.
8. Iliopectineal line sharp.
8. Iliopectineal line rounded.
9. Obturator
foramen
egg9. Obturator
foramen
trishaped.
angular.
10. Sacrum short and narrow. 10. Sacrum long and wide.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
B. Sternum:
Length of body
Length of manubrium x 100 = 46.2 (male and
54.3 (female)
C. Femur:
Pearson and Bell made a study of the sex difference in the
femur:
Male
Female
Right
Left
Right
Left
1. Bicondylar width
80.147 79.404 70.123
69.886
2. Vertical diameter
of head
47.059 46.769 41.123
40.765
3. External condyle
oblique length
61.846 61.048 55.804
55.176
4. Vertical diameter
of neck
33.849 34.337 29.337
29.520
D. Humerus:
Dwight gives the following measurement for male and female
bones (humerus):
Male
Female
1. Vertical diameter of head
48.7
42.6
2. Transverse diameter of head 44.6
38.9
E. Cranium:
Male
Female
1. Less curve of shaft.
1. More curve of shaft.
2. Mastoid process larger.
2. Predominance of cranial roof
over cranial base Mastoid process smaller.
3. Cranium placed horizontally 3. Cranium placed horizontally
rests on mastoid process.
rests on the occipital and
maxilliary bones.
4. Styloid process shorter.
4. Styloid process longer and
slender.
5. Forehead higher and more 5. Forehead less high and more
oblique.
vertical.
6. Superciliary ridges less sharp 6. Superciliary ridges sharper,
or more rounded.
7. Zygomatic arches and frontal 7. Zygomatic arches and frontal
sinuses more prominent.
sinuses less prominent.
8. Lower jaw larger and wider. 8. Lower jaw narrower and
lighter and chin not projecting.
LEGAL MEDICINE
82
9. Face larger in proportion to
the cranium.
9. Face smaller in proportion to
cranium.
t n e
Determination of the Race of the Skeleton:
It is becoming more difficult to determine the race because of the
amalgamation of races. For practical consideration there is hardly no
race that is absolutely pure.
The following points may be used in determining the race in the
remains of a person:
A. Extrinsic Factors:
1. Color of the skin
2. Facial features
3. Nature of the hair
4. Mode of dressing
B. Indices:
1. Skull:
Maximum width of the skull „ a. Cephalic Index = axunum length of the skuLl
Below 70 — Hyperdolico-cephalic
70 — 74.9 — Dolico-cephalic — Semato — Caucasian
75 — 79.0 — Mesaticephalic — Mongolian
80 — 84.9 — Brachycephalic — Malayan
u o u-4. i A
Height of the orbit
b. Orbital Index = w,.T..—ttt
x 100
Width of the orbit
Above 89 — Megasemes — Mongolian
84 — 89 — Mesosemes — Semato-Caucasian
Below 84 — Microsemes — Malayan
, ,
Breadth of the base
,
c. Nasal Index =
• —r—r
*~ x 100
Length of the nose
Above 53 — Platyrrhine — Malayan
48 — 53 — Mesorrhine — Mongolian
Below 48 — Leptorrhine — Semato — Caucasian
TT ;„u „ .
Height of the skull
, _
Height Index = z—~———.—.—_ 100
Length of the skull
X
M
T
T
0
n n
f T
A
x
2. Pelvis:
Pelvic Index =
Anteroposterior diamete^
Transverse diameter
Below 85 — Platypellic — Semato — Caucasian
86 — 95 — Dolicopellic — Malayan
Above 95 — Mesopellic — Negroes
x
1 Q Q
n n
1 0 0
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
83
,
.
..
,
Pubis length x 100
b. Ischium-pubis Index = —=——
:———
Ischium length
Caucasians (200 cases): <90=Male; 90-95=Sex?; > 95= Female
Negroes (100 cases): < 84= Male; 84-88=Sex? ; > 88= Female.
(GradwohVs Legal Medicine by Camps, Lucas & Robinson,
3rded.,p. 112).
3. Extremities:
,
,
Length of the lower leg
.. _
a. Crural Index = 7 — *
. ..
x 100
Length of the upper leg
95 — 98 — Semato-Caucasian
98 —102 — Mongolian and Malayan
,, _
Length of humerus + length of radius x 100
b. IntermembralIndex = — — — — 7 7
— — — — . . . . .
Length of femur + Length of tibia
(Modi p. 22)
Indian — 67.27
European - 70.4
Negroes —70.3
,t j
Length of humerus
„„
c. Humero-femoral Index = -=—
..
x 100
Length of femur
T
L
T
rt
r
1
Other Differential Racial Characteristics of Skeletons:
Caucasian
Elongated
Raised
Proportionately small
Mongolian
Square
inclined
Small
4. Upper
Extremity
Small
Small
5. Lower
Extremity
Normal
Small
1. Skull
2. Forehead
3. Face
Negro
Narrow and elongated
Small and compressed
Malar bones and jaw
projecting; teeth set
obliquely
Long in proportion to
body; forearm large in
proportion to arm;
hand small
Leg6 large in proportion to thighs; feet
wide and flat, heelbones projecting backwards.
AGE:
Aside from the size of the bones and dental examination, the age
of the person to whom the skeleton belongs may be determined by:
LEGAL MEDICINE
84
1. Appearance of the ossification centers:
External cuneiform, capitate, hamates heads of
1 year
humerus, femur, tibia.
Lower epiphysis of tibia, lower epiphysis of fibula,
2 years
capitulum of humerus, first four metacarpal heads.
Internal cuneiform, tarsal, navicular, triquetrum
3 years
phalanges, patella.
Midcuneiform, lunate, upper end of fibula, greater
4 years
trochanter of femur.
Scaphoid, trapezium, carpal, navicular, greater
5 years
tubercle of the humerus, lower end of the fibula.
Upper end of the radius, lower end of ulna, trape6-7 years
zoid, scaphoid.
Internal epicondyle of the humerus, rami of
8-9 years
ischium and pubis, olecranon.
Epiphysis of os calcis, pisiform, trochlea of hu10-11 years
merus, lesser trochanter of femur.
External epicondyle of the humerus, patella com12-14 years
plete.
Acromion, iliac crest.
14-16 years
Tuber ischia.
17-19 years
Inner clavicle.
20-21 years
(A Simplified Textbook of Medical Jurisprudence Toxicology by
C.K. Parikh, p. 39).
CO
2. Union of Bones and Epiphyses:
Anterior fontanelles should be closed.
1-1/2 years
The
condylar portion of the occipital bone fuses
years
with the squama; the metopic suture also closes.
4 years
The greater tubercle fuses with the head of the
humerus.
5 years
The condylar portion of the occipital bone fuses
with the basi-occiput.
9 years
The ilium, pubes and ischium should meet in the
acetabulum, rami of ischium and pubis fuse.
13 years
Ilium and pubes should be united but still separable
on maceration.
15 years
The epiphysis of os calcis (calcaneum) joins the
bone; the coracoid should be united to the scapula.
16 years
The olecranon should be united to the ulna.
The head of the radius and the lower end of the
16-17 years
humerus should be joined to their respective shaft.
17-18 years
The internal condyle should be united to the
humerus.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
85
18-20 yean
The head of the femur should have joined diaphysis; the epiphysis of long bones of the hand and
foot should have united to the diaphyses; the basiocciput should be fused with the basisphenoid.
20 years
The epiphyses of the fibula should be united to the
diaphysis. Distal radius unites.
22 years
The inner (secondary) epiphysis of the clavicle fuses.
25 years
The crest of the ilium and the articular facts of the
ribs should be united, if all the epiphysis have
united, the person is above 25 years of age.
(A Simplified Textbook of Medical Jurisprudence & Toxicology by
C.K. Parikh, p. 40).
3. Dental Identification (supra p. 61).,
4. Obliteration of cranial sutures (see illustration).
4U-50
20-3Q
MOLAR
root calcification
more important
than eruption
Approximate time of closure of cranial sutures. The inner aspect closes
several years before the outer as a rule. Molar tooth root calcification is also
noted.
Determination of the Duration of Interment:
The period from the time of death up to the time of examination
may be determined by the nature and presence of the soft tissues
and the degree of erosion of the bones. Ordinarily, all the soft
tissues in a grave disappear within a year. However, it is influenced
by several factors.
86
LEGAL MEDICINE
Fragmentation and erosion of bones after a long burial
The Bases of the Estimate for Duration of Interment are:
1. Presence or absence of soft tissues still adherent to the bones.
2. Firmness and weight, brittleness, dryness of the bones.
3. The degree of erosion of the surface of the bones.
4. The changes in the clothings, coffin, and painting.
Determination of the Presence or Absence of Ante-Mortem or Postmortem Injuries:
Individual bones must be examined in detail for possible fractures.
Importance must be laid on whether these injuries in the bones
occurred during life or in the process of exhumation. Note the presence of vital reaction, principally the signs of repairs.
Superimposed Photography:
This is a special method of determining the person to whom the
skull belongs. The negatives of the picture of the skull and the
suspected individuals are superimposed and printed. This will show
whether the contour of the skull fits the contour of the face of the
suspected person.
E DETERMINATION OF SEX /
Legal Importance of Sex Determination:
1. As an aid in identification:
Habit, social life, manner of dressing, physical features and
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
87
inclination are generally dependent on the sex. These points are
useful in identification.
2. To determine whether an individual can exercise certain obligations vested by law to one sex only:
V
above,
^AA^H
3. Marriage or the union of a man and a woman:
Any male of the age of sixteen years or more, and any female
at the age of fourteen years or more, not under any of the impediments mentioned in articles 80 to 84, may contract marriage
(Art. 54, Civil Code).
4. Rights granted by law are different io different sexes:
Majority commences upon the attainment of the age of twentyone years (Art. 402, Civil Code).
Notwithstanding the provisions of the preceding article, a
daughter above twenty-one but below twenty-three years of age
cannot leave the parental home without the consent of the father
or mother in whose company she lives, except to become a wife,
or when she exercises a profession or calling, or when the father
or mother has contracted a subsequent marriage (Art. 403, Civil
Code).
5. There are certain crimes wherein a specific sex can only be the
offender or victim:
a. In rape (Art. 335, Revised Penal Code), seduction (Art. 337 &
338, Revised Penal Code), abduction (Art. 342 & 343, Revised
Penal Code) or abuse against chastity (Art. 245, Revised Penal
Code) a woman is the victim.
b. In case of prostitution, the offender must be a woman:
For purposes of this article, women who, for money or
profit, habitually indulge in sexual intercourse or lascivious
conduct, are deemed to be prostitutes (Art. 202, No. 5, Revised
Penal Code).
c. In adultery the offender is a married woman and in concubinage
the offender is a husband.
(sts to Determine the Sex:
pocial test:
Differences in the social role of the sexes used to be clearly
marked but now they are less than they used to be. Dress, hairstyle, general bodily shape provide an immediate and accurate
answer to the vast majority of cases.
88
LEGAL MEDICINE
Genital test:
The presence of penis indicates a male, its absence and the
presence of a vaginal opening, indicates a female. We may look
for the testes in the scrotum and if they are absent we must not
conclude that the individual is not a male. They may be in the
abdomen or inguinal canal undescended.
3. Gonadal test:
Presence of testes in male and ovary in female. This will involve exploration of the abdomen and in some cases a histological examination of the gonad to see whether its microscopic
structure is characteristically ovarian or testicular.
4. Chromosomal test:
f^-^t*
*~W-cT
Shortly after the war, Barr noticed that there was a difference
between cells derived from men and women suitably stained and
examined under the microscope. The nucleus of the cells is a
densely staining area in the cell itself and Barr noticed that there
was a small part of nucleus which stained deeply than the rest
in woman's cells but not in cells from men. He observed this in
white cells from the blood and cells obtained by scraping the
mucous membrane of the mouth. This is called Barr bodies.
(Medico-Legal Journal, Part 3, Vol. 40, p. 79).
Problems in Sex Determination:
Sex determination may be possible and can scientifically be
distinguished on account of the biological structure differences;
however, in the following instances there will be no way to determine the sex:
1. Gonadal agenesis — Sex organs (testes or ovaries) have never developed.
2. True hermaphrodism — A state of bisexuality. The gonads of both
sexes are present which may be separated or combined as ovotestis.
<fc Evidences of Sex:
1. Presumptive evidences:
(a) General features and contour of the face.
cK^Presence or absence of hair in some parts of the body.
@ Length of the scalp hair. Generally, the female has long hair in
the scalp than that of the male.
(ji/Clothes and other wearing apparel, but not in a transvestite.
Transvestism is a form of sexual deviation characterized by
an overwhelming desire to assume the attire and be accepted as
a member of the opposite sex.
f eJ Figure — Females have prominent pelvis, while those of the
males are slender.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
(P Habit or inclination — Pseudohermaphrodite* are persons who
have the gonadal tissue of one sex and the behavior of the
opposite sex,
g} Voice and manner of speech.
The Important Distinguishing Presumptive Characters between the
Two Sexes are as follows:
Female
Male
a. Hips are broader in relaShoulders are broader than
tion to shoulders.
hips.
b. Generally smaller build.
Larger build.
c. Breasts developed.
Generally not developed,
very rarely and may be
developed in cases like
gynaecomazia.
d. Adam's apple (Thyroid
Adam's apple prominent.
cartilage) not prominent.
e. Striae present on breasts,
e. Striae absent.
abdomen and buttocks in
ladies who have borne
children.
f. Pubic hair straight and
Pubic hair thick, curved
upward extending up to
stop short above the monsumbilicus.
veneris.
g. Hair absent on face, abdog Hair present on chest and
face moustaches, beard,
men and chest.
etc.
h. Female skull is smaller
h Male skull is longer, heavier
and of thick bones.
lighter, and has thin bones
and smooth,
i- Trunk abdominal segment
i Trunk abdominal segment
smaller.
larger.
j . Thighs conical.
j Thighs cylindrical.
(From: Handbook of Forensic Medicine and Toxicology by Dr. P. V.
Chadha, IVth ed., p. 68).
2. Highly probable evidences of sex:
(a^Possession of vagina, uterus and accessories in female, and penis
, in male.
( j p Presence of developed and large breasts in female.
c. Muscular development and distribution of fat in the body.
3. Conclusive evidence:
( paJi Presence of ovary in female and testis in males.
90
LEGAL MEDICINE
Evidence of Sex in Mutilated or Decomposed Body:
1. General physical and muscular development.
2. Hairiness of the scalp, face, chest, pubes and other parts of the
body.
3. Prominence of the Adam's apple.
4. Amount of subcutaneous fat in specific parts of the body.
5. Presence of linea albicantes, enlarged nipple, cutex in fingernails
and lipstick or coloring materials.
6. Presence of prostate gland in male or uterus and ovary in female.
If in doubt, a microscopic examination must be made on the
suspicious ovarian or testicular tissue.
F. DETERMINATION OF AGE ^
Legal Importance of Determination of Age:
jtAs an aid to identification:
Mention of the age of the wanted or missing person will create
an impression of the physical characteristics, social life and psychic and mental behavior of that person. Although it may only
be presumptive, it may be useful in identification.
'^Determination of criminal liability:
Art. 12, Revised Penal Code — Circumstances which exempt
from criminal liability — The following are exempted from criminal
liability:
1
2. A person under nine years of age.
3. A person over nine years of age and under fifteen, unless he
has acted with discernment, in which case, such minor, shall
be proceeded against in accordance with the provisions of
article 80 of this code.
^DiDetermination of right of suffrage:
Suffrage shall be exercised by citizens of the Philippines not
otherwise disqualified by law, who are eighteen years of age or
over, and who shall have resided in the Philippines for at least
one year and in the place wherein they propose to vote for at least
six months preceding the election. No literacy, property, or other
substantive requirement shall be imposed on the exercise of
suffrage. The Batasan Pambansa shall provide a system for the
purpose of securing the secrecy and sanctity of the vote (Art.
VI, Sec. 1, Philippine Constitution as amended in 1984).
Ji. Determination whether a person can exercise civil rights:
Majority commences upon the attainment of the age of twentyone years.
MEDICOLEGAL ASPECTS OF IDENTIFICATION
The person who has reached majority is qualified for all acts
of civil life, save the exceptions established by this Code in special
cases. (Art. 402, Civil Code).
^.Determination of the capacity to contract marriage:
Any male of the age of sixteen years or upwards, and any
female of the age of fourteen years or upwards, not under any
of the impediments mentioned in articles 80 to 84 may contract
marriage (Art. 54, Civil Code).
<As a requisite to certain crimes:
ArRape — Rape is committed by having carnal knowledge of a
woman under any of the following circumstances:
1. By using force or intimidation;
2. When the woman is deprived of reason or otherwise unconscious; and
—^
3. When the woman is under/twelve years of agej even though
neither of the circumstanceTm^ntioned in the two preceding paragraphs shall be present (Art. 335, Revised Penal
Code).
^Infanticide — The penalty provided for parricide in article 246
and for murder in article 248 shall be imposed upon any person
who shall kill any child less than three days of age (Art. 255,
Revised Penal Code).
^ », JLIH^
prSeductions:
(lyGualified seduction — The seduction of a virgin over twelve
years and under eighteen years of age, committed by any
person in public authority, priests, house-servant, domestic,
guardian, teacher, or any person who, in any capacity, shall
be entrusted with the education or custody of the woman
seduced, shall be punished by prision correccional in its minimum and medium periods (Art. 337, Revised Penal Code).
(2^imple seduction — The seduction of a woman who is
single or a widow of good reputation, over twelve but
under eighteen years of age, committed by means of deceit,
shall be punished by arresto mayor (Art. 338, Revised
Penal Code.
d. Consented abduction — The abduction of a woman victim over
twelve and under eighteen years of age, carried out with her
consent and with lewd designs shall be punished by the penalty
of prision correccional in its minimum and medium period
(Art. 343, Revised Penal Code).
I
LEGAL MEDICINE
' Determination of the Age of the Fetus:
1. Application of the Hess's Rule or Haase's Rule:
a. For fetus of less than 25 cm. long (Crown-feet length) — Get
the square root of the length in centimeter and the result is
the age of the fetus in months.
Example: If the length of the fetus is 16 cm., the age is 4
months.
b. For fetus 25 centimeters or more — Divide the length of the
fetus by 5, and the result is the age in month.
Example: If the length of the fetus is 40 cm., the age is 8
months.
(The age referred to in this rule is lunar month, not calendar
month. One lunar month is equivalent to 28 days.)
2. Examination of the product of conception:
Age
Nature of the product of conception
1 month — Ovum is about 1.0 cm. long, weighing about 2.6 gm.
The eyes are seen as two dark spots and limb buds
present.
2 months — The ovum is about 4.0 cm. long and weighs about 10
gram. Eyes and nose are recognizable. Clavicle,
mandible, ribs and vertebra show the center of
ossification. Anus is seen as a dark spot.
3 months — Length is 8 cm. weighing 30 gms. Nails begin to
appear as thin membrane on the fingers and toes.
Fiacenta is formed.
Sex organs have appeared
Ossification has begun in most of the bones.
4 months — Length is 13 cm. weight 204 gm. Sex can be distinguished; Skull is partly ossified, with wide sutures
and f ontanelles.
Lanugo hair is visible on the body. Convolution of
the brain begins to appear.
5 months — Length is 23 cm. and weight is 450 gm. Skin begins
to be covered with vernix caseosa. Ossification
center in os calcis. Dental gum appears at the
mandible.
6 months — Length is about 30 cm.; weight is about a kilo. Skin
is still wrinkled but subcutaneous fat is beginning to
form. Hair appears on the head. The eyebrows and
eyelashes are beginning to form. The eyelids are
adherent. The testicles lie close to the kidneys.
Meconium is seen in the upper part of the large
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
93
intestine. The centers of ossification are seen in
the four divisions of the sternum.
7 months — Length is 18 cm. Weight is 1.5 kg. Eyelids are open.
Testicle is beginning to descend into the scrotum. Nails
do not reach the tips of the fingers. Lanugo hair is disappearing from the face. Primary center of ossification
of talus has appeared. Body is dark red and plump,
with hair on the scalp. The child is viable (28 weeks).
Length
is 42 cm. Weight is 2 to 2-1/5 kg. Skin is
8 months —
only slightly wrinkled and flesh-colored. Lanugo hair
is beginning to be shed. Testicle is generally in the
scrotum. Nails reach the end of fingers. Convolutions of the brain are more distinct. Pappillary
membrane disappears. The skin is red but not wrinkled.
9 months — The length is about 45 to 50 cm. and weighs about 3
to 3.5 kg. Skin is with slight wrinkles. Scalp is covered
with dark hair. Nails have grown over finger tips.
Testes have descended to the scrotum.
Vemix
caseosa present over flextures of joints and neck
folds. Meconium is seen at the end of the large
intestine. Ossification center appears at the lower
end of the femur. Signs of maturity is present.
Age Determination During Infancy:
1. Age based on height or weight:
a. Height:
New bom full term child — 50 cm.
After 6 months
— 60 cm.
After one year
— 68 cm.
After 4 years
— Double the birth height (one
meter)
b. Weight:
Newly born full term child — 2.5 to 3 kg.
Roughly a child increases in weight by 0.5 kg. per month.
At the end of 6th month — Child doubles the birth weight.
At the end of one year — Child weighs three times the
birth weight.
The estimation of the age utilizing the weight and/or the height
is not quite useful inasmuch as there is a difference in the rapidity
of growth not only in children of different sex, but also in children of the same sex.
2. Physical characteristics of infant:
Newly bom — Skin covered with vernix caseosa and red.
Meconium present in the rectum.
LEGAL MEDICINE
94
Lanugo hair almost disappeared.
Limbs and body plump.
Scalp hair about 2 inches long ( 5 cm.).
After 24
— Skin firm and less red.
hours
Umbilical cord shrivelled, soft and bluish in
color. Lungs more or less distended with air.
2nd to 3rd — Skin with yellowish tinge.
day
Skin sometimes with cracks and with separation of the scales. Umbilical cord brown and
dry.
3rd to 4th —Skin becomes more yellow. Umbilical cord
day
brownish-red, flattened, semi-transparent and
twisted.
4th to 6th — Umbilical cord separates from abdomen,
day
Foramen ovale partly close.
6th to 12th — Cicatrization of the umbilical cord.
Ductus arteriosus close.
Age Determination in Childhood and Adulthood:
1. Age based on the eruption of teeth:
a. Temporary (deciduous or milk) teeth:
Central incisor (lower)
Central incisor (upper)
Lateral incisor (upper)
Lateral incisor (lower)
First molars
Canines
Second molars
b. Permanent teeth:
First molar
Central incisors
Lateral incisors
First bicuspid
Second bicuspid
Canines
second molars
Third molars
6th month
7th month
9th month
1 Oth month
12th month
18th month
2nd year
6th year
7th year
8th year
9th year
10th year
11th year
11th-12th year
17th-18th year or at
any period later
2. Appearance of ossification centers (Supra p. 84).
3. Union of epiphysis with shaft of bones (Supra p. 84).
4. Obliteration of cranial sutures (Supra p. 85).
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
Other Points to Consider in the Determination of Age:
1. Growth of pubic hair, beard and mustache:
The pubic hair begins to appear at the age of 13 in female and
14 in male. The growth of thick dark hair is well marked on the
pubes, scrotum and in the axillae at about 16 to 17 years of age.
Mustache and beard begin to appear in male at the age of 16 to
18.
2. Changes of the breast in female:
The development of the breast in female commences at the
age of 13 to 14. The degree and the commencement of development may be influenced by habit and social environment.
3. Development of the voice:
Males develop low tone voice between the age of 16 to 18,
while females change their voice on the same period. Males
become low pitch while females become high pitch.
4. Changes in color of the hair:
The black color of the hair becomes gray after forty. Silverywhite color may be seen in advanced old age. Sometimes gray
hair appears in younger people or may appear suddenly after
extreme terror, grief or shock. Localized areas of gray hair may
be due to neuralgia or other diseases of the fifth cranial nerve.
Pubic hair may turn gray at the age of 50.
5. Grade or year in school or college:
Usually children enter the primary school at the age of 7.
They finish high school at the age of 17. Graduation in a collegiate course depends on the number of years required for the
course.
6. Menstruation in women:
Menstruation usually commence at the age of 12 but in warm
countries it may start at an earlier age.
7. Degree of mental development.
8. Manner of dressing, self-beautification and social life.
9. Atheromatous changes of blood vessels, opacity of the lens
and cornea (arcus senilis).
10. Wrinkleness of the skin usually appears after forty.
IDENTIFICATION OF BLOOD AND BLOOD STAINS
Legal Importance of the Study of Blood:
Y^For disputed parentage (maternity nnd paternity):
a. Disputed paternity may arise:
(1) When the wife committed adultery and the husband denied
to be the father of the child.
96
LEGAL MEDICINE
{2) When a child was born out of lawful wedlock and the
mother claimed someone to be the father but he vehemently denied it.
(3]T In a claim for support or right of succession of the alleged
illegitimate child,
b. Disputed maternity may arise:
fflTTn case of allegation of jnterchange of children in a hospital
or nursery home, either accidentally or deliberately.
(•2ffn cases of wayward or stray children being claimed by two
or more women.
(-SfFor ownership of dead fetus or newly born child found in
street trash.
tSC'vrcumstantial or corroborative evidence against or in favor of the
perpetrator of a crime:
Example:
"A" was found dead with a deep stab wound on the chest. "B"
was found with a kitchen knife in his hand stained with blood.
Examination of the weapon showed that the stain was blood of
human origin and belonging to the same group as that of the
deceased "A". With such result of the examination, the investigating
authorities have a very strong presumption that " B " was the one
who committed the crime.
^Determination of the cause of death:
The amount of blood or blood stains found in the scene of the
crime or found inside the body of the deceased outside the blood
vessels may imply that the cause of death of the person is hemorrhage.
^Determination of the direction of^ escape of the victim or the
assailant:
The shape of the blood or blood stains will give the investigator an idea on the direction of the source of blood. Usually,
in small drops, the tapering end of the blood spot is towards the
direction of the moving source of blood.
^Determination of the approximate time the crime was committed:
Although there are variations as to the color and soluble
changes as to regards the age of the stain, we can only say that
when there is too much change, it is not very recent.
•^Determination of the place of commission of the crime.
^Determination of the presence of certain diseases.
Problems to be Answered in the Examination of Blood:
-tTDetermine whether the stain is due to blood.
Aril due to blood, determine whether it is of human origin or not.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
3flf it is of human origin, to what group does it belong?
4rDoes it belong to the person in question?
grThe manner, degree and condition of the article which have been
stained.
fVAge of the stain.
PRELIMINARY OR GROSS EXAMINATION OF THE STAIN:
1. Determine the material, make, color of the article stained.
2. Note which surface has been stained and the color of stain. Recent
blood stains are dark-red.
3. Study the direction of the origin of the blood stain. The spot of
blood is usually tapering towards the direction of the source. A
fall will give a splash appearance.
4. For small and discolored stains, the use of a lens or ultra-violet
light may be useful.
5. Determine the amount by the degree of soaking, size and intensity
of color.
PHYSICAL EXAMINATIONS:
1. Solubility test:
Recent blood shed is soluble in saline solution and imparts a
bright red color.
Stains which have been exposed to air become dry; hemoglobin
is transformed to meth-hemoglobin or hematin. If the stain has
been kept in damp places for a long time; hemoglobin is transformed to hematin.
2. Heat test:
Solution of the blood stain when heated will impart a muddy
precipitate.
3. Luminescence test:
Stains on dark fabric mixed with mud, paint, etc. emit bluishwhite luminescence in a dark room when sprayed with one of the
two solutions:
a. 3-amino-phthalic-acid-hydrazide-HCL
1 gram
Sodium peroxide
5 grams
Distilled water
1,000 cc.
b. 3-amino-phthalic-acid-hydrazide-HCL
1 gram
Sodium carbonate
50 grams
Hydrogen peroxide (10 Vol.)
50 grams
Distilled water
1,000 cc.
The substance responsible for the reaction is hematin. Older
stains therefore react better than new ones.
Although the solutions are said not to interfere with further
tests, unsprayed specimen of the material must be kept for the
98
LEGAL MEDICINE
serologic test. (Lyon's Medical Jurisprudence for India by S.P.S.
Greval, 1953, p. 303).
CHEMICAL EXAMINATIONS:
1. Saline extract of the blood stain plus ammonia will give a brownish tinge due to the formation of alkaline hematin.
2. Benzidine test:
A piece of white filter paper is pressed firmly on the suspected
stain. Benzidine reagent is dropped on the paper, then followed
by drops of active hydrogen peroxide. A positive result will show
blue color. A positive result is not conclusive, because an oxidizing agent will give a positive blue color reaction. Benzidine
test has the sensitivity up to 1:300,000 dilution.
Benzidine reagent:
Benzidine sulphate is dissolved in glacial acetic acid to form
10% solution.
3. Guaiacum test (Van Deen's Dyas' or Schombein's Test):
To a white filter paper pressed and rubbed on the surface of the
stain, the solution of the alcoholic tincture of guaiacum is added
and then hydrogen peroxide or ozonic ether is applied by drops.
If blood is present, a blue color is imparted by the mixture. It
is not conclusive like the benzidine test because potato skin,
iron rust, cheese, blue and indigo may give a positive reaction to
the test. The guaiacum test is positive up to 1:5,000 dilution.
4. Phenolphthalein test (Kastle-Meyer Test):
A drop of the Kastle-Meyer's reagent is dropped on a white
filter paper with the stain and left for at least ten seconds. A
positive result will show a pink color after the addition of hydrogen peroxide. This test is not conclusive but sensitive up to
1:80,000,000 dilution. This test proves only the presence of
peroxidase.
Kastle-Meyer's reagent:
Phenolphthalein
. .2 grams
Potassium hydroxide
.20 grams
Distilled water
100 cc.
5. Leucomalachite Green test:
This test which was recommended by Adler in 1904 is quite
useful, but it is not so sensitive as the benzidine test. It depends
upon the fact that leucomalachite green is oxidized to malachite
green with a bluish-green or peacock-blue color by hydrogen
peroxide solution. The reaction occurs also with a solution of
the blood pigment previously boiled. On the other hand, the
reaction is negative when iron is removed from hemoglobin
forming hematoporphyrin.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
99
MICROSCOPIC EXAMINATIONS:
Saline extract of the stain is examined under the microscope.
Note the presence of red blood cells, leucocytes, epithelial cells and
microorganisms. The presence of red blood cells will conclusively
show that the stain is blood. By microscopic examination, we can
differentiate the origin or the part of the body it came from. Menstrual blood will show abundance of vaginal epithelial cells and Doederlein's bacilli.
MICRO-CHEMICAL TESTS:
1. Hemochromogen crystal or Tokayama test:
A fragment of the suspected material is placed on a slide glass and
a drop of hemochromogen reagent is added. A cover glass is
placed on top and heated gradually for a time, then examined
under the microscope. Crystals varying from salmon color to
dark brown and pink and which are irregular rhomboids or in
clusters, may be seen. This test is positive to any substance
containing hemoglobin.
Hemochromogen solution:
Sodium hydroxide (10%)
3 cc.
Pyridine
3 cc.
Glucose (saturated solution).. .3 cc.
Distilled water
7 cc.
Hemochromogen crystals
hemin crystal*
100
LEGAL MEDICINE
2. Teichmann's blood crystals or Hemin crystals test:
On the microscopic slide is placed fragments of the stain and a
drop of water with trace of sodium chloride added. Add glacial
acetic acid and evaporate to dryness under a cover slip. Dark
Drown rhombic prisms of chloride of hematin are formed. This
is considered as the best of the micro-chemical test.
3 . Acetone-haemin of Wagenhaar test:
A particle of dried stain or a fiber of the stained fabric is placed
on a glass slide and covered with a cover slip with a needle interposed to prevent direct contact of the cover slip with the slide.
A drop of acetone is run under the cover slip so that the material
is surrounded and a drop of diluted oxalic or acetic acid is then
added. When examined under high power microscope, small
dark, dichroic acicular crystals of acetone-haemin are seen.
SPECTROSCOPIC EXAMINATIONS:
This examination depends on the principle that blood pigments
have the power to absorb light of certain wave length and produce
certain characteristic absorption bands on the spectrum. By means
of the spectroscope we can determine the presence of the following
substances:
1. From fresh blood stains:
a. Oxyhemoglobin
b. Hemoglobin
c. Reduced hematin or hemochrogen
2. From older stains:
a. Methemoglobin
b. Alkaline hematin
c. Hematoporphyrin
d. Reduced hematin
3. Other blood preparations:
a. Acid hematin
b. Alkaline hematin
c. Carboxyhemogiobin
d. Hematin
BIOLOGIC EXAMINATIONS:
1. Precipitin test:
This test is to determine whether the blood is of human origin
or not.
Principle of the test:
By injecting an animal, usually, a rabbit, with defibrinated blood
of unrelated animal, an anti-serum is produced in the blood of
the animal injected. The serum of this animal injected is capable
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
101
specifically of precipitating the serum of the unrelated animal
whose blood serum has been injected. However, closely related
animals may also give the same response.
Preparation of the anti-human serum:
A dose of 1.5 cc. to 2.0 cc. per kilogram body weight of human
defibrinated blood is injected intravenously in the marginal vein
of the rabbit's ear. The dose is then repeated every third day with
three or five injections. The titre of the rabbit serum is tested
with the human serim. If the anti-human rabbit serum has
sufficient power to produce a ring of haziness at the junction of
the two sera, then the titre is sufficient for the examination of
the unknown.
Some biologists prefer combined intravenous and intraperitoneal injection of the serum but the result is the same.
If the titre is sufficiently strong the rabbit is bled to death and
the serum is oollected for the examination of the unknown.
Procedure of the test:
A normal saline extract must be made on the stain to be examined. The saline extract must be diluted from 1:10 up to 1:100,000.
At least capillary glass tubes, clean and dry on a rack, are used
in the examination. The following are the series of mixtures
including the controls:
1. Extract 1:100,000 + Anti-human serum
2. Extract 1:10,000 + Anti-human serum
3. Extract 1:1,000 + Anti-human serum
4. Extract 1:100 + Anti-human serum
5. Extract 1:10 + Anti-human serum
6. Extract 1:100 + Normal Rabbit serum
7. NaCl + Anti-human serum
8. Substrate extract + Anti-human serum
9. Heterogenous blood 1:1,000 + Anti-human serum
^10. Known human 1:1,000 + Anti-human serum
s 6 to 10 are controls. Normally, there must be positive
\readticm in No. 10 even if the rest are negative.
A\ positive reaction is manifested as an area of haziness in the
form* of a white ring at the point of contact between the two
solutions mixed. Animals of the allied specie may also give a
positive reaction to sheep and goat.
Substances responsible for a false positive reaction:
The following common substances, if present in the extract,
will precipitate the anti-serum and thus produce the semblance of
a positive reaction:
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LEGAL MEDICINE
a. Soap. This is of special importance in washed stains.
b. Rancid oil is found sometimes in pillow cases and head dresses.
The soluble fraction of the oil prevents frothing yet the extract
gives a sharp and quick reaction.
Two errors are introduced, namely:
(1) False positive reaction from the rancid oil itself.
(2) Failure of foam test and danger of group reaction — monkey blood in high concentration will act like human blood.
c. Alum. This is used as a household remedy in gargles and mouth
washes and may stain any article.
d. Tannin and allied substances derived from vegetable tissue. The
stain of saliva of the betel chewer not only looks like bloodstain but by virtue of the tannin present in most of the constituents of the prepared betel it also acts on the antisera.
Stains on leather and plant tissue should be removed by applying moist filter paper to the surface (leather contains tannin).
(From: Lyon's Medical Jurisprudence for India, S.P.S. Greval,
10 in ed., 1953, p. 315)
Substances responsible for a false negative reaction:
a. Mineral acids
b. Corrosive sublimate
c. Chloride of lime
d. Sulfate of copper and iron
e. Bisulphide of carbon and sodium
f. Nitrate of silver
g. Thymol
h. Permanganate of potassium
Value of the precipitin test:
If positive result is obtained, we can tell in a more or less
conclusive way that the blood stain is of human origin; although
anthropoid ape may give the same result.
The same test and technique may be made to determine whether muscles, secretions, bones and other body fluids are of
human origin or not.
Certain materials like alcohol, formaldehyde, corrosive sublimate, lysol, creoline, carbolic acid, acids and alkalies destroy the
property of blood to react with precipitin.
2. Blood grouping:
Principle of the test:
All human beings have their blood belonging to any of the four
principal blood groups. A normal suspension of human red blood
cells when mixed with its own serum or serum of a similar group
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
103
will make the red blood cells suspension remain even. But if
suspended in the serum of another group, the red blood cells
clump with one another and this is called agglutination. The red
blood cells contain agglutinogens and the serum contains agglutinins.
Procedure of the test:
Two methods may be utilized and both should be employed
in the examination:
a. Detection of agglutinins
b. Detection of agglutinogens
a. Detection of agglutinins:
A saline extract is made on the stain. The solution is then
mixed on a slide glass with A, B, and O cell suspensions. The
results should be examined after agitation for several hours until
a decisive reading is possible.
b. Detection of agglutinogens:
Agglutinogens cannot be detected in dried stains since the
red blood cells lose this power on drying, but the presence may
be shown by their ability to absorb agglutinins A and B and
their power to inhibit the action of the sera containing these
agglutinins from the test sera. When these are subsequently
tested against known test corpuscles, the absorption which has
taken place will become apparent. Corresponding absorption
will result if only agglutinogen A' or B is present in the stain.
The portion of stained material should be mixed with Group
O serum. (Medical Jurisprudence and Toxicology by Glaister,
8th ed., p. 308).
Value of the test:
It may solve disputed parentage (paternity or maternity). A
positive result is not conclusive that the one in question is the
offspring, but a negative result is conclusive that he is not the child
of the alleged parents.
Inheritance Patterns of ABO Blood Groups:
Group of
Group of
Exclusion
Parents
Children
Cases
OxO
A, B, AB
O
Ox A
O.A
B, AB
OxB
0,B
A, AB
Ax A
O, A
B, AB
AxB
O, A, B, AB
BxB
O, B
A, AB
O x AB
A, B
0 , AB
A x AB
A, B, AB
0
LEGAL MEDICINE
104
O
A, B, AB
O
A, B, AB
Inheritance of M—N type
Possible Children
Parents
MxM
M
M, MN
MxMN
MN
MxN
M, N, MN
MN x MN
MN, N
MN x N
N
NxN
Grouping is true not only with blood but also with other fluids
of the body like saliva, vaginal secretion, seminal fluid, milk, urine
and others.
Age of the Blood Stains:
When blood is exposed to the atmosphere or some other influences, its hemoglobin is converted to meth-hemoglobin or hematin.
The color is changed from red to reddish-brown. The presence of
acid accelerates the formation of hematin. These changes take place
in warm weather within 24 hours. Blood of one week old and that
of six weeks may not present a difference in physical and chemical
properties.
Differential Characteristics of Blood from Different Sources:
1. Arterial Blood:
a. Bright scarlet in color.
b. Leaves the blood vessel with pressure.
c. High oxygen contents.
2. Venous Blood:
a. Dark red in color.
b. Does not spill far from the wound.
c. Low oxygen content.
3. Menstrual Blood:
a. Does not clot.
b. Acidic in reaction owing to mixture with vaginal mucous.
c. On microscopic examination, there are vaginal epithelial cells.
d. Contains large number of Deoderlein's bacillus.
4. Man's or Woman's Blood:
There is no method differentiating a man's blood from a woman's blood. Probably, the presence of sex hormone in female
blood may be a point of differentiation.
5. Child's Blood:
a. At birth, it is thin and soft compared with that of adult.
b. Red blood cells are nucleated and exhibit greater fragility.
c. Red blood cells count more than in adult.
Bx AB
ABx AB
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
H. IDENTIFICATION OF HAIR AND FIBERS
How the Hair and Fibers Change Color:
1. Addition of a substance that will coat the outer surface of the
hair so as to impart a different color.
Example: Salts of bismuth, lead, silver and pyrogallic acid.
2. Addition of substances which bleach or change the natural
color of the fiber or hair.
Example:
Hydrogen peroxide, chlorine and diluted nitric
acid.
Characteristics of the Different Kinds of Fibers:
1. Cotton Fibers:
Flattened, twisted fibers with thickened edges. Irregularly
granulated cuticle. No transverse markings. Fibers show spiral
twist. Fibers swell in a solution of copper sulphate and sodium
carbonate dissolved in ammonia. It is insoluble in strong sodium
hydroxide but soluble in strong sulfuric acid and partially dissolved in hot strong hydrochloric acid.
2. Flax Fibers:
>
Apex tapering to fine point. Transverse sections are polygonal
and show a small cavity.
The fibers consist of cellulose and give blue or bluish-red color
when treated with a weak solution of potassium iodide saturated
in iodine and sulfuric acid.
The fibers which show transverse lines and are usually seen in
group formation, dissolve in a solution composed of copper
sulphate and sodium carbonate in ammonia.
3. Hemp Fibers:
Fibers show transverse lines and consist of cellulose.
Large oval cavities are seen in transverse sections. The end is
usually blunt, and there is often a tuft of hair at the knots.
Stains are bluish-red with phloroglucin, and yellow with both
aniline sulphate and weak solution of potassium iodide saturated
in iodine with sulfuric acid.
4. Abaca Fibers:
Fibers are smooth without transverse or longitudinal markings.
The cavities are large and uniform.
The walls are lignified.
The tips are fine points.
5. Jute Fibers:
Fibers are quite smooth without either longitudinal or transverse
markings.
106
LEGAL MEDICINE
The fibers have typical large cavities which are not uniform but
vary with the degree of contraction of the walls of the fibers
which are lignified.
The ends are blunt.
The fibers are stained red with phloroglucin and yellow with
aniline sulphate, also with iodine and sulfuric acid.
6. Wool Fibers:
These fibers can easily be distinguished from vegetable fibers
since the former show an outer layer of flattened cells and imbricated margins.
The interiors are composed of fibrous tissues but sometimes
the medulla is present.
They do not dissolve in a solution composed of copper sulphate,
sodium carbonate and ammonia.
Stain is yellow with iodine and sulfuric acid and also with
picric acid.
Do not dissolve in sulfuric acid.
Smell of singeing on burning.
7. Silk Fibers:
Manufactured silk is almost structureless, microscopically.
Fibers stain is brown with iodine and sulfuric acid and yellow
with picric acid.
They dissolve slowly in a mixture of copper sulphate, sodium
carbonate and ammonia.
8. Linen Fibers:
Fibers are straight and tapering to a point.
Cortical area shows transverse lines which frequently intersects,
simulating a jointed appearance.
The medullary region shows a thin dense line.
They do not dissolve in concentrated sulfuric acid.
If placed in 1% alcoholic solution of fuchsin and then in a
solution of ammonium hydroxide, they assume a bright red
color (Medical Jurisprudence and Toxicology by Glaister, 8th ed„
P. 110).
The Vegetable and Animal Fibers may be Differentiated as Follows:
1. Ignition test:
a. Animal fibers
— Burn and fuse; smell of burnt hair, fused
and globular; fume turns red litmus to
blue.
b. Vegetable fibers — Rapid combustion, end charred and break
sharply; smell of burning wood; vapor
turns blue litmus to red.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
107
2. Chemical tests: Use of concentrated nitric acid:
a. Animal fibers — Turn yellow.
b. Vegetable fibers — No change in color.
3. Picric acid test:
a. Wool and silk — Yellow.
b. Cellulose
— No change.
4. Millon's Reagent test:
a. Wool and silk — Turn brown.
b. Cellulose fibers — Turn black.
5. Soaked in tannic acid:
a. Wool and silk — No change.
b. Cellulose fibers — Black.
6. Heated with 10% NaOH:
a. Wool and silk — Dissolve.
b. Cellulose
— Not affected.
Once the fibers are found to be of animal origin, the next step
is the examination to determine whether these fibers are human
hair or hair of other animals:
Parts of the Hair:
1. Cuticle — The outer layer of the hair.
2. Cortex or middle layer — Consists of longitudinal fibers bearing
the pigment.
3. Medulla or core — Contains air bubbles and some pigments.
Differences Between Hair Forcibly Extracted and Naturally Shed Hair:
If a hair-root has been extracted forcibly, the bulb is irregular in
form due to rupture of the sheath and shows an undulating surface,
together with excrescences of different shapes and sizes. A naturally
shed bulb has a rounded extremity, a smooth surface, and most
probably show signs of atrophic or fatty degeneration, especially
in an elderly person (Medical Jurisprudence and Toxicology by
Glaister, 8th ed., p. 99)
Distinctions between Human and Animal Hair
Human
Animal
Medulla
Air network in fine grains.
Cells invisible without treatment
in water.
Value of I lower than 0.3.
Fuzz without medulla.
Air network in forms of
large or small sacks.
Cells easily visible.
Value of I higher than 0.6
Fuzz with medulla.
LEGAL MEDICINE
108
Cortex
Looks like a thick muff.
Pigments in the form of fine
grains.
Cuticle
Thin scales not protruding, covering one another to about
4/5.
Looks lixe a fairly thin
hollow cylinder.
Pigments in the form of
irregular grains larger
than that of human's.
Thick scales protruding,
do not cover one another to the same degree
as the human's.
Hair and blood in the victim's hand showing struggle
Note: Medullary index (I) is the relation between the diameter of
the medulla and the diameter of the whole hair. (Soderman,
p. 176).
The hair and fiber may be examined microscopically in its
cross-section and longitudinal aspect.
Comparative study must be made to show similarity of the
hair and fibers in question to the known where they are alleged to belong.
(From: — Modern Criminal Investigation by Harry Soderman,
4th ed., p. 191).
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
109
Differentiation Between Sections of Gorilla, Chimpanzee and
Human Hair:
Gorilla
Medulla very constantly present.
Medulla of small
size.
Chimpanzee
Constantly present.
Small but slightly
larger than human's or gorilla's.
Human
Very frequently absent.
Small size, slightly
smaller than gorilla's or chimpanzee's.
Granules less coarse,
peripheral, near
cuticular margins.
Cuticular margins,
extremely regular.
Granular
cortical Centrally placed.
pigment, central
around medulla.
Cuticular
margins Less regular than in
regular, but less
human hair.
tnan in human
hair.
(From: Recent Advances in Forensic Medicine by Sydney Smith
& Giaister,p. 109).
Other Points in the Identification of Hair:
1. Characteristics of the hair:
Hair on body surfaces is fine while those from the beard,
mustache and scalp are very thick.
Hair from the eyebrows and lashes is tapering gradually to fine
points.
2. Length of the hair:
Hair from the scalp grows 2.5 cms. a month.
Beard hair grows at the rate of 0.4 millimeter a day.
3. Color of the hair:
The color of the hair may be black, blonde or brunette.
Hair from older persons may be white or gray.
The hair may be artificially colored by bismuth, lead or silver
salts. It may be bleached by addition of hydrogen peroxide,
chlorine or diluted hydrochloric or nitric acid.
How to detect presence of coloring or bleaching material in hair:
a. Examination of hair may show pigments at nodes.
b. The new portion of the hair recently grown has a different color
from the treated part.
c. The hair in other parts of the body may not correspond in
color.
d. The scalp may be dyed.
e. The texture of the hair may be altered.
110
LEGAL MEDICINE
4. Does the Hair Belong to a Male or a Female?
In many instances it is quite impossible to state the sex from the
hair, but certain points may be worthy of mention:
Ha& on the scalp of male are shorter, thicker and more wiry than
that of female's.
Eyebrow hair of a male is generally long and more wiry than that
of a female's.
(From: Recent Advances in Forensic Medicine by Sydney Smith and
Glaister, p. 121).
Estimations of Age Based on the Hair:
This is quite difficult and the examiner hesitates in giving his
opinion. However, there are some points of distinction:
Hair of children are fine, short, deficient of pigments and, as a
rule, devoid of medulla.
At the adolescent age, hair may appear at the pubis. Hair on the
scalp becomes long, wiry, and thick.
In the case of older persons, the color is usually white or gray,
with marked absorption of pigments and degenerative changes.
Chapter IV ^
MEDICOLEGAL ASPECTS OF DEATH
Importance of Death Determination: £f P ^ * ^
yThe civil personality of a natural person is extinguished by death:
The civil personality is extinguished by death. The effect of
death upon the rights and obligations of the deceased is determined by law, by contract and by will (Art. 42, Civil Code).
£ The property of a person is transmitted to his heirs at the time of
death:
Succession is a mode of acquisition by virtue of which the
property, rights and obligations to the extent of the value of the
inheritance of a person are transmitted through his death to
another or others either by will or by operation of law (Art. 774,
Civil Code).
3<The death of a partner is one of the causes of dissolution of
partnership agreement:
Dissolution (of a partnership) is caused. . . (5) by the death of
any partner;. . (Art. 1830, Civil Code).
4\77ie death of either the principal or agent is a mode of extinguishment of agency:
Agency is extinguished. . . (3) By death, civil interdiction,
insanity or insolvency of the principal or of the agent. . . (Art.
1919, Civil Code).
f/The criminal liability of a person is extinguished by death:
How criminal liability is totally extinguished — Criminal liability
is totally extinguished:
1. By death of the convict, as to the personal penalties; and as
to pecuniary penalties, liability therefore is extinguished
only when the death of the offender occurs before judgment.
(Art. 89, Revised Penal Code).
The civil case for claims which does not survive is dismissed upon
death of the defendant:
When the action is for recovery of money, debt or interest
thereon, and the defendant dies before the final judgment in the
court of the First Instance, it shall be dismissed to be prosecuted
in the manner especially provided by these rules (Rule 3, Sec. 21,
Rules of Court).
Ill
112
LEGAL MEDICINE
Notice to creditor to be issued by court — Immediately after
granting letters, testamentary or of administration, the court shall
issue a notice requiring all persons having money claims against the
decedent to file them in the office of the clerk of said court (Rule
86, Sec. 1, Rules of Court).
ieath is the termination of life. It is the comrjjgte_cessation of all
the vital functions without possibility of resuscitatioriJ It is an irreversible loss of the properties of living matter. Dying is a continuing
process while death is an event that takes place at a precise time.
The ascertainment of death is a clinical and not a legal problem.
Previously, complete and persistent cessation of heart action and
respiration (cardio-respiratory) is the standard criteria in the determination of death, but the following events in the recent years led to
the development of uncertainty of the moment of death:
1. The increasing use of mechanical resuscitative devices which can
maintain respiration and cardiac functions almost indefinitely.
Heart vitality may be maintained by coronary perfusion or its
rhythm by defibrillation or pace maker. Breathing can be sustained by a respirator or pulmonator.
2. There is an increasing demand of organs for transplantation. Vital
organs can now be transplanted and the shorter the time space between the death of the donor and the transplantation process, the
more is the chance of success of surgery. It becomes a problem as
to when the donor dies for the immediate removal of the organ to
be transplanted. The surgeon must see to it that the donor is dead
before the organ to be transplanted is removed, otherwise he may
be held liable if done prematurely.
3. Coma following administration of excessive doses of modern
sedatives and hypnotics could be mistaken for death. Coma
induced by barbiturates could be mistaken for death because it
clinically appears to have eliminated breathing and heart action,
chill the body and makes reflexes weak or totally non-existent.
Based on the Criterion Used in its Determination, Death may be:
1. Brain Death — Death occurs when there is deep-'Irreversible coma,
^absence of electrical brain activity and complete cessation of all
the vital functions without possibility of resuscitation.
2. Cardio-Respiratory Death — Death occurs when there is a>continuous and persistent cessation of heart action and respiration.
Cardio-respiratory death is a condition in which the physician and
the members of the family pronounced a person to be dead based
on the common sense or intuition.
MEDICO-LEGAL ASPECTS OF DEATH
113
3. Some countries or states provide both brain and cardio-respiratory
bases in an alternative or eclectic way in the determination of the
moment of death. In 1970, the state of Kansas became the first
to enact a statute which specifies more clearly the accepted
alternatives for defining death. Section 1, Chapter 378 of the
Kansas Statute provides the following:
"A person will be considered medically and legally dead if, in
the opinion of a physician, based on ordinary standards of medical
practice, there is the absence of spontaneous respiratory and
cardiac function and, because of the disease or condition which
caused, directly or indirectly, these functions to cease, or because
of the passage of time since these functions ceased, attempts at
resuscitation are considered hopeless; and, in this event, death will
have occurred at the time these functions ceased.
Second, a person will be considered medically or legally dead if,
in the opinion of a physician, based on ordinary standards of
medical practice, there is the absence of spontaneous brain function; and if based on ordinary standards of medical practice,
during reasonable attempts to either maintain or restore spontaneous circulatory or respiratory function in the absence of aforesaid brain function, it appears that further attempts at resuscitation or supportive maintenance will not succeed, death will have
occurred at the time when these conditions first coincide. Death
is to be pronounced before artificial means of supporting respiratory and circulatory function are terminated and before any
vital organ is removed for purposes of transplantation."
Brain Death:
Inasmuch as there are no universally accepted criteria yet to
establish a condition of brain death, the following proposal or
recommendations are made by different committees or bodies:
1. According to the Harvard Report of 1968, the following are the
characteristics of "irreversible coma":
a. Unreceptivity and unresponsibility — There is a total unawareness to externally applied stimuli and inner need and complete
unresponsiveness — our definition of irreversible coma. Even the
most intense painful stimuli evoke no vocal or other response,
not even a groan, withdrawal of his limb, or quickening of
respiration.
b. No movements or breathing — Observations covering a period of
at least 1 hour by physicians is adequate to satisfy the criteria
of no spontaneous muscular movements or spontaneous respiration or response to stimuli such as pain, touch, sound, or
114
LEGAL MEDICINE
light. After the patient is on a mechanical respirator, the total
absence of spontaneous breathing may be established by turning
off the respirator for three minutes and observing whether there
is any effort on the part of the subject to breath spontaneously.
(The respirator may be turned off for this time provided that at
the start of the trial period the patient's carbon dioxide tension
is within the normal range, and provided also that the patient
had been breathing room air for at least 10 minutes prior to the
trial).
c. No reflexes — Irreversible coma with abolition of central
nervous system activity is evidenced in part by the absence of
elicitable reflexes. The pupil will be fixed and dilated and will
not respond to a direct source of bright light. . . Ocular movement (to head turning and to irrigation of the ears with ice
water) and blinking are absent. There is no evidence of postural
activity (decerebrate or other). Swallowing, yawning, vocalization are in abeyance. Corneal and pharyngeal reflexes are
absent. As a rule the stretch or tendon reflexes cannot be
elicited, i.e. tapping the tendons of the biceps, triceps and
pronator muscles, quadriceps and gastrocnemius muscles with
the reflex hammer elicits no contraction of the respective
muscles. Plantar or noxious stimulation gives no response.
d. Flat electro-encephalogram — Of great confirmatory value is
the flat or iso-electric E.E.G. We must assume that the electrodes have been properly applied, that the apparatus is functioning normally, and that the personnel in charge are competent.
All of these tests shall be repeated at least 24 hours later with
no change. It is emphasized that the patient be declared dead
before any effort is made to take him off the respirator, if he is
then on a respirator.
2. In 1969, the Ad Hoc Committee of Human Transplantation
convened under the auspices of the Institute of Forensic Sciences,
Duquesne University School of Law adopted the proposed criteria
for the determination of death otherwise known as Philadelphia
Protocol, and the following were considered:
a. Lack of responsiveness to internal and external environment.
b. Absence of spontaneous breathing movements for 3 minutes,
in the absence of hypocarbia and while breathing room air.
c No muscular movements with generalized flaccidity and no
evidence of postural activity or shivering,
d. Reflexes and response:
(1) Pupils fixed and dilated, non-reactive to strong stimuli.
MEDICO-LEGAL ASPECTS OF DEATH
115
(2) Corneal reflexes absent.
(3) Supra-orbital or other pressure response absent (both pain
response and decerebrate posturing).
(4) Absence of snouting or sucking response.
(5) No reflex response to upper airway stimulation.
(6) No reflex response to lower airway stimulation.
(7) No ocular response to ice water stimulation of the inner
ear.
(8) No deep tendon reflexes.
(9) No superficial reflexes.
(10) No plantar responses.
e. Falling arterial pressure without support by drugs or other
means.
f. Iso-electric electro-encephalogram (in absences of hypothermia,
anesthetic agents and drugs intoxication) recorded spontaneously and during auditory and tactile stimulation.
It is further laid down that these criteria shall have been
present for at least 2 hours and that death should be certified
by two physicians other than the physician of a potential
organ recipient (Gradwohrs Legal Medicine, Francis Camps,
Ann Robinson & Bernard Lucas, ed. 3rd ed. p. 51-52).
Other Set of Criteria to Establish Brain Death:
1. Mohandas and Chou (1971) made a summary of the criteria of
brain death which was accepted by the University of Minnesota
Science Center.
2. The Ottawa General Hospital (1970) set up guidelines for the
criteria of cerebral death.
3. In France (1968) the Council of Ministers published a decree
which adopted the official definition of death on recommendation of the French Academy of Medicine.
Although the consideration of brain death is the most ideal
criteria, the difficulty and practicability of its application is a problem. Electro-encephalogram which is the most reliable instrument
to determine brain activities is not available in many places. Even
if available, the number of competent persons to apply the instrument and the interpretation of the results is quite limited.
The use of the criteria of brain death may only be applied to
those persons who are potential organ donors.
LEGAL MEDICINE
f A. KINDS OF DEATH ^ j j ^
)MATIC DEATH OR CLINICAL DEATH:
This is the state of the body in which there is ^complete, persistent and continuous cessation of the vital functions of the
brain, heart and lungs which maintain life and health^ It occurs
the moment a physician or the other members of the family
declare a person has expired, and some of the early signs of
death are present. It is hardly possible to determine the exact
time of death.
Immediately after death the face and lips become pale, the
muscles become flaccid, the sphincters are relax, the lower jaw
tends to drop, the eyelids remain open, pupils dilate and the
skin losses its elasticity. The body fluid tends to gravitate to the
mostf dependent portions of the body and the body heat gradually
assiimes the temperature of the surroundings.
(OLECULAR OR CELLULAR DEATH:
After cessation of the vital functions of the body there is still
^animal life among individual cells. This is evidence by the presence of/excitability of muscles and^ciliary movements and other
functions of individual cells.
About three to six hours later, there is death of individual cells.
This is known as molecular or cellular death. Its exact occurrence
cannot be definitely ascertained because its time of appearance is
influenced by several factors. Previous state of health, infection,
climatic condition, cellular nutrition, etc. influence its occurrence.
^APPARENT DEATH" OR "STATE OF SUSPENDED ANIMATION":
This condition is not really death but merely aCtransient loss of
consciousness or temporary cessation of the vital functions of the
body on account of disease, external stimulus or other forms of
influence.^ It may arise especially in hysteria, uremia, catalepsy
and electric shock.
It may be induced voluntarily as has been cited by foreign
authors (Col. Townshend who could be able to pass into a state
of pulselessness for half an hour). Involuntary suspension is
shown in still-birth. A newly born child may remain at the state
of suspended animation and may die unless prompt action is
taken. A person who has been rescued from drowning may
appear dead but life is maintained after continuous resuscitation.
It is important to determine the condition of suspended animation to prevent premature burial. There are records of cases
wherein a person was pronounced dead, placed in a coffin and
MEDICO-LEGAL ASPECTS OF DEATH
117
later angrily rise from it and walk unaided. The relative has sent
death notice and placed wreaths near his coffin (Daily Mail
England, 1948).
ji B. SIGNS OF DEATHS
^XC^®
CESSATION OF HEART ACTION AND CIRCULATION: tl R C I ^ A "
There must be anfentire and continuous cessation of the heart
action and flow of blood in the whole vascular system^ A temporary suspension of the heart action is still compatible with life.
The length of time the heart may cease to function and life is still
maintained depends upon the length of time it is readily reestablished and upon the oxygenation of blood at the time of the
suspension. \As a general rule, if there is no heart action for a
period of five minutes death is regarded as certain^
Respiration ceases frequently before the stoppage of heart
contraction and circulation. Usually the auricle of the heart
contracts after somatic death for a longer period than the ventricle.
And the auricle is the last to stop, hence called ultimen martens.
In judicial hanging, the heart continues to beat for twenty
minutes or half an hour after the individual has been executed
although its beating is irregular and feeble. In decapitation of
criminals, heart beating is present for an hour after decapitation
has taken place.
Methods of Detecting the Cessation of Heart Action and Circulation:
a. Examination of the Heart:
(1) Palpation of the Pulse:
Pulsation of the peripheral blood vessels may be made at
the region of the wrist or at the neck. The pulsation of the
vessels is synchronous with the heart beat. Occasionally the
pulsation is very imperceptible and irregular that the examiner experience much difficulty.
(2) Auscultation for the Heart Sound at the Precordial Area:
The rhythmic contraction and relaxation of the heart is
audible through the stethoscope. Heart sound can be
audible during life even without the aid of a stethoscope by
placing the ear at the precordial area.
Errors in the Method of Determining Heart Action:
(a) The heart itself may, like other muscles, be in a state of
apparent and not real death.
(b) The heart sound may not always be appreciable to the
ear even with the aid of the stethoscope.
118
LEGAL MEDICINE
Difficulties in Auscultation may be Encountered in:
(a) Stout person.
(b) Fatty degeneration of the heart.
(c) Pericardial effusion.
(3) Flouroscopic Examination:
Fluoroscopic examination of the chest will reveal the
shadow of the heart in its rhythmic contraction and relaxation. The shadow may be enlarged and the excursion made
less visible due to pericardial effusion.
(4) By the Use of Electrocardiograph:
The heart beat is accompanied by the passage of electrical charge through the impulse conducting system of the
heart which may be recorded in an electrocardiograph
machine. The electrocardiograph will record the heart beat
even if it is too weak to be heard by auscultation. This is
the best method of determining heart action but quite
impractical,
b. Examination of the Peripheral Circulation:
(1) Magnus'Test:
A ligature is applied around the base of a finger with
moderate tightness. In a living person there appears a
bloodless zone at the site of the application of the ligature and a livid area distal to the ligature. If such ligature
is applied to the finger of a dead man, there is no such
change in color. The color of the area where the ligature
is applied will be the same as that one distal to it. There
may be no appreciable change of color if a living person
is markedly anemic.
( 2 ) Opening of Small Artery:
In the living, the blood escapes in jerk and at a distance.
In a dead man, the blood vessel is white and there is no
jerking escape of blood but may only ooze towards the
nearby skin. When bigger arteries are cut, blood may flow
without pressure continuously.
(3) Icard's Test:
This consists of the injection of a solution of fluorescein
subcutaneously. If circulation is still present, the dye will
spread all over the body and the whole skin will have a
greenish-yellow discoloration due to flourescein. In a dead
man, the solution will just remain at the site of the injection.
This test should be applied only with the use of the daylight
as the color is difficult to be appreciated with the use of
artificial light.
MEDICO-LEGAL ASPECTS OF DEATH
119
(4) Pressure on the Fingernails:
If pressure is applied on the fingernails intermittently,
there will be a zone of paleness at the site of the application of pressure which become livid on release. There
will be no such change of color if the test is applied to a
dead man.
(5) Diaphanous Test:
The fingers are spread wide and the finger webs are
viewed through a strong light. In the living, the finger webs
appear red but yellow in the dead. The finger webs may
appear yellow in a strong light even if living in cases of
anemia or carbon monoxide poisoning.
(6) Application of Heat on the Skin:
If heated material is applied on the skin of a dead man,
it will not produce true blister. There is no sign of congestion, or other vital reactions. But if applied to a living
person, blister formation, congestion, and other vital
reactions of the injured area will be observed.
(7) Palpation of the Radial Pulse:
Palpation of the radial artery with the fingers, one will
feel the rhythmic pulsation of the vessel due to the flow of
blood. No such pulsation will be observed in a dead man.
(8) Dropping of Melted Wax:
Melted sealing wax is dropped on the breast of a person.
If the person is dead, there will be no inflammatory edema
at the neighborhood of the dropped melted wax.
y
CESSATION OF RESPIRATION:
Like heart action, cessation of respiration in order to be considered as a sign of death must be continuous and persistent. A
person can hold his breath for a period not longer than 3-1/2
minutes. In case of electrical shock, respiration may cease for
sometime but may be restored by continuous artificial respiration.
In the following conditions there may be suspension of respiration without death ensuing.
a. In a purely voluntary act, as in divers, swimmers, etc. but it
cannot be longer than two minutes.
b. In some peculiar condition of respiration, like Cheyne-Stokes
respiration, but the apneic interval cannot be longer than
fifteen to twenty seconds;
c. In cases of apparent drowning;
d. Newly-born infants may not breathe for a time after birth and
may commence only after stimulation or spontaneously later.
120
LEGAL MEDICINE
Methods of Detecting Cessation of Respiration:
a. Expose the chest and abdomen and observe the movement
during inspiration and expiration.
b. Examine the person with the aid of a stethoscope which is
placed at the base of the anterior aspect of the neck and hear
sound of the current of air passing through the trachea during
each phase of respiration.
c. Examination with a Mirror:
The surface of a cold-looking glass is held in front of the
mouth and nostrils. If there is dimming of the mirror after
a time, there is still respiration. The dimming of the cold
mirror is due to the condensation of the warm moist air exhaled
from the lungs if respiration is still going on. However, it must
not be forgotten that the dimming of the mirror may be due to
the expulsion of the air from the lungs due to the contraction
of the diaphragm in rigor mortis. Ordinarily there is no dimming
of the mirror when the subject is dead.
d. Examination with a Feather or Cotton Fibers:
Place a fine feather or a strip of cotton in front of the lips
and nostrils. If there is movement of the feather or cotton not
due to external air, respiration is present. The feather or cotton
fibers will be blown away during expiration and towards the
nose and mouth during inspiration. This is not a reliable test
as the slightest movement of outside air or nervousness of the
observer will move the feather or cotton fibers.
e. Examination with a Glass of Water:
Place a glass half full of water at the region of the chest. If
the surface of the water is smooth and stable, there is no
respiration taking place, but if it waves or water movement is
observed, then respiration is taking place. This is not a good
test because of the difficulty of preventing movement of the
place where the body lies.
f. Winslow's Test:
There is no movement of the image formed by reflecting
artificial or sun light on the water or mercury contained in a
saucer and placed on the chest or abdomen if respiration is
not taking place. The reflection is utilized to magnify the
/ movement of the surface of mercury or water.
. COOLING OF THE BODY (ALGOR MORTIS):
'After death the metabolic process inside the body ceases, yj No
more heat is produced but the body loses slowly its temperature
by evaporationJor by conduction to the surrounding atmosphere.
MEDICO-LEGAL ASPECTS OF DEATH
i r|
The progressive fall of the body temperature is one of the most
prominent signs of death.
/'
The rate of cooling of the body is not uniform. It is rapid
during the first two hours after death and as the temperature of
the body gradually approaches the temperature of the surroundings, the rate becomes slower.
It is difficult to tell exactly the length of time the body will
assume the temperature of the surroun
Several factors
influence the rate of fall of the body temperature.
The fall of temperature may occur before death in the following conditions:
(
a. Cancer
b. Phthisis
c. Collapse
The fall of temperature of 15 to 20 degrees fahrenheit is considered as a certain sign of death.
Post-mortem Caloricity is the rise of temperature of the body
after death due to rapid and early putrefactive changes or some
internal changes. It is usually observed in the first two hours
after death.
Post-mortem caloricity may occur in the following conditions:
a. Cholera.
b. Yellow fever.
c. Liver abscess.
d. Peritonitis.
e. Cerebro-spinal fever.
f. Rheumatic fever.
g. Tetanus.
h. Smallpox.
i. Strychnine poisoning.
Factors Influencing the Rate of Cooling of the Body:
a. Conditions that are connected with the body:
(1) Factors Delaying Cooling:
(a) Acute pyrexia! diseases.
(b) Sudden death in good health.
(c) Obesity of person.
(d) Death from asphyxia.
(e) Death of the middle age.
(2) Factors Accelerating Cooling:
(a) Leanness of the body.
(b) Extreme age.
(c) Long-standing or lingering illness.
(d) Chronic pyrexial disease associated with wasting.
122
LEGAL MEDICINE
b. Conditions that are connected with the surroundings:
(1) Factors Delaying Cooling:
(a) Clothings.
(b) Want of access of air to the body.
(c) Small room.
(d) Warm surroundings.
(2) Factors Accelerating Cooling:
(a) Unclothed body.
(b) Conditions allowing the access of air.
(c) Large room permitting the dissipation of heat.
(d) Cooling more rapid in water than in air.
Methods of Estimating How Long a Person Has Been Dead From
the Cooling of the Body:
a. When the body temperature is normal at the time of death,
the average rate of fall of the temperature during the first two
hours is one-half of the difference of the body temperature and
that of the air.
During the next two hours, the temperature fall is one-half of
the previous rate, and during the succeeding two hours, it is
one-half of the last mentioned rate.
As a general rule the body attains the temperature of the
surrounding air from 12 to 15 hours after death in tropical
countries
(Medical Jurisprudence and Toxicology by Modi,
12th ed.,p. 121).
b. To make an approximate estimate of the duration of death
from the body temperature, the following formula has been
suggested:
(Normal Temperature) 98.4°F — (Rectal Temperature)
Approximate number of hours
after death
This formula is only applicable to cases where the rectal
temperature has not yet assumed the temperature of the surroundings, otherwise, the result will be constant.
c. Chemical Method:
Schourup's formula for the determination of the time of death
of any cadaver whose cerebro-spinal fluid is examined for the
concentrations of lactic acid (L.A.), non-protein nitrogen
(N.P.N.) and amino acid (A.A.) and whose axillary temperature
has been taken at the time the cerebro-spinal fluid has been
removed.
MEDICO- LEGAL ASPECTS OF DEATH
123
36— T + antilog, L.A. + N.P.N. — 15 + A.A. — 1
180
16.7
7.35
4
T — temperature
1 = axillary temperature
The lactic acid content of the cerebro-spinal fluid rises from
15 mg. to over 200 mg. per 100 cc. The rise is rapid during the
first 5 hours following death.
The non-protein nitrogen (N.P.N.) increases from 15 to 40
mg. per 100 cc. during the first 15 hours. This test is modified
by ante-mortem anemia and rapid cooling of the body.
Amino-acids (A.A.) increases from 1 mg. to 12 mg. percent
during the first 15 hours, but the result is modified by rapid
cooling of the body.
Limitations of the Schourup's Formula:
a. The method is only applicable to adults, as the rate of biochemical change in a child is far more rapid than in adult. It is
the value to person over the age of 15 years.
b. The cerebrospinal fluid must be free of blood, the presence of
which raises the lactic concentration.
c. Injuries must not have allowed the escape of cerebrospinal
fluid.
d. Death must have occurred' within a period 15 hours prior to
the withdrawal of the sample of cerebrospinal fluid, as after
that time the changes in the concentration per time unit become irregular (Modern Trend in Forensic Medicine by Keith
. Simpson, 1953, pp. 83-84).
INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE:
After death the whole body is insensible. No kind of stimulus
is capable of letting the, body have voluntary movement.
This condition must be observed in conjunction with cessation
of heart beat and circulation and cessation of respiration.
The insensibility and loss of power to move may be present
although living, in the following conditions:
a. Apoplexy.
b. Epilepsy.
c. Trance.
d. Catalepsy.
e. Cerebral concussion.
f. Hysteria.
124
LEGAL MEDICINE
S ^ HMANGES
AN
IN THE SKIN:
The following are the changes undergone by the skin after death:
a. The skin may be observed to be-pale and vgaxy-looking due to
the absence of circulation. Areas of the skin specially the most
dependent portions will develop livid discoloration on account
of the gravitation of blood.
bsLoss of Elasticity of the Skin:
Normally when the body surface is compressed, it readily
returns to normal shape. After death, application of pressure
to the skin surface will make the surface flattened. Application of pressure with the finger tip will produce fitting impression like one observed in edema.
Post-mortem Contact Flattening — On account of the loss
of elasticity of the skin and of the post-mortem flaccidity of
muscles, the body becomes flattened over areas which are in
contact with the surface it rests. This is observed at the region
of the shoulder blades, buttocks and calves if death occurs
while lying on his back. Certain degree of pressure may be
applied on the face immediately after death and may be mistaken for traumatic deformity.
c. ppacity of the Skin:
Exposure of the hand of a living person to translucent
light will allow the red color of circulation to be seen underneath the skin. The skin of a dead person is opaque due to the
absence of circulation.
d. Effect of the Application of Heat:
Application of melted sealing wax on the breast of a dead
person will not produce blister or inflammatory reaction on
the skin. In the living, an inflammatory edema will develop
about the wax.
6. CHANGES IN AND ABOUT THE EYE:
a. Loss of Corneal Reflex:
The cornea is not capable of making any reaction to whatever intensity of light stimulus. However, absence of corneal
reflex may also be found in a living person the following conditions:
(1) General anesthesia.
(2) Apoplexy.
(3) Uremia.
(4) Epilepsy.
(5) Narcotic Poisoning.
(6) Local Anesthesia.
MEDICO-LEGAL ASPECTS OF DEATH
125
b. Clouding of the Cornea:
The normal clear and transparent nature of the cornea is
lost. The cornea becomes slightly cloudy or opaque after death.
If the cornea is kept moist by the application of saline solution
after death, it will remain transparent. Opacity of the cornea
may be found in certain diseases, like cholera, and therefore
is not a reliable sign of death.
c. Flaccidity of the Eyeball:
After death, the orbital muscles lose their tone making the
intra-orbital tension rapidly fall. The eyeball sinks into the
orbital fossa. Intra-orbital tension is low.
d. The Pupil is in the Position of Rest:
The muscle of the iris loses its tone. The pupil can not
react to light. The size of the pupil varies at the time of death,
however, if contracted, it may infer poisoning by narcotic
drugs. A relaxed iris may be found in life in the following
conditions:
(1) Action of drugs like atropine.
(2) Uremia.
(3) Tabes dorsalis.
(4) Apoplexy.
e. Ophthalmoscopic Findings:
(1) The optic disc is pale and has the appearance of optic
atrophy.
(2) The remaining portion of the fundus may have a yellow
tinge which later changes to a brownish-gray or slate color.
(3) The retina becomes pale like the optic disc.
(4) The retinal vessels become segmented, no evidence of blood
flow.
The retinal veins and arteries are indistinguishable :
f. Tache noir de la sclerotique":
After death a spot may be found in the sclera. The spot
which may be oval or round or may be triangular with the base
towards the cornea and may appear in the sclera a few hours after
death. At the beginning it is yellowish but later it becomes
brown or black. This is believed to be due to the thinning of
the sclera thereby making the pigmented choroid visible.
lt
7 .'ACTION OF HEAT ON THE SKIN:
This test is useful to determine whether death occurred before
or after the application of heat.
The heat is applied to a portion of the leg or arm. If death is
real, only a dry blister is produced. The epidermis is raised but
126
LEGAL MEDICINE
on pricking the blister, no fluid is present. There is no redness of
the surrounding skin. In the living, the blister contains abundant
serum and area of vital reaction (congestion) on the skin around
is present.
The 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 to stimulus.
c. Onset of rigor mortis.
^O^C. CHANGES IN THE BODY FOLLOWING DEATH
^l^CHANGES IN THE MUSCLE: p f £
•
After death, there is complete relaxation of the whole muscular
system. The entire muscular system is contractile for three to six
hours after death, and later rigidity sets in. Secondary relaxation
of the muscles will appear just when decomposition has set in.
The Entire Muscular Tissue Passes Three Stages After Death:
Stage of primary flaccidity (post-mortem muscular irritability):
The ^nuscles are relaxed and capable of contracting when
stimulated^ The pupils are dilated, the sphincters are relaxed,
^-"Shd there is incontinence of urination and defecation.
b. Stage of post-mortem rigidity (Cadaveric rigidity, or Death
struggle of muscles or Rigor Mortis):
The^whole body becomes rigid due to the contraction of the
muscles."!This develops three to six hours after death and may
last frorfftwenty-f our to thirty-six hours.
Jc. Stage of secondary flaccidity or commencement of putrefaction
(Decay of the muscles):
The muscles become flaccid, noJonger capable of responding
to mechanical or electrical stimulus and the reaction becomes
alkaline. ~
/a. Stage of Primary Flaccidity or Period of Muscular Irritability:
Immediately after death, there is complete relaxation and
softening of all the muscles of the body. The extremities may
be flexed, the lower jaw falls, the eyeball loses its tension, and
there may be incontinence of urination and defecation.
To determine whether the muscles are still irritable, apply
electric current and note whether there is still irritability of the
muscles. Normally during the stage of primary flaccidity, the
muscles are still contractile and react to external stimuli,
mechanical or electrical owing to the presence of molecular
life after somatic death.
MEDICO-LEGAL ASPECTS OF DEATH
127
This stage usually lasts about three to six hours after death.
In warm places, the average duration is only one hour and fiftyone minutes (Mackenzie cited by Modi, p. 122).
Chemically, the reaction of the muscle is alkaline and the
normal constituents of the individual muscle proteins are the
same as in life.
b. Stage of Post-mortem Rigidity, or Cadaveric Rigidity, or Death
Stiffening, or "Death Struggle of Muscles" or rigor mortis:
Three to six hours after death the muscles gradually stiffen.
It usually starts at the muscles of the neck and lower jaw and
spreads downwards to the chest, arms, and lower limbs. Usually
the whole body becomes stiff after twelve hours. All the
muscles are involved — both voluntary and involuntary. In the
heart, rigor mortis may be mistaken for cardiac hypertrophy.
Chemically, there is an increase of lactic acid and phosphoric
content of the muscle. The reaction becomes acidic. There is
no definite explanation as to how such contraction of muscles
occurs although it has been proven that there is coagulation of
the plasma protein.
In the medico-legal view point, post-mortem rigidity may be
utilized to approximate the length of time the body has been
dead. In temperate countries it usually appears three to six
hours after death, but in warmer countries it may develop
earlier.
In temperate countries, rigor mortis may last for two or
three days but in tropical countries the usual duration is
twenty-four to forty-eight hours during cold weather and
eighteen to thirty-six hours during summer. When rigor mortis
sets in early, it passes off quickly and vice versa.
Factors Influencing the Time of Onset of Rigor Mortis:
(1) Internal Factors:
(a) State of the Muscles:
Rigor mortis appears late and the duration is longer
in cases where the muscles have been healthy and at
rest before death, It has been observed that in the
following deaths, the onset of rigor mortis is hastened:
i. Animal having been hunted to death.
ii. Prolonged convulsion and lingering illness.
iii. Death from typhoid fever, typhus, cholera and
phthisis.
128
LEGAL MEDICINE
(b) Age:
Rigor mortis has early onset in the aged and new-born.
The onset is delayed in good health and good muscular
development.
(c) Integrity of the Nerves:
Section of the nerve will delay onset of rigor mortis
as shown in paralyzed muscles.
(2) External Factors:
(a) Temperature:
The development of rigor mortis is accelerated by
high temperature but a temperature above 75°C will
produce heat stiffening.
(b) Moisture:
Rigor mortis commences rapidly but the duration is
short in moist air.
/
^ Conditions Simulating Rigor Mortis:
(1) Heat Stiffening:
If the dead body is exposed to temperatures above
75°C it will coagulate the muscle proteins and cause the
muscles to be rigid. The stiffening is more or less permanent and may not be easily affected by putrefaction. The
body assumes the "pugilistic attitude" with the lower and
upper extremities flexed and the hands clenched because
the flexor muscles are stronger than the extensors.
Heat stiffening is commonly observed when the body of
a person is placed in boiling fluid or when the body is
burned to death.
J@) Cold Stiffening:
The stiffening of the body may be manifested when
the body is frozen, but exposure to warm condition will
make such stiffening disappear. The cold stiffening is due
to the solidification of fat when the body is exposed to
freezing temperature. Forcible stretching of the flexed
extremities will produce a sound due to the frozen synovial
fluid.
J$) Cadaveric Spasm or Instantaneous Rigor:
This is the instantaneous rigidity of the muscles which
occurs at the moment of death due to extreme nervous
tension, exhaustion and injury to the nervous system or
injury to the chest. It is principally due to the fact that the
last voluntary contraction of muscle during life does not
MEDICO-LEGAL ASPECTS OF DEATH
129
stop after death but is continuous with the act of cadaveric
rigidity.
In case of cadaveric spasm, a weapon may be held in the
hand before death and can only be removed with difficulty.
For practical purposes it cannot be possible for the murderer or assailant to imitate the condition. In cadaveric
spasm, only group of muscles are involved and they are
usually not symmetrical.
The findings of weapon, hair, pieces of clothing, weeds
on the palms of the hands and firmly grasped is a very
important medico-legal point in the determination whether
it is a case of suicide, murder or homicide. The presence
of weeds held by the hands of a person found in water
shows that the victim was alive before disposal..
Instantaneous rigor may also be found following ingestion of cyanide but usually it is generalized and symmetrical.
Strychnine may produce the same but rigidity appears
/^sometime after ingestion.
/Distinctions Between Rigor Mortis and Cadaveric Spasm:
( i f Time of Appearance:
^ i v t . K M ^
affiles-opY
Rigor mortis appears three to six hours after death,
while cadaveric spasm appears immediately after death.
{^Muscles Involved:
Rigor mortis involves all the muscles of the body
whether voluntary or involuntary, while cadaveric spasm
involves only a certain muscle or group of muscles and
are asymmetrical.
(3^0ccurrence:
Rigor mortis is a natural phenomena which occurs
after death, while cadaveric spasm may or may not appear
on a person at the time of death.
(^Medico-Legal Significance:
Rigor mortis may be utilized by a medical jurist to
approximate the time of death, while cadaveric spasm may
be useful to determine the nature of the crime.
1
Distinctions Between Muscular Contraction and Rigor Mortis:
Rigor Mortis
Muscular Contraction
(1)
Muscle
in rigor mortis
(1) Contracted muscle is
losses
this
translucency,
more or less transparent,
and
becomes
opague.
or rather translucent.
(2) It has lost this elasti(2) It is very elastic, i.e.,
130
LEGAL MEDICINE
capable of restoration
to its original form as
soon as the distorting
force has ceased to act.
(3) In reaction to litmus, it
is either neutral or slightly alkaline, and any reduction in this alkalinity is very speedily
removed.
(4) If the contraction be
overcome by mechanical force, the muscles
though they may remain for a time uncontracted, possess still
their inherent power
of contraction; they
may then keep the limb
fixed in a new position
or allow a return to
the old position.
city and readily maintains a distorted position.
(3) It is distinctly and constantly acid (until dec o m p o s i t i o n is advanced) owing to the
development of sarcolatic and other acid
metabolites.
(4) If rigor mortis be overcome by mechanical
force, absolute flaccidity
corresponding in degree
with the amount of
mechanical movement,
at once ensues, and
there is no power to
resume the old position
nor any new one, except
so far as gravity may
cause a new position.
This flaccidity is permanent till decomposition
destroys the
muscles.
(From: Taylor's Principles and Practice of Medical Jurisprudence, 11th ed.. Vol I, p. 179).
c. Stage of Secondary Flaccidity or Secondary Relaxation:
After the disappearance of rigor mortis, the muscle becomes
soft and flaccid. It does not respond to mechanical or electrical
stimulus. This is due to the dissolution of the muscle proteins
which have previously been coagulated during the period of
rigor mortis.
This body while at the stage of rigor mortis, if stretched or
flexed to become soft, will no longer be rigid. This condition
f the muscles is not secondary flaccidity.
CHANGES IN THE BLOOD:
a. Coagulation of the Blood:
The stasis of the blood due to the cessation of circulation
MEDICO-LEGAL ASPECTS OF DEATH
131
enhances the coagulation of blood inside the blood vessels.
Blood clotting is accelerated in cases of death by infectious
fevers and delayed in cases of asphyxia, poisoning by opium,
hydrocyanic acid or carbon monoxide poisoning. The clotting
of blood is a very slow process that there is a tendency for the
blood to separate forming a red clot at the lower level and
above it is a white clot known as chicken-fat clot.
Blood- may remain fluid inside the blood vessels after death
for (Ho 8 hours.
^distinctions Between Ante-mortem from Post-mortem Clot:
Ante-mortem Clot
Post-mortem Clot
(1) Firm in consistency.^- l ^
u^ )
consistency.
(2) Surface of the blood"^ '
(2) Surface of the blood
vessel raw after the
^ " ^ - v e s s e l s smooth
and
clots are removed.
p£v t l f *Thealthy after the clots
are removed.
(3) Clots homogenous in
(3) Clots can be stripped
construction so it canoff in layers.
not be stripped into
layers.
(4) Clot with uniform color.
(4) Clot with distinct layer.
bfPost-mortem Lividity or Cadaveric Lividity, or Post-mortem
Suggillation or Post-mortem Hypostasis or Livor Mortis:
The stoppage of the heart action and the loss of tone of
blood vessels cause the blood to be under the influence of
gravity. Blood begins to accumulate in the most dependent
portions of the body. The capillaries may be distended with
blood. The distended capillaries coalesce with one another
until the whole area becomes dull-red or purplish in color
known as post-mortem lividity.* If the body is lying on his
back, the lividity will develop on the back. Areas of bone
prominence may not show lividity on account of the pressure.
If the position of the body is moved during the early stage
of its formation, it may disappear and develop again in the
most dependent area in the new position assumed. But if
the position of the body has been changed after clotting or
the blood has set in or when blood has already diffused into
the tissues of the body, a change of position of the body will
not alter the location of the post-mortem lividity.
Ordinarily, the color of post-mortem lividity is dull-red or
pink or purplish in color, but in death due to carbon monoxide
1
0
S o f t i n
132
LEGAL MEDICINE
poisoning, it is bright pink. Exposure of the dead body to cold
or hot may cause post-mortem lividity to be bright-red in
color.
The lividity usually appears three to six hours after death
and the condition increases until the blood coagulates. The
time of its formation is accelerated in cases of death due to
cholera, uremia and typhus fever. Twelve hours after death,
the post-mortem lividity is already fully developed. It also
involved internal organs.
Physical Characteristics of Post-mortem Lividity:
(1) It occurs in the most extensive areas of the most dependent
portions of the body.
(2) It only involves the superficial layer of the skin.
(3) It does not appear elevated from the rest of the skin.
(4) The Color is uniform but the color may become greenish
at the start of decomposition.
(5) There is no injury of the skin.
Kinds of Post-mortem (Cadaveric) Lividity:
Hypostatic Lividity:
The blood merely gravitates into the most dependent
portions of the body but still inside the blood vessels and
still fluid in form. Any change of position of the body
leads to the formation of the lividity in another place.
This occurs during the early stage of its formation.
This appears during the later stage of its formation
when the blood has coagulated inside the blood vessels
or has diffused into the tissues of the body. Any change
of position will not change the location of the lividity.
Importance of Cadaveric Lividity:
(1) It is one of the signs of death.
(2) It may determine whether the position of the body has
been changed after its appearance in the body.
(3) The color of the lividity may indicate the cause of death.
Example: a. In asphyxia, the lividity is dark.
b. In carbon monoxide poisoning, the lividity
is bright pink.
Hemorrhage, anemia — less marked.
Hydrocyanic acid — bright red.
Phosphorus — dark brown.
Potassium chlorate, Potassium bichromate —
chocolate or coffee brown.
MEDICO-LEGAL ASPECTS OF DEATH
133
c. If the body is found for considerable time in
snow or ice the lividity is bright red.
(4) It may determine how long the person has been dead.
(5) It 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:
a. Posture of the body when found:
The body may become rigid in the position in which he
died. Post-mortem lividity may develop in the assumed position. This condition may occur and is of value if the state and
position of the body was not moved before rigidity and lividity
took place.
b. Post-mortem Hypostasis (Lividity):
Hypostatic lividity will be found in areas of the body which
comes in contact with the surface where the body lies. If there
is already coagulation of blood or if blood has already diffused
into the tissues of the body, a change of position will not alter
the location of the post-mortem lividity.
c. Cadaveric Spasm:
In violent death, the attitude of parts of the body may infer
position on account of the spasm of the muscles.
Example: (1) In drowning, the victim may be holding the
sea weeds.
(2) In suicide, the wounding weapon may be grasped
tightly by the hands.
Distinctions Between Contusion (Bruise) and Post-mortem Hypostasis:
Contusion (Bruise)
Post-mortem Hypostasis
a. Below the epidermis in the a. In the epidermis or in the
true skin in small bruises or
cutis, as a simple stain or
extravasations, below this in
a showing through the epilarger ones, and often much
dermis of underlying endeeper still. The reason is
gorged capillaries,
obvious, viz., that the epidermis has no blood-vessels to
be ruptured.
b. Cuticle was probably abraded b. Cuticle unabraded, because
by the same violence that pro- the hypostasis is a mere
duced the bruise. In small
sinking of the blood; there
punctures, such as flea bites,
is no trauma.
^
this is not observed.
134
LEGAL MEDICINE
c. A bruise appears at the seat
of and surrounding the injury.
This may or may not be a
dependent part.
d. Often elevated, because the
extravasated blood and subsequent inflammation swell
the tissues.
e. Incision shows blood outside
the vessels. This is the most
certain test of difference, and
can be observed even in very
small bruises.
f. Colour variegated. This is
only true of bruises that are
some days old; it is due to
the changes in the haemoglobin produced during life.
g. If the body happens to be
constricted at, or supported
on, a bruised place, the
actual surface of contact
may be a little lighter than
the rest of the bruise, but
will not be white.
Always in a part which for
the time of formation is
dependent, i.e., at a place
where gravity ordains it.
Not elevated, because either
the blood is still in the vessels
or, at most, has simply soaked
into and stained the tissues.
Incision shows the blood is
still in its vessels; and if any
oozing occurs drops can be
seen issuing from the cut
mouths of the vessels.
Colour uniform. The wellknown change in colour
(green, yellow, etc.) produced in blood extravasted
into living tissues does not
occur in dead tissues with
the same regularity.
In a place which would otherwise be the seat of a hypostasis pressure of any kind,
even simple support (the
wrinkling of a shirt or necktie, garters, etc.) is sufficient
to obliterate the lumen of
venules and capillaries, and
so to prevent their filling
with blood.
White lines
or patches of pressure bordered by,the dark color of a
hypostasis are produced and
marks of floggings, strangulation, etc., are thus sometimes simulated.
(From: — Taylor's Principles and Practice of Medical Jurisprudence, 11th ed. 1949, Vol I, p. 175-176.
Internal Hypostasis in Visceral Organs:
Post-mortem lividity also occurs in the internal organs. The
principal organs affected are the lungs, loops of the intestine
and brain. It may in some instances be mistaken for disease.
MEDICO-LEGAL ASPECTS OF DEATH
135
Post-mortem hypostasis in the organs may have the pathological
appearance in the visceral organs. In the heart, it may simulate
coronary occlusion while in the lungs it may appear like pneumonic changes. The intestine may be reddened to appear like
strangulation.
Differences between Post-mortem Lividity of Organs and Simple
Congestion:
a. Post-mortem staining in organs is irregular and occurs in the
most dependent parts, while congestion is generally uniform
and found all over the organs.
b. The mucous membrane in post-mortem staining (lividity) is
dull and lusterless, but not so in congestion.
c. In post-mortem staining (lividity) inflammatory exudate is not
seen, and areas of redness alternating with pale areas will be
found if a hollow viscus is stretched out and held in front of
a light. This is not seen in cases of simple congestion.
Distinctions between Post-mortem Lividity from Hemorrhage
of Scurvy, Phosphorus Poisoning, or Purpura:
a. History Before Death:
History will reveal the presence of scurvy, phosphorus
poisoning or purpura.
b. Time of Appearance:
In cases of scurvy, purpura or phosphorus poisoning, the
skin lesion is present even before death, while in cases of postmortem lividity it only appears after death.
c. Location:
In post-mortem lividity, it is only present in the most dependent portions of the body, while in purpura, scurvy or phosphorus poisoning, the lesions may be found and distributed
all over the skin or organs.
Other Changes in the Blood:
a. Hydrogen ion Concentration — After death the Ph of the blood
and tissues drops because of the terminal accumulation of C O 2 ,
glycogenolysis and glycolysis with accumulation of phosphoric
acid and lactic acid, and splitting off of amino-acid and fatty
acids.
After about 24 hours, the reaction become alkaline due to
the production of ammonia from enzymatic protein breakdown
and the rise of serum concentration of nonprotein nitrogenous
components.
b. The breakdown of liver glycogen leads to the accumulation of
dextrose in the inferior vena cava and right side of the heart.
136
LEGAL MEDICINE
c. There is a rise of non-protein nitrogen and free amino-acid.
d. Chemical — The chloride in the plasma and red blood cells falls
due to the extravascular diffusion so that after 72 hours it is
only 1/2 of its content.
Magnesium content increases as a result of diffusion from
without.
Potassium increases owing to diffusion from the vascular
endothelium.
3. AUTO LYTIC OR AUTODIGESTTVE CHANGES AFTER DEATH:
After death, proteolytic, glycolytic and lipolytic ferments of
glandular tissues continue to act which lead to the autodigestion
of organs. This action is facilitated by weak acid and higher
temperature. It is delayed by the alkaline reaction of the tissues of
the body and low temperature. Their early appearance is observed in the parenchymatous and glandular tissues.
Autolytic action is seen in the maceration of the dead fetus inside the uterus. The stomach may be perforated, glandular tissues
become soft after death due to autodigestion and the action of
autolytic enzymes.
Microscopic examination of the tissues under the influence of
autolytic enzymes shows disintegration, swelling or shrinkage,
vacuolization and formation of small granules within the cytoplasm of the cells. There is also a change in the staining capacity
and become desquamated from the underlying layers (Legal
Medicine by Gradwohl, p. 135).
4. PUTREFACTION OF THE BODY:
Putrefaction is the breaking down of the complex proteins into
simpler components associated with the evolution of foul smelling
gasses and accompanied by the change of color of the body.
Tissue Changes in Putrefaction:
The following are the principal changes undergone by the soft
tissues of the body in the process of putrefaction:
a. Changes in the Color of the Tissue:
A few hours after death, there is hemolysis of the blood
within the blood vessels and as a result of which hemoglobin is
liberated. The hemoglobin diffuses through the walls of the
blood vessels and stains the surrounding tissues thereby imparting a red or reddish-brown color.
While in the tissues, the hemoglobin undergoes chemical
changes and various derivatives of hemoglobin are formed. On
account of these chemical changes the tissue color is gradually
MEDICO-LEGAL ASPECTS OF DEATH
137
changed to greenish-yellow, greenish-blue, or greenish-black
color.
The earliest change is greenish color of the skin seen at the
region of the right iliac fossa and it gradually spreads over the
whole abdominal wall. Blood later extravasates into the cavities
of the body.
Marbolization — It is the prominence of the superficial veins
with reddish discoloration during the process of decomposition
which develops on both flanks of the abdomen, root of the neck
and shoulder and which makes the area look like a "marbled"
reticule of branching veins. This is observed easily among dead
persons with fair complexion.
b. Evolution of Gases in the Tissues:
One of the products of putrefaction is the evolution of gases.
Carbon dioxide, ammonia, hydrogen, sulphurated hydrogen,
phosphoretted hydrogen, and methane gases are formed. The
offensive odor is due to these gases and also due to a small
quantity of mercaptans.
The formation of gases causes the distention of the abdomen
and bloating of the whole body. Gases formed in the subcutaneous tissues and in the face, and neck cause swelling of the
whole body. Small gas bubbles are found in solid visceral
organs and give rise to the "foamy" appearance of the organs.
Effects of the Pressure of Gases of Putrefaction:
(1) Displacement of the Blood:
There may be post-mortem bleeding in open wounds on
account of the increased pressure inside the body brought
about by the accumulation of gases. The post-mortem
lividity may be shifted to other parts of the body. The
heart may empty itself of blood.
(2) Bloating of the Body:
On account of the accumulation of gas, the body is
blown-up and swollen. The eyes may be protruding from
its sockets, the tongue may come out of the mouth, and
the face is black with thick lips having the appearance of
a negro (tete de negri).
( 3 ) Fluid Coming Out of Both Nostrils and Mouth:
Fluid coming out of both nostrils and mouth is usually
in the form of froth. It is due to the putrefaction of the
upper gastro-intestinal and respiratory tracts.
( 4 ) Extrusion of the Fetus in a Gravid Uterus:
On account of the increased intra-abdominal pressure,
the contents of the gravid uterus may be expelled, but this
138
LEGAL MEDICINE
event is quite doubtful when the product of conception is
nearing full term because of the difficulty of expulsion.
There is more likelihood for the uterus to rupture inside
the abdominal cavity.
(5) Floating of the Body:
The specific gravity of a decomposed body is much less
as compared with a recently dead. This is brought about by
the increase of gaseous content and increase in volume due
to bloating without any increase in weight,
c. Liquefaction of the Soft Tissues:
As decomposition progresses, the soft tissues of the body
undergo softening and liquefaction. The eyeballs, brain, stomach,
intestine, liver and spleen putrefy rapidly, while highly muscular
organs and tissues relatively putrefy late.
Decomposition in water with bloating of the whole body, blackening of the face and
attitude of the extremities at the time of recovery.
Factors Modifying the Rate of Putrefaction:
a. Internal Factors:
(1) Age:
Healthy adults decompose later than infants. It may be
late in a newborn infant who have not yet been fed. Markedly emaciated person has the tendency to mummify.
MEDICO-LEGAL ASPECTS OF DEATH
139
(2) Condition of the Body:
Those of the full-grown and highly obese persons decompose more rapidly than skinny ones. Bodies of still-born
are usually sterile so decomposition is retarded.
( 3 ) Cause of Death:
Bodies of persons whose cause of death is due to infection decompose rapidly. This is also true when the
diseased condition is accompanied with anasarca. Bodies
whose sudden death is not due to microorganism decompose late.
b. External Factors:
(1) Free Air:
(a) Air — The accessibility of the body to free air will
hasten decomposition.
(b) Moderate Moisture — Moderate amount of moisture will
accelerate decomposition, but excessive amount will
prevent the access of air to the body thereby delaying
decomposition. Moisture is necessary for the growth
and multiplication of bacteria, however, if the evaporation of fluid is marked, there will be mummification of the tissues and putrefaction will be retarded.
(c) Condition of the Air — If the air is loaded with septic
bacteria, decomposition will be hastened.
(d) Temperature of the Air — The optimum temperature
for specific decomposition is 70°F to 100°F. Decomposition does not occur at temperatures below 32°F
or about 212°F.
(e) Light — The organism responsible for the putrefaction
prefers more the absence of light.
(2) Earth:
Dry absorbent soil retards decomposition while moist
fertile soil accelerates decomposition.
( 3 ) Water:
Decomposition in running water is more rapid than in
still water. Bacteria-laden pools will accelerate decomposition.
( 4 ) Clothings:
Clothings initially hasten putrefaction by maintaining
body temperature but in the later stage, clothings delay
decomposition by protecting the body from the ravages
of flies and other insects. Tight clothings delay putrefaction
140
LEGAL MEDICINE
due to the diminution of blood in the area on account
of pressure.
Physical Changes of the Body during Putrefaction in Chronological
Order:
a. External Changes:
(1) Greenish discoloration over the iliac fossa appearing after
one to three days.
(2) Extension of the greenish discoloration over the whole
abdomen and other parts of the body.
(3) Marked discoloration and swelling of the face with bloody
froth coming out of the nostrils and mouth.
(4) Swelling and discoloration of the scrotum, or of the vulva.
(5) Distention of the abdomen with gases.
(6) Development of bullae in the face of varying sizes.
(7) Bursting of the bullae and denudation of large irregular
surfaces due to the shedding of the epidermis.
(8) Escape of blood-stained fluid from the mouth and nostrils.
(9) Brownish discoloration of the surface veins giving an
arborescent pattern on the skin.
(10) Liquefaction of the eyeballs.
(11) Increased discoloration of the body generally and progressive increase of abdominal distention.
(12) Presence of maggots.
(13) Shedding of the nails and lossening of the hairs.
(14) Conversion of the tissue into semi-fluid mass.
(15) Facial feature unrecognizable.
(16) Bursting of the abdomen and thoracic cavities.
(17) Progressive dissolution of the body.
b. Internal Changes:
(1) Those which Putrefy Early:
(a) Brain.
(b) Lining of the trachea and larynx.
(c) Stomach and intestines.
(d) Spleen.
(e) Liver.
(f) Uterus (if pregnant or in puerperal stage).
(2) Those which Putrefy Late:
(a) Esophagus.
(b) Diaphragm.
(c) Heart.
(d) Lungs.
(e) Kidneys.
(f) Urinary bladder.
MEDICO-LEGAL ASPECTS OF DEATH
141
(g) Uterus (if not gravid).
(h) Prostate gland.
Organs rich in muscular tissues resist putrefaction longer than the
parenchymatous organs with the exception of the stomach and
intestines which by reason of their contents at the time of death
decompose quickly.
Factors Influencing the Changes in the Body after Burial:
a. State of the Body Before Death:
An emaciated person at the time of death will decompose
slower as compared with well-nourished individual when placed
under the same conditions and circumstances. Skinny person
has more tendency to mummify, especially at the regions of
the extremities.
b. Time Elapsed between Death and Burial and Environment of
the Body:
If the temperature of the surroundings at the time of death is
conducive for the growth and multiplication of bacteria, then
the longer the time such body is exposed to such condition
the faster is the decomposition. However, if the body has been
frozen to death for quite a time, there will be retardation of
body decomposition. The presence of filthy, pultaceous and
organic materials in the surroundings coupled with the presence
of light and optimum temperature will enhance the decomposition.
c. Effect of Coffin:
The use of a coffin will delay decomposition if it is airtight and hard. If soft and weak, water can easily percolate at
the floor and top, thus it will not serve the purpose. The body
in a coffin usually decompose later as compared with the body
which is coffinless.
d. Clothings and Any Other Coverings on the Body when Buried:
Clothings and other body coverings delay decomposition.
Most often the covered portions of the body are well preserved
for sometime.
The most probable reasons why clothings
retard decomposition are:
(1) It affords some protection from insects and aids adipocere
formation keeping the body under it continuously moist by
absorbing water from the soil.
(2) The pressure of the clothings on the body.
e. Depth at which the Body was Buried:
As a general rule, the greater the depth the body has been
buried, the better is the preservation. There is aeration in
142
LEGAL MEDICINE
shallow grave and this is a conducive invitation for injects and
other animals. The changes of temperature of the body on
account of the changing weather conditions is more marked
in shallow graves.
f. Condition and Type of Soil:
Dry, arid and sandy soil promotes mummification of the
body. The presence of straw or other organic matters that will
introduce more bacteria will accelerate decomposition.
g. Inclusion of Something in the Grave which will Hasten Decomposition:
Some organic materials, like food are sometimes included
with the dead body inside the coffin because of their superstition that it will be utilized by the departed soul in its life
hereafter. Its presence inside the coffin will accelerate putrefaction.
h. Access of Air to the Body After Burial:
Air may hasten evaporation of the body fluid and promotes
mummification. Bacteria-laden air will promote decomposition.
Humid air will enhance adipocere formation. However, accessibility of air means also accessibility of insects and other
scavengers which will promote destruction of the soft tissues of
the body.
i. Mass Grave:
This is seldom seen, except in mass massacre, war and in
plane crash. There is relatively rapid decomposition of the
bodies,
j. Trauma on the Body:
Persons dying from infection decompose rapidly while those
dying of violent death decompose relatively slow.
On account of the presence of several factors which modify
decomposition of the body after death, it is quite difficult to
make an estimate as to the duration of death of a decomposed
body without considering those different elements influencing it.
Chronological Sequence of Putrefactive Changes Occurring in
Temperate Regions:
Putrefactive Changes
Time
a. Greenish discoloration over the
iliac fossae. The eyeballs are soft
and yielding.
1 to 3 days after death.
b. Greenish discoloration spreading
over the whole abdomen, external
genitals and other parts of the
MEDICO-LEGAL ASPECTS OF DEATH
143
body. Frothy blood from the
mouth and nostrils.
3 to 5 days after death.
Abdomen distended with gas.
Cornea fallen in and concave.
Purplish red streaks of veins
prominent on the extremities.
Sphincters relaxed. Nails firm.
8 to 10 days after death.
Body greenish-brown. Blisters
forming all over the body. Skin
peels off.
Features unrecognizable.
Scrotum
distended.
Body swollen up owing to
distention. Maggots found on the
body. Nails and hair loose and
easily detached.
14 to 20 days after death.
Soft parts changes into a thick,
semi-fluid black mass.
Skull
exposed. Orbits empty.
2 to 5 months after death.
(Casper, Forensic Medicine, cited by Modi, Medical Jurisprudence and Toxicology, 12 ed., 157, p. 134).
Chronological Sequence of Putrefactive Changes Occurring in
Tropical Region:
Time Since Death
Condition of the Body
12 hours
Rigor mortis present all over. Hypostasis
well-developed and fixed. Greenish discoloration showing over the caecum.
Rigor mortis absent all over. Green dis24 hours
coloration over whole abdomen and
spreading to chest. Abdomen distended
with gases.
Ova of flies seen.
48 hours
Trunk bloated. Face discolored and
swollen.
Blisters present. Moving
maggots seen.
Whole body grossly swollen and dis72 hours
figured. Hair and nails loose. Tissues
soft and-discolored.
One week
Soft viscera putrefied.
Only more resistant viscera distinguishTwo weeks
able. Soft tissues largely gone.
Body skeletonized.
One month
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LEGAL MEDICINE
(From: — Lambert's Medico-Legal Post-mortem in India, 2nd ed.,
p. 25).
Body decomposition in warm countries, according to Lambert,
will reduce the whole body to a skeleton in a month's time when
exposed to air. In water, putrefaction proceeds twice as slowly
as it is in air. When the body is buried, the rate depends on the
mode of burial. In deep burial with coffin, putrefaction proceeds
from four to six times as slowly as compared with that one in
air, but with shallow coffinless burial, it is very slightly retarded.
Decomposition - Soft tissues of the chest and head have disappeared while
those of the abdomen and extremities are mummified.
Chronological Sequence of Putrefactive Changes When the Body
Has Been Submerged in Water:
Putrefactive Changes
Time
a. Very little change if water is
cold. Rigor mortis may persist.
First four or five days.
b. The skin on the hands and feet
became sodden and bleached.
The face appears softened and
lias a faded white color.
From five to seven days.
c. Face swollen and red. Greenish
discoloration on the eyelids, lips,
neck and sternum. Skin of the
hands and feet wrinkled. Upper
MEDICO-LEGAL ASPECTS OF DEATH
145
surface of brain greenish in
color.
One to two weeks.
d. Skin wrinkled. Scrotum and penis
distended with gas. Nails and
hair still intact. Lungs emphysematous and covered the heart.
Four weeks.
e. Abdomen distended, skin of
hands and feet come off with
nails like a glove.
Six to eight weeks.
(Observation of Devergie, cited by Modi, Medical Jurisprudence
and Toxicology, 12th ed. 1957, p. 138).
Factors Influencing the Floating of the Body in Water:
a. Age:
Bodies of fully-developed and well-nourished newly-born
infants float relatively rapid.
b. Sex:
Women float sooner than men. This is due to the lightness of
female bones and greater porportion of fat, hence lesser specific
gravity.
c. Conditions of the Body:
Stout persons float quicker than skinny, lean and thin
bodies. Bodies with loose clothings will soon come to the
surface.
d. Season of the Year:
The moist hot air of summer is very favorable for putrefaction. Putrefaction makes the body bloat on account of gas
formation, hence it will accelerate floating of the body.
e. Water:
Dead body floats in a shallow and stagnant water of creeks
or pond sooner than in deep water of running stream. The stagnant water has higher specific gravity than clear water, so it is
easy for the dead body to overcome it by gas formation. Body
floats sooner in sea than in fresh water on account of the high
specific gravity of sea water.
f. External Influence:
The presence of heavy-wearing apparel or the addition of
weight in the pockets or attached to the body by means of
rope or string will delay the floating of the body.
Order of Putrefaction When the Body is in Water:
a. Face and neck or sternum.
b. Shoulders.
LEGAL MEDICINE
146
c. Arms.
d. Abdomen.
e. Legs.
Decomposition — The whole body almost skeletonized
Influence of Bacteria in Decomposition:
Decomposition is due to action of bacteria in various tissues of
the body. During the early period of decomposition, aerobic
activities are prominent. Later, the facultative aerobes and anaerobes are present. In the advanced stage, the activities of the
anearobes are the most prominent with the production of gasses.
The softening of the tissues is the result of bacterial action,
proteolytic and autolytic ferments.
The microorganism that plays an important and dominant
role in decomposition is Clostridium welchii. This bacteria starts
to grow in parenchymatous organs. It is responsible for the disintegration of cytoplasm, destruction of nuclei and generation of
gases in the cells.
Other bacteria which participate in tissue destruction during
the period of decomposition are:
a. Bacillus coli.
b. Bacillus proteus vulgaris.
c. Bacillus mesentericus.
d. Bacillus aerogenes capsulatus.
MEDICO-LEGAL ASPECTS OF DEATH
147
Other Destructive Agents During Decomposition:
a. Flies:
(1) Maggots (Larvae):
The presence of maggots is dependent upon the accessibility of the body to adult flies. The flies lay eggs which
after a time is hatched to form maggots. The maggots have
a strong desire to live in damaged skin surface. Maggots
may also be observed in bodies buried in shallow graves
and even in floating decomposed bodies in water pools.
(2) Adult Flies:
The common house flies are carnivorous.* They devour
the juicy areas of exposed portions of the body. Destruction
by adult flies is observed better when the body is found on
surface ground.
b. Reptiles:
Lizards and snakes are attracted to dead bodies and eat the
soft tissues. Small bones may be fractured in the process and
may be mistaken for injuries during the life time of the deceased.
c. Rodents:
Rats and mice will nibble the skin and other tissues and may
show unexplainable injuries. The bones may also be attacked
and showed certain degree of erosions.
d. Other Mammals:
The dogs may participate in the destruction of the soft
tissues especially in cases where the victim is lying on the
ground. In most instances, the different parts of the body is
scattered and separated from one another. A part may be
missing or seen in some far distant places. In India, jackals
also participate in the destruction of decomposed tissues.
e. Fishes and Crabs:
If the body is in water, fish of almost all species and crustacean will be feeding on the soft tissues. Man-eating fishes
like sharks may devour the whole body of a person.
f. Molds:
As a general rule, molds do not destroy the dead bodies but
their growth cause disfigurement and minor superficial lesions
on the skin.
After a period of time, all of the soft tissues of the body will
disappear. Only the teeth, bones and hair will remain. These
tissues will remain undestroyed for an indefinite time. The
bones may show signs of disintegration by the diminution of
LEGAL MEDICINE
weight and erosion of the epiphysis. Flat bones disintegrate
faster than round bones. The degree of ossification is also a
factor in the bone destruction.
Death in the sea with post-mortem erosion of the face due to the activities
of the fishes and other aquatic animals.
SPECIAL MODIFICATION OF PUTREFACTION:
a. Mummification:
Mummification is the dehydration of the whole body which
results in the shivering and preservation of the body. It usually
occurs when a dead body is buried in a hot, and arid place with
dry atmosphere and with free access of hot air. In most cases,
the natural physical appearance is not modified, hair may be
kept intact although there may be change in color of the skin.
The internal organs may be shrunken, hard and with a darkbrown or black color. If the whole fluid contents of the body
has evaporated, preservation is for an indefinite time but the
whole body may become brittle, weight markedly reduced
and may later be destroyed by pulverization.
Mummification is observed in warm countries where evaporation of body fluid takes place earlier and faster than
decomposition. Death in deserts, like in Egypt, the body has
more tendency to mummify. However, a mummified body
may after a time be attacked by moths and verm ins causing
destruction.
MEDICO-LEGAL ASPECTS OF DEATH
149
Kinds of Mummification:
(1) Natural Mummification;
When a person is buried in hot, arid, sandy soil, there will
be insufficient moisture for the growth and multiplication
of putrefactive bacteria. The body will become dehydrated
and mummified which is caused by the forces of nature.
(2) Artificial Mummification:
The principles involved in artificial mummuification are:
(a) Acceleration of the evaporation of the tissue fluid of
the body before the actual onset of decomposition.
(b) Addition of some body preservatives to inhibit decomposition and to allow evaporation of fluid. This is made
by treatment of the body with arsenic, formalin, resinous or tarry materials.
b. Saponification or Adipocere Formation:
This is a condition wherein the fatty tissues of the body are
transformed to soft brownish-white substance known as adipocere. The layer of subcutaneous tissue is the frequent site of
its formation. It occurs naturally in the visceral organs and
even in non-fatty tissues of the body like the muscles.
Adipocere is a waxy material, rancid or moldy in odor,
floats in water, and dissolves in ether and alcohol. With diluted
solution of copper sulfate, it gives a light greenish-blue color. It
is inflammable and burns with a faint yellow flame. When
distilled it produces a dense oily vapor.
Some Theories on the Formation of Adipocere:
(1) The fats of the body split into glycerol and fatty acids.
The fatty acids combine with calcium, magnesium, potassium, sodium, and ammonium salts to form an insoluble
soap. These ester of fatty acid somehow delay body decomposition and make the body surface greasy to touch.
(2) There is gradual hydrogenation of pre-existing fat in the
body like olein to higher fatty acids. Hydrogenation
causes remarkable swelling and stiffening of the fats. The
new hydrogenated fat is quite stable but on exposure to
air becomes yellow, hard and brittle.
Factors Influencing Adipocere Formation in Earth Burial:
(1) State of Health Before Death:
Adipocere formation depends primarily on the presence
of fat in the body of the deceased. It is difficult for adi-
LEGAL MEDICINE
pocere to develop in the state of extreme emaciation.
Areas of the body where fat is abundant develop adipocere
recognizable through the naked eye rapidly as compared
with the other areas. The amount of water in the surroundings is not very essential to the phenomena. Water of the
body may be drawn from the muscles and internal organs.
(2) Time Interval between Death and Burial:
Generally, the longer the space of time interval between
death and burial, the greater is the degree of adipocere
formation. This is further accelerated when the body is
subjected to autopsy. Exposure of the internal organs
to external elements promotes enzymatic and bacterial
actions in the process of hydrolysis and glycerol formation.
(3) Effect of the Coffin:
The coffin has air space and if crudely made, it may
allow water to come in contact with the body surface
thereby enhancing hyrolysis of fat. If water has been freely
admitted, colliquative putrefaction will develop for a
longer time thus making adipocere formation scanty.
(4) Presence of Clothings and Other Coverings of the Body:
Adipocere formation is found to be more advanced
under clothings or other body coverings, especially if the
clothings are tight.
(5) Type of Soil:
Dry soil is conducive to mummification. Sufficiently
moist soil accelerates adipocere formation.
(6) Access of Air to the Body After Burial:
The disturbance of a body in the grave shortly after
burial or before the formation of adipocere prolongs its
formation.
(7) Mass Grave:
There is more tendency for adipocere formation when
several bodies are located in a grave because of the abundance of moisture.
Maceration:
This is the softening of the tissues when in a fluid medium
in the absence of putrefactive microorganism which is frequently observed in the death of the fetus en utero.
When the fetus dies en utero, provided that the death of the
fetus is not due to attempted abortion or rupture of the membrane, the child is enclosed by the membrane in sterile con-
MEDICO-LEGAL ASPECTS OF DEATH
151
dition. Putrefaction does not take place and the fetus becomes
soft. The softening of the body may be due to the action of
the autolytic and proteolytic enzymes and ferments. /
The appearance of the fetus is typical. The hody is discolored either reddish or greenish with the skin peeling off and
the arms flaccid and frail. As maceration advances, there is
brownish-red discoloration of the skin. There may be blister
formation and the odor is somewhat rancid. For a definite and
appreciable degree of maceration to take place, it requires about
twenty-four hours.
DURATION OF DEATH
In the determination as to how long a person has been dead from
the condition of the cadaver and other external evidences, the
following points must be taken into consideration:
1. Presence of Rigor Mortis:
In warm countries like the Philippines, rigor mortis sets in
from 2 to 3 hours after the death. It is fully developed in the
body after 12 hours. It may last from 18 hours to 36 hours
and its disappearance is concomitant with the onset of putrefaction.
2. Presence of Post-mortem Lividity:
Post-mortem lividity usually develops 3 to 6 hours after
death. It first appears as a small petechia-like red spots which
later coalesce with each other to involve bigger areas in the
most dependent portions of the body depending upon the
position assumed at the time of death.
3. Onset of Decomposition:
In the Philippines like other tropical countries, decomposition is early and the average time is 24 to 48 hours after death.
It is manifested by the presence of watery, foul-smelling froth
coming out of the nostrils and mouth, softness of the body and
presence of crepitation when pressure is applied on the skin.
4. Stage of Decomposition:
The approximate time of death may be inferred from the
degree of decomposition, although it must be made with extreme
caution. There are several factors which modify putrefaction of
the body. For the stage of decomposition and the approximate
time after death, see tabulations (supra p. 143).
5. Entomology of the Cadaver:
In order to approximate the time of death by the use of the
flies present in the cadaver, it is necessary to know the life cycle
152
LEGAL MEDICINE
of the flies. The common flies undergo larval, pupal and adult
stages. The usual time for the egg to be hatched into larva is
24 hours so that by the. mere fact that there are maggots in the
cadaver, one can conclude that death has occurred more than
24 hours.
6. Stage of Digestion of Food in the Stomach:
It takes normally 3 to 4 hours for the stomach to evacuate its
contents after a meal. The approximate time of death may be
deduced from the amount of food in the stomach in relation to
his last meal. This determination is dependent upon the amount
of food taken and the degree of tonicity of the stomach.
The extent of the gastric emptying and the progression of the
meal in the gastro-intestinal tract can be useful in estimating the
time of death. However, the position and condition of the decedent's last meal is influenced by the following factors:
a. Size of the Last Meal — The stomach usually starts to empty
within ten minutes after the first mouthful has entered. A
light meal leaves the stomach within 1-1/2 to 2 hours after
being eaten. A medium-sized meal will require 3 to 4 hours.
A heavy meal is entirely expelled into duodenum in 4 to 6
hours.
b. Kind of Meal — Liquid move more rapidly than semi-solid and
the latter more rapidly than solids.
c. Personal Variation — Psychogenic pylorospasm can prevent
departure of the meal from a stomach for several hours, contrariwise, a hypermotile stomach may enhance entry of food into
the duodenum.
d. Other Factors:
(1) Kinds of Food Eaten — Vegetables may require more time
for gastric digestion. The less fragmentation of the food
will require more time to stay in the stomach. The absence or insufficiency of pepsin and other digestive ferments will delay the food in the stomach. Absence or
insufficiency of the gastric hydrochloric acid content
and lesser amount of liquid consumed with solid food
will likewise delay gastric evacuation.
The head of the meal ordinarily reaches the distal ileum and
cecum between 6 and 8 hours after eating.
The conclusion may be of value in the estimation of death if
one is familiar with the decedent's eating habit and meal time,
quantity of the last meal and the interval between the last two
meals.
MEDICO-LEGAL ASPECTS OF DEATH
153
7. Presence of Live Fleas in the Clothings in Drowning Cases:
A flea can survive for approximately 24 hours submerged in
water. It can no longer be revived if submerged more than that
period. In temperate countries, people use to wear woolen
clothes. If the body is found in water, the fleas may be found
in the woolen clothings. The fleas recovered must be placed in
a watch glass and observed if it is still living. If the fleas still
could move, then the body has been in water for a period less
than 24 hours. Revival of the life of the fleas is not possible if
they are in water for more than 24 hours.
8. Amount of Urine in the Bladder:
The amount of urine in the urinary bladder may indicate the
time of death when taken into consideration, he was last seen
voiding his urine. There are several factors which may modify
urination so it must be utilized with caution.
9. State of the Clothings:
A circumstantial proof of the time of death is the apparel
of the deceased. If the victim is wearing street clothes, there
is more likehood that death took place at daytime, but if in
night gown or pajama, it is more probable that death occurred
at night time.
10. Chemical Changes in the Cerebrospinal Fluid (15 Hours Following Death):
a. Lactic acid increases from 15 mg. to 200 mg. per 100 cc.
b. Non-protein nitrogen increases from 15 to 40 mg.
(
c. Amino-acid concentration rises from 1 to 12% following death.
11. Post-mortem Clotting and Decoagulation of Blood:
Blood clots inside the blood vessels in 6 to 8 hours after death.
Decoagulation of blood occurs at the early stage of decomposition. The presence of any of these conditions may infer
the approximate duration of death.
12. Presence or Absence of Soft Tissues in Skeletal Remains:
Under ordinary condition, the soft tissues of the body may
disappear 1 to 2 years time after burial. The disappearance of
the soft tissues varies and are influenced by several factors.
When the body is found on the surface of the ground, aside
from the natural forces of nature responsible for the destruction
of the soft tissues, external elements and animals may accelerate
its destruction.
13. Condition of the Bones:
If all of the soft tissues have already disappeared from the
skeletal remains, the degree of erosion of the epiphyseal ends of
LEGAL MEDICINE
154
long bones, pulverization of flat bones and the diminution of
weight due to the loss of animal matter may be the basis of the
approximation.
Post-mortem Conditions Simulating Disease, Poisoning or Injury:
a. Post-mortem hypostasis simulating contusion or inflammation
or poisoning.
b. Blister of the cuticle simulating scalds or burns.
c. Swelling, detachment or splitting of the skin simulating
injury.
E. PRESUMPTION OF DEATH
Rule 131, Sec. 5(x), Rules of Court:
Disputable Presumption:
That a person not heard from for seven years, is dead.
Presumption of Death:
Art. 390, Civil Code and Sec. 5(x), Rule 131, Rules of Court:
After an absence of seven years, it being unknown whether or not
the absentee still lives, he shall be presumed dead for all purposes,
except for those of succession.
The absentee shall not be presumed dead for the purpose of
opening his succession till after an absence of ten years. If he disappeared after the age of seventy-five years, an absence of five years
shall be sufficient in order that his succession may be opened.^
Art. 391, Civil Code and Sec. 5(x), Rule 131, Rules of Court:
The following shall be presumed dead for all purposes, including
the division of the estate among the heirs:
(1) A person on board a vessel lost during a sea voyage, or an
aeroplane which is missing, who has not been heard of for
four years since the loss of the vessel or aeroplane.
(2) A person in the armed forces who has taken part in war, and
has been missing for four years:
(3) A person who has been in danger of death under other circumstances and his existence has not been known for four years.
Art. 392, Civil Code:
If the absentee appears, or without appearing his existence is
proved, he shall recover his property in the condition in which it
may be found, and the price of any property that may have been
alienated or the property acquired therewith; but he cannot claim
either fruits or rents
MEDICO-LEGAL ASPECTS OF DEATH
155
F. PRESUMPTION OF SURVIVORSHIP
Sec. 5(jj), Rule 131, Rules of Court:
When two persons perish in the same calamity, such as wreck,
battle, or conflagration, and it is not shown who died first, there
are no particular circumstances from which it can be inferred, the
survivorship is presumed from the probabilities resulting from the
strength and age of the sexes, according to the following:
1. If both were under the age of fifteen years, the older is presumed to have survived;
2. If both were above the age of sixty, the younger is presumed
to have survived;
3. If one is under fifteen and the other above sixty, the former
is presumed to have survived;
4. If both be over fifteen and under sixty, and the sexes be different, the male is presumed to have survived; if the sexes be the
same, then the older;
5. If one be under fifteen or over sixty, and the other between
those ages, the latter is presumed to have survived.
Art. 43, Civil Code:
If there is a doubt, as between two or more persons who are called
to succeed each other, as to which of them died first, whoever
alleges the death of one prior to the other, shall prove the same; in
the absence of proof, it is presumed that they died at the same time
and there shall be no transmission of rights from one to the other.
Chapter V
MEDICO-LEGAL INVESTIGATION OF DEATH
An inquest officer is an official of the state charged with the duty
of inquiring into certain matters. In a medico-legal investigation,
an inquest officer is the one charged with the duty of investigating
the manner and cause of death of a person. He is authorized to
summon witnesses and direct any person to perform or assist in the
investigation when necessary.
The following officials of the government are authorized to make
death investigations:
1. The Provincial and City Fiscals:
Sec. 983, Revised Aministrative Code:
The district health officer, upon the request of any provincial fiscal of a province within his district, or of any judge of
a Court of the First Instance (now Regional Trial Court), or of
any justice of the peace (now, Municipal Trial Court), shall conduct in person, when practicable, investigations in cases of death
where there is suspicion that death was caused by the unlawful act
or omission of any person, and shall make such other investigations as may be required in the proper administration of
justice.
Sec. 38, Rep. Act 409 as amended by Rep. Act. 1934 (Revised
Charter of the City of Manila):
The City Fiscal shall also cause to be investigated the cause of
sudden deaths which have not been satisfactorily explained and
when there is suspicion that the cause arose from the unlawful
acts or omissions of other person, or from foul play, and, in
general, victims of violence, sex crimes, accidents, self-inflicted
injuries, intoxications, drug addiction, states of malingering and
mental disorders, which occur within the jurisdiction of the
City of Manila, and the examination of evidences and telltale
marks of crimes. For that purpose, he may cause autopsies to
be made and shall be entitled to demand and receive for purposes of the office of the medical examiner, or the criminal
investigation laboratory of the Manila Police Department, or
subject to the rules and conditions previously established by
the Secretary of Justice, the aid of the medico-legal section
of the National Bureau of Investigation. If in case the fiscal
156
MEDICO-LEGAL INVESTIGATION OF DEATH
157
of the city deems it necessary to have further expert assistance for
the satisfactory performance of his duties in relation with medicolegal matters or knowledge, including the giving of medical testimony in the courts of justice, he shall request the same, in the
same manner and subject to the same rules and conditions as
above specified, from the office of the medical examiner, or from
the criminal investigation laboratory of the Manila Police Department, or from the medico-legal officer of the said bureau, who shall
thereupon furnish the assistance required in accordance with
his powers and facilities. He shall at all times render such professional services as the Mayor or board may require and shall
have such powers and perform such other duties as may be prescribed by law or ordinance.
2. Judges of the Courts of the First Instance (now Regional Trial
Courts) Sec. 983, Revised Administrative Code (Supra).
3. Justice of the Peace (now Municipal Trial Courts) Sec. 983,
Administrative Code (Supra).
4. The Director of the National Bureau of Investigation — Rep. Act.
157 (An act creating the National Bureau of Investigation).
Sec. 1. — There is hereby created a Bureau of Investigation
under the Department of Justice which shall have the following
functions:
(a) To undertake investigations of crimes and other offenses
against the laws of the Philippines, upon its own initiative and
as public interest may require;
(b) To render assistance, whenever properly requested in the investigation or detection of crimes and other offenses;
(c) To act as a national clearing house Of criminal and other
information for the benefit of all prosecuting and law-enforcement entities of the Philippines, identification records of
all persons without criminal convictions, records of identifying marks, characteristics, and ownership or possession of all
firearms as well as the test bullets fired therefrom;
(d) To give technical aid to all prosecuting and law-enforcement
officers and entities of the Government as well as courts that
may request its services;
(e) To extend its services, whenever properly requested in the
investigation of cases of administrative or civil nature in which
the government is interested;
(f) To undertake the instruction and training of a representative
number of city and municipal peace officers at the request
of their respective superiors along effective methods of crime
158
LEGAL MEDICINE
investigation and detection in order to insure greater efficiency
in the discharge of their duties;
(g) To establish and maintain an up-to-date scientific crime
laboratory and to conduct researches in the furtherance of
scientific knowledge in criminal investigation;
(h) To perform such other related functions as the Secretary (now
Minister) of Justice may assign from time to time.
Sec. 5. — The members of the investigation staff of the Bureau
of Investigation shall be peace officers, and as such have the
following powers:
(a) To make arrests, searches, and seizures in accordance with
existing laws and rules;
(b) To issue subpoena or subpoena duces tecum for the appearance
at government expense of any person for investigation;
(c) To take and require sworn truthful statements of any person
or person so summoned in relation to cases under investigation,
subject to constitutional restrictions;
(d) To administer oaths upon cases under investigation;
(e) To possess suitable and adequate firearms for their personal
protection in connection with their duties and for the proper
protection of witnesses and persons in custody; Provided, that
no previous special permit for such possession shall be required;
(f) To have access to all public records and, upon authority of
the President of the Philippines in the exercise of his visitorial
powers, to record of private parties and concerns.
5. The Chief of Police of the City of Manila:
Sec. 34, Rep. Act 409 (Revised Charter of the City of Manila)
as amended by Sec. 1, Rep. Act. 1934 — Chief of Police:
There shall be a chief of police. . . (who) shall cause medicolegal examination by the medical examiner of the Manila Police
Department of victims of violence or foul play, sex crimes, accidents, sudden death when the cause thereof is not known, selfinflicted injuries, intoxication, drug addiction, states of malingering and mental disorders, which are being investigated by the
Manila Police Department or, in exceptional cases, by other
agencies requesting assistance of the Manila Police Department;
and shall cause examination by the medical examiner of the Manila Police Department or by a criminal investigation laboratory
established within said department, or evidences and telltale
marks of crime. He shall have such powers and perform such
further duties as may be prescribed by law or ordinances.
MEDICO-LEGAL INVESTIGATION OF DEATH
159
6. Solicitor General:
Sec. 95 (b) P.D. 856 (Code of Sanitation of the Philippines)
Autopsies shall be performed in the following cases:
3
4. Whenever the Solicitor General, provincial or city fiscal
as authorized by existing laws, shall deem it necessary to
disinter and take possession of remains for examination to
determine the cause of death.
Stages of Medico-Legal Investigation:
1. Crime Scene Investigation (Investigation of the place of commission of the crime).
2. Autopsy (Investigation of the body of the victim).
1. CRIME SCENE INVESTIGATION:
The crime scene is the place where the essential ingredients of
the criminal act took place. It includes the setting of the crime
and also the adjoining places of entry and exit of both offender
and victim.
Not all crimes have a well-defined scene, like estafa, malversation, continuing crimes, etc. However, where medical evidence
may be present, like murder, homicide, physical injuries, sex
crime, crime scene is almost invariably present.
Violent death in a vehicular accident scene.
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LEGAL MEDICINE
Crime scene investigation includes appreciation of its condition
and drawing an inference from it. It also includes the collection of
the physical evidences that may lead to the identity of the perpetrator, the manner the criminal act was executed, and such
other things that may be useful in the prosecution of the case.
Importance of Crime Scene Investigation:
A great amount of physical evidence may be lost or unrecovered
if the investigation merely starts at the autopsy table or in the medical examining room. Blood, semen and other stains, latent finger
and foot prints, and articles of value that may lead to the identification of the offender and victim may be beyond the comprehension
of the investigator if the crime scene is not investigated.
In violent death.cases, the manner and cause of death may be
inferred from the condition of the crime scene. The condition of
the crime scene may indicate struggle, handgun firmly grasped in
the palm of the hand of the deceased may indicate suicide, the
presence of a great quantity of shed blood may infer hemorrhage
as the cause of death of the victim.
The investigator has the earliest possible opportunity to interview persons who have knowledge of the circumstances of actual
events in the commission of the criminal act. The proximity of
the narration to the actual occurrence makes it reliable than those
given after a lapse of time. ^
Persons to Compose the Search Team:
a. A physician who has had previous knowledge and training in
medico-legal investigation must direct the search and assume
responsibility for an effective search.
b. A photographer who will take pictures of the scene and the
pieces of evidence recovered. He may also act as sketcher and
measurer.
c. An assistant who will act as the note taker, evidence collector
and helper. He must have previous knowledge and training
in evidence collection.
Equipment Needed in Crime Scene Investigation:
a. Those needed in the search of physical evidence — Flashlight
and magnifying lens.
b. Those needed in the collection of evidence — forceps, knife,
screw driver, scalpel, cutting instruments like plier, pair of
scissors and fingerprint kit.
MEDICO-LEGAL INVESTIGATION OF DEATH
D. WHEEL METHOD
E. ZONE METHOD
METHODS OF SEARCH AT THE CRIME SCENE.
161
162
LEGAL MEDICINE
c. Those needed in the preservation and transportation of evidence
collected — Bottles, envelopes, test tubes, pins, thumb tacks,
labelling tag and pencil.
d. Those necessary for the documentation of the scene — Photographic camera, sketching kit, measuring tape, compass, chalk or
any writing instrument.
Methods of Conducting a Search:
Before the actual performance of the search, it is advisable to
stand aside and make an estimate of the situation. A picture of
the whole area must be taken and the area must be cordoned or
bystanders must not be allowed to get in. Depending upon the
size, terrain and condition of the crime scene, the following
methods of search may be applied:
a. Strip Method — The area is blocked out in the form of a rectangle. The searcher proceeds slowly at the same pace along the
path parallel to one side of the rectangle.
b. Double Strip or Grid Method — The searchers will traverse first
parallel to the base and then parallel to the side.
c. Spiral Method — The searchers follow each other in the path in
the spiral manner beginning from the center towards the outside
or vice versa.
d. Wheel Method — The searchers gather at the center and proceed
outwards along radii or spokes.
e. Zone Method — Whole area is divided into subdivisions or
quadrants and search is made in the individual quadrants.
Disposal of the Collected Evidence:
All evidences collected must be protected, identified and
preserved. Reasonable degree of care must be exercised to preserve shape, to minimize alterations due to contamination, chemical changes, addition of extreneous substances. In the process
of transferring of the evidences, the number of persons who
handle them must be kept at a minimum and each transfer should
be receipted.
Examination of the Dead Body in the Crime Scene:
After a complete search, the investigating physician must make
a thorough inspection of the dead body. Special consideration
must be made on the following:
a. Evidences which will tend to prove identity.
b. Position of the victim.
c. Condition of the apparel worn.
d. Approximate time of death.-
MEDICO-LEGAL INVESTIGATION OF DEATH
163
e. Presence of wounding instrument and its approximate distance
from the body.
f. Potential cause of death.
In a death by gunshot, the clothing must be left Undisturbed
at the crime scene. A lot of information may be gathered from
it:
a. The bullet might have produced an exit on the skin but failed to
cause mark or tear on the clothings which through improper
handling may not be recovered.
b. Examination "in situ" may be useful in the determination of
the site of entrance and exit of the bullet and also the trajectory
of the shot.
2. AUTOPSIES:
An autopsy is a comprehensive study of a dead body, performed by a trained physician employing recognized dissection
procedure and techniques. It includes removal of tissues for
further examination.
Autopsies vs. Post-mortem Examination:
Post-mortem examination — refers to an external examination
of a dead body without incision being made, although blood and
other body fluids may be collected for examination.
Autopsy — indicates that, in addition to an external examination, the body is opened and an internal examination is conducted.
(Modern Legal Medicine Psychiatry and Forensic Science by
Curran, McGarry and Petty, p. 51 footnote).
Kinds of Autopsies:
a. Hospital or Non-official Autopsy
b. Medico-legal or Official Autopsy
a. Hospital or Non-official Autopsy:
This is an autopsy done on a human body with the consent
of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical
diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease process; and (5) educating students and physicians (Forensic
Pathology, A Handbook for Pathologists, Fisher and Petty, July
1977, p. 1).
Inasmuch as previous consent of the next of kin is necessary
before a non-official autopsy can be performed, the Civil
164
LEGAL MEDICINE
Code states who is the rightful person to give such consent.
The order is provided in Articles 294 and 305.
The consent shall be obtained from: (1) The spouse; (2) the
descendants of the nearest degree; (3) the ascendants, also of
the nearest degree; (4) the brothers and sisters (Art. 294,
Civil Code).
In case of descendants of the same degree, or of brothers
and sisters, the oldest shall be preferred. In case of ascendants,
the paternal shall have a better right (Art. 305, Civil Code).
b. Medico-Legal or Official Autopsy:
This is an examination performed on a dead body for the
purposes of: (1) determining the cause, manner (mode), and
time of death; (2) recovering, identifying, and preserving
evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating
death due to disease from death due to external cause for
protection of the innocent (Forensic Pathology, A Handbook for Pathologists, Fisher and Petty, July 1977, p. 1).
In cases which require a medico-legal autopsy, the dead
body belongs to the state for the protection of public interest
until such time as a complete and thorough investigation into
the circumstances surrounding the death and the cause thereof
has been completed. The physician entasked to perform such
autopsy is considered to be the authoritative agent and representative of the state who has the "property right" of the
dead body.
All that need to be turned over to the next of kin responsible for burial of the deceased is that remaining portion or
portions of the body not needed for any medicolegal purposes
(Forensic Medicine by Tedeschi, Eckert & Tedeschi, Vol. II,
p. 972).
Sec. 983, Revised Administrative Code — Investigation into
cause of death (supra p. 156).
Sec. 1089, Revised Administrative Code — Proceedings in cases
of suspected violence or crime:
If the person who issues a death certificate has any reason
to suspect or if he shall observe any indication of violence or
crime, he shall at once notify the justice of the peace (now
Municipal Trial Judge), if he be available, or if neither the
justice of the peace nor the auxiliary justice be available, he
shall notify the municipal mayor, who shall take proper steps
MEDICO-LEGAL INVESTIGATION OF DEATH
to ascertain the circumstances and cause of death; and the
corpse of such deceased person shall not be buried or interred
until permission is obtained from the provincial fiscal, if he be
available, and if he be not available, from the mayor of the
municipality in which the death occurred.
When shall an Autopsy be Performed on a Dead Body:
Sec. 95 (b), P.D. 856, Code of Sanitation:
a. Whenever required by special laws;
b. Upon order of a competent court, a mayor and a provincial or
city fiscal;
c. Upon written request of police authorities;
d. Whenever the Solicitor General, Provincial or city fiscal as
authorized by existing laws, shall deem it necessary to disinter
and take possession of the remains for examination to determine
the cause of death; and
e. Whenever the nearest kin shall request in writing the authorities
concerned in order to ascertain the cause of death.
Persons who are Authorized to Perform Autopsies and Dissections:
The following are authorized to perform autopsies and dissections:
a. Health Officers;
b. Medical officers of law enforcement agencies; and
c. Members of the medical staff of accredited hospitals.
(Sec. 95 (a) P.D. 856).
a. Health officers:
The health officers referred to by the Sanitation Code are
the district health officer (now provincial health officer) and
local health officer (now the rural health officer).
(1) District Health Officer (see Sec. 983, Revised Administrative
Code (supra, p. 156).
(2) Local Health Officer:
Sec. 984, Revised Administrative Code —Person to make
investigation — When it is not practicable for the district
health officer to conduct such investigation in person, he
may require any local health officer or member of a municipal board of health who is a registered physician to
perform such duty; and where the services of a registered
physician in the Government service cannot be thus obtained, he may require a "cirujano ministrante" who is a
member of the board or a sanitary inspector to act in the
matter.
b. Medical Officers of Law Enforcement Agencies:
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LEGAL MEDICINE
(1) Medical examiner of the City of Manila (See Sec. 34 and
38 of Rep. Act 409 as amended by Rep. Act. 1934).
(2) Medical staff of the National Bureau of Investigation
which is composed of those assigned in the central office
in Manila under the Medico-Legal Section and those
assigned in the regional offices of the Bureau in accordance with the administrative plantilla implementing
Rep. Act. 157.
(3) Medico-Legal officers of the Philippine Constabulary
assigned in the Philippine Constabulary Crime Laboratory
(PCCL) and those assigned in different regional commands.
Insofar as medico-legal investigation of criminal cases
occurring within the jurisdiction of the City of Manila is
concerned, there are two officers qualified to make the
investigation:
(a) The medical examiners of the Manila Police Department; and
(b) The Medico-Legal Officers of the National Bureau of
Investigation.
The Medical examiner or medico-legal officer "may
investigate cases of sudden deaths, which have not
been satisfactorily explained and when there is
suspicion that the case arose from unlawful acts or
omissions of other persons, or from foul play, and in
general victims of violence, sex crimes, accidents,
self-inflicted injuries, intoxication, drug addiction,. .
." (Sec. 38, Act. 409 as amended by Rep. Act. 1934).
c. Members of the medical staff of accredited hospitals.
Distinction between Pathological (Non-official) and Medicolegal (Official) Autopsies:
Pathological Autopsy
Medico-legal Autopsy
a. Requirement Must have the consent It is the law that gives
of the next of kin.
the consent. Consent of
relatives are not needed.
b. Purpose
Confirmation of clini- Correlation of tissue
cal findings of re- changes to the criminal
search.
act.
c. Emphasis
Notation of all ab- Emphasis laid on effect
normal findings.
of wrongful act on the
body.
Other findings
MEDICO-LEGAL INVESTIGATION OF DEATH
e. Conclusion
f. Minor or
non-pathological
167
may only be noted in
mitigation of the criminal responsibility.
Summation of all ab- Must be specific for the
normal findings irre- purpose of determining
spective of its corre- whether it is in relation
lation with clinical to the criminal act.
findings.
Need not be men- If
the
investigator
tioned in the report. thinks it will be useful
in the administration of
justice, it must be included.
Other Salient Features Peculiar to Medico-Legal Autopsies:
a. Clinical history of the deceased in most instances absent,
sketchy or doubtful.
b. The identity of the deceased is the responsibility of the forensic pathologist.
c. The time of death and the timing of the tissue injuries must
be answered by the forensic pathologist.
d. The forensic pathologist must alert himself of the possible
inconsistencies between the apparent cause of death and his
actual findings in the crime scene.
e. A careful examination of the external surface for possible
trauma including the clothings to determine the pattern of
injuries in relation to the injurious agent.
f. The autopsy report is written in a style that will make it easier
for laymen to read and more clearly organized insofar as the
mechanism of death is concerned.
g. fhe professional and environmental climate of a forensic
pathologist is with the courts, attorneys and police who make
scrutiny of the findings and conclusion.
The following Manner of Death should be Autopsied:
a. Death by violence.
b. Accidental death.
c. Suicides.
d. Sudden death of persons who are apparently in good health.
e. Death unattended by physician.
f. Death in hospitals or clinics (D.O.A.) wherein a physician was
not able to arrive at a clinical diagnosis as the cause of death.
g. Death occurring in an unnatural manner.
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LEGAL MEDICINE
PROCEDURE OF AUTOPSY
Guidelines in the Performance of Autopsies:
1. Be it an official (medico-legal) or non-official autopsy, the pathologist must be properly guided by the purposes for which autopsy
is to be performed. In so doing the purpose of such dissection will
be served.
2. The autopsy must be /comprehensive and must not leave some
parts of the body unexamined. Even if the findings are already
sufficient to account for the death, these should not be a sufficient reason for the premature termination of the autopsy. The
existence of a certain disease or injury does not exclude the possibility of another much more fatal disease or injury. The findings
of coronary disease does not exclude the probability of injury or
poisoning.
3. Bodies which are severely mutilated, decomposing or damaged by
fire are still suitable for autopsy. No matter how putrid or
fragmentary the remains are, careful examination may be productive of information that bears the identity and other physical
trauma received. Frequently a pathologist's reluctance to perform an autopsy on decomposed body is due to the odor or
vermin rather than to his belief that the examination would not
be productive.
4. All autopsies must be performed in a manner which show respect
of the dead body. Unnecessary dissection must be avoided.
A wife consented to the performance of an autopsy but
specifically stated that it must be performed in a "decent"
manner. The autopsy was done in broad daylight in the cemetery in full view of all the neighborhood residents. Thetourt
held that the condition was violated and she was awarded
damage even though she has consented to the examination
(Hill V. Travelers Ins. Co. 294 S.W. 1097, Tenn. 1927).
5. Proper identity of the deceased autopsied must be established in
non-official autopsy. An autopsy on a wrong body may be a
ground for damages.
Two patients occupying adjoining beds died within a fiveminute interval. There was authorization to perform an autopsy on one of them but the nurse interchanged the tags. The
deceased wherein there was no authorization given was autopsied. The next of kin brought an action against the hospital
administrator, the pathologist and the coroner for unauthor-
MEDICO-LEGAL INVESTIGATION OF DEATH
169
ized autopsy. The liability was made on the nurse who unfortunately was not made as one of the defendants (Schwalb
v. Connely, 179p. 2d 667, Colo.).
The award for damages for wrongful autopsy is not on account
of the mutilation of the deceased body but for the injury to the
feelings and mental suffering of the living because of the illegal
act.
After the death of the husband and without the consent of
the wife, an autopsy was performed on the body of the deceased. The widow filed a suit for unlawful autopsy and failure
to replace the brain, heart and organs. The court held that
there is no justification for the autopsy and dismemberment
and have injured the feelings of the widow. The sum of $1,000
was awarded as reasonable damages (Gould v. State of New
York, 181 Misc. 884, 46 N. Y.S. 2d 313).
6. A dead body must riot be embalmed before the autopsy. The
embalming fluid may render the tissue and blood unfit for toxicological analyses. The embalming may alter the gross appearance
of the tissues or may result to a wide variety of artifacts that tend to
destroy or obscure evidence. An embalmer who applied embalming
fluid on a dead body which in its very nature is a victim of violence is liable for his wrongful act.
7. The body must be autopsied in the same condition when found
at the crime scene. A delay in its performance may fail or modify
the possible findings thereby not serving the best interest of
justice.
Precautions to be Observed in Making Medico-Legal Post-mortem
Examination:
1. The physician must have all the necessary permit or authorization to perform such an examination. Such permit must be
issued by the inquest officer. The absence of such authorization
may hold the physician civilly and criminally liable.
2. The physician must have a detaUed'liistory of the previous symptoms and condition of deceased to be used as his guide in the
post-mortem examination.
3. The true^fuentity of the deceased must be ascertained. If no one
claims the body, a complete date to reveal his identity must be
taken.
4. Examination must be made in a Well-lighted place and it is advisable that no unauthorized person should be present.
170
LEGAL MEDICINE
5. All external findings must be properly described and if possible a
sketch must be made or photograph must be taken to preserve the
evidence.
6. All steps and findings in the examination must be recorded.
Rules in the Examination:
1. Look before you cut.
2. Never cut unless you know exactly what you are cutting.
3. Weigh and measure everything that can be weighed or measured.
Stages in the Post-mortem Examination of the Dead Body:
1. Preliminary Examination:
a. Examination of the Surroundings (Crime Scene):
Attention must be focused on the furniture; bullet holes on
the ceiling, floor and walls; amount, color, shape and degree of
spread of the blood stains, position of the wounding weapon;
foot and fingerprints and hairs and clothes.
b. Examination of the Clothings:
Look for marks to establish identity, kind and quality of the
garment, stains, grease, cut and "tear or other marks of resistance
and violence.
c. Identity of the Body:
Determine the height, weight, color of the hair and eyes,
complexion, condition and number of teeth, bodily deformity,
scars and tattoo marks, clothings, dog tag and fingerprints.
2. External Examination:
a. Examination of the Body Surfaces:
Inspect the natural orifice of the body. All wounds must be
described in detail, blood stains and foreign bodies.
b. Determination of the Position and Approximate Time of Death:
In this stage, the presence and degree of hypostasis, rigor
mortis and putrefaction and color of the blood stain must be
noted. Examination of the hands for the presence of cadaveric
spasm and wounding weapon may be necessary for the proper
solution of the crime.
3. Internal Examination:
Examine all body orifices for blood and foreign bodies. Blood
coming out of the nostrils may imply fracture on the base of the
anterior cranial fossa. Hemorrhage of the ears may imply fracture
of the middle cranial fossa.
MEDICO-LEGAL INVESTIGATION OF DEATH
171
Advantages of Starting Autopsy on the Head:
1. If the autopsy starts on the chest or abdomen, excision of the
organs will cause the blood content of the brain and the meninges
to necessarily lose its original pattern;
2. There is the unavoidable contamination of the body associated
with the autopsy, which prevents liable culturing of microorganisms from the cranial contents;
3. Manipulation of other blood vessels, specially at the neck may
result in air bubbles' being artificially drawn into the cerebral
vessels, impairing fair evaluation of air embolism that might have
occurred during life (Forensic Medicine, Vol. 1, by Tedeschi,
Eckert and Tedeschi, p. 35).
A primary incision must be made from the suprasternal notch to
the pubic symphysis passing to the left of the umbilicus. Cut the
rectus abdominis muscle at several points to expose the abdominal
cavity and flap the skin at the region of the chest from the primary
incision to the lateral aspect of the chest exposing the ribs. Disarticulate the sterno-clavicular joint and cut the ribs medial to the
costo-chondral junction. Remove the breast and begin examining
the following:
Abdominal and Chest Wall:
Fat
— Amount, color, moisture, fibrosis.
Musculature
— Development, color, thickness,
atrophic changes.
Peritoneal Cavity:
— Amount, character, color, consisFluid
tency, purulent or bloody material.
—
Amount of fat, extent, adhesions,
Omentum
blood distribution.
— Level of the anterior border, adLiver
hesions, blood distribution, color,
fatty
or atrophic changes.
Chest Cavity:
Fluid
Adhesions
Pleura
Mediastinum
Thymus
— Amount, color, character, consistency, purulent or bloody material.
— Kind, extent, concommitant disease, distribution.
— Luster, hemorrhage, disease.
— Enlargement of the lymph nodes,
tumor.
— Weight, lobulation, fatty degeneration.
172
LEGAL MEDICINE
See a tabulation regarding the weight of the thymus gland with
respect to age.
Open the pericardial sac and examine its contents, principally the
heart. The normal pericardial fluid is from 5 cc. to 6 cc. and yellowish in color. Remove the heart by cutting the root of the blood
vessels connected with it. Examine the heart on the following
points:
Weight
Normal in men — 300 grams; women 250 grams.
External
— Size, shape, consistency, contraction or relaxation of the ventricle.
—
— Adhesions, amount of fat, luster,
petechial
hemorrhages,
milky
patches.
Cavities
— Amount of blood, blood clots,
emboli, dilatation.
Tricuspid — 12 cm.;
Measure of the Orifices
— Normal:
pulmonary — 8.0 cm.; mitral —
10.0 cm.; aortic — 7.0 om.
Thickness of the Ventricle — Normal: left — 1.4 cm.; right —
0.4 cm.
Endocardium
— Ulceration, vegetation and sclerosis
of the valves, mural endocardium,
thrombi, cordae tendinae, trabec u l e , papillary muscles. Mottling
(Tigroid heart).
Myocardium
— Color, consistency, resistance to section infraction, sclerosis, fibrosis
edema.
Coronary Vessels
— Special attention must be made to
the anterior branch of the left
coronary artery, sclerosis, atheroma,
embolism.
Epicardium
Removed both lungs by cutting the region of the hilus. After
examining the fluid or adhesions within the chest wall, the following
points must be considered in the examination:
Weight
— Normal: right — 400 grams; left —
350 grams.
External Examination
— State of collapse, size, consistency,
color, crepitation, consolidation,
luster, exudate, anthracosis, petechiae, blood distribution.
MEDICO-LEGAL INVESTIGATION OF DEATH
1. Size:
Larger
Smaller
2. Shape:
Congenital changes
Acquired changes
3. Weight:
Increased
Diminished
4. Color:
Grayish-red
Slaty-black
Bluish-red
Light-brownish
173
— Emphysema, pneumonia, edema.
— Compression, atelectasis.
— Abnormal furrows, increased number of lobes.
— Pleuritis deformans, retractions due
to fibrosis in the lung itself, furrows
corresponding to the first rib,
partial enlargement due to localized
emphysema, change due to adhesions.
— Edema, inflammation, congestion,
induration.
— Emphysema.
— Variation due to age, occupation,
content of air and blood.
— Anthracosis.
— Atelectasis.
— Hemosiderin brown induration.
5. Air content and consistency:
Note the softness, crepitancy, and compressibility.
Marked softness
— Formation of cavity or postmortem decomposition.
Firm consistency
— Consolidation.
Compressibility
— Emphysema.
Cut Surface
— Color, condition of consolidation,
amount of air and fluid exuding on
pressure, bronchi, blood vessels.
Bronchial Lymph Nodes
— Enlargement, anthracosis, tuberculosis.
Examine the mediastinum for enlargement of the lymph glands,
hemorrhage, inflammatory conditions and other pathology.
Abdominal Cavity:
Go to the abdominal cavity and remove the spleen by pulling it
and cutting the vessels at the region of the hilus. Examine the spleen
on the following points:
Weight
— Very variable, approximately 150
grams.
174
LEGAL MEDICINE
External Examination
— Size, color, consistency, thickness
of the capsule, smoothness or
wrinkling of the capsule.
Cut Surface
— Resistance to cutting, bulging of
cut surface, color, prominence of
the Malphigian corpuscles, and
trabeculae, consistency of the pulp
by scraping with sharp edge of
knife.
Separate the intestine by cutting the mesentery near its attachment with the intestine from the jejenum downward. Open the
duodenum and verify the potency of the common bile duct. Separate the stomach, duodenum, and pancreas by cutting at the
cardiac end of the stomach.
Stomach
Small Intestine
Large Intestine
Rectum
— Distention, shape, contents, condition of the mucosa, post-mortem
changes.
— Length, external appearance, contents, mucosa, lymphoid follicles
and Peyer's patches, obstruction,
Merkel's diverticulum, parasites.
— Length, external appearance, contents, mesocolic glands, epiploic
appendages, thickness of the walls,
condition of the mucosa, inflammation, ulcerations, condition of
the appendix, parasites.
— New growth, hemorrhoid, dysenteric ulcers, fistulae.
The liver is removed by separating it from the diaphragm, but
avoid cutting the suprarenal glands at the upper pole of the kidneys. The following points must be taken into consideration in the
examination of the liver:
Weight
External Examination
Cut Surface
Male — 1,400 grams; Female:
1,200 grams (Filipino).
Size, color, consistency, sharpness
of the edges, rib markings, scars,
thickness of the capsule, lobulation,
granulation.
Resistance to cutting, amount of
blood vessels, condition of the bile
duct.
MEDICO-LEGAL INVESTIGATION OF DEATH
175
Gall Bladder
— Adhesions, distention, color and
consistency ^>f the bile, condition
and staining of the mucosa, thickness and adhesions of the walls,
concretion, obstruction of the
cystic, hepatic and the common
bile duct.
The kidneys must be removed after the removal of the adrenals
and examine them on the following points:
— 120 to 150 grams. The left is
Weight
heavier than the right.
— Perirenal tissue, size, shape and
External Examination
consistency, color, thickness and
adherence of the capsule, external
surface of the cortex, granulation,
cyst, fetal lobulation, condition
of the veins.
— Condition of the cut edges (everted
Cut Surface
or not). Proportionate thickness
of the cortex and the medulla
(normal — 1.3), cortical striation,
pyramidal striation.
— Pelvic fat, stones, inflammatory
Pelvis
changes.
—
Obstruction, dilatation, inflamUreter
matory changes.
— Distention and contents, condition
Bladder
of the mucosa and trigonum,
opening of the ureter.
Genital Organs:
Male
Remove the prostate and the seminal vesicle with
the urinary bladder. The testicle and the epididymis is removed by pushing through the inguinal glands and opening the internal inguinal
ring. Note the condition of the testicle, epididymis, seminal vesicle and prostate.
Remove the uterus and its adnexa together with
Female
the upper portion of the vagina.
— Corpus luteum, hydatid cyst, tumor.
Ovary
— Distention, hydrosalpinx, pyosalFallopian Tube
pinx, hematosalpinx adhesions.
—
Resting, menstruating, gravid, inUterus
voluting, atrophic, tumor.
LEGAL MEDICINE
176
Cardio-Vascular System:
Aorta
Veins
Sclerosis, atheroma, syphilis, aneurysm.
Thrombosis, phlebitis.
Neck Organs:
Remove the larynx, pharynx and tongue including the tonsils.
The condition of the lymph glands, obstruction and edema of the
glottis, foreign body and materials in the larynx and trachea, condition of the thyroid gland, and condition of the tongue and tonsils
should be noted.
Head:
The scalp is incised from the mastoid process of one side passing
the vertex to the mastoid process on the opposite side. The flaps
are turned down to the back and to the front. Note the presence
of hemorrhage, bruise, hematoma and fracture of the skull. Open
the skull by sawing at the forehead above the eyebrow to the region
of the upper portion of the ear and another vertically a little behind
the vertex and meeting the horizontal cut at the region of the upper
portion of the ear. Remove the flap of bone and note the condition
of the meninges. Remove the brain after cutting it from its attachment and the tentorium cerebelli. Examine the brain for pathological condition, hemorrhage, laceration, softening, and the base and
side of the cranial box for hemorrhage and fracture. Make several
incisions on the brain and study the injury or disease.
Examination of the Extremities:
There is no technical incision for the extremities. Just open what
is deemed necessary and appropriate for the occasion.
Weight and Measure of the Organs Removed:
The specimen which are collected for further study must be placed
in clean jars and brought to the laboratory are:
LjOrgans for toxicological examination.
2. Slices of organs for histopathologic^ study.
(For a more detailed examination of post-mortem examination,
consult any textbook on pathology.)
AVERAGE MEASUREMENT OF INDIVIDUAL
ORGANS
HEART:
Weight of heart
Male
300 gms.
Both
Female
250 gms.
MEDICO-LEGAL INVESTIGATION OF DEATH
Relative weight of
heart to body
1 to 169
Length of heart
8.5 — 9
Circumference of
Mitral orifice
10.9 cms.
Tricuspid orifice
12.7 cms.
Aortic orifice
8.0 cms.
Pulmonary orifice
9.2 cms.
Pulmonary artery
Circumference base
of ventricle
Thickness of the wall of
Left ventricle
Right ventricle
177
1 to 162
8-8.5
10.4 cms.
12.0 cms.
7.7 cms.
8.9 cms.
8.0 cms.
28.8 cms.
1.1 —1.4 cms.
0.5 — 0.7 cms.
SPLEEN:
Weight of spleen
Measurement
150 —250 gms.
12.0 x 4.5 x 3.0 cms.
PANCREAS:
Weight of pancreas
Measurement
90 — 120 gms.
23.0 x 4.5 x 2.8 cms.
LIVER:
Weight
Measurement
Length from right to left
Width of right lobe
Vertical diameter of right lobe
Vertical diameter of left lobe
KIDNEYS:
Male
Weight
Measurement
Thickness of:
Cortex
Medulla
Relation to body weight
Relation to weight of heart
OVARY:
Weight
BRAIN:
Weight
1500 to 1800 gms.
25 — 32 cms.
18 — 20 cms.
20 — 22 cms.
15 —16 cms.
Both
150 gms.
11 x 5 x 4.5 cms.
Female
4.6 cms.
1 — 3 cms.
1:200
1:1.1
7.0 gms.
1,358 gms.
1,234 gms.
178
LEGAL MEDICINE
ADRENALS:
Weight
Measurement
WEIGHT OF THYMUS:
Newborn
I - 55 years
j
6 - l10
O years
j
I I - 115
5 3years
20 years
16 - 20
j
253years
21 - 25
353years
26 - 35
453years
36 - 45
553years
46 - 55
653years
56 - 65
6 6 - 775
5 3years
4.8 — 7.3 gms.
40 x 20 x 2 mms.
Both
13.26 gms.
22.08 gms.
26.18 gms.
37.52 gms.
25.52 gms.
24.73 gms.
19.8 gms.
16.27 gms.
12.85 gms.
6.08 gms.
6.00 gms.
Mistakes in Autopsies:
1. Error or omission in the collection of evidence for identification:
a. Failure to make frontal, oblique and profile photographs of the
face;
b. Failure to have fingerprints made;
c. Failure to have a complete dental examination performed.
2. Errors or omission in the collection of evidence required for
establishing the time of death:
a. Failure to report the rectal temperature of the body;
b. Failure to observe changes that may occur in the intensity and
distribution of rigor mortis — before, during and after autopsy.
c. Failure to observe the ingredients of the last meal and its
location in the alimentary tract.
3. Errors or omission in the collection of evidence required for other
medico-legal examination:
a. Failure to collect specimens of blood and brain for determination of the contents of alcohol and barbiturates;
b. Failure to determine the blood group of the dead person if
death by violence was associated with external bleeding;
c. Failure to collect nail scrapings and samples of hair if there is
reasonable chance that death resulted from assault.
d. Failure to search for seminal fluid if there is a reasonable
chance that the fatal injuries occurred incident to a sexual
crime;
e. Failure to examine clothings, skin and the superficial portion
of the bullet tract for residue of powder, and the failure to
MEDICO-LEGAL INVESTIGATION OF DEATH
179
collect samples of any residue for the purpose of chemical
identification;
f. Failure to use an X-ray for locating a bullet or fragments of
bullet if there is any doubt with regard to their presence and
location;
g. Failure to protect bullet from defacement, such as is likely
to occur if they are handled with metal instruments.
h. Failure to collect separate specimens of blood from the right
and left sides of the heart in instances in which the body was
recovered from water.
i. Failure to strip the dura mater from the calvaria and base of the
skull. Many fractures of the skull have been missed because the
pathologist did not expose the surface of the fractured bone.
4. Errors or omission result in the production of undesirable artifacts
or in the destruction of valid evidence:
a. Opening of the skull before blood is permitted to drain from
the superior vena cava. If the head is opened before the blood
drained from it, blood will almost invariably escape into the
subdural and subarachnoidal space, and such an observation
may then be interpreted as evidence of ante-mortem hemorrhage.
b. The use of a hammer and chisel for opening the skull. A
hammer and chisel should never be used for the purpose in a
medico-legal autopsy. Fracture produced by the chisel are
frequently confused with ante-mortem.
c. Failure to open the thorax under water if one wishes to obtain
evidence of pneumothorax.
d. Failure to tie the great vessels between sites of transection and
the heart when air embolism is suspected.
e. Failure to open the right ventricle of the heart and the pulmonary artery in situ if pulmonary thrombo-embolism is
suspected.
f. Failure to remove the uterus, vagina and vulva en masse if rape
or abortion is suspected.
(From the American Journal of Forensic Medicine and Pathology,
Vol. 2, No. 4 (Dec. 1981) p. 306).
Negative Autopsies — An autopsy is called a negative autopsy if after
all efforts, including gross and microscopic studies and toxicological
analyses, fail to reveal a cause of death. It is an autopsy which
after a meticulous examination with the aid of other examinations
does not yield any definite cause of death.
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LEGAL MEDICINE
There are reports that approximately 2 to 10% of the total autopsy
cases in medico-legal centers yield a negative result although theoretically there must be a cause of death.
Negligent Autopsy — An autopsy wherein no cause of death is found
on account of imprudence, negligence, lack of skill or lack of foresight of the examiner. The act or omission which may be inadvertent
or deliberate may be:
1. Failure to have an adequate history or facts and circumstances
surrounding the death. Special circumstances surrounding death
may require special autopsy techniques which the pathologist may
fail to do during the autopsy. Air embolism, drug reaction, vagal
inhibition may be left unnoticed because of absence of history.
2. Failure to make a thorough external examination — Animal bites,
injection marks, electrical necrosis may be overlooked in a hasty
external examination.
3. Inadequate or improper internal examinations — Condition of
the organs, presence of air in pneumothorax or bubbles of air in
the circulatory system may remain unnoticed by the pathologist.
4. Improper histological examination — Tissue blocks may not be
taken in the proper areas, poor preparation of the microscopic
slides and improper lighting during the process of examination
may lead to an erroneous interpretation.
5. Lack of toxicological or other laboratory aids — A qualitative and
quantitative determination of toxic materials or its metabolites
must be shown. Sometimes difficulty is encountered by the
forensic chemist because of the lapse of time and rapid elimination
of the drug.
6. Pathologist incompetence — The examiner must have had vast
experience in autopsy investigation and must have the capacity
to distinguish pathological changes in the body tissues.
(Handbook of Forensic Pathology by Abdullah Fatteh, pp. 254255).
Religious Objections to Autopsies:
There is no place in the Bible, in the Talmudic or Post-Talmud ic
writings, is there evidence that post-mortem examination is prohibited. According to traditional interpretation, which is not necessarily accepted by all Jewish groups, autopsies and transplantation of
organs are permitted only in those cases where the decendants gave
consent.
MEDICO-LEGAL INVESTIGATION CF DEATH
181
There is no definite statement by the Catholic Church which can
be construed as prohibiting autopsies. Autopsies have been encouraged when it appeared that benefit would accrue from them. Similarly, there appears to be nothing in the writings of the Protestant
clergy to point to the prohibition of autopsies.
Chapter VI
nation of the cause of death. It must further be shown that the
death is the direct and proximate consequence of the criminal or
negligent act of someone. If death developed independent of an
unlawful act, then the person who committed the unlawful act
cannot be held responsible for the death.
However, there are some post-mortem findings of a physician
which may be useful in the proper adjudication of the case. The
presence of defense wounds on the victim may qualify the crime to
homicide. The presence of serration or series of cuts in the borders
of a stab wound may infer multiple thrusts of the wounding instrument and show the manifest intent of the offender to kill.
The cause of death is the injury, disease or the combination of
both injury and disease responsible for initiating the trend or
physiological disturbance, brief or prolonged, which produce the
fatal termination. It may be immediate or proximate.
Cause of Death — This applies to cases
when trauma or disease kill quickly that there is no opportunity
for sequelae or complications to develop. An extensive brain
laceration as a result of a vehicular accident is an example of
immediate cause of death.
2/The Proximate (Secondary) Cause of Death — The injury or
disease was survived for a sufficiently prolonged interval which
permitted the development of serious sequelae which actually
caused the death. If a stab wound in the abdomen later caused
generalized peritonitis, then peritonitis is the proximate cause of
death.
The mechanism of death is the physiologic derangement or biochemical disturbance incompatible with life which is initiated by the
cause of death. It may be hemorrhagic shock, metabolic disturbance,
respiratory depression, toxemic condition, cardiac arrest, tamponade,
etc.
Cardiorespiratory arrest is a terminal mechanism of most causes
of death and can never stand independently as a reasonable explanation for the fatality. The cause of such arrest must be stated,
182
CAUSES OF DEATH
183
like hemorrhage, skull fracture, sepsis, trauma on the chest, etc. to
make it valid as specific cause of death.
The manner of death is the explanation as to how the cause of
death came into being or how the cause of death arose. The manner
of death may be natural or violent.
V.Natural Death — It is natural when the fatality is caused solely
by disease (lobar pneumonia, ruptured tubal pregnancy, cancerous
growth, cerebral hemorrhage due to hypertension, etc.).
2/violent or Unnatural Death — Death due to injury of any sort
(gunshot, stab, fracture, traumatic shock, etc.). A physician must
not include in the consideration of the manner of death that such
violent death is suicidal, accidental or homicidal.
Such conclusion cannot be determined in the post-mortem
examination. It requires a thorough investigation of all possible
clues in which medico-legal findings are only a part of.
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. In a case of homicide, the medical
findings may tend to favor suicide or accidental death, and visa
versa. Cases of such nature infer that the medical examination and
police investigation is far from being complete. There is a need for
further investigation and evaluation to unravel the truth.
Degree of Certainty to the Cause of Death:
1. When the structural abnormalities established beyond doubt the
identity of the cause of death (Ex.: Intracerebral spontaneous
hemorrhage, stab wound with profuse hemorrhage, crushing head
injury in vehicular accident, etc.).
2. When there is that degree of probability amounting to almost
certainty the cause of death. (Ex.: Lobar pneumonia, electrical
shock).
3. When the cause of death is established primarily by historical facts
which are confirmed or supported by positive or negative anatomic or chemical findings (Ex.: Tetanus, hydrophobia, drug
reaction).
4. When neither history, laboratory and anatomic findings, taken
individually or in combination is sufficient to determine the cause
of deathr.but merely speculate as to the cause of death (Ex.: Crib
death among infants, Iatrogenic diseases).
Use of the Term "Probably":
As much as possible the use of the term "probably" as a qualification to a cause of death must be discouraged inasmuch as it is
184
LEGAL MEDICINE
not definite. In the prosecution of a criminal case if the resulting
cause of death is merely a probable consequence of a criminal act,
such situation will fall short of "proof beyond reasonable doubt"
and may lead to the acquital of the accused.
If sometime after painstaking effortB the examiner cannot ascribe
a definite cause of death on the body lesions found, the use of the
"probably" in the cause of death may be tolerated.
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 cessation of vital functions.
2. Understanding and exposition of the mechanism by which the
anatomic and other deviations from normal actually caused the
death, or how the deviation created or initiated the train of sufficiently potent functional disturbance which led ultimately either
to cardiac standstill or to respiratory arrest.
(The Pathology of Homicide by Lester Adelson (1974) p. 15).
Instantaneous Physiologic Death (Death from Inhibition, Death from
Primary Shock, Syncope with Instantaneous Exitus):
This is sudden death which occurs within seconds or a minute or
two (no more) after a minor trauma or peripheral stimulation of
relatively simple and ordinarily innocuous nature. The peripheral
irritation or stimulation initiates the cardio-vascular inhibitory reflex.
The fulminant circulatory failure is caused by (vagocardiac) slowing
or stoppage of the heart, reflex dilatation with profound fall in blood
pressure or a combination of both mechanisms.
A blow to the larynx or solar plexus, a kick in the scrotum,
pressure on the carotid sinus, etc. can cause such death.
Death by inhibition can be made only by exclusion and is completely dependent on the availability of accurate information. After
serious natural disease has been eliminated by autopsy and toxicological analyses are noncontributory, then only the physiologic
death may be entertained (Medico-legal Investigation of Death by
Werner Spitz and Russel Fisherm, p. 93).
Among the diseases wherein there are no specific finding, pathognomic of a disease still determined are:
1. Sudden Infant Death Syndrome (Crib Death) — This is the unexpected death of infants, usually under six months of age, while in
apparently good health. The sudden death cannot be predicted
and there is no way to prevent or foretell on the basis of present
knowledge. Although autopsies in some of the cases revealed the
CAUSES OF DEATH
185
presence of congenital heart disease or abnormality, contagious
disease, nutritional deficiency and other pathological conditions,
no consensus has yet been arrived at as to the definite cause of
death.
/2. Sudden Unexplained Nocturnal Death (SUND) — This is known as
"pok-kuri" disease in Japan and "bangungut" in the Philippines.
It is the sudden death of healthy men of young age seen in East
Asian countries. Awareness of relatives and the prompt delivery
of resuscitation are the only effective means of treatment.
The term Dead on Arrival (DOA) must not be construed literally.
It may mean that the patient was actually dead on arrival or was
dying on arrival. Death occurs on a precise time while dying is a
continuing process. If a patient is dead then the procedure of
management is resuscitative or to let him return to life again, while
if the patient is dying, the procedure is to apply emergency measures
to prevent death from ensuing.
DOA may be placed in the item "cause of death" in the death
certificate even if the patient has stayed alive in the hospital or clinic
for sometime provided the attending physician had not been given
ample opportunity to arrive at a working diagnosis as to the cause of
death. The working diagnosis need not be precise and exacting. It
is sufficient that there are some bases to such conclusions.
If the attending physician cannot determine the cause of death, it
will be much more appropriate to place under "Cause of Death" in
the Death Certificate "undetermined" rather than DOA. It is more
responsive to the purpose why such item is included in the certificate.
MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF
DEATH:
a. Natural Death.
b. Violent Death:
(1) Accidental death.
(2) Negligent death.
(3) Infanticidal death.
(4) Parricidal death.
(5) Murder.
(6) Homicidal death.
Natural Death:
This is death caused by a natural disease condition in the
body. The disease may develop spontaneously or it might have
been a consequence of physical injury inflicted prior to its
development. If a natural disease developed without the
186
LEGAL MEDICINE
intervention of the felonious acts of another person, no one can
be held responsible for the death.
"Sudden death" is the termination of life which comes
quickly under circumstances when its arrival is not expected.
It may be due to natural or violent cause. Heart diseases and
cerebral apoplexy are the most common causes of deaths due to
natural causes, while poisoning, asphyxia and severe trauma are
frequent causes of violent death.
The natural death may or may not be associated with violence. Although the history and external findings may show
that death is due to natural cause, a complete autopsy must be
made to determine exactly the cause of death and exclude the
possibility of violent cause.
If signs of violence are associated with the natural cause of
death, the physician must be able to answer the following
questions:
Did the Person Die of a Natural Cause and were the Physical
Injuries Inflicted Immediately After Death ?
If violence was applied on a dead person, the person inflicting
the physical injuries cannot be guilty of murder, homicide or
parricide. The act is considered to be an impossible crime and
is penalized as such. In order that it may be considered an
impossible crime, the person inflicting the physical injuries must
have no knowledge that the victim is already dead at the time of
infliction.
Criminal liability shall be incurred by any person who performs an act which would be an offense against persons and
property, were it not for the inherent impossibility of its accomplishment. . . (Art. 4, No. 2, Revised Penal Code). The
court having in mind the social danger and the degree of criminality shown by the offender shall impose upon him the
penalty of arresto mayor or a fine ranging from 200 to 500
pesos. (Art. 59, Revised Penal Code).
"A" has a grudge and wanted to kill "B". One night "A"
entered the bedroom of "B", and without knowing that "B"
died of heart failure an hour ago, inflicted several stab wounds
on " B " "A" cannot be held liable for murder because it is an
impossible crime. " B " was already dead when the stab wounds
were inflicted. However, the law still imposes penalty for such
act depending upon the degree of criminality and social danger
of the offender (Art. 59, Revised Penal Code).
CAUSES OF DEATH
187
Was the Victim Suffering from a Natural Disease and the
Violence Only Accelerate the Death ?
If the violence inflicted on a person suffering from a natural
disease only accelerated the death of the victim, the offender
inflicting such violence is responsible for the death of the
victim. It is immaterial as to whether the offender has no
intention of killing the victim. The fact that the victim died,
the offender must be held responsible to whatever be the
consequence of his wrongful act.
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, Revised Penal Code).
Example:
"A" gave a blow in the abdomen of "R". Unfortunately
" B " died of severe abdominal hemorrhage due to the traumatic rupture of the liver which was severely diseased. "A"
is liable for the death of "B", even if "A" has no intention to
kill "B". "A" must be held liable for consequences of his
felonious act. However, he may avail himself of the mitigating circumstance that he had no intention to commit so
grave a wrong as that committed (Art. 13, Revised Penal
Code).
A blow with a fist or a kick, although it did not produce
external injuries but inflammation of the spleen and peritonitis and although the victim was previously affected with
the disease, the accused must be responsible for the death
because he accelerated the time of death by his voluntary
and unlawful act (U.S. v. Rodriguez, 23 Phil. 22).
The deceased was suffering from tuberculosis. The accused gave fist blows in the hypochondriac region which
caused bruising of the liver, followed by internal hemorrhage
and death. The accused is liable for homicide (People v.
Ilustre, 54, Phil. 544).
Did the Victim Die of a Natural Cause Independent of the
Violence Inflicted?
If a person died of a natural cause and the physical injuries
inflicted is independent of the cause of death, the accused will
not be responsible for the death but merely for the physical
injuries he had inflicted.
Example:
"A" and "B" are sweethearts. "A" at the fit of anger
slapped " B " in the face. "B" is suffering from severe heart
LEGAL MEDICINE
disease. After the slapping, " B " died of heart failure. "A"
cannot be held responsible for the death of "B". He can
only be held for slight physical injury brought about by the
slapping.
The defendant struck a boy with the back of his hand on
the mouth. Although the mouth was bleeding, he was able
to work. A few days later, he developed fever and died. The
court believed that the fever which caused the death was not
the direct consequence of the injury inflicted. It was not
denied that malaria fever was prevalent in the locality, so it
was quite probable that the death was due to a natural cause.
The defendant was acquitted (U.S. v. Palaton, 49 Phil. 117).
To make the offender liable for the death of the victim, it
must be proven that the death is the natural consequence of the
physical injuries inflicted. If the physical injuries is not the
proximate- cause of death of the victim, then the offender cannot be held liable for such death. Proximate cause is that cause,
which in natural and continuous sequence, unbroken by an
efficient intervening cause, produces injury or death, and without which the result would not have occurred.
So in natural death with concomitant physical injuries, it is
necessary for the physician to determine whether the physical
injuries would accelerate the death, or the injuries itself developed independently and produced the death or that the person
died absolutely of a natural cause.
A physician must determine for the interest of justice with
absolute care at autopsy and laboratory examination the real
cause of death. Opinion evidence must be given with caution
and must be made after a thorough deliberation of the facts
and other findings.
The Following are Deaths Due to Natural Cause:
(1) Affection of the central nervous system:
(a) Cerebral Apoplexy:
The sudden loss of consciousness followed by paralysis or death due to hemorrhage from thrombosis or
embolism in the cerebral vessels.
i. Cerebral Hemorrhage:
This is brought about by the breaking or rupture
of the blood vessels inside the cranial cavity.
ii. Cerebral Embolism:
This is the blocking of the cerebral blood vessels
by bolus or matters in the circulation.
CAUSES OF DEATH
189
iii. Cerebral Thrombosis:
This is the occlusion of the lumen of the cerebral
vessels by the gradual thickening of its wall thereby
preventing the flow of blood peripheral to it.
(b) Abscess of the Brain:
A circumscribed accumulation of infective materials
in certain areas of the brain. It may produce coma or
death when it ruptures or when it produces acute edema
of the brain.
(c) Meningitis of the Fulminant Type:
There is inflammation of the covering membranes of
the brain due to infection or some other causes.
(2) Affection of the Circulatory System:
(a) Occlusion of the Coronary Vessels:
The occlusion may be due to embolism, thrombosis
or stenosis of the coronary openings. This is the most
common cause of sudden death due to natural cause.
(b) Fatty or Myocardial Degeneration of the Heart:
The heart muscles may gradually degenerate and
replaced by fatty or fibrous tissues such that extra strain
put on the heart may produce sudden heart failure.
(c) Rupture of the Aneurysm of the Aorta.
(d) Valvular Heart Diseases:
The valves of the heart may be diseased either to
become insufficient or stenotic and may produce sudden death.
(e) Rupture of the Heart:
This is found in severe cardiac dilatation with fibrosis
of the myocardium.
(3) Affections of the Respiratory System:
(a) Acute edema of the larynx:
This may develop from acute infection or from
swallowing irritant substance.
(b) Tumor of the larynx.
(c) Diphtheria.
(d) Edema of the lungs.
(e) Pulmonary embolism.
(f) Lobar pneumonia.
(g) Pulmonary hemorrhage:
Severe coughing or slight exertion may rupture a
normal or diseased pulmonary vessel causing severe
hemorrhage.
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LEGAL MEDICINE
(4) Affection of the Gastro-Intestinal Tract:
(a) Ruptured peptic ulcer.
(b) Acute intestinal obstruction.
(5) Affections of the Genito-Urinary Tract:
(a) Acute strangulated hernia.
(b) Ruptured tubal pregnancy.
(c) Ovarian cyst with twisted pedicle.
(6) Affection of the Glands:
(a) Status thymico-lymphaticus:
This is a condition associated with the enlargement
of the thymus and hyperplasia of the lymphoid tissues
in general.
(b) Acute Hemorrhagic Pancreatitis:
An acute inflammation of the pancreas accompanied
with hemorrhages and in some cases suppuration and
gangrene.
(7) Sudden Death in Young Children:
(a) Bronchitis.
(b) Congestion of the lungs.
(c) Acute broncho-pneumonia.
(d) Acute gastro-enteritis.
(e) Convulsion.
, (f) Spasm of the larynx.
Violent Death:
Violent deaths are those due to injuries inflicted in the body
by some forms of outside force. The physical injury must be
the proximate cause of death.
The death of the victim is presumed to be natural consequence of the physical injuries inflicted, when the following
facts are established:
(1) That the victim at the time the physical injuries were inflicted was in normal health.
(2) That the death may be expected from physical injuries
inflicted.
(3) That death ensued within a reasonable time (People v.
Datu Baginda, C.A. 44 O.G. 2287).
Classification of Trauma or Injuries:
(1) Physical injury — Trauma sustained thru the use of physical
force.
(2) Thermal injury — Injury caused by heat or cold.
(3) Electrical injury — Injury due to electrical energy.
CAUSES OF DEATH
191
(4) Atmospheric injury — Those due to the change of atmospheric pressure.
(5) Chemical injury — Those caused by chemicals.
(6) Radiation injury — Those brought about by radiation.
(7) Infection — Those caused by microbic invasion.
In violent death, the death of the victim is not due to the natural
and direct consequence of the injuries inflicted. If there is an
intervening cause other than the physical injuries, then the offender cannot be held liable for the death of the patient.
Refusal of the victim to submit to a surgical operation do not
relieve the accused from the natural and ordinary result of the
felonious act and does not relieve him of his criminal liability
(U.S. v. Marasigan, 27 Phil. 504).
The presence of infection on the wounds inflicted if not deliberately induced by the victim makes the offender also responsible
for it (People v. Red, C.A. 43 O.G. 5072).
The accused inflicted physical injuries to the victim. While the
victim was undergoing medical treatment, he removed the drainage from his wound and as a result of which he died of peritonitis.
The defense made by the offender is that the deceased could not
have died had he not removed the drainage. HELD: Death was
the natural consequence of the mortal wound. The victim in
removing the drainage from his wound did not appear as acting
voluntarily and with knowledge that he was performing an act
prejudicial to his health (People v. Quiamon, 62 Phil. 162).
Penal Classification of Violent Deaths:
(^Accidental Death:
Death due to misadventure or accident. An accident is
something that happens outside the sway of our will, and
although it comes about through some act of will, lies
beyond bounds of human forseeable consequences.
In a pure accidental death, the person who causes the
death is exempted from criminal liability.
Art. 12, No. 4, Revised Penal Code:
Exempting Circumstances:
The following are exempt from criminal liability:
4. Any person who, while performing a lawful act with
due care, causes an injury by mere accident without
fault or intention of causing it.
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Elements of the Provision:
(a) A person is performing a lawful act.
(b) He performed it with due care.
(c) He caused injury to another by mere accident.
(d) He is without fault and with no intention of causing it.
Example:
A patient died a few minutes after the administration of
penicillin by injection. The physician took the history from
the patient as to the presence of allergic diseases, made the
necessary tests and took other necessary precautions to
prevent any untoward reaction. The physician cannot be
held liable for the death of the patient because it is purely
accidental.
A driver who, while driving his automobile on the proper
side of the road at a moderate speed and with due diligence,
suddenly and unexpectedly sees a man in front of his
vehicle coming from the sidewalk and crossing the street
without any warning that he would do so, but because it is
not physically possible to avoid hitting him, the said driver
runs over the man. He is not criminally liable, it being a
mere accident (U.S. v. Tayongtong, 21 Phil. 476, cited by
L. Reyes).
The accused was a driver of a loaded truck. While driving
at a curve the front tire exploded and as a consequence of
which the truck fell in a ditch and pinned one of the passengers. The tire, engine, brake and wheel were in good
condition before the incident. HELD: There being no
proof of excessive speed, the accident under consideration
caused by the blow-out of the tire cannot give rise to
liability of the driver (People v. Hatton (C.A.) 49 O.G.
1866).
The accused while hunting saw wild chickens and fired a
shot. He heard a human being cry and found that the
victim was hit. There was no evidence of the intention of
the accused to kill the deceased. HELD: If life is taken by
misfortune while the actor is in the performance of a lawful
act executed with due care and without intention of doing
harm, there is no criminal liability (U.S. v. Tanedo, 15
Phtf 196).
(2yNegligent Death:
Death due to reckless imprudence, negligence, lack of
skill or lack of foresight.'
CAUSES OF DEATH
193
The Revised Penal Code provides that felonies may be
committed when the wrongful act results from imprudence, negligence, lack or foresight or lack of skill.
If death occurred due to the recklessness of someone,
he may be charged for homicide through reckless imprudence.
Example:
A surgeon while performing a laparotomy to arrest
bleeding, left foreign bodies (forcep or gauze) inside the
abdominal cavity and as a result of which the patient died.
The surgeon is liable for homicide through reckless imprudence.
A physician is equally liable for the same offense if the
untoward effects of the administration of drug administered
is due to the want of the necessary precautionary measures
in the administration of the drug.
If a person does an act and death of the victim is a plain
foreseeable consequence, then it is not accidental but homicidal through simple negligence or reckless imprudence.
The defendant fired a shot on the ground to pacify a
quarrel. The bullet ricochetted and hit a bystander who
died thereafter. The defendant is guilty of homicide though
reckless imprudence. It is apparent that he did not exercise
precautionary measures, considering that the place is
populated and there is likelihood to hit the bystander
(People v. Nocum, 77 PhU. 1018).
(^Suicidal Death (Destruction of One's Self):
The law does not punish the person committing suicide
because society has always considered a person who attempts to kill himself as an unfortunate being, a wretched
person deserving more of pity than of penalty.
But, a person who gives assistance to the commission of
suicide of another is punishable because he has no right to
destroy or assist in the destruction of the life of another.
Art. 253, Revised Penal Code:
Giving assistance to suicide:
Any person who shall assist another to commit suicide
shall suffer the penalty of prision mayor; if such person
lends his assistance to another to the extent of doing the
killing himself, he shall suffer the penalty of reclusion
temporal. However, if the suicide is not consummated
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the penalty of arresto mayor in its medium and maximum
periods shall be imposed.
Acts Punishable in Giving Assistance to Suicide:
(a) The offender assisted in the commission of suicide of
another which was consummated.
(b) The offender gave assistance in the commission of
suicide to the extent of d6ing the killing himself which
is consummated.
(c) The offender assisted another in the commission of
suicide which is not consummated.
(4fParricidal Death (Killing of One's Relative):
Art. 246, Revised Penal Code:
Parricide:
Any person who shall kill his father, mother, or child,
whether legitimate or illegitimate, or any of his ascendants
or descendants, or his spouse, shall be guilty of parricide
and be punished by the penalty of reclusion perpetua
to death.
Requisites of the Crime:
(a) A person was killed by the offender.
(b) The person killed was the father, mother, or child,
whether legitimate or illegitimate in relation with the
offender, or other legitimate ascendants, or descendants
or spouse of the offender.
The father, mother or child killed must either be legitimate or illegitimate to make it parricide, so that the
killing of one's illegitimate father is parricide.
But, insofar as with the other ascendants or descendants or spouse, it must be legitimate to make it parricide.
Thus, the killing of a common-law wife or one's illegitimate
grandfather is not parricide.
A moro who has three wives and killed the last married
to him cannot be guilty of parricide (People v. Subano,
73 Phil. 692).
A stranger who cooperated and took part in the commission of the crime of parricide is not guilty of parricide
but only of homicide or murder as the case may be
J (People v. Patricio, 46 Phil. 875).
(Sr) Infanticidal Death (Killing of a child less than three days
old):
Art. 265, Revised Penal Code:
CAUSES OF DEATH
195
Infanticide:
The penalty provided for parricide in article 246 and for
murder in article 248 shall be imposed upon any person
who shall kill any child less than three days of age.
If the crime penalized in this article be committed by the
mother of the child for the purpose of concealing for
dishonor, she shall suffer the penalty of prision correccional
in its medium and maximum periods, and if said crime be
committed for the same purpose by the maternal grandparents or either of them, the penalty shall be prision
mayor.
Requisites of the Crime:
(a) A person was killed.
(b) The person killed was a child less than three days old.
The penalty to be imposed depends upon the killer of
the child. If the killer is the father, mother or any of the
legitimate ascendants, the penalty corresponding to parricide shall be imposed. If the killing is made by any other
persons, the penalty for murder shall be imposed.
There is no medical explanation why three days is made
to distinguish infanticide from murder and parricide.
Concealment of the dishonor is not an element of the
crime but only mitigates penalty. So that if the mother or
the maternal grandparents killed the child to conceal the
dishonor the penalty for parricide is not imposed but only
that jone provided in the second paragraph of Art. 255.
(6TMurder:
Art. 248, Revised Penal Code:
Murder:
Any person who, not falling within the provisions of
article 246 shall kill another, shall be guilty of murder and
shall be punished by reclusion temporal in its maximum
period of death, if committed with any of the following
circumstances:
1. With treachery, taking advantage of superior strength,
with the aid of armed men, or employing means to
weaken the defense or of means or persons to insure
or afford impunity.
2. In consideration of a price, reward or promise.
3. By means of inundation, fire, poison, explosion,
shipwreck, stranding of a vessel, derailment or assault
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upon a street car or locomotive, fall of an airship, by
means of motor vehicles, or with the use of any other
means involving great waste and ruin;
4. On occasion of any of calamities enumerated in the
preceding paragraph, or of an earthquake, eruption of
a volcano, destructive cyclone, epidemic, or any other
public calamity;
5. With evident premeditation;
6. With cruelty, by deliberately inhumanly augmenting
the suffering of the victim, or outraging or scoffing at
his person or corpse.
Requisites for the Crime of Murder:
(a) The offender killed the victim;
(b) The killing is attended by any of the qualifying circumstances mentioned;
(c) There was the intent of the offender to kill the victim;
(d) The killing is not parricide or infanticide.
Whenever the killing is attended by more than one of
the qualifying circumstances mentioned, only one of them
will make the killing, murder and the rest will be considered
as generic aggravating circumstances.
The presence of several wounds inflicted by the offender prove murder because there is cruelty if the victim is
alive, or scoffing or outraging at the corpse if inflicted after
death.
The presence of gunshot wound of entrance at the back
as a general rule qualifies act to murder because there was
treachery, i There is treachery when the offender commits
any of the crimes against person, employing means, or
method, or form in its execution thereof which tend directly or specially to insure its execution, without risk to
himself arising from the defense which the offended party
may make (Art. 14, Par. 16, Revised Penal Code).
Death:
Art. 249, Revised Penal Code:
Homicide:
Any person who, not falling within the provisions of
article 246 shall kill another without the attendance of any
of the circumstances enumerated in the next preceding
article, shall be deemed guilty of homicide and be punished
by reclusion temporal.
(7-Hlomicidal
CAUSES OF DEATH
197
Requisites of the Crime of Homicide:
(a) The victim of a criminal assault was killed;
(b) The offender killed the victim without any justification;
(c) There is the intention on the part of the offender to kill
the victim and such presumption can be inferred from
the death of the victim;
(d) That the killing does not fall under the definition of the
crime of murder, parricide or infanticide.
If a pharmccist wrongly compound a prescription correctly prescribed by the physician and lethal dose of poisonous drugs were included and as a result of which the patient
almost died, the crime committed is physicial injuries
through reckless imprudence.
It cannot be frustrated
homicide through reckless imprudence because of the
absence of intent to kill by the pharmacist (People v.
Castillo, 76 Phil. 72).
Frustrated homicide is distinguished from physical
injuries in that in the commission of the latter there is no
intent to kill.
Death under Special Circumstances:
(1) Death Caused in a Tumultuous Affray:
Art. 251, Revised Penal Code:
When while several persons, not composing groups
organized for the common purpose of assaulting and attacking each other reciprocally, quarrel and assault each
other in a confused and tumultuous manner, and in the
course of affray someone is killed, and it cannot be ascertained who actually killed the deceased, but the person
or persons who inflicted serious physical injuries can be
identified, such person or persons shall be punished by
prision mayor.
If it cannot be determined who inflicted the serious
physical injuries on the deceased, the penalty of prision
correccional in its medium and maximum periods shall be
imposed upon all those who shall have used violence upon
the person of the victim.
Requisites of the Crime:
(a) The person was killed in a confused or tumultuous
affray;
(b) That the actual killer is not known; and
(c) That the person or persons who inflicted the serious
physical injuries or violence are known.
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198
(2) Death or Physical Injuries Inflicted under Exceptional
Circumstances:
Art. 247, Revised Penal Code:
Any legally married person who, having surprised his
spouse in the act of committing sexual intercourse with
another person, shall kill any of them or both of them in
the act or immediately thereafter, or shall inflict upon
them any serious physical injury, shall suffer the penalty
of de8tierro.
If he shall inflict upon them physical injuries of any
other kind, he shall be exempt from punishment.
These rules shall be applicable, under the same circumstances, to parents with respect to their daughters under
eighteen years of age, and their seducers, while the daughters
are living with their parents.
Any person who shall promote or facilitate the prostitution of his wife or daughter, or shall otherwise have
consented to the infidelity of the other spouse shall not
be entitled to the benefits of this article.
Requisites of the Crime:
(a) Surprise of the spouse:
i. There must be valid marriage.
ii. That the guilty spouse was caught by surprise in
the act of committing sexual intercourse with
another person.
iii. That the killing or the injury was inflicted to either
or both at the very act or immediately thereafter.
(b) Surprise of a daughter:
i. The daughter is below 18 years of age.
ii. The daughter is living with the parents.
iii. The parents caught her by surprise committing
sexual intercourse with the seducer.
iv. The killing was done at the very act of sexual
intercourse or immediately thereafter.
2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF
DEATH:
An analysis of all deaths from natural causes will ultimately
lead to the failure of the heart, lungs, and the brain, so that
death due to pathological lesions may be classified into:
a. Death from Syncope
b. Death from Asphyxia
c. Death from Coma.
CAUSES OF DEATH
199
All of the above mentioned conditions invariably produce the
so-called sudden death. Sudden death is the termination of life
which comes quickly when it is not expected.
a. Death from Syncope:
This is death due to sudden and fatal cessation of the action
of the heart with circulation included.
,
Causes of Death from Syncope:
(1) Coronary disease, as embolism or thrombosis.
(2) Rupture of the heart through softened infarct.
( 3 ) Myocardial degeneration.
(4) Valvular diseases.
(5) Rupture of the aortic and other aneurysm.
(6) Systemic embolism occurring in bacterial endocarditis.
( 7 ) Congenital heart diseases of the newborn.
(8) Reflex inhibition of the heart or of the cardiac center,
as in shock, emotion or blow over the area of some of
the sensory nerve.
( 9 ) Arterial hypertension with sclerosis.
(10) Deficiency cf blood as in profused hemorrhage, especially
if sudden.
(11) Exhaustive diseases.
(12) Extensive injury to the body from mechanical cause.
Symptoms of Syncope:
(1) Person falls and remains motionless.
(2) Face is pale.
( 3 ) Pulse at the wrist disappears or is filiform.
( 4 ) Respiration ceases.
In non-fatal cases, consciousness returns in a few second,
but in fatal ones, the following other symptoms appear:
(5) Person breaks out into cold sweat.
(6) Dimness of vision.
( 7 ) Pulse rapid and filiform.
( 8 ) There may be vomiting and involuntary movement of the
limbs.
( 9 ) The person may be passing into the state of delirium.
(10) Death may be preceded by convulsion.
b. Death from Asphyxia:
Asphyxia is 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.
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LEGAL MEDICINE
Gauges of Death from Asphyxia:
(1) Diseases of the respiratory system, as pneumonia, acute
bronchitis, bronchitis in infancy, rupture of the blood
vessels in pulmonary tuberculosis with cavitation.
(2) Impaction of foreign bodies in the larynx.
(3) Compression of the larynx.
(4) Pressure on the respiratory tract due to tumor, or intracranial hemorrhage.
(5) Strangulation, suffocation, hanging, drowning, inhalation
or irritant gases.
(6) Refraction of the atmosphere.
(7) Causes operating in the nervous system:
(a) Paralysis of the respiratory muscles or respiratory
center from injury or disease or action of poison.
(b) Fixation of the respiratory muscles from over stimulation of the spinal cord as in strychnine poisoning.
(8) Causes operating from the lung or pulmonary circulation:
(a) Pleurisy with effusion.
(b) Emphysema.
(c) Pulmonary embolism.
(d) Pulmonary thrombosis.
Symptoms of Asphyxia:
(1) Stage of Increasing Dyspnea :
This stage usually lasts from 1/2 to 1 minute:
(a) Increased rate and depth of respiration, leading to
difficulty of breathing (dyspnea).
(b) Exaggerated movement of inspiratory muscles soon
replaced by exaggerated expiration.
(c) Rise of blood pressure, consequently the heart beat
becomes quicker and more forcible.
(d) Person becomes bluish and consciousness is lost.
(e) Pupils are contracted.
(2) Stage of Expiratory Convulsion:
(a) This stage lasts for about a minute:
i. Marked expiratory effort.
ii. Convulsive movement of the limbs accompanied by
expiratory effort.
iii. Blood pressure gradually lowers owing to the failure
of the heart due to lack of oxygen.
CAUSES OF DEATH
201
(3) Stage of Exhaustion:
This stage lasts for about three minutes. The person lies
still except for occasional deep inspiration. Blood pressure
falls and pupils are dilated.
Post-mortem Findings in Death from Asphyxia:
(1) External Findings:
(a) Lividity of the hps, fingers and toenails.
(b) Livid markings on the skin.
(c) Marked post-mortem lividity.
(2) Internal Findings:
(a) Lungs:
i. Lungs engorged with dark blood.
ii. On section, there is dark color frothy exudation.
iii. Punctiform hemorrhages of the pleura (Tardieu
Spots).
iv. Reddish discoloration of the trachea and bronchial
mucous membrane.
(b) Heart:
i. Subpericardial petechial hemorrhages.
ii. Right ventricle of the heart dilated and engorged.
iii. Left side of the heart and arterial system empty.
(c) Abdominal viscera congested.
(d) Brain congested and may show punctiform hemorrhages.
(e) Blood dark in color.
(f) Rigor mortis has slow onset.
c. Death from Coma:
Coma is the state of unconsciousness with insensibility of the
pupil and conjunctivae, and inability to swallow, resulting from
the arrest of the functions of the brain.
Causes of Coma:
(1) Gross lesions of the brain:
(a) Depressed fracture.
(b) Apoplexy.
(c) Embolus.
(d) Abscess.
(e) Tumor.
(2) Poisons:
(a) Uremia.
(b) Cholemia.
(c) Acetonemia.
(d) Ingested morphine.
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(e) Ingested alcohol.
Symptoms of Coma:
(1) Person unconscious.
(2) Breathing is stertorous.
(3) Pulse is full but intermittent.
(4) Cold, clammy perspiration.
(5) Imperfect perception of sensory impression.
(6) Delirium.
(7) Relaxation of all sphincter muscles.
(8) Accumulation of mucous in the respiratory passages.
Post-mortem Findings:
The findings in coma are the same as in asphyxia, and
addition, there is congestion of the brain and the spinal cord.
Chapter VII
^S^ECIAL DEATHS
1. JUDICIAL DEATH:
Modern methods in the execution of death sentences have
abandoned inhuman, cruel and barbarous means. Executions by
garroting, decapitation by means of the guillotine and by drowning
which were common during the medieval days are no longer
practiced. The statutes of all countries state the legal procedure
for the execution of death penalties. The constitution, like that
of the Philippines, imposes certain limitations to the law-making
body as to the method to be established.
Art. Ill, Sec. 1, Par. 19, of the Philippine Constitution provides
that "cruel and unusual punishment shall not be inflicted." The
wait for the provision of the new constitution punishment prohibited must not only be cruel but also unusual or vice versa.
Banishment may be unusual but not cruel and therefore valid.
Death penalty is not cruel and unusual whether it be by hanging,
shooting, or electrocution (Legarda v. Valdez, 1 Phil 146).
Punishments are cruel when they involved torture or a lingering
death, but the punishment of death is not cruel because it is not
barbarous and inhuman.
The purpose of the guaranty by the constitution is to eliminate
many inhuman and uncivilized punishments formerly known,
the infliction of which tend to barbarize present civilization
(McElvaine v. Brush, 142 U.S. 155).
Death Penalty:
1. Arguments in Favor of the Death Penalty:
( 1 ) It is the only method of eliminating the hopeless enemy
of society — Escape from prison, commutation of sentence
and pardon are ways that criminals, helped by their friends,
escaped life imprisonment.
( 2 ) It deters potential criminals as no other form of punishment does.
(3) Its brutalizing effect is an unproven assumption. — It is
contended that if capital punishment is properly carried
out, instead of brutalizing society, it satisfies the sense of
justice and provides social satisfaction and a sense of protection.
203
204
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(4) It is the only means whereby society is relieved of the
support for those who continually war upon it. Society
will be relieved of- expenses of maintaining the irreformable
criminals who prey upon it.
(5) It is a positive selective agency to wipe out the stock of
irreformable criminals — Killing the hopeless criminals will
eliminate some of the degenerated stock of society.
2. Arguments Against Death Penalty:
(1) It is an irreversible penalty. — Mistaken judgments as to
guilt can no longer be remedied.
(2) It is not reformative. — Capital punishment indicates impossibility of reformation of offenders. No one is incorrigible sociologically.
(3) Capital punishment is not a deterrent in effect. — There is
no country where death penalty is imposed and criminality,
diminished.
(4) Capital punishment diminished the certainty of punishment.
— It is a common experience that the court will not convict
a person when the penalty to be imposed is death. If capital
punishment is done away entirely, the court is more likely
to convict and thus society is protected in greater measure.
(5) Capital punishment violates humanitarian sentiments. —
Men can take a life in self-defense or in the heat of passion,
and have a relieving sense of justification, but to take in
cold blood the life of a prisoner causes all the humanitarian
sentiments developed in thousands of years to revolt.
( 6 ) Capital punishment is retributive — Revengeful acts of
society is already an out of fashion philosophy. The test
is to have a corrective approach.
( 7 ) It is a cold-blooded and deliberate kind of murder. — The
executioner has no passion to justify the performance of
his act. It is, however, a question whether a man who pulls
the trap may not feel he is doing a public service that is
even greater than a policeman who shoots a fleeing murderer or robber.
Methods of Judicial Death:
1. Death by Electrocution:
A person is made to sit on a chair made of electrical conducting materials with straps of electrodes on both wrists,
ankles, and head. An alternating current voltage of more than
1,500 volts is put on until the convict dies.
SPECIAL DEATHS
205
If the convict does not die after a few minutes that the current
was put on, it is necessary to apply another current until he is
pronounced dead by the physician. The law states that the
penalty is death by electrocution so that the convict must be
put to death. It is the duty of the administrator of the penitentiary to mitigate as much as possible the sufferings of the
convict in the execution of death sentence.
Art. 81, Revised Penal Code — When and how the death
penalty is to be executed. — The death sentence shall be executed with preference to any other and shall consist in putting
the person under sentence to death by electrocution.
The
death sentence shall be executed under the authority of the
Director of Prisons, endeavoring so far as possible to mitigate
the sufferings of the person under sentence during electrocution as well as during the proceedings prior to the execution.
If the person under sentence so desire, he shall be anesthesized at the moment of the electrocution.
Art. 82, Revised Penal Code — Notification and execution of
the sentence and assistance to the culprit. — The court shall
designate a working day for the execution, but not the hour
thereof, and such designation shall not be communicated to
the offender before sunrise of said day, and the execution shall
not take place until after the expiration of at least eight hours
following the notification, but before sunset.
During the
interval between notification and the execution, the culprit
shall, in so far as possible, be furnished with assistance as he
may request in order to be attended in his last moments by
priests or ministers of the religion he professes and to consult
lawyers, as well as in order to make a will and confer with
members of his family or persons in charge of the management
of his business, of the administration of his property, or of the
care of his descendants.
Art. 83, Revised Penal Code — Suspension of the execution
of the death sentence. — The death sentence shall not be inflicted upon a woman within the three years next following
the date of the sentence or while she is pregnant not upon any
person over seventy years of age. In this last case, the death
sentence shall be commuted to reclusion perpetua with the
accessory penalties provided in article 40.
Art. 84, Revised Penal Code — Place of execution and persons who may witness the same. The execution shall take place
in the penitentiary of Bilibid in a space closed to public view
and shall be witnessed only by the priests assisting the offender
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and by his lawyers and by his relatives, not exceeding six, if
he so request, by the physician and the necessary personnel
of the penal establishment, and by such persons as the Director
of Prisons may authorize.
Death by electrocution is the only method recognized by
our civil law. There is a growing sentiment to remove capital
punishment although it is a means to discourage future wrongdoers.
Death may be due to shock; respiratory failure due to bulbar
paralysis or asphyxia;and due to prolong and violent convulsion.
2. Death by Hanging:
The convict is made to stand in an elevated collapsible flatform with a black hood on the head, a noose made of rope
around the neck and the other end of which is fixed in an elevated
structure above the head. Without the knowledge of the convict, the flatform suddenly collapses which causes the sudden
suspension of the body and tightening of the noose around the
neck. Death may be due to asphyxia or injury of the cervical
portion of the spinal cord.
In the Philippines, this method of death execution is only
allowed on death penalties imposed by military tribunals or
court marshals.
It is considered to be the most gruesome
means of death and is imposed primarily to those who have
been found guilty of very grave offenses.
In the Philippines, death penalty that are imposed by the civil
court must only be by electrocution. Hanging is not recognized as
a means of executing death sentence, although the decision of the
military tribunals may impose death by hanging.
The following are the causes of death in judicial hanging:
a.
b.
c.
d.
e.
f.
Dislocation or fracture of the upper cervical vertebrae.
Partial or complete severance of the spinal cord.
Rupture of the cervical muscles.
Asphyxia due to the pressure on the vagus nerve.
Syncope due to the pressure on the vagus nerve.
Cerebral anemia which results to an inhibition of the vital
centers of the brain.
3. Death by Musketry:
The convict is made to face a firing squad and is put to death
by a volley of fire. The convict may be facing or with his back
towards the firing squad.
SPECIAL DEATHS
207
This method of execution of death penalty is applied to
military personnel and decided by the court marshals. Death
by musketry is considered less heinous than death by hanging.
4. Death by Gas Chamber:
The convict is enclosed in a compartment and an abnoxious
or asphyxiating gas is introduced. The most common gas
used is carbon monoxide. The convict will not be removed
from the gas chamber unless he is pronounced dead by the
penitentiary physician.
This method is not recognized by the Philippine civil or
military law. In some states of the United States, it is a legal
means of judicial death execution.
Other Methods of Capital Punishment:
1. Beheading — The most common way of beheading is with the
use of the guillotine. The device is something like a file-driver
with a heavy axe to severe the head. The descent of the blade
strikes the neck from behind and the head falls into a basket.
2. Crucifixion — Nailing the person on a cross and death develops
by traumatic asphyxia.
3. Beating — A hard object is forcibly applied to the head to
crush the skull.
4. Cutting asunder — Mutilating the body usually with sharp
heavy instrument until death ensues.
5. Precipitation from a height.
6. Destruction by wild beast.
7. Flaying — skinning alive.
8. Impaling.
9. Stoning.
10. Strangling.
11. Smothering.
12T Drowning.
Euthanasia or "mercy killing" is the deliberate and painless
acceleration of death of a person usually suffering from an incurable and distressing disease.
It is universally condemned but some advocate its legalization
based on humanitarian sentiments.
In the Philippines there is no law dealing specifically with the
matter but the general sentiment is that it is contrary to the
principle that "no person has the right to end his own life, much
LEGAL MEDICINE
208
less can he delegate such right to another." Medical ethics states
that the duty of a physician is to save life, not to end it.
Philosophically — It is the proper function of society to safeguard man's right to die when he chooses to, provided it will not
prejudice the rights of others.
Churches — All churches are against euthanasia because an individual does not have the full dominion over his life to the extent
of determining whether or not he will continue to live. Only
God who created mankind has the sole right to extinguish it.
Medicine — There is no sense in performing euthanasia inasmuch as there is no physical pain so severe that modern medication available today cannot substantially provide relief.
The physician may be mistaken in the diagnosis of impending
death. Recovery, of the kind bordering closely on a miracle,
may occur. There is belief in the saying, "While there is life,
there is hope."
Sociologically — The practice of euthanasia is an endorsement
or toleration of society to suicide and a general approval of crime
committed for a benevolent motive.
Types of Euthanasia:
1. Active Euthanasia — Intentional or deliberate application of
the means to shorten the life of a person. It may be done with
or without the consent or knowledge of the person. Active
euthanasia on demand is the putting to death of a person in
compliance with the wishes of the person (patient) to shorten
his sufferings.
2. Passive Euthanasia — There is absence of the application of
the means to accelerate death but the natural course of the disease
is allowed to have its way to extinguish the life of a person.
Consequently the concept of orthothanasia and dysthanasia
was adopted.
a. Orthothanasia — When an incurably ill person is allowed to
die a natural death without the application of any operation
or treatment procedure.
b. Dysthanasia — When there is an attempt to extend the life
span of a person by the use of extraordinary treatments
without which the patient would have died earlier.
Note: Dysthanasia does not comply with the definition of
euthanasia.
(Report on the 4th World Congress on Medical Law, Manila,
March 16-17, 1976, p. 57).
SPECIAL DEATHS
209
Ways of the Performing Euthanasia:
1. Administration of a lethal dose of poison.
2. Overdosage of sedatives, hypnotics or other pain relieving drugs.
3. Injection of air into the blood stream.
4. Application of strong electric currents.
5. Failure to institute the necessary management procedure which
is essential to preserve the life of the patient.
a. Failure to perform tracheostomy when there is marked distress in breathing due to laryngeal obstruction.
b. Failure to give transfusion in severe hemorrhage.
c. Depriving the child of nutrition.
d. Removal of patient from a respirator when voluntary breathing is not possible.
Who May Perforin Euthanasia:
1. The patient himself:
A n y person who deliberately puts an end to his life commits
suicide. Suicide is not a crime in our jurisdiction because a
person committing suicide is a moral wreck and he must be
given an eye of pity or sympathy rather than an eye of penalty
by law. This is also based on a philosophy that a person has a
complete dominion over his own body.
2. The physician, with or without the knowledge and consent of
the patient:
Even if a physician has humanitarian or merciful motive in
putting to death a patient, his act his punishable in spite of the
patient's consent.
Art. 253, Revised Penal Code — Giving assistance to suicide —
A n y person who shall assist another to commit suicide shall
suffer the penalty of prision mayor; if such person lends his
assistance to another to the extent of doing the killing himself,
he shall suffer the penalty of reclusion temporal. However, if
the suicide is not consummated, the penalty of arresto mayor
in its medium and maximum periods shall be imposed.
The above provision contemplates the following situations:
a. If a physician assists a person in the commission of suicide
(by giving him a lethal dose of poison, for example) without
actually administering it, the law imposes upon him the
penalty of prision mayor (6 yrs. and 1 day to 12 yrs. imprisonment).
b. If the physician lends his assistance to another to the extent
of doing the killing himself, he shall be punished by reclusion
temporal (12 yrs. and 1 day to 20 yrs.);
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LEGAL MEDICINE
c. If the suicide with the assistance of the physician is not
consummated, the penalty of arresto mayor (1 month and
1 day to 6 months) in its medium and maximum period shall
be imposed; and
3.
If poison was administered by the physician to the patient
without the knowledge and consent of the patient, then it is
murder. Treachery is inherent to the act of poisoning and treachery qualifies the killing to murder.
In other jurisdictions, the modern attitude is to allow physicians to perform euthanasia in some special cases.
In the case of Dr. Adams who was charged for murder by
administering a pain-killing drug to a patient suffering from a
painful and- incurable disease, which he was then acquitted,
the court held that "If the first purpose of medicine (the
restoration of health) could no longer be achieved, there was
much for the doctor to do, and he was entitled to do all
that was proper and necessary to relieve pain and suffering
even if the means he took might incidentally shorten life by
hours or perhaps even prolong it. The doctor who decides
whether or not to administer the drug would not do his
job if he were thinking in terms of hours or even in months.
The defense in the present case was that the treatment
given by Dr. Adams was designed to promote comfort,
and if it was the right ana proper treatment the fact that it
shortened life did not convict him of murder" (R. v. Adams,
Crim., L.R. 365, 1957).
In a recently decided case (In the matter of Karen Quinlan, N.J. Sup. Ct. Mar. 3 1 , 1 9 7 6 ) , Karen Quinlan had been in
coma for almost a year and has been kept alive by a respirator.
The father petitioned the court to authorize
discontinuation of the respirator because there is no "reasonable possibility" that she would recover and to allow her to
die "with grace and dignity". The court allowed such removal provided it is with the consent of the attending physician and a panel of hospital staff. The court based it on
the right of privacy of the patient or the right of the patient
to make life— sustaining medical decision and that since
the patient was incompetent to make such decision, it belonged to her father acting as a guardian. The court does not
question the "state's undoubted power to punish the taking
of human life, but that power does not encompass individuals terminating treatment pursuant to their right of privacy".
SPECIAL DEATHS
211
3. SUICIDE:
Suicide or self-destruction is usually the unfortunate consequence of mental illness and social disorganization.
Societal
reaction to suicide varies in different jurisdiction. Some consider
suicide a crime (Maryland, N e w Jersey, North Carolina, Oklahoma,
South Dakota); others impose no penalty for suicide but suicide
attempts are considered felonies or misdemeanors and could result
to jail sentences.
In criminal statistics there is under-reporting of suicide cases
because of the following reasons:
1. Even if the facts are clear to support suicide, the strong opposition of the family, the physician, attorney and friends may
cause a certification that it is accidental, because they are not
only bereaved but also stigmatized. The legal and moral implications of suicidal death prevent certification of such manner
of death. If insured may deprive the beneficiary from receiving
the full value of the policy, the usual religious rites may not be
accorded the deceased, and other benefits provided by law
which the heirs are entitled may not be received.
2. There is a lack of generally accepted standards for determining death by suicide. To make death suicidal, it must
be the direct, conscious, intentional act of self-destruction.
Subconscious or sub intended acts which directly or indirectly
cause or hasten death is not considered to be suicide.
No
single finding in the investigation of death is an absolute criterion
of suicide.
Suicide rarely occurs during the pre-addescent age. The incidence increase with the age but more in the elderly. There is
more incidence in male than in female. Most victims have experienced depression of long duration prior to dying.
Suicide occurs in almost every conceivable location but a vast
majority of cases occur at home. It may occur in other places
like hotel, automobile, jails, hospitals and mental institutions.
The bodies of victims may be found in rivers, lakes, open fields.
The scene of death is orderly.
Psychological Classification of Suicide:
1. First degree — deliberate, planned, premeditated, self-murder.
2. Second degree — impulsive, unplanned, under great provocation
or mitigating circumstances.
3. Third degree — sometimes called "accidental" suicide. This
occurs when a person puts his or her life into jeopardy by
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LEGAL MEDICINE
voluntary self-injury, but where we infer that the intention
to die was relatively low because the method of self-injury was
relatively harmless, or because provisions for rescue were made.
The person was "unlucky" actually to die.
4. Suicide under circumstances which suggest a lack of capacity
for intention, as when the person was psychotic or highly
intoxicated from the effects of drugs, including alcohol.
5. Self-destruction due to self-negligence — for example, such
self-destructive behaviors as chronic alcoholism, reckless driving,
ignoring medical instructions, cigarette smoking, and similar
dangerous activities. In general, such deaths are not at present
classified as "suicide."
6. Justifiable suicide — for example, the self-destructive action of
a person with a terminal illness. This last category is of considerable current interest to philosophers, theologians and
social psychologists.
(From:
Psychological Aspects of Suicide by Robert Litman,
Modern Legal Medicine Psychiatry and Forensic Science, Curran,
McGarry & Petty, ed. 19, 980, F. A. Davis Co., p. 843).
Common Methods of Commiting Suicide:
1. Drugs and poisons — Barbiturates, non-barbiturate sedatives,
acids and other irritants, carbon monoxide, pesticides and
herbicides, other organic and inorganic poisons.
2. Hanging.
3. Firearm.
4. Jumping from a height.
5. Drowning.
6. Cutting and stabbing.
7. Suffocation by plastic bag.
8. Electrocution.
Suicide and Drug:
"Automatism" due to drug may be considered as accidental
rather than suicidal. A patient develops a state of toxic delirium
after ingesting one or several doses of tlffe drugs, alcohol or a combination thereof and while in the delirious or automatism stage,
takes much more of the drug unintentionally.
Evidences That Will Infer Death is Suicidal:
1. History of depression, unresolved personal problem, or mental
disease;
2. Previous attempt of self-destruction;
3. If committed by infliction of physical injuries, the wounds are
SPECIAL DEATHS
213
located in areas accessible to the hand, vital parts of the body
and usually solitary.
4. The effects of the act of self-destruction may be found in the
body of the victim:
a. Hand may be blood-stained if suicide was done by inflicting
wound;
b. Wounding hand may be positive to paraffin test in gunshot.
The wound of entrance may show manifestation of a contact
or near shot.
c. Empty bottle or container of poison may be present at the
suicide scene;
d. Absence of signs of struggle; or
e. Cadaveric spasm present in the wounding hand holding the
weapon.
5. Presence of suicide note;
6. Suicide scene in a place not susceptible to public view, and
7. Evidences that will rule out homicide, murder, parricide, and
other manner of violent death.
DEATH FROM STARVATION
Starvation or inanition is the deprivation of a regular and constant
supply of food and water which is necessary to normal health of a
person.
Death b y itarvation
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LEGAL MEDICINE
Types of Starvation:
1. Acute starvation — is when the necessary food has been suddenly
and completely withheld from a person.
2. Chronic starvation — is when there is a gradual or deficient supply
of food.
Causes of Starvation:
1. Suicidal:
a. People deprived of liberty or prisoners may go in a "hunger
strike" to create sympathy.
b. Mistaken belief that people can live without food for a prolonged period.
c. Excessive desire to lose weight.
d. Lunatics during depressive state.
e. As an expression of political dissent.
2. Homicidal:
a. Deliberate deprival of food for helpless illegitimate children,
feeble-minded and old persons.
b. Punishment or act of revenge by deliberate incarceration in
an enclosed place without food m water.
3. Accidental:
a. Scarcity of food or water during famines or draught.
b. Shipwreck, entombment of miners caused by landslides, marooned sailors, or fall in a pit.
Length of Survival:
The human body without food loses l/24th of its weight daily,
and a loss of 40% of the weight results to death.
The length of survival depends upon the presence or absence of
water. Without food and water, a person cannot survive more than
10 days, but with water a person may survive without food for 50
to 60 days.
Factors that Influence the Length of Survival:
a. Age — Children suffer earlier from the effects of starvation
than old aged people. A child demand more food for growth
and development. Assimilation and utilization of food elements
is slowed and weakened in old age.
b. Condition of the body — During starvation, fat stored up in the
body is the one utilized to maintain life. It is but natural that
a healthy person with more fat deposit can resist more deprival
of food.
SPECIAL DEATHS
2
1S
c. Sex — Women can withstand starvation longer because they
have relatively more adipose tissues than men.
d. Environment — Exposure to higher temperature will accelerate
death.
Suitable clothings will delay death. Active physical
exertion will hasten death. Severe cold will also hasten death.
The Length of Survival Depends Upon the Following:
a. Presence or absence of water.
b. Partial or complete withdrawal of food.
c. Surroundings.
d. Females survive better than males, but children and older
persons die quickly.
e. Condition of the body.
Symptoms:
1. Acute feeling of hunger for the first 30 to 48 hours and this is
succeeded by localization of the pain at the epigastrium which
can be relieved by pressure.
2. A feeling of extreme thirst.
3. The face is pale and cadaverous.
4. Four or five days later, there is a general emaciation and absorption of the subcutaneous fat.
5. The eyes are sunkened, glistening dilated pupils and with anxious
expression.
6. The lips and tongue are dry and with cracks, while the breath is
foul and offensive.
7. The voice becomes weak, faint and inaudible.
8. The skin is dry, rough, wrinkled and emitting a peculiar disagreeable odor.
9. The pulse is weak and the temperature is subnormal.
10. The abdomen is sunkened and the extremities are thin, flaccid
with marked loss of muscular power.
11. The intellect may remain for sometime, later becomes delirious
and convulsion or coma appears before death.
12. Symptoms of secondary infection may later appear on account
of the weakened resistance of the body.
Cause of Death:
1. Inanition
2. Circulatory failure due to brown atrophy of the heart
3. Intercurrent infection
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LEGAL MEDICINE
Post-mortem Findings:
1. External Findings:
a. Body greatly emaciated and emitting a peculiar offensive odor.
b. The eyes are dry, red and open with the eyeballs sunkened.
c. The skin is dry, shrivelled and sometimes with secondary skin
infection.
d. Bed sores may be present.
2. Internal Findings:
a. The muscles are pale, soft, wasted with the subcutaneous fat
almost completely disappeared.
b. There is a general reduction in the size and weight of all organs,
except the brain.
c. The brain is pale and soft, while meningeal vessels are congested
and frequently, there is a serous effusion in the ventricle.
d. The heart is small, with flabby and pale muscles and generally
empty chambers (brown atrophy).
e. The lungs are edematous with hypostatic congestion.
f. The stomach is small, contracted and empty with the mucous
membrane less stained with bile.
g. The intestine is thin, empty, with its thin and translucent wall
and with the disappearance of the mucosal folds.
h. There may be superficial or extensive ulceration of the colon as
in ulcerative colitis.
i. The liver, spleen, kidneys and pancreas are small and shrunken.
Microscopically, the liver shows necrosis of the central zone.
The liver damage was due to protein deficiency.
j. The gall bladder is distended with bile while the urinary bladder
is empty.
k. There is demineralization of bones and in pregnant women, it
may produce osteomalacia.
1. Findings are refenable to concomitant disease which may
develop on account of the diminished resistance.
Effects of Chronic Starvation:
Incomplete withdrawal of food to the body may cause a different
effect. The person will manifest symptoms referrable to the food
deficiency.
1. Deprivation of protein in the diet reduces the amount of protein
in the serum and edema, anemia, leucopenia and weakened
cardiac function develop.
SPECIAL DEATHS
217
2. Absence of various vitamins in the food for a long period of time
may cause nutritional disturbance:
a. Deficiency in Vitamin A will cause hyperkeratosis of the skin
atrophy of the mucous membrane, drying up of the salivary
and lacrimal glands and night blindness.
b. Deficiency of Vitamin B will cause neuritis, sore tongue, hypertrophy of the heart, and other manifestations of beri-berL
c. Deficiency of Vitamin C will cause hemorrhage in various parts
of the body, kidneys, periosteum. Massive hemorrhage in the
gums is observed in adults.
d. Deficiency of Vitamin D and calcium may be followed by
respiratory catarrh, anemia, osteomalacia and skeletal deformities.
3. Deficiency of sugar, fat and minerals produce various disturbance
in the body.
Medico-Legal Questions in Death Due to Starvation:
1. Determination whether death was caused by starvation:
It is necessary to examine carefully the internal organs and to
search for the existence of any disease which may possibly be the
cause of death.
Some diseases may also lead to pathological
emaciation, like malignant disease, tuberculosis, diabetes mellitus,
anemia and chronic diarrhea. Absence of any disease which may
cause severe emaciation and the presence of a cause for the deprivation of food are the basis for the diagnosis of death by
starvation.
2. Determination of the cause of the starvation:
Starvation may be suicidal, homicidal or accidental.
The
condition of the surroundings, history and previous life of the
victim and his mental condition before he starved must be taken
into consideration in the determination of the cause.
Chapter VIII
DISPOSAL OF THE DEAD BODY
Sec. 1103, Revised Administrative Code:
Persons Charged with Duty of Burial:
The immediate duty of burying the body of a deceased person,
regardless of the ultimate liability for the expense thereof, shall
devolve upon the persons hereinbelow specified:
(a) If the deceased was a married man or woman, the duty of
burial shall devolve upon the surviving spouse if he or she
possesses sufficient means to pay the necessary expenses.
( b ) If the deceased was an unmarried man or woman, or a child,
and left any kin, the duty of burial shall devolve upon the
nearest kin of the deceased, if they be adults and within the
Philippines and in possession of sufficient means to defray the
necessary expenses.
(c) If the deceased left no spouse or kindred possessed of sufficient means to defray the necessary expenses, as provided in
the two foregoing subsection, the duty of burial shall devolve
upon the municipal authorities.
Any person upon whom the duty of burying a dead body is imposed by law shall perform such duty within forty-eight hours after
death, having ability to do so.
Sec. 1104, Revised Administrative Code:
Right of Custody to body:
A n y person charged by law with the duty 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; and, in case of death
due to or accompanied by a dangerous communicable disease, such
body shall until buried remain in the custody of the local board of
health or local health officer, or if there be no such, then in the
custody of the municipal council.
C O N C E P T O F POSSESSION:
The right of custody over a dead body means possession. Possession means the holding of a thing or enjoyment of a right. The
possession of a thing means two things: either in the concept of
218
DISPOSAL OF THE DEAD BODY
219
ownership or the holder of a thing keeping it while the ownership
belongs to another.
Literally speaking, the right of custody does not -mean ownership
of a dead body. The possessor cannot exercise the full rights of
ownership.
Kenny (Canada), in his Outlines of Criminal Law (15 ed. p. 219)
cited a case of a group of individuals known as "resurrection men"
who used to disinter dead bodies from cemeteries and sell them to
the anatomy departments of medical colleges. Since the law provides that the crime of theft or robbery cannot be committed on
things which have no owner, these people were not successfully
prosecuted for theft.
In the case of Philips v. Montreal General Hospital (33 S.C. 483;
14 R . L . 159) decided in Quebec, Canada, it has been held that there
is a right of property in human remains, at least in a limited sense.
The right of possession of a corpse is equivalent to ownership and
any unlawful interference with that right is an actionable wrong.
The surviving spouse has the preferential right and duty to make
arrangements, for the funeral of the deceased spouse and to decide
how the remains should be disposed of. This is also the rule in the
United States, where the superior and preferred right of the surviving
spouse to the burial and any other legal disposition of the remains of
the husband is undisputed (Ameida Vda. de Carillo v. Carillo, 67
Phil. 92).
Executor's Right of Custody Superior to the Right of Spouse Dead
Body:
If ever the deceased left a will stating among other things the
manner his body will be disposed, such provision of the will
if validly executed and allowed, will prevail over the provisions of
the Administrative Code.
An executor is the person mentioned in a will who will carry on
the provision of the will. He is duty-bound to execute whatever is
stated in the will after the death of the decedent. But, in the absence of a testamentary disposition, the right of the surviving spouse
is paramount.
In the case of Hunter v. Hunter, decided in Ontario, Canada (65
O . L . R . 586), the deceased had been a staunch and devout Protestant and an Orangeman. His wife is an equally devout Catholic.
At the time of his last illness he expressed a wish to be buried in
the place where his wife would be buried, which was taken to
mean, in a Roman Catholic cemetery. He was then received into
the Roman Catholic Church and died about three weeks later.
One of the deceased's son-the plaintiff in the case-has been named
LEGAL MEDICINE
220
executor of the will, and claimed the body for burial, which he
intended should be in a Protestant cemetery. This was resisted
by the widow who contended that her husband should be buried
in a cemetery of the church he had joined recently. The court
maintained the son's claim holding that, as executor, he had a right
to have the body for the purpose of burial. The wife was prevented from interfering with that right (Cited by Meridith).
METHODS OF DISPOSAL OF THE D E A D B O D Y :
1. Embalming:
Embalming is the artificial way of preserving the body after
death by injecting 6 to 8 quarts of antiseptic solutions of formalin,
perchloride of mercury or arsenic, which is carried into the common carotid and the femoral arteries. Usually, alcohol is added
to minimize the strong odor of the chemical and glycerine to
lessen the evaporation of water from the tissues of the body. If
the preservation of the body is for a longer time, the abdominal
and thoractic viscera are removed, washed and soaked in strong
antiseptic solution before they are returned. The skin is painted
with vaseline or covered with plaster of Paris to prevent too much
evaporation.
2. Burial or Inhumation:
a. The body must be buried within forty-eight hours after death:
Sec. 1092, Revised Administrative Code:
Time within which body shall be buried:
Except when required for the purposes of legal investigation
or when specifically authorized by the local health authorities, no
unembalmed body shall remain unhurried longer than fortyeight hours after death; and after the lapse of such period the
permit for burial, interment, or cremation of any such body
shall be void and a new permit must be obtained.
When it has been certified or is known that any person died
of, or with a dangerous communicable disease, the body of such
person shall be buried within twelve hours after death, unless
otherwise directed by the local board of health or other health
authority.
The dead body must be buried within forty-eight hours after
death except:
( 1 ) When it is still a subject matter of legal investigation;
( 2 ) When it is specifically authorized by the local health authorities that the body may be buried more than 48 hours
after death;
DISPOSAL OF THE DEAD BODY
221
( 3 ) Impliedly when the body is embalmed.
If the person died of communicable disease, the body must
be buried within 12 hours unless the local health officer permits
otherwise.
If the body is not buried within 48 hours after death, the
permit previously issued is deemed cancelled and there is a
need of a new permit.
Considering the climatic conditions in the Philippines, the
time limit provided for by law regarding burial time should be
reduced to 24 hours instead of 48 hours. Decomposition of
the body in tropical countries, like the Philippines, is relatively
rapid.
b. Death Certificate Necessary before Burial:
Sec. 1087, Revised Administrative Code:
Requirement of Certificate of Death — By whom to be issued:
Except in cases of emergency, no dead body shall be buried
without a certificate of death. If there has been a physician in
attendance upon the deceased, it shall be the duty of the said
physician to furnish required certificate. If there has been no
physician in attendance, it shall be the duty of the local health
officer or of any physician to furnish such certificate. Should
no physician or medical officer be available, it shall be the duty
of the mayor, the secretary, or of a councilor of the municipality to furnish the required certificate.
Sec, 91, P.D. 856 Code of Sanitation — Burial Requirement:
The burial of remains is subject to the following requirements:
( a ) No remains shall be buried without a death certificate.
This certificate shall be issued by the attending physician.
If there has been no physician in attendance, it shall be
issued by the mayor, the secretary of the municipal
board, or a councilor of the municipality where the death
occurred. The death certificate shall be forwarded to
the local civil registrar within 48 hours after death.
The death certificate shall be forwarded by the person issuing
it to the municipal secretary within forty-eight hours after death.
The law requires the necessity of a death certificate before
burial, except in emergency cases. The following may sign the
death certificate:
( 1 ) The attending physician, if there is any;
( 2 ) The local health (municipal health officer) if there is no
physician in attendance;
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LEGAL MEDICINE
(3) The municipal mayor, if there is no local health officer and
no physician in attendance;
(4) The municipal secretary, in the absence of the mayor;
( 5 ) Any councilor.
The order in the enumeration is exclusive and successive.
The presence of the preceding person will exclude the
succeeding person in the enumeration.
Inasmuch as almost all municipalities of the Philippines
have municipal health officers; the municipal mayor,
secretary and any of the councilors are practically inhibited
to sign the death certificate.
It appears unusual and contrary to the intent and purpose
of the death certificate when persons not qualified to know
the cause of death, are authorized by law to sign it.
This provision of the Administrative Code was promulgated during the time when physicians were quite
scarce.
c. Permission from the Provincial Fiscal or from the Municipal
Mayor is Necessary if Death is Due to Violence or Crime:
Sec. 1089, RevisedAdministrative Code:
Proceedings in case of suspected violence or crime:
If the person who issues a death certificate has any reason to
suspect or if he shall observe any indication of violence or
crime, he shall at once notify the justice of the peace, if he be
available, or if neither the justice of the peace nor the auxiliary justice be available, he shall notify the municipal mayor,
who shall take proper steps to ascertain the circumstances and
cause of death; and the corpse of such deceased person shall
not be buried or interred until permission is obtained from the
provincial fiscal, if he be available, and if he be not available, fjom the mayor of the municipality in which the death
occurred.
Sec. 91 ( f ) , P . D . 856 Code of Sanitation:
If the person who issues a death certificate has reasons to
believe or suspect that the cause of death was due to violence
or crime, he shall notify immediately the local authorities
concerned. In this case the deceased shall not be buried until
a permission is obtained from the provincial or city fiscal. If
these officials are not available, permission shall be obtained
from any government official authorized by the law.
DISPOSAL OF THE DEAD BODY
223
In cases of death wherein violence or crime is suspected, it is
necessary to notify the following in order to determine the
circumstances and nature of death:
( 1 ) Justice of the peace.
( 2 ) Auxiliary justice of the peace, if the former is not available.
But the permission for burial may only be granted by:
(1) Provincial fiscal.
( 2 ) Municipal mayor if the fiscal is not available.
Sec. 1090, Revised Administrative Code:
Burial and transfer permits:
Municipal secretaries, in the capacity of secretaries of municipal boards of health in places where such boards have been
organized, or, in places where there are no municipal boards of
health, in the capacity of clerks to municipal councils, shall,
upon the presentation of death certificates, issue permits for
the burial or transfer of the dead and shall record on said certificates the place of interment and when practicable the number
of the grave from which the body or remains have been transferred, and the disposition that is to be made of such body or
remains. No permit shall be granted by any municipal secretary,
or by any other person, to inter or disinter, bury or remove for
burial, any human body or remains until a certificate of death,
as hereinbefore required, shall have been filed; when it is
impossible to secure a death certificate in the form and manner
hereinbefore provided, municipal secretaries may issue the same
upon such data as may be obtainable.
In case of the transfer of bodies or remains from one municipality to another municipality, a copy of the death certificate
shall accompany the transfer permit.
Sec. 1094, Revised Administrative Code:
Disposition of body and belonging of person dying of dangerous
communicable disease:
The body of a person dead of any dangerous communicable
disease shall not be carried from place to place, except for the
purpose of burial or cremation. It shall be the duty of the local
health authorities to cause such body to be thoroughly disinfected before being prepared for burial and the house, furniture, wearing apparel, and everything capable of conveying
or spreading infection shall also be disinfected or destroyed £ y
fire. The local health authority, if there be any, subject to the
approval of the Director of Health, shall,consistently with the
provisions hereof, prescribe the conditions under which the
224
LEGAL MEDICINE
bodies of persons dying of a dangerous communicable disease
shall be buried or cremated.
Sec. 91 ( h ) , P.D. 856 Code of Sanitation:
When the cause of death is a dangerous communicable
disease, the remains shall be buried within 12 hours after death.
They shall not be taken to any place of public assembly. Only
the adult members of the family pf the deceased may be permitted to attend the funeral.
Sec. 1091, Revised Administrative Code:
Burial permit (Death Certificate) must be presented before
burial:
No sexton, superintendent, or other person having charge of
a burial ground or cemetery shall assist in, assent to or allow
any interment, disinterment or cremation to be made until a
permit from the municipal secretary, authorizing the same, has
been presented.
Placing of body in overground tomb:
Sec. 1099, Revised Administrative Code:
Exhibition of permit to sexton:
The placing of the body of any deceased person in an unsealed overground tomb is prohibited, unless the coffin, or
casket containing the remains shall be permanently sealed.
The provision shall not apply to tombs and vaults which are
strictly receiving vaults for bodies or remains awaiting final
disposition, nor to embalmed bodies awaiting final disposition.
The depth of the grave must be at least 1-1/2 meters:
Sec. 1100, Revised Administrative Code:
Depth of grave:
A grave shall be dug, when practicable, to a depth of one and
one-half meters and after the implacement of the body shall be
well and firmly filled.
Sec. 91 ( c ) , P.D. 856 Code of Sanitation:
Graves where remains are buried shall be at least one and onehalf (1-1/2) meters deep and filled well and firmly.
The Law Penalizes Desecration of Burial Premises:
Sec. 2695, Revised Administrative Code:
Desecration of burial premises:
Any person who wantonly or maliciously defaces, breaks, or
destroys any tomb, ornament, or gravestone erected to any
deceased person, or any momento or memorial, or any plant,
tree or shrub pertaining to places of burial of a dead body, or
DISPOSAL OF THE DEAD BODY
225
who shall wantonly or maliciously remove any fence, post, or
wall or any burial ground or cemetery, shall be punished by a
fine of not more than two hundred pesos or by imprisonment
for not more than six months, or both.
Although it did not totally repeal the provision of the Administrative Code, The Code of Sanitation provides:
Burial Grounds Requirements:
P.D. 856)
(Sec. 90, Code of Sanitation,
The following requirements shall be applied and enforced:
a. It shall be unlawful for any person to bury remains in
places other than those legally authorized in conformity
with the provisions of the Chapter.
b. A burial ground shall at least be 25 meters distant from any
dwelling house and no house shall be constructed within
the same distance from any burial ground.
c. No burial ground shall be located within 50 meters from
any source of water supply.
Other Burial Requirements:
The burial of remains is subject to the following requirements:
( 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 on account of race, nationality, religious or
political persuasion.
( 3 ) Except when required by legal investigation or when permitted by the local health authority, no unembalmed
remains shall remain unburied longer than 48 hours after
death.
FUNERALS:
Art. 305, Civil Code:
The duty and the right to make arrangements for the funeral of
a relative shall be in accordance with the order established for
support, under article 294. In case of descendants are of the same
degree, or of brothers and sisters, the eldest shall be preferred. In
case of ascendants, the paternal shall have a better right.
The order mentioned in the article 294 is as follows:
a. The spouse;
b. The descendants of the nearest degree;
c. The ascendant, also of the nearest degree;
d. The brothers and sisters.
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LEGAL MEDICINE
Att. 306, Civil Code:
Every funeral shall be in keeping with the social position of the
deceased.
Art. 307, Civil Code:
The funeral shall be in accordance with the expressed wishes of
of the deceased. In the absence of such expression, his religious
belief or affiliation shall determine the funeral rites. In case of
doubt, the form of funeral shall be decided upon by the person
obliged to make arrangement for the same, after consulting the
other members of the family.
Art. 309, Civil Code:
Any person who shows disrespect to the dead, or wrongfully
interferes with a funeral shall be liable to the family of the deceased for damages, material or moral.
This provision is further implemented by the Revised Penal
Code by considering it a criminal act. The funeral rite is a religious ceremony or manifestations of any religion.
Art. 132, Revised Penal Code:
Interruption of religious worship:
The penalty of prision correccional in its minimum period shall
be imposed upon any public officer or employee who shall prevent
or disturb the ceremonies or manifestations of any religion.
If the crime shall have been committed with violence, or threat,
the penalty shall be prision correccional in its medium and maximum periods.
Art. 133, Revised Penal Code:
Offending the religious feeling:
The penalty of arresto mayor in its maximum period to prision
correccional in its minimum period shall be imposed upon anyone
who, in a place devoted to religious worship or during the celebration of any religious ceremony shall perform acts notoriously
offensive to the feeling of the faithful.
Art. 2219, Civil Code provides that moral damages may be
recovered for acts mentioned in Art. 309, Civil Coda)
Limitations to the Funeral Rites:
a. Will of Deceased:
The deceased during his lifetime may have made a will or
expressly stated to his next of kin that his body after his death
must be disposed in the manner he desires.
b. Burial of the person sentenced to death must not be held with
pomp:
DISPOSAL OF THE DEAD BODY
227
Art. 85, Revised Penal Code:
Provision relative
burial:
to
the corpse of person executed and its
Unless claimed by his family, the corpse of the culprit shall,
upon the completion of the legal proceedings subsequent to the
execution, be turned over to the institute of learning or scientific research first applying for it, for the purpose of study and
investigation, provided that such institute shall take charge of
the decent burial of the remains. Otherwise, the Director of
Prisons shall order the burial of the body of the culprit at
government expense, granting permission to be present thereat
to the members of the family of the culprit and the friends of
the latter. In no case, shall the burial of the body of the person
sentenced to death be held with pomp.
c. Restriction as to funeral ceremonies in cases of deaths due to
communicable disease:
Sec. 1105, Revised Administrative Code:
Restrictions as to funeral ceremonies in certain cases:
In case of death due to dangerous communicable disease or
due to any epidemic recognized by the Director of Health, the
body of the deceased shall not be taken to any place of public
assembly, nor shall any person be permitted to attend the
funeral of such deceased person, except the adult members of
the immediate family of the deceased, his nearest friends, not
exceeding four, and other persons whose attendance is absolutely necessary. After the deceased shall have been buried for a
period of one hour, a public funeral may be held at the grave
or in a place of public assembly or elsewhere.
In case of death due to other causes the right to hold public
funerals in an orderly manner and to take the remains of the
deceased into churches or other places for this purpose shall not
be interferred with.
Sec. 91 ( h ) , P.D. 856 Code of Sanitation:
When the cause of death is a dangerous communicable
disease, the remains shall be buried within 12 hours after death.
They shall not ba taken to any place of public assembly. Only
adult members of the family of the deceased may be permitted
to attend the funeral.
3. Disposing of the Dead Body in the Sea:
Some dead bodies are not buried, embalmed or cremated but
thrown over board in an open sea provided that the deceased is
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LEGAL MEDICINE
not suffering from dangerous communicable disease. Such manner
of disposal may be the will of the deceased or a part of religious
practice.
Sec. 1093, Revised Administrative Code:
Permit for conveyance of body to sea for burial:
Where death is not due to a dangerous communicable disease a
special permit may, upon written request, be issued, by the
officer authorized to issue burial permits, for the conveyance of
a dead body to sea for burial. In such cases, the body must be
transported in the manner prescribed by the municipal board of
health, if such there be, and the marine laws governing burial at
sea must be complied with.
4. Cremation:
Cremation is the pulverization of the body into ashes by the
application of heat.
The body must first be identified before cremation, and no
cremation must be made unless there is a permit to do so. Cremation must be made in a crematory made for the purpose.
The time required to transform the human body to ashes is
dependent upon the degree or intensity of heat applied, duration
of the application of heat, physical condition of the body and the
presence of clothings and other protective materials in the body.
In a gas incinerator, it usually requires about four hours to transform the whole body into ashes.
Instances When Permission for Cremation Must N o t Be Granted:
a. If the deceased left a written direction that he or she must not
be cremated.
b. If the exact identity of the deceased has not yet been definitely
ascertained.
c. When the exact cause of death cannot be definitely ascertained
and further inquiry or examination may be needed (Forensic
Medicine by Kerr, 4th ed., p. 22).
5. Use of tiie Body for Scientific Purposes:
Sec. 97, P.D. 856, Code of Sanitation:
Use of remains for medical studies and scientific research:
Unclaimed remains may be used by medical schools and scientific institutions for studies and research subject to the rules and
regulations prescribed by the Department.
Sec. 1107, Revised Administrative Code:
Use of dead body for scientific purposes:
DISPOSAL OF THE DEAD BODY
229
The body of any deceased person which is to be buried at
public expense and which is unclaimed by relatives or friends for
a period of twenty-four hours after death shall be subject to the
disposition of the Bureau of Health, and, by order of the Director
of Health, may be devoted to the purposes of medical science and
to the advancement and promotion of medical knowledge and
information, subject to such regulations as said Director of Health,
with the approval of the Department Head, may prescribe. The
regulations of the Director of Health shall provide for the decent
burial of the remains of such bodies and for defraying the necessary expenses incident thereto. Except as herein provided, it shall
be unlawful for any person to make use of any dead body for any
scientific investigation other than that of performing an autopsy.
Corpse of prisoners after judicial execution may be turned over to
institution of learning or scientific research:
Art. 85, Revised Penal Code:
Provisions relative to the corpse of the person executed and its
burial:
Unless claimed by the family, the corpse of the culprit shall
upon completion of the legal proceedings subsequent to the
execution, be turned over to the institute of learning or scientific
research first applying for it, for the purpose of study and investigation, provided that such institution shall take charge of the
decent burial of the remains. Otherwise, the Director of Prisons
shall order the burial of the body of the culprit at government
expense, granting permission to be present thereat to the members
of the family of the culprit and the friends of the latter. In no
case shall the burial of the body of a person sentenced to death
be held with pomp.
Sec. 98, P.D. 856, Code of Sanitation:
Special precautions for safe handling of cadavers containing
radioactive isotopes:
a. Cadavers containing only traces (very small dose) of radioactive
isotope do not require any special handling precautions.
b. Cadavers containing large amounts of radioactive isotopes
should be labelled properly identifying the type and amount of
radioactive isotopes present and the date of its administration.
c. Before autopsy is performed, the Radiation Health Officer or
his duly authorized representative should be notified for proper
advice. The pathologist and/or embalmer should be warned
accordingly of the radioactivity of the cadaver so that radiation
precautions can be properly enforced.
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LEGAL MEDICINE
d. Normal burial procedures, rules and regulations may be carried
out on the above-mentioned cadaver provided that their amount
of radioactivity has decayed to a safe level which will be determined by the Radiation Health Officer or his authorized representative.
e. Cremation — If cremation is performed without autopsy, there
is no handling problem; otherwise, autopsy precautions should
be strictly enforced. Precautions should be taken to prevent
any possible concentration of radioactivity at the base cf the
stack of the crematorium.
DONATION OF PART(S) OF HUMAN BODY
PERMISSIONS T O USE H U M A N O R G A N S O R P O R T I O N S O F
THE H U M A N B O D Y F O R M E D I C A L , S U R G I C A L , O R SCIENTIFIC PURPOSES, U N D E R C E R T A I N C O N D I T I O N S
Republic Act N o . 349 as amended by
Republic Act 1056
A N A C T T O L E G A L I Z E P E R M I S S I O N S T O USE H U M A N ORG A N S O R A N Y P O R T I O N O R P O R T I O N S O F THE H U M A N
B O D Y F O R M E D I C A L , S U R G I C A L , O R SCIENTIFIC PURPOSES, U N D E R C E R T A I N C O N D I T I O N S
Sec. 1. Any person may validly grant to a licensed physician,
surgeon, known scientist, or any medical or scientific institution,
including eye banks and other similar institutions, authority to
detach at any time after the grantor's death any organ, part or parts
of his body and to utilize the same for medical, surgical or scientific purposes.
Similar authority may also be granted for the utilization for
medical, surgical, or scientific purposes, of any organ, part or parts
of the body which, for a legitimate reason, would be detached
from the body of the grantor.
Sec. 2. The authorization referred to in section one of this Act
must: be in writing; specify the person or institution granted the
authorization; the organ, part or parts to be detached, the specific
use or uses to which the organ, part or parts are to be employed;
and, signed by the grantor and two disinterested witnesses.
If the grantor is a minor or an incompetent person, the authorization may be executed by his guardian with the approval of the
court; in default thereof, by the legitimate father or mother, in the
order named. Married women may grant the authorization re-
DISPOSAL OF THE DEAD BODY
231
ferred to in section one of this Act, without the consent of the
husband.
After the death of the person, authority to use human organs
or any portion or portions of the human body for medical, surgical or scientific purposes may also be granted by his nearest
relative or guardian at the time of his death or in the absence
thereof, by the person or head of the hospital, or institution
having custody of the deceased. Provided, however, that the said
person or head of the hospital or institution has exerted reasonable efforts to locate the aforesaid guardian cr relative.
A copy of every such authorization must be furnished the
Secretary of Health.
Sec. 2-A. The provisions of sections one and two of this Act
notwithstanding, it shall be illegal for any person or any institution to detach any organ or portion of the body of a person
dying of a dangerous communicable disease even if said organ or
portions of the human body shall be used for medical or scientific
purposes.
A n y person who shall violate the provisions of this
section shall be punished with an imprisonment of not less than
six months nor more than one year.
If the violation is committed by an institution, corporation or association, the director,
manager, president, and/or other officials and employees who,
knowingly or through neglect, perform the act or acts resulting
in said violation shall be held criminally responsible therefore.
Sec. 3. An authorization granted in accordance with the provisions of this Act shall bind the executors, administrators and
successors of the deceased and all members of his family.
Sec. 4. Any law or regulation inconsistent with the Act are
hereby repealed.
Sec. 5. This Act shall take effect upon its approval.
A P P R O V E D , May 17, 1949, Amendment Approved June 12,
1954.
Sec. 96, Code of Sanitation ( P . D . 856).
Donation of Human Organs for Medical, Surgical and Scientific
Purposes According to the Sanitation Code ( P . D . 856):
Any person may donate an organ or any part of his body to a
person, a physician, a scientist, a hospital or a scientific institution upon his death for transplant, medical, or research purposes
Bubject to the following requirements:
a. The donation shall be authorized in writing by the donor
specifying the recipient, the organ or part of his body to be
donated and the specific purpose for which it will be utilized.
LEGAL MEDICINE
232
b. A married person may make such donation without the consent
of his spouse.
c. After the death of a person the next of kin may authorize the
donation of an organ or any part of the body of the deceased
for similar purposes in accordance with the prescribed procedure.
d. If the deceased has no next of kin and his remains are in the
custody of an accredited hospital, the Director of the hospital
may donate an organ or any part of the body of the deceased
in accordance with the requirements prescribed in this Section.
e. A simple written authorization signed by the donor in the
presence of two witnesses shall be deemed sufficient for the
donation of organs or parts of the human body required in this
Section, notwithstanding the provisions of the Civil Code of the
Philippines on matters of donation. A copy of written authorization shall be forwarded to the Secretary.
f. A n y authorization granted in accordance with the requirements
of this Section is binding to the executors, administrators, and
members of the family of the deceased.
Persons w h o can grant permission to detach, after death, human
organs or part or parts of the human body for medical, surgical
and other scientific purpose:
a. Before
Death:
( 1 ) By the deceased during his lifetime.
( 2 ) If the deceased is a minor or incompetent, permission may
be executed by the guardian with the approval of the court
or by the legitimate father or mother. A married woman
may give consent without the consent of the husband.
b. After Death:
(1) The nearest relative.
(2) In the absence of the nearest relative, permission may be
given by the head of the hospital or institution having
custody of the deceased.
Persons permitted to detach human organs, or parts of the human
body for medical, surgical and other scientific use:
a. Licensed physicians and surgeons.
b. Known scientists.
c. Medical or scientific institutions including eye-banks.
Requirements for a Valid Authorization:
a. It must be in writing.
b. It must specify the person or institution granted the authorization.
DISPOSAL OF THE DEAD BODY
233
c. It must specify the organ or part of the body to be detached.
d. It must be signed by the grantor and two disinterested persons.
e. A copy of the authorization must be furnished to the Secretary
of Health.
Limitation to the Authorization:
It will be illegal to removed organs or portions of the human
body if the deceased died of a dangerous communicable disease.
Penal Provision:
Imprisonment of not less than six months nor more than one
year.
If committed by an institution, the director, manager,
president or other officials or employees who knowingly or
through neglect performed an act or acts resulting in said violation
shall be criminally responsible.
EXHUMATION:
The deceased buried may be raised or disinterred upon the
lawful order of the proper authorities. The order may come from
the provincial or city fiscals, from the court, and from any entity
vested with authority to investigate.
If the body is exhumed for the purpose of performing postmortem examination, no deodorant must be applied to the body
for it might interfere in the detection of, chemicals. After the
body has been disinterred, it must be identified by relatives,
friends, or by marks on the body. The physician must describe
the coffin, clothings, degree of decomposition before stating the
actual disease or violence in his report.
Sec. 1082, Revised Administrative Code:
Cemetery permits — It shall be unlawful to establish, maintain,
enlarge, reopen, or remove any burial ground or cemetery, or to
disinter a human body or human remains, until a permit therefor,
approved by the Director of Health, shall have been obtained.
Questions: Is the National Bureau of Investigation required to
obtain a permit from the Director of Health for exhumation of a
dead body in the course of a legal investigation conducted by it?
The query was made on the presumption that the one to perform
the exhumation is a physician who is in a capacity to protect
public health.
Answer: In the opinion rendered by the Secretary of Justice the
answer is yes. Sec. 1082 and 1095 of the Revised Administrative
Code requiring a permit in disinterring a human or human remains
from the Director of Health also extends to cases where exhu-
234
LEGAL MEDICINE
mation has to be done for an autopsy by any person authorized
to do so in the course of a legal investigation. The language of
those two sections are clear and absolute in terms and admits of
no exception. Nor any exception to the said requirement be
found in any of the provisions dealing with legal investigations.
This is so because the purpose of the requirement of said permit is
the protection of health which may not be sacrificed where a
legal investigation is being conducted (Opinion of the Secretary of
Justice, No. 26, series of 1954).
Sec. 1095, Revised Administrative Code:
Permit to disinter after three years — Treatment of remains:
Permission to disinter the bodies or remains of persons who
have died of other dangerous communicable disease, may be
granted after such bodies had been buried for a period of three
years; and, in special cases, the Director of Health may grant
permission to disinter after a shorter period when in his opinion
the public health will not be endangered thereby.
The body or remains of any such deceased person, upon exhumation, shall be immediately disinfected and inclosed in a
coffin, case, or box, securely fastened, and this coffin, case, or
box shall be placed in sn outside box which shall also be securely
fastened.
Sec. 1096, Revised Administrative Code:
Special permit to disinter embalmed body
receiving vault for transfer:
or to remove from
Special permits may be issued at any time for the disinterment
or exhumation of remains of persons, dying of other than dangerous communicable disease, that have been properly embalmed
by an undertaker or embalmer, or for the transfer or removal of
bodies that have been placed in a receiving vault awaiting transportation from the Philippines.
Boxes containing the bodies
or remains shall be plainly marked so as to show the name of the
deceased, place of death, cause of death and the point to which
such bodies or remains are to be shipped.
Sec. 1097, Administrative Code:
Exhumation in case of death from dangerous communicable
disease:
Bodies or remains of persons who have died of any dangerous
communicable disease may be exhumed only after the lapse of five
years from burial, though in special cases the Director of Health
may grant a permit to disinter after a shorter period when in his
opinion the public health will not be endangered thereby.
DISPOSAL OF THE DEAD BODY
235
In every such case, the body or remains, after being disinfected
must be placed in a suitable and hermetically sealed container!
Sec. 92, Code of Sanitation — Disinterment Requirements:
Disinterment of remains is subject to the following requirements;
a. Permission to disinter remains of persons who died of nondangerous communicable diseases may be granted after a burial
period of three ( 3 ) years.
b. Permission to disinter remains of persons who died of dangerous
communicable diseases may be granted after a burial period of
five ( 5 ) years.
c. Disinterment of remains covered in paragraphs "a" and " b " of
this Section may be permitted within a shorter time than that
prescribed in special cases, subject to the approval of the
Regional Director concerned or his duly authorized representative.
d. In all cases of disinterment, the remains shall be disinfected and
placed in a durable and sealed container prior to their final
disposal.
Art. 308, Civil Code:
No human remains shall be retained, interred, disposed of or
exhumed without the consent of the persons mentioned in articles
294 and 305.
The persons mentioned in articles 294 are:
( 1 ) Spouse;
( 2 ) Descendants of the nearest degree;
( 3 ) Ascendants of the nearest degree; and
( 4 ) Brothers and sisters.
How Long Can Exhumation Be Done After Interment:
a. If the person died of dangerous communicable disease, the dead
body may be exhumed only after a lapse of five years from the
date of burial. However, permit to disinter may be given after
a shorter period when in the opinion of the Director of Health
it will not endanger public health.
Sec. 1097, Administrative Code — Exhumation in case of death
from dangerous communicable disease — Bodies or remains of
persons who have died of any dangerous communicable disease
may be exhumed only after the lapse of five years from burial,
though in special cases the Director of Health may grant a
permit to disinter after a shorter period when in his opinion
the public health will not be endangered thereby.
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LEGAL MEDICINE
Sec. 92 (b & c), ( P . D . 856) Code of Sanitation — Disinterment
requirements:
a
b. Permission to disinter remains of persons who died of
dangerous communicable diseases may be granted after
burial period of five ( 5 ) years.
c. Disinterment of remains covered in paragraphs "a" and " b "
of this Section may be permitted within a shorter time than
that prescribed in special cases, subject to the approval of
the Regional Director concerned or his duly authorized
representative.
b. If a person died of a cause other than dangerous communicable
disease, permission for exhumation may be granted after such
body had been buried for a period of three ( 3 ) years. However,
in special cases the Director of Health may grant permission
after a shorter period when in his opinion the public health will
not be endangered thereby.
Sec. 1095, Revised Administrative Code — Permit to disinter
after three years — Treatment of Remains — Permission to
disinter the bodies or remains of persons who have died of other
than dangerous communicable disease, may be granted after
such bodies had been buried for a period of three years; and, in
special cases, the Director of Health may grant permission to
disinter after a shorter period when in his opinion the public
health will not be endangered thereby.
Sec. 92 ( a ) , ( P . D . 856) Code of Sanitation — Disinterment
requirement — Permission to disinter remains of person who
died of non-dangerous communicable diseases may be granted
after a burial period of three ( 3 ) years.
c. Sec. 1098, Revised Administrative Code — Shipment of remains
by sea — No body or remains shall be shipped to the United
States except under such conditions and regulations as may be
prescribed by the United States Public Health Service. The
outside box containing the body or remains of a deceased
person intended for shipment by sea shall be plainly marked so
as to show the name, age, nationality of the deceased person,
the cause of death, and the destination of the remains.
d. If the dead body is a subject matter of criminal investigation it
may be exhumed anytime.
Sec. 95 ( b ) , ( P . D . 856) Code of Sanitation — Autopsy shall be
performed in the following cases — ( 4 ) Whenever the Solicitor
General, Provincial or city fiscal as authorized by existing laws,
DISPOSAL OF THE DEAD BODY
237
shall deem it necessary to disinter and take possession of the
remains for examination to determine the cause of death.
Requirements to be Satisfied in Exhumation:
a. Duration of interment as required (supra).
b. Exhumation permit:
Sec. 1082, Revised Administrative Code — Cemetery permits
— It shall be unlawful to establish, maintain, enlarge, reopen,
or remove any burial ground or cemetery, or to disinter a
human body or human remains, until a permit therefor, approved by the Director of Health, shall have been obtained.
c. Compliance of the sanitary requirements:
Sec. 1095,2nd. par., Revised Administrative Code —Permit to
disinter after three years — The body or remains of any such
deceased person, upon exhumation, shall be immediately
disinfected and inclosed in a coffin, case, or box, as securely
fastened, and this coffin, case, or box shall be placed in an
outside box which shall also be securely fastened.
Sec. 92 ( d ) , ( P . D . 856) Code of Sanitation — In all cases of
disinterment, the remains shall be disinfected and placed in a
durable and sealed container prior to their final disposal.
Procedures Followed in Medico-Legal Exhumations:
a. There must be a formal request from any of the law enforcement agency or any entity or person authorized by law to make
investigation addressed to any establishment or person authorized to perform medico-legal investigation. The request must
mention the name of the deceased, place of interment, date of
interment, suspicion as to the cause of death, etc. The reason
for the request may be:
( 1 ) To determine the cause of death;
( 2 ) To determine the identity of the deceased;
( 3 ) To recover organs or tissues for further examination:
( a ) For toxicological analysis,
( b ) For histopathological examination,
(c) Smears from vaginal canal and blood for alcohol determination; or
( 4 ) To recover foreign bodies:
( a ) Metallic fragment or whole slug for ballistic examination.
( b ) Operative sponge, medical instrument to prove negligence of surgeon.
b. If the physician found out that there is justification to the
exhumation and a strong probability for the purpose to be
realized, he may then set the date and time of the exhumation.
238
LEGAL MEDICINE
c. A written request for exhumation of the body of the deceased
must be sent to the Ministry of Health or the Regional Director
concerned, mentioning among other things:
(1) Name of the deceased.
(2) Place of exhumation.
( 3 ) Date and time of exhumation.
( 4 ) Duration of interment.
( 5 ) Purpose of exhumation.
The Ministry of Health aside from issuing the necessary
permit together with the conditions to be complied with, will
inform the local health officer concerned to assist the physician
to perform the exhumation to see to it that public health will
not be prejudiced.
d. During actual exhumation, the grave must be properly identified by the person who was present when the body was
interred.
e. During the process of disinterment care and diligence must be
observed to avoid destruction, deformity, contamination or
such other effects that will prevent the realization of its objectives.
f. After opening the coffin, the body must be viewed by any or
more persons who can identify the deceased. The names of the
person who identified the grave, who viewed and identified the
deceased must be included in the report. The exhuming physician must describe the coffin, wearing apparel and condition of
the body.
g. Actual autopsy and adoption of the procedure is needed to
accomplish the purpose of the exhumation.
h. Disinfection of the body and all the areas involved must be
carried out with the assistance of the local health officer and
return of the body to the burial place.
What must be Included in the Exhumation Report:
a. The name of the deceased and the personal circumstances (age,
sex, civil status, address, occupation, etc.).
b. The purpose(s) of exhumation;
c. The name, address and designation of the requesting party;
d. The date, time and place of exhumation;
e. The description of the burial place;
f. The name and address of person(s) who identified the burial
place;
g. The condition of the body and coffin (if there is) after disinterment.
DISPOSAL OF THE DEAD BODY
239
h. The name and address of the person(s) who identified the body
of the deceased;
i. The post-mortem examination and accomplishment of the
pnrpose(s) of the exhumation;
j. The conclusion(s) based on the findings and result of the
examination;
k. Remarks (if any); and
1. The signature and designation of the physician.
Some Problems in Exhumation:
a. Identity of the deceased:
The exhumed buried deceased might not be subject-matter
of exhumation especially when the burial ground is a cemetery.
Mass burial of "salvaging" victims or disaster victims may cause
serious problem to the physician. There must be a meticulous and
time consuming attempt of the exhuming physician to establish
identity in order that his report may be of some value in the
investigative or judicial proceedings.
b. Refusal of the next-of-kin to give consent or to cooperate in the
exhumation-autopsy:
This situation is frequently observed when the next-of-kin
has a strong possibility to be involved in the investigation.
The proper remedy to this situation is to petition the court
to issue an order to exhume the body stating the specific
reasons why exhumation-autopsy will serve the best interest
of justice.
Chapter IX
MEDICO-LEGAL ASPECTS OF
PHYSICAL INJURIES
Physical injury is the effect of some forms of stimulus on the body.
The effect may only be apparent when* the stimulus applied is
insufficient to cause injury and the body resistance is great. It may
be real when the effect is visible.
The effect of the application of stimulus may be immediate or
may be delayed. A thrust to the body of a sharp pointed and sharp
edged instrument will lead to the immediate production of a stab
wound, while a hit by a blunt object may cause the delayed production of a contusion.
^ C a u s e s of Physicial Injuries:
A^Thysical Violence
J
Br Heat or Cold
J
Or Electrical Energy
A
ECChemical Energy
\
E. Radiation by Radio-Active Substances
V F Change of Atmospheric Pressure (Barotrauma)
G. Infection
A. PHYSICAL INJURIES BROUGHT ABOUT
BY PHYSICAL VIOLENCE
The effect of the^apphcation of physical violence on a person is
the production ofTwojund: )
f\
A wound is the solution of the natural continuity of any tissue of
the living body. It is the disruption of the anatomic integrity of a
tissue of the body. In several occasions, the word physical injury is
used interchangeably with wound. However, the effect of the physical violence may not always result to the production of wound, but
the wound is always the effect of physical violence.
Physics of Wound Production:
Wound = Kinetic energy X time X area X "other factors"
MV
Kinetic Energy =
240
2
M=Mass
V=Velocity
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
Kinetic energy:
Inasmuch as kinetic energy is based on the mass and velocity
factors and that the velocity is squared, the velocity component is
the important factor. This explains why an M-16 bullet which has a
speed or 3,200 ft/sec. will do more damage than a 0.38 caliber bullet
which is heavier but has a much slower velocity.
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.
Area of Transfer:
The larger the area of contact between the force applied on the
body, the lesser is the damage to the body. By applying an equal
force, the damage caused by stabbing is greater compared to a blunt
instrument.
"Other Factors":
The less elastic and plastic the tissue, the greater the likelihood
that a laceration will result. Elasticity and plasticity refer to the
ability of a tissue to return to its "normal" size and shape after being
deformed by a pressure.
The movement of the parts of the body as a result of the force
being applied to them and the local stretching of tissue during
acceleration and deceleration cause most of the internal injuries seen
in traumatized individuals.
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 (Legal Medicine Annual 1980,
Cyril Wecht ea\, p. 36).
Vital Reaction:
It is the sum total of all reactions of tissue or organ to trauma.
The reaction may be observed macroscopically and microscopically.
The following are the common reactions of a living tissue to trauma:
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 on account of the involvement of the sensory
nerve.
LEGAL MEDICINE
242
d. Loss of function — On account of the trauma, the tissue may
not be able to function normally.
The presence of the vital reaction differentiates an ante-mortem
from a post-mortem injury.
In the following instances vital reactions or changes may not be
observed even if injury was inflicted during life:
a. If physical injuries are inflicted during the agonal state of a
living person. The body cells or tissue during the period may no
longer have the potential capacity to react to the trauma; and
b. If death is so sudden as not to give the tissues of the body, the
chance to react properly. This is commonly observed in deaths
due to sudden coronary occlusion.
t / c L A S S I F I C A T I O N OF WOUNDS:
cV^fs to Severity:
&S&ortal Wound — Wound which is caused immediately after
infliction or shortly thereafter that is capable of causing death.
Parts of the Body where the Wounds Inflicted are Considered
Mortal:
(a) Heart and big blood vessels.
(2) Brain and upper portion of the spinal cord.
(3) Lungs.
(4) Stomach, liver, spleen and intestine.
J^f Non-mortal wound — Wound which is not capable of producing
death immediately after infliction or shortly thereafter.
3^. As to the Kind of Instrument Used:
a. Wound brought about by blunt instrument (contusion, hematoma, lacerated wound).
~~
b. Wound brought about by sharp instrument:
( 1 ) Sharp-edged instrument~(incised wound).
( 2 ) Sharp-pointed instrument (punctured wound).
( 3 ) Sharp-edged and sharp pointed instrument (stab wound).
c. Wound brought about by tearing force (lacerated wound).
d. Wound brought about by change of atmospheric pressure
(barotrauma).
e. Wound brought about by heat or cold (frostbite, burns or scald).
f. Wound brought about by chemical explosion (gunshot or
shrapnel wound).
g. Wound brought about by infection,
ifc As to the Manner of Infliction:
a. Hit — by means of bolo, blunt instrument, axe.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
243
b. Thrust or stab — bayonet dagger.
c. Gunpowder explosion — projectile or shrapnel wound.
d. SlidingTor rubbing or abrasion.
^4^s regards to the Depth of the Wound:
a. /Superficial — When the wound involves only the layers of the
skin.
iyDeep — When the wound involves the inner structure beyond
the layers of the skin.
{Impenetrating — one in which the wounding agent enters the
body but did not come out or the mere piercing of a solid
organ or tissue of the body.
"Penetrating Wound — Wound where the dimension of
depth and direction is an important factor in its description. It involves the skin or mucous surface and the
deeper underlying tissues or organs caused directly by the
wounding instrument. Punctured, stab and gunshot wounds
/ usually belong to this type of wound."
(£) Perforating — When the wounding agent produces communication between the inner and outer portion of the
hollow organs. It may also mean 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.
f^i^
>. As regards to the Relation of the Site of the Application of Force
and the Location of Injury:
a. Coup Injury — Physical injury which is located at the site of the
application of force, -y. k***'
s
b. Contre-Coup Injury — Physical injury found opposite the site
of the application force.
c. Coup Contre-Coup Injury — Physical injury located at u\e site
and also opposite the site of application of force.
d. "Locus Minoris Resistencia" — Physical injury located not at
the site nor opposite the site of the application of force but in
some areas offering the least resistance to the force applied.
A blow on the forehead may cause contusion at the region of
the eyeball because of the fracture on the papyraceous bone
forming the roof of the orbit.
e. Extensive Injury — Physical injury involving a greater area of
the body beyond the site of the application of force. It has
not only the wide area of injury but also the varied types of
injury. A fall from a height or a run-over victim of a vehicular
244
LEGAL MEDICINE
accident may suffer from multiple fractures, laceration of
organs, and all types of skin injuries.
When a stationary head is hit by a moving object, there is the
tendency for the development of contusion of the brain at the site
of impact.
When the moving head hits a firm, fixed and hard object, brain
contusion may develop at the opposite of the site of impact.
A coup-contra-coup location of brain injury may be found
when a fixed head is hit with a moving object and then falls on
another hard object.
( ^ 4 s to the Regions or Organs of the Body Involved:
The wounds of the different organs and regions of the body will
be discussed separately under "Injuries in Various Parts of the Body.'
7. Special Types of Wounds:
a. Defense Wound — Wound which is the result of a person's
instinctive reaction of self-protection. Injuries suffered by a
person to avoid or repel potential injury contemplated by the
aggressor.
A person w h o is conscious that he is going to be hit by a
Qblnni instrument on the head may raise his flexed forearms over
his head, causing injuries on the forearms.
Incised ( d e f e n s e ) w o u n d
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
245
If someone is going to stab another with Psharp instrument
the tendency of the potential victim is to ta^e~Hbld of the
instrument thus causing the production of an incised or a stab
wound on the palm of the hand.
vn-UAj„L
\yPatterned Wound — Wound in the nature and shape of an
object or instrument and which infers the object or instrument
causing it.
Impact of the face on the radiator grill of a car may cause
imprint of the radiator grill on the face.
A person run over by a wheel of a car, tire marks are shown on
the body.
Due to hanging, the nature of the abrasion mark on the neck
may infer material used.
Contusion produced by belt, branch of tree, metallic rod,
etc. may have the shape of the wounding instrument.
jtf Self-inflicted Wound—Self-inflicted wound is a wound produced
on oneself. As distinguished from suicide, the person has no
intention to end his life.
Motive of Producing Self-inflicted Wounds:
(1) To create or deliberately magnify an existing injury or
disease for pension or workman's compensation;
( 2 ) To escape certain'obligations or punishment. During war
time soldiers may cut their fingers to avoid frontline
assignments and prisoners may inflict physical injuries on
their body to avoid hard labor and just be confined in a
hospital to receive food and rest.
( 3 ) To create a new identity or destroy the existing one. Fingerprints may be destroyed by acid, by cutting or burning. A
person may even Request for the services of a plastic
surgeon to create a new identity or destroy existing ones.
(4) To gain attention or sympathy.
( 5 ) Psychotic behavior.
Some Ways of Self-Mutilation:
(1) Head banging or bumping — This is commonly observed
in overactive children and causes hematoma.
(2) Exposure of parts of the body to heat radiation from open
fires, radiators, or protective grills over radiator (thermophilia).
(3) Penetrating nail or spike to the chest wall, or insertion into
the urinary bladder in a female.
(4) Castration by amputation of the penis.
246
LEGAL MEDICINE
(5) Trauma inflicted on the female genitalia to induce abortion or promotes hemorrhage and creates an anemia.
( 6 ) Subcutaneous injection of fecal matters to promote
abscess formation.
( 7 ) Pricking of acne eruption to lead to a severe facial disfigurement.
( 8 ) Subcutaneous injection of air to create a condition of
emphysema.
( 9 ) Nail-biting (onychophagia) which may lead to maceration
of the skin and an infection.
(10) Grinding of the teeth (bruxism) is frequently seen in the
mentally retarded and can lead to abnormal tooth wear, a
bilateral hypertrophy of the masseter and a pain on
chewing.
(11) Pressure on the subcutaneous tissue by a tightly applied
cord or belt around the body:
(a) Tribal customs of metal band around the heck or a
leg by some African tribes may cause a permanent
disfigurement.
( b ) Use of shoes made of metal by Chinese women.
(12) Pulling of the body hair (Trichotillomania).
(Forensic Medicine A Study in Trauma & Environmental
Hazards by Tedeschi, Eckert & Tedeschi, Vol. 1, p. 496).
LEGAL CLASSIFICATION OF PHYSICAL INJURIES:
utilation:
Art. 262, Revised Penal Code:
The penalty of reclusion temporal to reclusion perpetua shall be
imposed upon any person who shall intentionally mutilate another
by depriving him, either totally or partially, of some essential organ
for reproduction.
A n y other intentional mutilation shall be punished by prision
mayor in its medium and maximum periods.
Kinds of Mutilation Punishable Under the Code:
1. Intentionally depriving a person, totally or partially of some of
the essential organs for reproduction, and
2. Intentionally depriving a person of any part or parts of the human
body other than the organs for reproduction.
Mutilation is the act of looping or cutting off any part or parts
of the living body. In order to be punishable under the Code, it
must be intentional, otherwise it will be considered as a physical
injury.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
247
The loss of an eye due to stabbing is not mutilation. It is evident
that the putting out of an eye does not fall under the definition
(U.S. v. Bogel, 7Phil 285).
"Mayhem " is the unlawful and violent deprival of another of the
use of a part of the body so as to render him less able in fighting,
either to defend himself or to annoy his adversary. Mutilation of
other parts of the body other than the organ of reproduction may be
classified as mayhem. However, if it is not deliberate then it may fall on
paragraph 2, Art. 263, Revised Penal Code (Serious Physical Injuries).
Is vasectomy and tubal ligation within the purview of mutilation as
defined and penalized by Art. 262 of the Revised Penal Code?
On September 1973 upon the request of the Executive Director of
the Population Commission, the Secretary of Justice rendered an
opinion that vasectomy and tubal ligation are not mutilation and a
legitimate method of contraception despite the fact that it is done
intentionally and deprives a person of his power of reproduction
because:
"1. In the case of U.S. v. Bogel et. aL 5 Phil. 285 (1907) the Supreme
Court, in holding that the putting out of an eye is not mutilation
under Article 415 of the Spanish Penal Code which penalized
intentional mutilation, stated "Viada in his commentary on
Article 415 which penalized intentional mutilations, points out
that by mutilation (mutilacion) is understood, according to the
"Diccionario de la Lengua Espahola", the looping or clipping
off (ceranamiento) of one part of the body. As this provision
of the Spanish Penal Code was the source of the above quoted
provision of the Revised Penal Code, it is the same expounded
by Viada that the prohibition in the latter provision should be
understood.
Y o u stated that tubal ligation and vasectomy "do not involve
looping or clipping off of the organs of reproduction of both
sexes". I understood that these two methods of surgical sterilization are affected by the closing of a pair of tubes in either man
or the woman so that the sperm and ovum cannot meet; it does
not involve the removal of reproductive glands or organs as in
the case of castration, with which it is sometimes confused.
{Encyclopedia Americana, Sterilization, Human Vol. 25, p. 269;
an article written by the Executive Director of the Human
Betterment Association of American, I.C.) Such being the case,
I do not think that these method of contraception could be
regarded as mutilation within the contemplation of Article 262,
Supra."
248
LEGAL MEDICINE
/ Serious Physical Injuries:
Art. 263, Revised Penal Code:
Any person who shall wound, beat, or assault another, shall be
guilty of the crime of serious physical injuries and shall suffer:
1. The penalty of prision mayor, if in consequence of the physical
injuries inflicted, the injured person shall become insane, imbecile,
impotent, or blind;
2. The penalty of prision correccional in its medium and maximum
periods, if in consequence of the physical injuries inflicted, the
person injured shall have lost the use of speech or the power to
hear or to smell, or shall have lost an eye, a hand, a foot, an arm,
or a leg or shall have lost the use of any such member, or shall
have become incapacitated for the work in which he was theretofor habitually engaged;
3. The penalty of prision correccional in its minimum and medium
periods, if in consequence of the physical injuries inflicted, the
person injured shall have become deformed, or shall have lost any
other part of his body, or shall have lost the use thereof, or shall
have been ill or incapacitated for the performance of the work in
which he was habitually engaged for a period of more than ninety
days;
4. The penalty of arresto mayor in its maximum period to prision
correccional in its minimum period, if the physical injuries inflicted shall have caused the illness or incapacity for labor of the
injured person for more than thirty days.
If the offense shall have been committed against any of the
persons enumerated in article 246, or with attendance of any of
the circumstances mentioned in article 248, the case covered by
subdivision number 1 of this article shall be punished by reclusion
temporal in its medium and maximum periods; the case covered
by subdivision number 2 by prision correccional in its maximum
period to prision mayor in its minimum period; the case covered
by subdivision number 3 by prision correccional in its medium
and maximum periods; and the case covered by subdivision
number 4 by prision correccional in its minimum and medium
periods.
The provisions of the preceding paragraph shall not be applicable to a parent who shall inflict physical injuries upon his child
by excessive chastisement.
The crime of serious physical injuries may be due to:
(1) Wounding;
( 2 ) Beating;
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
249
( 3 ) Assaulting ( A r t . 263); or
( 4 ) Administering injurious substances (Art. 264) without the intent to kill.
It may be committed through a simple negligence or imprudence.
The main purpose of dividing the provision into four paragraphs
is to graduate the penalties depending upon the nature and character of the wound inflicted and their consequences on the
person of the victim.
In paragraph one, the injured person became insane, imbecile,
impotent, or blind.
Insanity has not been defined or qualified by the article.
Imbecility infers that the injured person must be of the preadolescent age and that on account of the physical injuries inflicted there is an arrest of mental development.
Impotency is the inability to grant to the partner sexual gratification.
Blindness must be total or involvement of both eyes. If only
one eye became blind, then the physical injury will fall in paragraph 2 of Article 263.
In paragraph two, the following nature and character of the
wound or consequences of the injuries inflicted must be present:
a. Loss of the use of speech or the power to hear or to smell, or
loss of an eye, a hand, a foot, an arm, or a leg;
b. Loss of the use of any such member; or
c. Becomes incapacitated for the work in which he was therefore
habitually engaged.
There must be a total loss of hearing capacity. If the loss of
power to hear is only in one ear, it is a serious physical injury
under paragraph 3, article 263 (People v. Hernandez, 94 Phil. 49).
Insofar as loss of a hand is concerned, the prosecution must
prove by clear and conclusive evidence that the offended party
actually cannot make use of his hand and that such impairment is
permanent (People v. Reli. C.A. 53 O.G. 5695).
In paragraph three, the following physical injuries or their consequences are included:
a. Deformity;
b. Loss of any other member of his body;
c. Loss the use thereof; or
d. Becomes ill or incapacitated for the performance of the work
in which he was habitually engaged for more than 90 days, as
a consequence of the physical injuries inflicted.
250
LEGAL MEDICINE
Deformity is a condition of physical ugliness. It must be permanent and conspicuous. The loss of the front teeth, the development of a pigmented scar on the face, or loss of the pinna of the
ear are considered deformities. However, the development of a
scar in covered plots of the body may not be considered deformity
because it is not conspicuous and visible.
"The loss of any other part of his body" means loss of the parts
of the body not mentioned in paragraph 2, Art. -263.
Incapacity means the inability of the injured person to perform,
or engage on a work or vocation before he sustained injury.
In paragraph four, the injured person becomes ill or incapacitated
for labor for more than thirty days and impliedly less than 90
days.
It is noteworthy to mention that in paragraphs 3 and 4 of
article 263 there is no mention of periods of medical attendance
but merely incapacity.
Administering Injurious Substances or Beverages:
Art. 264, Revised Penal Code:
The penalties established by the next preceding article shall be
applicable in the respective cases to any person who, without intent
to kill, shall inflict upon another any serious physical injury, by
knowingly administering to him any injurious substances or beverages or by taking advantages of his weakness of mind or credulity.
Elements of the crime:
a. The offender inflicted upon another person any serious physical
injury.
b. The infliction of physical injury was done knowing that the
substance or beverage administered is injurious or took advantage
of the victim's weakness or credulity; and
c. There was no intent to kill on the part of the offender.
If the offender does not know that the substance administered is
injurious, he cannot be held liable under the above provision.
The throwing of acid on the face of someone does not fall within
the provision because what the provision contemplates is administering or taking in the injurious substance or beverages (U.S. Chiong
Songco, 18 Phil. 459).
The provision does not contemplate of slight or less serious
physical injuries which is the consequence of injurious substances
or beverages, but results only in serious physical injuries.
If the administration of injurious substances or beverages is
intentional, the crime committed is frustrated murder. Treachery is.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
251
inherent when injurious substances or beverages are introduced into
the body.
/ L e s s Serious Physical Injuries:
Art. 265, Revised Penal Code:
A n y person who shall inflict upon another physical injuries not
described in the preceding articles, but which shall incapacitate
the offended party for labor ten_days„or more, or shall require
medical attendance for the same period, shall be guilty of less serious
physical injuries and shall suffer the penalty of arresto mayor.
Whenever less serious physical injuries shall have been afflicted
with the manifest intent to insult or offend the injured person, or
under circumstances adding ignominy to the offense, in addition to
the penalty of arresto mayor, a fine not exceeding 500 pesos shall
be imposed.
A n y less serious physical injury inflicted upon the offender's
parents, ascendants, guardians, curators, teachers, or persons of rank
or persons in authority, shall be punished by prision correccional in
its minimum and medium periods, provided that, in the case of
persons in authority, the deed does not constitute the crime of
assault upon such person.
The basis to determine whether the physical injury is less serious
or not is by either the period of medical attendance or period of
incapacity; both of which is ten days or more but not more than
thjrty days.
The fact that the injury only requires medical attendance for two
days but incapacitated the victim from attending to his ordinary
work for a period of 29 days makes the crime less serious physical
injuries (U.S. v. Trinidad, 4 Phil. 152).
There must be proof as to the period of medical attendance. In
the absence of such proof of medical attendance or incapacity,
although the wound actually healed in more than 30 days, the crime
committed is only slight physical injuries (People v. Penesa, 81 Phil.
398).
The crime *of less serious physical injuries may be qualified and a
fine or a higher penalty is imposed when:
a. There is a manifest intent to insult or offend the injured person;
b. There are circumstances adding ignominy to the offense;
c. The victim is the offender's parents, ascendants, guardian,
curators or teachers; or
d. The victim is a person of rank or person in authority, provided
that the crime is not direct assault.
LEGAL MEDICINE
Obligation Imposed on Physicians W h o have Treated Persons Suffering From Serious and Less Serious Physical Injuries:
P R E S I D E N T I A L D E C R E E N O . 169
W H E R E A S , Pursuant to Proclamation N o . 1081, dated September
21, 1972 and N o . 1104, dated January 17, 1973, martial law has
been declared throughout the Philippines to, among other goals,
restore and maintain peace and order;
W H E R E A S , for the attainment of the aforesaid goal, and to enable
the law-enforcement agencies to keep track of all violent crimes,
conduct timely investigation thereon and effect the immediate arrest
of the perpetrators thereof, it is necessary that all persons treating
physical injuries resulting from any form of violence be required to
report such fact to said agencies;
W H E R E A S , while some of the victims of violent crimes, or those
who may have sustained physical injuries in the act of committing
or as a result of the commission of a crime submit themselves for
medical treatment in hospitals, medical clinics, sanitariums, or
other medical establishments or to medical practitioners, they do
not report their injuries to the law-enforcement agencies for one
reason or another;
N O W , T H E R E F O R E , I, F E R D I N A N D E. M A R C O S , pursuant to
Proclamation N o . 1081, dated September 21, 1972 and N o . 1104,
dated January 17, 1973 and in my capacity as Commander-in-Chief
of all the Armed Forces of the Philippines, do hereby order and
decree that:
1. The attending physician of any hospital, medical clinic, sanitarium or other medical establishments, or any medical practitioner, who has treated any person for serious or less serious
physical injuries as those injuries are defined in Articles 262,
263, 264 and 265 of the Revised Penal Code shall report the
fact of such treatment personally or by the fastest means of
communication to the nearest Philippine Constabulary unit
without delay: provided, that no fee shall be charged for the
transmission of such report thru government communication
facilities; and
2. The report called for in this Decree shall indicate when practicable the name, age, address and nearest of kin of the patient;
the nature and probable cause of the injury; the approximate
time and date when, and the place where the injury was sustained; time, date and nature of treatment; and the physical
diagnosis and/or disposition of the patient.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
253
I do further order and decree that any violation of this Decree
and/or the rules and regulations which shall be promulgated by
competent authorities in accordance herewith, with malicious intent
or gross negligence, shall suffer the penalty of imprisonment for not
less than one year nor more than ( 3 ) years and/or a fine of not less
than 1,000 nor more than 3,000 pesos, as a military tribunal may
direct. In addition, the government license or permit of the attending physician to practice his profession shall be cancelled by the Civil
Service Commission after the sentence imposed by the military
tribunal become final and executory.
The Secretary of Health and the Secretary of National Defense
shall promulgate the necessary rules and regulations to carry out the
purpose of this Decree.
Done in the City of Manila, this 4th day of April, in the Year of
Our Lord, nineteen hundred and seventy-three.
(SGD) F E R D I N A N D E. MARCOS
President
Republic of the Philippines
Slight Physical Injuries and Maltreatment:
Art. 266, Revised Penal Code:
The crime of slight physical injuries shall be punished:
1. By arresto menor when the offender has inflicted physical injuries
which shall incapacitate the offended party for labor from one to
nine days, or shall require medical attendance during the same
period;
2. By arresto menor or a fine not exceeding 200 pesos and censure
when the offender has caused physical injuries which do not
prevent the offended party from engaging in his habitual work nor
require medical attendance;
3. By arresto menor in its minimum period or a fine not exceeding
50 pesos when the offender shall illtreat another by deed without
causing any injury.
Kinds of Slight Physical Injuries Punishable by the Code:
1. Physical injuries which incapacitate the victim for labor from one
to nine days, or require medical attendance for the same period.
This kind of slight physical injuries will require medical certification as to the duration of medical attendance, or period of
incapacity.
In case of divergency in the duration of medical
attendance and incapacity, the physician must always consider the
best interest of the victim in the determination of the period.
254
LEGAL MEDICINE
2. Physical injuries which did not prevent the offended party from
engaging in his habitual work or which did not require medical
attendance.
If the victim merely suffered from small contusion or superficial
abrasion which does not require medical attendance or incapacity,
this falls in the paragraph of slight physical injury.
3. Ill-treatment of another by deed without causing any injury.
A slight slap on the face or holding tightly the arm of the victim
which did not even develop redness of the skin may be a form of
ill-treatment.
If there is no evidence to show actual injury, or incapacity for
labor, or period of medical attendance, the accused can only be
guilty of slight physical injuries (People v. Penesa, 81 Phil. 398;
People v. Amarao et al., C.A. 36 O.G. 3462).
A tender slap on the face, holding the arm tightly, application
of pressure in some parts of the body, or mild blow which show
no sign of physical violence may still be considered slight physical
injuries or maltreatment (3rd paragraph).
Physical Injuries Inflicted in a Tumultuous Affray:
Art. 252, Revised Penal Code:
When in a tumultuous affray as referred to in the preceding article,
only serious physical injuries are inflicted upon the participants
thereof and the person responsible therefor cannot be identified, all
those who appear to have used violence upon the person of the
offended party shall suffer the penalty next lower in degree than that
provided for the physical injuries so inflicted.
When the physical injuries inflicted are of a less serious nature
than the person responsible therefor cannot be identified, all those
who appear to have used any violence upon the person of the offended party shall be punished by arresto from five to fifteen days.
Elements of the Crime:
a. There is a tumultuous affray;
b. Participant(s) suffered from serious physical injuries;
c. The person(s) who inflicted such serious physical injuries
cannot be identified; and
d. All those who appear to have used violence upon the person
of the offended party shall be penalized by arresto from five to
fifteen days.
/ T Y P E OF WOUNDS (Medical Classification):
\/Closed Wound — There is nojareach of continuity of the skin or
mucous membrane.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
255
a. Superficial — When the wound is just underneath the layers of
the skin or mucous membrane.
(1) Petechiae. r***-*"**
( 2 ) Contusion. \ - * * - « \ .
( 3 ) Hematoma. £ i M
b. Deep.
(1) Musculoskeletal Injuries.
( a ) Sprain.
( b ) Dislocation.
(c) Fracture.
( d ) Strain.
( f ) Subluxation.
(2) Internal Hemorrhage.
( 3 ) Cerebral Concussion.
2^. Open Wound — There is a breach of continuity of the skin or
mucous membrane.
~~
"
a.
b.
c.
d.
e.
1
Abrasion, q*!*Incised Wound, h-'iva
Stab Wound.
Punctured.
Lacerated.
CLOSED WOUNDS:
Petecbjaej_^___
This is a circumscribed extravasation of blood in the subcutaneous
tissue or underneath the mucous membrane. The cause of passage of
blood from the capillaries may be due to the increase intra-capillary
pressure or increased permeability of the vessel. The hemorrhage
may be small or pinhead sized but several petechiae may coalesce to
form a bigger hemorrhagic area. Mosquito or other insect bites may
cause the formation of circumscribed hemorrhages.
Petechiae is not always a product of trauma. Petechial hemorrhage may be a post-mortem finding in asphyxial death, coronary
occlusion and blood diseases. It may also develop post-mortem in
death by hanging.
There is gravitation of blood into the most
dependent part of the body which eventually leads to the rupture of
over-distended capillaries specially seen at the region of the leg.
Contusion:
Contusion is the effusion of blood into the tissues underneath the
skin on account of the rupture of the blood vessels as a result of the
application of blunt force or violence.
256
LEGAL MEDICINE
When a blunt force is applied, it momentarily compresses the
blood vessels at the point of contact, thereby temporarily forcing the
blood out of the area and setting up a fluid wave under pressure.
When the pressure exceeds the cohesive force of the cells forming
the capillary, arteriole, or venule wall, the vessel ruptures.
Inasmuch as it used to take more time for the blood to get out of
the blood vessels, contusion does not immediately develop after the
application of force.
It may develop after a lapse of minutes or
even hours after the application of force. The variation depends on
the part of the body injured, tenderness of the tissues affected,
condition of the blood vessels involved, and natural disease. Women
are much more easily bruised than men while boxers are less prone
to suffer contusion inspite of heavy punishment.
C o n t u s i o n of the right eyelids
The size of the contusion is usually greater than the size of the
object causing it. The location of the contusion may not always
indicate the site of the application of force. For instance, a blow
on the forehead may cause black-eye or contusion around the tissues
of the eye-ball, or a kick on the leg may cause appearance of contusion at the region of the ankle on account of the gravitation of the
effusion, between muscles and fascia.
On the medico-legal viewpoint, a contusion as indicated by its
external pattern may correspond to the shape of the object or
weapon used to produce it; its extent may suggest the possible degree
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
257
of violence applied; and its distribution may indicate the character
and manner of injury as in manual strangulation around the neck.
It may infer grave complications and consequences on account of
serious injuries of the underlying tissues.
Age of Contusion:
The age of contusion can be appreciated from its color changes.
The size tends to become smaller from the periphery to the center
and passes through a series of color changes as a result of the
disintegration of the red blood corpuscles and liberation of hemoglobin.
The contusion is red sometimes purple soon after its complete
development.
In 4 to 5 days, the color changes to green.
In 7 to 10 days, it becomes yellow and gradually disappears on
the 14th or 15th day.
The ultimate disappearance of color varies from one to four
weeks depending upon the severity and constitution of the body.
The color changes start from the periphery inwards.
Distinction Between
(Supra p. 133).
Contusion
and
Post-mortem
Hypostasis
Factors Influencing the Degree and Extent of Contusion:
(a) General condition of the victim — Some healthy persons are
easily bruised.
( b ) Part of the body affected — Bloody parts of the body produce
larger contusion, specially where subcutaneous tissue is loose.
In areas of the body with excessive fat, contusion easily develops, while parts of the body with abundant fibrous tissue and
good muscle tone, bruising is less.
(c) Amount of force applied — Other factors being equal, the
greater the force applied the more effusion of blood will
develop.
(d) Disease — Contusion may develop with or without the application of force. Examples: Purpura, Hemophilia, Aplastic
anemia, Whooping cough, even vicarious menstruation.
(e) Age — Children and old age persons tend to bruise more easily.
Children have loose and tender skin. Old people have less
flesh and the blood vessels are more fragile.
(f) Sex — Women, specially if obese, easily develop contusion.
Athletes, like boxers do not develop contusion easily.
(g) Application of heat and cold — If immediately after injury
cold compress is applied the production of contusion will be
LEGAL MEDICINE
258
minimized. After it has already developed, application of
warm compress will hasten its disappearance.
The distinction between ante-mortem and post-mortem contusions
in an undecomposed body is that in ante-mortem bruising, there is
swelling, damage to epithelium, extravasation, coagulation and infiltration of the tissues with blood, while in post-mortem bruising there
are no such findings.
/ H e m a t o m a (Blood Cyst, Blood Tumor, "Bukolg):
/Hematoma is the extravasation or effusion of blood in a newly
formed cavity underneath the skin. It usually develops when the
blunt instrument is applied in part of the body where bony tissue is
superficially located, like the head, chest and anterior aspect of the
legs. The force applied causes the subcutaneous tissue to rupture on
account of the presence of a hard structure underneath. The destruction of the subcutaneous tissue will lead to the accumulation of
blood causing it to elevate.
Distinction Between
Contusion and Hematoma:
(a) In contusion the effused blood are accumulated in the interstices of the tissue underneath the skin, while in hematoma
blood accumulates in a newly formed cavity underneath the
skin.
( b ) In contusion, the skin shows no elevation and if ever elevated, the elevation is slight and is on account of inflammatory
changes, while in hematoma the skin is always elevated.
(c) In contusion, puncture or aspiration with syringe of the
lesion no blood can be obtained, while in hematoma, aspiration will show presence of blood and subsequent depression of the elevated lesion.
Abscess, gangrene, hypertrophy, fibroid thickening and even
malignancy are potential complications of hematoma.
/Musculo-Skeletal Injuries:
(1) Sprain — Partial or complete disruption in the continuity of a
muscular or ligamentous support of a joint. It is usually caused
by a blow, kick or torsion force.
(2) Dislocation — Displacement of the articular surface of bones
entering into the formation of a joint.
( 3 ) Fracture — Solution of continuity of bone resulting from violence or some existing pathology.
(a) Close or Simple Fracture — Fracture wherein there is no
break in continuity of the overlying skin or where the external air has no point of access to the site of injury.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
259
( b ) Open or Compound Fracture — The fracture is complicated
by an open wound caused by the broken bone which protruded with other tissues of the broken skin.
(c) Comminuted Fracture — the fractured bone is fragmented
into several pieces.
( d ) Greenstick Fracture — A fracture wherein only one side of
the bone is broken while the other side is merely bent.
( e ) Linear Fracture — When the fracture forms a crack commonly
observed in flat bones.
( f ) Spina/ Fracture — The break in the bone forms a spiral
manner as observed in long bones.
(g) Pathologic Fracture — Fracture caused by weakness of the
bone due to disease rather than violence.
• ( 4 ) Strain — The over-stretching, instead of an actual tearing or
the rupture of a muscle or ligament which may not be associated
with the joint.
/ ( 5 ) Subluxation — Incomplete dislocation.
/Internal Hemorrhage:
Rupture of blood vessel which may cause hemorrhage may be due
to the following:
(a> Traumatic intracranial hemorrhage.
(b)- Rupture of parenchymatous organs.
(c)-Laceration of other parts of the body.
Cerebral Concussion (Commotio Cerebri):
Cerebral concussion is the jarring or stunning of the brain characterized by more or less complete suspension of its functions, as
a result of injury to the head, which leads to some commotion of
the cerebral substance.
Cerebral concussion is much more severe when the moving or
mobile head struck a fixed hard object as compared when the head
is fixed and struck by a hard moving object.
s^Signs and Symptoms:
(a) Unconsciousness which is more or less complete.
( b ) Muscles are relaxed and flaccid.
(c) Eyelids are closed and the conjunctivae are insensitive.
(d) Surface of the body is pale, cold and clammy.
(e) Respiration is slow, shallow and sighing.
( f ) Pulse is rapid, weak, faltering and scarcely perceptible to the
fingers.
(g) Temperature is subnormal.
260
LEGAL MEDICINE
(h) Sphincters are relaxed perhaps with unconscious evacuation of
the bowel and bladder.
( i ) Reflexes are present but sluggish and in severe cases may be
absent.
Loss of memory for events just before the injury (retrograde
amnesia) is a constant effect of cerebral concussion and is of medicolegal importance.
/ O P E N WOUNDS:
^ A b r a s i o n (Scratch, Graze, Impression Mark, Friction Mark):
[ i t is an injury characterized by the removal of the superficial
epithelial layer of the skin caused by a rub or friction against a
hard rough surface.! Whenever, there is forcible contact before
friction occurs, there may be contusion associated with abrasion.
The shape varies and the raw surface exudes blood and lymph
which later dries and forms a protective covering known as scab
or crust.
Abrasions
Characteristics of Abrasion:
a. ft develops at the precise point of impact of the force causing it.
b. Grossly or with the aid of a hand lens the injury consists of
parallel linear injuries which are in line with the direction of the
rub or friction causing it.
c. It may exhibit the pattern of the wounding material.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
261
d. It is usually ignored by the attending physician for it does not
require medical treatment but it has far-reaching importance in
the medico-legal viewpoint.
( 1 ) Abrasions caused by fingernails may indicate struggle or
assault and are usually located in the face, neck, forearms,
and hands.
( 2 ) Abrasions resulting from friction on rough surfaces, either
intentional or accidental are located on bony parts of the
body and usually associated with contusion or laceration.
( 3 ) Nature of the abrasion may infer degree of pressure, nature
of the rubbing object and the direction of movement.
e. Unless there is a supervening infection, abrasion heals in a short
time and leaves no scar. If the whole thickness of the skin is
involved, healing may be delayed and occasionally with scar
formation.
Torms of A brasion:
a. Linear:
\MOA
An > abrasion which appears as a single line. It may be a
straight or curved line. Pinching with the fingernails will produce a linear curved abrasion, while sliding the point of a needle
on the skin will produce a straight linear abrasion.
b. Multi-Linear:
An abrasion which develops when the skin is rubbed on a
hard rough object thereby producing several linear marks
parallel to one another. This is frequently seen among victims
of vehicular accidents.
c.
Confluent:
An abrasion where the linear marks on the skin are almost
indistinguishable on account of the severity of friction and
roughness o the object.
d. Multiple:
Several abrasions of varying sizes and shapes may be found in
different parts of the body.
Types of Abrasions:
a. Scratch:
This is caused by ajsharp-pointed object which slides across
the skin, like a pin, thorn or fingernail. The injury is always
parallel to the direction of slide.
The commencement and
termination are well defined and the depth depends on the
pressure applied. The fingernail scratch may be broad at the
point of commencement and may terminate with a tailing.
262
LEGAL MEDICINE
b. Graze:
These are usually caused by forcible contact with rough,
hard objects resulting to irregular removal of the skin surface.
The nature of the injury is dependent upon the degree of roughness of the object and the amount of pressure in the course of
the sliding. The course will be indicated by a clean commencement and tags on the end.
c. Impact or Imprint Abrasion (Patterned
Abrasion, "Abrasion A La Signature"):
Abrasion,
Stamping
Those whose pattern and location provides objective evidence
to show cause, nature of the wounding material or instrument
and the manner of assault or death.
(1) Marks of the grid of the radiator may be imprinted on the
skin.
(2) Tire thread marks may be seen on the skin in vehicular
accidents.
(3) Muzzle imprint in contact fire gunshot wound of entrance.
(4) Teeth impression mark in skin bites.
d. Pressure or Friction Abrasion:
Abrasion caused by pressure accompanied by movement
usually observed in hanging or strangulation. The spiral strands
of the rope may be reflected on the skin of the neck. The
lesion may dry up and assume a papyraceous or parchmentlike consistency.
.
~
,
,, ^
—.
.
A b r a s i o n in the f o r m of tire marks in a victim of vehicular accident
.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
263
Differential Diagnosis:
a. Dermal Erosion — A gradual breakdown or very shallow
ulceration of the skin which involves only the epidermis and
heals withour scarring. It may appear in spots and with no
previous history of friction or sliding.
b. Marks of Insects and Fishes Bites — The skin injury is irregular
with no vital reaction and usually found on angles of the mouth,
margins of nose, eyelids and forehead.
c. Excoriation of the Skin by Excreta — This condition is only
found among infants and the skin lesion heals when the cause is
removed. There is no apparent history of rubbing trauma on
the affected area.
d. Pressure Sore — Usually found at the back at the region of bony
prominence.
History of long standing illness, bed ridden
condition although pressure sore may start as a previous area of
abrasion.
^Distinction Between Ante-mortem from Post-mortem Abrasions:
Point of
Distinction
Ante-mortem
Abrasion
Post-mortem
Abrasion
Color
Reddish-bronze. in appearance due to slight exudation of blood.
Yellowish and translucent in appearance.
Location
Any area.
Generally occurs over
bony prominence, such
as elbow, and attributed
to rough handling of the
cadaver.
Vital
reaction
With intravital reaction
and may show remains of
damaged epithelium.
Shows no vital reaction
and is characterized by a
separation of the epidermis from complete loss
of the former.
2. Incised Wound (Cut, Slash, Slice):
This is produced by a sharp-edged (cutting) or ^sharp-linear edge
of the instrument, like a knife, razor, bolo, edge of oyster shell,'
metal sheet, glass, etc. It may be an impact cut when there is
forcible contact of the cutting instrument with the body surface,
or slice cut when cutting injury is due to the pressure accompanied
with movement of the instrument.
When the wounding instrument is a heavy cutting instrument,
like axe, big bolo, saber, the wound produced is called Chopped or
264
LEGAL MEDICINE
Hacked wound. The injury is quite severe, edges may or may not
be contused depending on the nature of the edge of the instrument used.
Characteristics of Incised Wound:
a. Edges are cleanboth extremities are sharp, except in
areas where the skin is loose or folded at the time of infliction.
b. The wound is straight and may be shelving if inflicted with the
wounding instrument applied with an acute angle to the surface
of the body involved.
c. Usually the wound is shallow near the extremities and deeper
at the middle portion. However, this finding may be modified
by the shape of the wounding instrument and part of the body
involved.
d. Because the blood vessels involved are clean-cut, profuse hemorrhage is invariably a feature.
e. Gaping is usually present due to the retraction of the edges but
Its presence and degree of retraction depends on the direction
of the incised wound with the line of cleavage (Langer's line).
f. If the incised wound is located in parts of the body covered
with clothes, the clothing itself will show clean-cut of its
texture.
g. In the absence of complication and/or when there is deeper
involvement present, healing is relatively fast and the scar may
not or may develop conspicuously.
h. Incised wound caused by broken edge of glass may be irregular
and may appear like a punctured or stab wound. Fragments of the
glass may be removed from the incised wound. Examination
with the aid of a magnifying lens is necessary to determine the
presence and removal of particles of flakes of glasses in the
wound.
Changes that occur in an Incised Wound:
After 12 hours
— Edges are swollen; adherent with blood and
with leucocyte infiltration.
After 24 hours
— Proliferation of the vascular endothelium
and connective-tissue cells.
After 36-48 hours — Capillary network complete; fibrolasts running at right angles to the vessels.
After 3-5 days
— Vessels show thickening and obliteration.
(From: Gradwohl's Legal Medicine by F.E. Camps ed., 3rd ed.,
p. 272).
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
265
M u l t i p l e Incised w o u n d s ( H o m i c i d a l ) .
Deep incised wound may cause clean-cut fracture of the bone,
severance of blood vessels and nerves or amputation. Paralysis
may develop on account of the severed nerve and profuse hemorrhage may result to death. Embolism or supervening infection may later develop.
^ Why a Person Suffers from Incised Wound:
a. As a therapeutic procedure — Pyogenic abscess and cystic
conditions may be treated by incision.
b. As a consequence of_self-defense — The sharp-edged instrument
may be held by the victim in his attempt to avoid the offender
to inflict more serious injuries on him.
c. Masochist may self-inflict incised wound as a means of sexual
gratification.
d^Addicts and mental patients may suffer from incised wound
irrationally.
Incised Wounds may be Suicidal, Homicidal or Accidental:
Suicidal — Located in peculiar parts of the body, like the jjeck,
flexor surfaces of the extremities (elbow, groin, knee), wrist,
and accessible to the hand in inflicting the injury. The most
common instrument used is the Jaarber's razor blade with an
improvised handle. There is usually superficial tentative cut
(hesitation cuts) and the direction varies with the location and
the hand (left or right) used in inflicting the injuries. The most
LEGAL MEDICINE
266
common site of suicidal incised wounds are on the wrist with
involvement of the radial artery and the neck.
^Homicidal — The incised wounds are deep, multiple and involve
both accessible and non-accessible parts of the body to the
hands of. the viGtim. "defense and other forms of wounds may
be present. Clothings are always involved.
ytil Accidental — Multiple incised wound isjoommonly observed on
the passengers and _driver of vehicular accidents on account of
the broken windshield and glass parts of windows. Stepping on
oyster shell, broken glassesTsharp edges of metal sheets are
common causes of incised wound on the sole of the foot.
Those associated in the use of kitchen knives in the preparation
of food, carpenters and handicraft workers who use sharp edged
instruments are frequent victims of accidental incised wounds.
Distinction Between Suicidal and Homicidal Cut-throat
Suicidal
Direction Oblique, from* Below left
ear, downwards, .across
front ^ e c k just .above
Adam's apple.
Severity
Usually _noi_so deep and
may only involve trachea
carotid and sometimes the
esophagus is involved.
Superficial Usually present before
Cut
the
commencement of
deeper wound.
Homicidal
Usually horizontal below
tho "Adam's'apple.
Usually deep and may
cause involvement of the
cartilage and bones.
Practically jibsent but
may rarely be present
when the victim struggled when attacked.
Usually victim _lying on
bed or in other place.
Position
of the
body
May be__sjtting facing a
mirror or standing,
Wounding
weapon
Firmly grasped (Cadaveric
spasm) or found lying
beside victim.
Blood found in front part
of the body. Hand generally
smeared
with
blood.
Weapon is jjbsent.
History of mental depression, domestic, financial
social problems, alcoholism etc. may prove suicide.
Absence of such history.
Blood
distribution
Motive
Blood found at the back
of the neck.
JIands
clean.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
Previous
history
of selfdestruction
May be present.
267
Always absent,
Stab Wound:
Stab wound is produced by the penetration of a sharp-pointed
and sharp edged instrument, like a^knjfe, saber, dagger, scissors. It
may involve the skin or mucous surface. IftRe sharp edgTportion
of the wounding instrument is the first to come in contact with
the skin, the wound produced is an incised wound, but if the
sharp-pointed portion first come in contact, then the wound is a
stab wound. As a general rule, like an incised wound, the edges
are cleanzcut, regular and distinct.
The surface length of a stab wound may reflect the width of
the wounding instrument. It may be smaller when the wound is
not so deep inasmuch as it is only caused by the penetration of
the tapering portion of the pointed instrument. It may be made
wider if the withdrawal is not on the same direction as when it
was introduced or the stabbing is accompanied by a slashing movement.
In the latter case the presence of an abrasion from the
extremity of the skin defect is in line with direction of the slashing
movement.
Incised and stab w o u n d s of the face and neck.
268
LEGAL MEDICINE
The extremities of stab wound may show the nature of the
instrument used. A double-bladed weapon may cause the production of both extremities sharp. A single bladed instrument
may produce as one of its extremities rounded and contused. This
distinction may not be clearly observed if the instrument is quite
thin.
The direction of the surface defect may be useful in the determination of the possible relative position of the offender and
the victim when the wound was inflicted.
As to whether the wound is a slit-like or gaping depends on the
looseness of the skin and the direction of the wound to the line
of cleavage (Langer's line).
The depth may be influenced by the size and sharpness of the
instrument, area of the body involved, and the degree of force
applied. Involvement of the bones may cause clean-cut fracture
on it. A portion of the wounding instrument, usually the tapering
part, may remain in the body. X-ray examinations may be needed
to reveal its location.
Hemorrhage is always the most serious consequence of a stab
wound. This is due to the severance of blood vessels or involvement of bloody organs.
M u l t i p l e stab w o u n d s
In the Description of a Stab Wound, the
included:
following must be
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
269
a. Length of the skin defect — The edges must be coaptated before
the length is measured. If the abrasion tailing is present in one
of the extremities, it must not be included in the measurement.
The length of the tailing must be mentioned separately. The
tailing infers the direction of withdrawal of the wounding
weapon.
b. Condition of the extremities — A sharp extremity may infer the
sharpness of the edge of the instrument used. If both extremities are sharp, it may be inferred that a double-bladed weapon
was used.
c. Condition of the edges — If the injury is due to one stabbing
act, the edges are regular and clean-cut. However if the wound
is caused by several stabbing acts (series of thrusts and withdrawal), the edges may be serrated or zigzag in appearance.
d. Linear direction of the surface wound — It may be running
vertically, horizontally, or upward medially or laterally.
e. Location of the stab wound — Aside from mentioning the
region of body where it is located, its exact measurement to
some anatomical landmarks must be stated.
f. Direction of penetration — This must be tri-dimensional (backwards or forwards, upwards or downwards, and medially or
laterally).
g. Depth of the penetration.
h. Tissue and organs involved.
^Stab Wound(s) may be Suicidal, Homicidal or Accidental:
a. Suicidal — Evidences showing that the stab wound is suicidal:
( l ) - r t is located over the .vital parts of the body.
(2) It is usually solitary. If multiple, they are located on one
part of the body.
(3) If located on covered parts of the body, the clothings are
not involved.
(AyThe stab wound is accessible to the hand of the victim.
(5)-The hand of the victim is smeared with blood.
(6)/The wounding weapon is firmly grasped by the hand of the
victim (cadaveric spasm).
( 7 ) If stabbing is accompanied with slashing movement, the
wound tailing abrasion is seen towards the hand inflicting
the injury,
(a HA suicide note may be present.
(9)/There is the presence of a motive for self-destruction.
LEGAL MEDICINE
270
(10)-No disturbance in the death scene, wounding instrument
is found near the victim.
b. Homicidal — Stabbing with homicidal intent is the most common.
Characteristics:
(1) Injuries other than stab wound may be present.
(2) Stab wound may be located injmy part of the body.
( 3 ) Usually there are ©ore than one stab wound.
(4) There is a motive for the stabbing. If without motive, the
offender must be insane or under the influence of drugs.
( 5 ) There is disturbance in the crime scene.
S t a b w o u n d w i t h intestinal herniation.
^Medical evidences showing intent of the offender to kill the victim:
a. There are more than one stab wounds.
b. The stab wounds are located in different parts of the body or
on parts of the body where vital organs are located.
c. Stab wounds are_deep.
d. Stab wound with serrated or zigzag borders infers alternative
thrust and withdrawal of the wounding weapon to increase
internal damages.
e. Irregular or stellate shape skin defects may be due to changing
direction of the weapon with the portion of the instrument at
the level of the skin as the lever. In this way a greater area of
involvement internally will be realized.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
271
Different measurement of the stab wounds may possibly be
produced by one weapon if it is tapering towards the sharp point.
Withdrawal of the instrument not on the same direction as when
it was introduced may increase the length of the skin defect.
A sharpened three-cornered file (tres-cantos) when used as a
stabbing weapon will produce three-cornered (extremities) skin
defect.
The most common immediate cause of death is hemorrhage
particularly when located in the chest or abdomen.
Accidental stab wounds are quite rare and are usually caused by
falling against a projecting sharp object like broken pieces of glass
or flattened and_pointed iron bars.
x^Tpunctured Wound: ^ >
'#^J£
. •
Punctured wound is the result of a thrust 6f'a jharp pointed
instrument. The external injury is quite small but the depth is
to a certain degree. It is commonly produced by an icepick, needle,
nail, spear,jJointed stick, thom, fang of animal ancfhook.
The nature of the external injury depends on the sharpness
and shape of the end of the wounding instrument. Contusion of
the edges may be present if the end is not so sharp. The opening
may be round, elliptical, diamond-shape or cruciate. An accurate
cross-section nature of the wounding object may well be appreciated when there is involvement of flat hard parts of the body
especially the skull.
External hemorrhage is quite limited although internal injuries
may be severe. However, direct involvement of blood vessels and
bloody organs may cause fatal consequence unless appropriate
medical intervention is applied.
The site of the external wound can be easily sealed by the
dried blood, serum or clotted blood so that introduction of
pathogenic microorganism which does not require the presence
of air in its growth and multiplication may find the place favorable, and may produce fatal consequences.
/ P u n c t u r e d wound is usually accidental but in rare instances it
may be homicidal or suicidal.
Characteristics:
a. The opening on the skin is very small and may become unnoticeable because of clotted blood and elasticity of the skin.
The wound is much deeper than it is wide.
b. External hemorrhage is limited although internally it may be
severe.
272
LEGAL MEDICINE
c. Sealing of the external opening will be favorable for the growth
and multiplication of anaerobic microorganism like bacillus
tetani.
Medical evidences that tend to show it is Homicidal: pppp
a. It is multiple and usually located in different parts of the body.
It may however be found in certain areas of the body.
M
b. The wounds are deep.
c. There are defense wounds on the victim.
d. There is disturbance in the crime scene (sign of struggle).
Proof to show it is Suicidal:
a. Located in areas of the body where the vital organs are located.
b. Usually singular but may be multiple but located in one area of
the body.
c. Parts of the body involved is accessible to the hand of the
victim.
d. Clothings usually is not involved.
e. Wounding is made by the weapon while the victim is in sitting
or standing position. There is bleeding towards the lower part
of body or clothing.
f. No disturbance of the crime scene.
g. Presence of suicide note.
h. Wounding instrument found near the body of the victim.
Punctured wound with puncturing instrument "loaded" with
poison:
a. Poison dart — cyanide or nicotine.
b. Fish spines.
c. Dog bites with hydrophobia virus.
d.Jnjection of air and poison as a way of euthanasia.
Lacerated Wound (Tear, Rupture, Stretch "Pulok."): $
Lacerated wound is a tear of the skin and the underlying tissues
due to forcible contact with a blunt instrument. It may be produced by a hit with a piece of .wood, iron bar, fist blow, stone,
butt of firearm, or other objects without sharp objects.
If the force applied to a tissue is greater than its cohesive force
and elasticity, the tissue tears and a laceration is produced.
Since the skin is composed of several types of tissues, namely
epidermis, connective tissue, fat, blood vessels, nerves, glandular
cells, etc. each having its own breaking point, the laceration will
be irregular and having strands of tissues bridging. The rupture of
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
27 3
continuity may only extend deeper to the stronger layer like that
of the galea aponeuritica in case of scalp injury.
Characteristics:
a. The shape and size of the injury do not correspond to the
wounding instrument.
b. The tear on the skin is rugged with extremities irregular and
ill-defined.
c. The injury developed is at the site where the blunt force is
applied.
d. The borders of the wound are contused and swollen.
e. It is usually developed on the areas of the body where the bone
is superficially located, like the scalp, malar region of the face,
front part of the leg, dorsum of the foot, etc.
f. Examination with the aid of the hand lens shows bridging tissue
joining the edges and hair bulbs intact.
g. Bleeding is not extensive because the blood vessels are not
severed evenly.
h. Healing process is delayed and has more tendency to develop
scar.
Classification of Lacerated Wounds
a. Splitting caused by crushing of the skin between two hard
objects. This is best seen in laceration of the scalp caused by a
hit of a blunt instrument, cut eyebrow of boxer and laceration
of the chin of motorcyclist.
b. Overstretching of the skin. When pressure is applied on one side
of the bone, the skin over the area will be stretched up to a
breaking point to cause laceration and exposure of the fractured
bone. In avulsion, the edges of the remaining tissue is that of
laceration.
c. Grinding compression — The weight and the grinding movement
may cause separation of the skin with the underlying tissues.
d. Tearing — This may be produced by a semi-sharp-edged instrument which causes irregular edges on the wound, like
hatchet and choppers.
Lacerated wounds may involve deeper tissues like laceration of
the muscles and fracture of bones depending upon the degree of
force applied in causing it.
It may be homicidal or accidental but rarely it is suicidal.
An insane person may hit his head on a concrete wall but when
loss of consciousness develops he will not be able to continue
further his act of self-destruction.
LEGAL MEDICINE
274
pistinctions Between an Incised Wound and a Lacerated Wound:
Incised Wound
Lacerated Wound
CJ*Edges are clean-cut, regular AUtfges are roughly cut, irregular
and well-defined.
and ill-defined.
M& There is no swelling or con- S There is swelling and contusion
tusion around the incised around the lacerated wound.
wound.
cj* Extremities of the wound are ^.Extremities of the wound are
sharp or may be round or ill-defined and irregular,
contused.
Examination by means of a
magnifying lens shows that
the hair bulbs are cut.
f
Healing is faster.
Examination with a magnifying
lens shows that the hair bulbs are
preserved,
n Healing is delayed.
Vt Scar is linear or spindle-shaped. X Scar is irregular.
St, It is caused by a sharp-edged 0 It is caused by a blunt instruinstrument.
ment.
GAPING OF W O U N D :
The separation of the edges especially in deep wound may be due
to the following:
Avulsion of the skin at the forehead with e x p o s u r e of the fractured skull and
part of the brain.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
275
1. Mechanical stretching or dilatation — The presence of a mechanical device on the edges to prevent coaptation will cause separation.
The presence of a canula in tracheostomy, drain (rubber or gauze)
in an incised abscess, or a retractor during a surgical operation are
examples of this type of gaping.
2. Loss of tissue — Separation of the edges of a wound may be on
account of loss of tissue bridging them. The loss of tissue may be
due to:
a. Destruction by pressure, infection, cell lysis, burning or chemical reaction.
b. Avulsion or physical or mechanical stretching resulting to
separation of a portion of the tissue.
c. Trimming of the edges. Debridment of the skin which came in
contact with the bullet at the gunshot wound of entrance and
the removal of necrotic material in an infected wound may
cause separation of the edges.
3. Retraction of the edges — Underneath the skin are dense networks
of fibrous and elastic connective tissue fibers running on the same
direction and forming a pattern more or less present in all persons.
This pattern of fiber arrangement is called cleavage direction or
lines or cleavage of the skin and their linear representation on the
skin is called Langer's line. These lines of cleavage are different in
different parts of the body.
If an incised wound or stab wound was inflicted wherein the
long axis of the wound is parallel or on the same direction as the
cleavage line of the part of the body involved, the wound will
appear narrow or slit-like because the edges of the wound will not
be subjected to the lateral pull of the severed connective tissue
fibers.
If the long axis of the wound is perpendicular to or with an
angle with the lines of cleavage, the tendency of the borders of
the wound is to separate on account of the retraction of the
severed fibers.
Practical Ways of Determining How Much of the Skin Surface is
Involved in an Injury or Disease:
The skin serves as a mechanical protection to the body. It is
punctuated with sensory nerve endings for pain, temperature and
touch. It also acts as a thermo-regulator, storage of water, excretor of sweat and also an organ for absorption.
The determination of how much skin involvement is important
in the mode of treatment and prognosis. Such determination may
276
LEGAL MEDICINE
Line of cleavage
Langer's line
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
B o d y surface
LEGAL MEDICINE
278
be significant in cases of burns, contusion and dermal manifestation of certain diseases.
In cases of burns in children and old age persons, involvement
of more than 70% of the body surface are almost invariably fatal.
In the estimation as to how much (by percentage) of the body
surface is involved, the rule of nine is used.
Body surface expressed as percentage using the rule of nine:
Whole of head and neck
Whole of one upper extremity
Whole of front chest and abdomen
Whole of posterior chest and abdomen
Whole of one lower extremity (front)
Whole of one lower extremity (back)
Pudental area
9%
9%
18%
18%
9%
9%
1%
Total
Factors Responsible for the Severity of Wounds:
9%
18%
18%
18%
18%
18%
1%
100%
1. Hemorrhage:
a. Hemorrhage may influence the severity of wound by:
( 1 ) Loss of blood incompatible with life:
Blood constitutes about 1/20 of the body weight of an
adult. By volume, an average size adult has 5 to 6 quarts
of blood (one quart is 946 c c ) . A loss of one tenth of its
volume may not cause any significant clinical change. A
loss of one quart may cause fainting even if the subject is
lying down.
But a loss of 1/3 to 2/5 of the circulating
blood may result to irreversible hypovolemic shock and may
be fatal.
The volume of blood lost may be related to the rate or
space of time a certain volume of blood has been shed.
The blood loss may be massive but if it occurred for a long
period of time, the hemopoietic organs may be able to
replace it thereby preventing the development of any
untoward effects.
Males can stand more lost of blood than females. Hypertension may cause excessive and rapid bleeding from an
arterial wound.
Persons suffering from hemophilia and
other clotting disorders and those being treated by anticoagulants can cause prolonged bleeding.
( 2 ) Hemorrhage may result in ah increase in pressure in or on
the vital organs to affect the normal function:
Intracranial hemorrhage may cause compression of the
vital centers of the brain. Hemopericardium (pericardial
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
279
tamponade) may cause embarrassment of the contraction
of the heart. Hemorrhage into the chest cavity may cause
diminution of the respiratory output with subsequent
anoxia.
(3) Hemorrhage may cause mechanical barriers to the function
of organs:
Hemorrhage into the tracheo-bronchial lumina can cause
asphyxia.
Interstitial hemorrhage into the muscles may
cause disturbance in the contractility.
b. Causes of Hemorrhage:
( 1 ) Trauma — Destruction of the blood vessel wall or increase
permeability of its wall due to external force.
( 2 ) Natural Causes:
(a) Common causes of hemorrhage due to natural causes:
i. Intra-cerebral hemorrhage (apoplexy):
The most common blood vessel involved is the
lenticulostraite branch of the middle cerebral
artery with subsequent bleeding into the basal
ganglia and adjacent structure.
ii. Spontaneous subarachnoid hemorrhage:
Usually due to rupture or perforation of a saccular berry aneurysm, commonly located at the
bifurcation of one of the constituent vessels of
the circle of Willis or one of its major branches.
This is usually a congenital focal defect of the muscular layer with subsequent over stretching and
degeneration of the internal elastic layer of the
blood vessel wall.
iii. Rupture of the arteriosclerotic aneurysm of the
aorta:
The weakening and thinning of the aortic wall
may lead to fusiform or saccular aneurysm usually
located at the abdominal portion.
iv. Rupture of esophageal varices in cases of cirrhosis
of the liver and bleeding of peptic ulcer of the
stomach and duodenum.
v. Pulmonary hemorrhage may be due to tuberculosis, lung abscess, or bronchiectasis. The
hemorrhage may be profused to cause severe anemia or
may be small to cause asphyxia.
vi. Ruptured ectopic pregnancy.
LEGAL MEDICINE
280
vii. Spontaneous rupture of cavernous hemangioma or
hepatoma.
viii. Rupture of the enlarged spleen (malaria, infectious
mononucleosis, typhoid fever).
(Medico-legal Investigation of Death by Fischer, p. 102).
2. Size of Injury:
Burns affecting one-third of the body surface of the third
degree type is usually fatal. Bigger wounds are more exposed
to infection and other physical conditions of the surroundings.
3. Organs Involved:
Trauma on the vital organs of the body are always serious.
Crushing wounds of the heart, brain or lungs are almost fatal.
4. Shock:
Shock may occur with or without violence. A slight blow on
the genitalia, slight bums in children or old persons, or slight
violence on the head or neck may cause severe shock. However,
violent traumas to healthy, strong persons may not produce shock.
5. Foreign Body or Substance Introduced into the Body:
Incision with an unsterilized scalpel may not be serious as the
bite of a venomous snake. A foreign substance or body may be
toxic by itself or may act as a physical irritant.
The Foreign Body or Substance may be:
a. Bacterial:
Tetanus b~1f
Pathogenic microorganism
b. Viral:
HydrophobiaW-H|f
Hepatitis
c. Foreign body:
Bullet
F- *>ZS (,
Glass fragments
Shrapnel
Gauze or rubber drain
d. Chemical:
Cyanide
Nicotine
o- ^
e. Toxin-:
j-fr
( 1 ) Snake Venom — Snake bite is characterized as two punctured wounds at the center of the reddened affected area.
The venom is injected through its fangs which is connected
to the poison gland.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
281
Snake Venom Toxicity will Depend on:
(a) Potency of venom injected.
( b ) The amount of venom injected by the fang depends on
the season of the year and the length of time the snake
has eaten. If a snake has just killed his prey, the toxic
content of its bite is smaller.
( c ) Size of the patient.
( d ) The immediate treatment instituted.
Snake Venoms are of Two Principal Classes:
( a ) Neurotoxic — It primarily paralyzes the respiratory and
cardiac center of the brain. Absorption of the venom
may cause nausea, vomiting, ascending paralysis, coma,
convulsion, and cardiac and respiratory arrest.
( b ) Hematoxic — Which affects particularly the blood. The
manifestations are pain and swelling of the affected
area, intravascular hemolysis, abdominal pain, nausea,
vomiting, petechial: hemorrhage on the gum, pulmonary
and cardiac edema.
Emergency Treatment may be:
(a) Incision of the wound to promote more external hemorrhage to drain the venom.
( b ) Tourniquette above the site of the wound.
(c) Placing ice on the bite site.
( d ) Sucking the wound to drain venom with the mouth.
(e) Administration of anti-snake venom serum.
( 2 ) Scorpion Venom — The venom of the scorpion has neurotoxic, hemolytic and hemorrhagic effect. A scorpion sting
produces only one punctured wound on the center of a reddened area.
The main symptoms are pain, edema and
reddening.
( 3 ) Coelenterate Sting (Jellyfish) — The tentacles penetrate into
the skin and cause explosion of the nematocyst and liberation of the venom. The symptoms are extreme pain of the
affected area, urticarial rash, abdominal pain, dilated pupils,
paleness and labored breathing.
Absence of Medical or Surgical Intervention:
A wound may not be fatal but on account of the neglect or ignorance in its management, it may become serious and fatal.
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LEGAL MEDICINE
FATAL EFFECT OF WOUNDS: p M r V
1. Wound may be Directly Fatal by Reason of:
a. Hemorrhage:
7p~£*SS
An incised wound at the lateral aspect of the neck involving
the carotid artery without surgical intervention is fatal due to
hemorrhage. While wounds in some areas of the body where big
blood vessels are not present and the retraction of tissues are
strong, death will not be a direct consequence due to hemorrhage in the absence of complication that may set in.
b. Mechanical Injuries on the Vital Organs:
A blow on the head may not necessarily produce external
lesions but may produce severe meningeal hemorrhage producing compression of the brain. A punctured wound of the
heart, even though how small, may produce death on account
of the tamponade of the heart.
c. Shock:
This is the disturbance of the balance of fluid in the body
capable of producing delayed or immediate death.
2. Wound may be Indirectly Fatal by Reason of:
a. Secondary Hemorrhage Following Sepsis:
A wound because of its nature and location is not capable of
producing severe hemorrhage, but on account of infection that
sets in, deeper tissues are involved including big blood vessels
thereby producing severe hemorrhage.
b. Specific Infection:
Pathogenic microorganisms may develop and multiply in the
wound causing septicemia, bacteremia, or toxemia. Tetanus, gas
gangrene infection are common in open wounds.
c. Scarring Effect:
Chronic gonorrheal infection may cause stricture of the
urethra.
Stricture of the esophagus may follow ingestion of
irritant poison. Keloid formation in burns may not only cause
deformity but disturbance of the normal respiration of locomotion.
d. Secondary Shock:
Nature of Death Due to Secondary Causes:
A person may have recovered from the immediate effects of the
trauma or violence, but may later die of its secondary effects or
changes.
These changes may be classified as follows:
1. Changes whose natural sequence are direct and obvious.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
283
Example: Septicemia, tetanus or complications arising from the
wounds.
2. Changes producing separate pathological lesions which in turn
proves to be fatal.
Example: Operation performed on a patient to ligate bleeding
vessel inside the abdominal cavity with reasonable
skill and with due diligence but as a result of which
peritonitis developed and caused death of the patient.
3. Changes where a definite pathological condition was present
before the injury.
Example: A person suffering from tumor or cyst and was stabbed
by someone. The stab is not capable of producing
death ordinarily. The person may die of the pathological condition and the accused is liable for his death.
4. Changes where a definite pathological condition of totally different nature arises after the wounding and the consequential
sequence is doubtful.
Example: Tuberculosis meningitis that develops following a
blow on the head.
COMPLICATIONS OF TRAUMA OR INJURY:
1. Shock:
Shock is the disturbance of fluid balance resulting to peripheral deficiency which is manifested by the decreased volume of
blood, reduced volume of flow, hemoconcentration and renal
deficiency. It is clinically characterized by severe depression of
the nervous system. Three major factors operate in the production of shock and all are likely to be associated together as the
condition develops.
a. Injury to the receptive nervous system.
b. Anoxemia — Reduction of effective volume of oxygen carrying
capacity of the blood.
c. Endothelial damage, thus increasing capillary permeability.
Kinds of Shock:
a. Primary Shock:
This is caused by immediate nerve impulse set up at the injured area which are conveyed to the central nervous system.
The impulse may also whelm the vital centers in the medulla
thereby shock develops within a short time due to vasomotor
collapse. If the reaction is not intense, the patient may live
longer or may recover completely from the effect of the shock.
LEGAL MEDICINE
284
b. Delayed or Secondary Shock:
Patient shows signs of general collapse which develop sometime after the infliction of injury. It is characterized by a low
blood pressure, subnormal temperature, cold clammy perspiration, muscular incoordination, rapid and shallow respiration.
The shock may be severe to produce death or the patient may
recover completely from its effects.
2. Hemorrhage:
Hemorrhage is the extravasation or loss of blood from the
circulation brought about by wounds in the cardio-vascular
system.
The degree and nature of hemorrhage depends upon
the size, kind and location of the blood vessel cut.
Kinds of Hemorrhage:
a. Primary
Hemorrhage:
It is the bleeding which occurs immediately after the traumatic injury of the blood vessel.
b. Secondary Hemorrhage:
This occurs not immediately after the infliction of the
injury but sometime thereafter on or near the injured area.
3. Infection:
Infection is the appearance, growth and development of microorganisms at the site of injury:
How Injury or Trauma Acquires Infections:
a. From the instrument or substance which produces the injury.
b. From the organs involved in the trauma applied. A bullet
wound may involve the intestine and causes its contents to spill
out in the peritoneal cavity causing peritonitis.
c. As an indirect effect of the injury which creates a local area of
diminished resistance causing the invasion and multiplication
of microorganisms.
d. Injury may depress the general vitality, especially among the
aged and the young children and makes the patient succumb to
terminal disease.
e. Deliberate introduction of microorganisms at the site of injury.
4. Embolism:
This is a condition in which foreign matters are introduced in
the blood stream causing sudden block to the blood flow in the
finer arterioles and capillaries.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
285
The Most Common Emboli in the Blood Stream are:
a. Fat Embolus:
( 1 ) Causes of Fat Embolus:
(a) By injection of oily substance into the circulation.
( b ) By injury of the adipose tissue which forces fat into the
circulation.
b. Air Embolism:
(1) Causes of Air Embolism:
(a) Gaping incised wound of the jugular vein.
( b ) Injection of soapsuds or air into pregnant uterus for the
purpose of tubal insuflation or criminal abortion.
(c) Injection of air into the urinary bladder for radiological
study.
( d ) Insuflation of the other non-potent tubes or hollow
organs.
( e ) Injection of air under pressure into the nasal sinus
after a therapeutic lavage.
HEALING OF WOUNDS:
1. Power of the Human Tissue to Regenerate:
Regeneration is the replacement of destroyed tissue by newly
formed similar tissue. The more highly specialized the tissue, the
less is the capacity for regeneration. Capacity for regeneration
decreases as age increases. The state of nutrition of the individual
aifects the capacity of regeneration.
The Following Regenerates Rapidly:
a. Connective tissues.
b. Blood forming tissues.
c. Surface epithelium of the skin.
Those Having No Power or Limited Capacity to Regenerate:
a. Highly specialized glandular epithelium.
b. Smooth muscles.
c. Neurons of the central nervous system.
Small clean-cut wound is covered with lymph in 36 hours.
The edges adhere in two days and the wound heals on the 7th
day leaving a linear scar.
Larger incised wound shows swelling of the edges 8 to 12
hours. Blood-stained serum is present in 2 days which afterwards
become seropurulent on the 3rd day, lasting in state from 4 to 5
days. Small red granulation forms in 12 to 15 days and the
epithelium grows from the edges. Scar develops later.
286
LEGAL MEDICINE
In cases wherein a definite infection is present, the time of
healing is very indefinite, however, at the advent of antibiotic and
sulfa drugs, healing is somewhat accelerated.
The Time of Healing of Wounds is Dependent on the following:
a.
b.
c.
d.
Vascularity
Age of the Person
Degree of Rest or Immobilization
Nature of the Injury
2. Kinds of Healing of Wounds:
a. Healing by Primary (First) Intention:
This type of healing takes place when there is minimal
tissue loss, more approximation of the edges and without
significant bacterial contamination.
Histologically, within 24 hours following injury, there is
an acute neutrophilic response, the epidermal layer thickened
on account of the mitotic activities of the basal cells. Scab will
be formed on the surface on account of the dehydration of the
surface clot.
After three days, the neutrophils will be replaced by the
macrophages and fibroblasts will appear in the epithelial layer.
Collagen fibers will bridge the raw area and epithelial proliferation will then cover the raw area. Newly formed capillaries sprout on all sides to form the vascular network and
collagen fibrils become abundant and differentiated surface
cells begin to proliferate to cover the exposed area.
Complete return of the area to its normal state may appear
after a lapse of one month with or without the formation of a
scar.
b. Healing by Secondary Intention:
This takes place when the injury causes a more extensive loss
of cells and tissues. Inevitably, there is more necrotic debris
and exudate that has to be removed. Inflammatory reaction is
more intense as compared with healing by primary intention.
Granulation tissue growth bears all the responsibility for its
closure.
Healing process may result to the production of a
large scar and greater loss of skin appendages such as hair, sweat
and sebaceous glands, and slower reparative process.
c. Aberrated Healing Process:
In some instances healing process deviates from the normal
way on a normal individual. Healing may result to:
( 1 ) Formation of Exuberant Granulation or "Proud Flesh" —
Excessive amount of granulation tissue may protrude and
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
prevent closing of the wound.
excision or cautery.
287
This can be remedied by
Keloid f o r m a t i o n after a severe acid b u m s .
( 2 ) Keloid Formation — There is abnormal amount of collagen
formed in the connective tissue thus producing a large
bulging tumorous scar, commonly known as keloid. It has
been claimed to be hereditary.
(3) Stricture — This is due to the contraction of the fibrous
tissue of the scar formed.
(4) Fistula or Sinus Formation — A fistula is a communication
between an inner cavity and the outside. Sinus is a tract
of infection traversing the inner part of the body. Unless
the causal factor, usually infection or foreign body is
removed, the condition may remain for a long time.
Chapter X
MEDICO-LEGAL INVESTIGATION OF WOUNDS:
The following rules must always be observed by the physician in
the examination of wounds:
1. All injuries must be described, however small for it may be important later.
2. The description of the wounds must be comprehensive, and if
possible a sketch or photograph must be taken.
3. The examination must not be influenced by any other information
obtained from others in making a report or a conclusion.
Outline of the Medico-legal Investigation of Physical Injuries:
1. General Investigation of the Surroundings:
a. Examination of the place where the crime was committed.
b. Examination of the clothings, stains, cuts, hair and other
foreign bodies that can be found in the scene of the crime.
c. Investigation of those persons who may be the witnesses to the
incident or those who could give light to the case.
d. Examination of the wounding instrument.
e. Photography, sketching, or accurate description of the scene of
the crime for purposes of preservation.
2. Examinations of the
Wounded Body:
a. Examinations that are applicable to the living and dead victim:
(1) Age of the wound from the degree of healing.
( 2 ) Determination of the weapon used in the commission of the
offense.
( 3 ) Reasons for the multiplicity of wounds in cases where there
are more than one wound.
( 4 ) Determination whether the injury is accidental, suicidal or
homicidal.
b. Examinations that are applicable only to the living:
( 1 ) Determination whether the injury is dangerous to life.
( 2 ) Determination whether the injury will produce permanent
deformity.
( 3 ) Determination whether the wound(s) produced shock.
288
MEDICO-LEGAL INVESTIGATION OF WOUNDS
(4) Determination whether the injury will produce complication as a consequence,
c. Examinations that are applicable to the dead victim:
( 1 ) Determination whether the wound is ante-mortem or postmortem.
(2) Determination whether the wound is mortal or not.
( 3 ) Determination whether death is accelerated by a disease or
some abnormal developments which are present at the time
of the infliction of the wound.
(4) Determination whether the wound was caused by accident,
suicide or homicide.
3. Examinations of the Wound:
The following must be included in the examinations of the
wound. The report made in connection with such examination
must also include in detail the following items:
a. Character of the Wound:
The description must first state the type of wound, e.g.
abrasion, contusion, hematoma, incised, lacerated, stab wound
etc. It must include the size, shape, nature of the edges, extremities and other characteristic marks. The presence of contusion collar in case of gunshot wound of entrance, scab formation in abrasion and other open wounds, infection, surgical
intervention, etc., must also be stated.
b. Location of the Wound:
The region of the body where the wound is situated must be
stated. It is advisable to measure the distance of the wound
from some fixed point of the body prominence to facilitate
reconstruction. This is important in determining the trajectory
or course of the wounding weapon inside the body.
c. Depth of the Wound:
The determination of the exact depth of the wound must
not be attempted in a living subject if in so doing it will prejudice the health or life. Depth is measurable if the outer
wound and the inner end is fixed. No attempt must be made in
measuring the stabbed wound of the abdomen because of the
movability of the abdominal wall.
c. Condition of the Surroundings:
The area surrounding the wound must be examined. In
gunshot wound near or contact fire will produce burning or
tattooing of the surrounding skin. In suicidal incised wound,
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LEGAL MEDICINE
there may be superficial tentative cuts (hesitation cuts). Lacerated wound may show contusion of the neighboring skin.
e. Extent of the Wound:
Extensive injury may show marked degree of force applied in
the production of the wound. In homicidal cut-throat cases, it
is generally deeper than in cases of suicide. Homicidal wounds
are extensive and numerous.
f. Direction of the Wound:
The direction of the wound is material in the determination
of the relative position of the victim and the offender when
such wound has been inflicted. The direction of the incised
wound of the anterior aspect of the neck may differentiate
whether it is homicidal or suicidal.
g. Number of Wounds:
Several wounds found in different parts of the body are
generally indicative of murder or homicide.
h. Conditions of the Locality:
(1) Degree of hemorrhage.
(2) Evidence of struggle.
(3) Information as to the position of the body
(4) Presence of letter or suicide note.
(5) Condition of the weapon.
Determination Whether the Wounds were Inflicted During Life or
After Death:
In the determination whether the wounds were inflicted during
life or after death, the following factors must be taken into consideration:
1. Hemorrhage:
As a general rule, hemorrhage is more profuse when the wound
was inflicted during the lifetime of the victim. In wounds inflicted after death, the amount of bleeding is comparatively less if
at all bleeding occurred. This is due to the loss of tone of the
blood vessels, the absence of heart action and the post-mortem
clotting of blood inside the blood vessels.
Violence inflicted on a living body may not show the formation
of a bruise until after death.
2. Signs of Inflammation:
There may be swelling of the area surrounding the wound,
effusion of lymph or pus and adhesion of the edges. Other vital
reactions are present whenever the wound was inflicted during
life, although it may be less pronounced when the resistance of
MEDICO-LEGAL INVESTIGATION OF WOUNDS
291
the victim is markedly weakened. The vital reaction may also
indicate the time of infliction of the wound. Post-mortem wounds
do not show any manifesting signs of vital reaction.
3. Signs of Repair:
Fibrin formation, growth or epithelium, scab or scar formation
conclusively show that the wound was inflicted during life. But
the absence of signs of repair does not show that injury was
inflicted after death. The tissue may not have been given ample
time to repair itself before death took place.
4. Retraction of the Edges of the Wound:
Owing to the vital reactions of the skin and contractility of the
muscular fibers, the edges of the wound inflicted during life
retract and cause of gaping. On the other hand, in the case of the
wound inflicted after death, the edges do not gape and are closely
approximated to each other because the skin and the muscles
have lost their contractility.
sanctions between Ante-mortem and Post-mortem Wounds:
Ante-mortem Wound
U- ok*
1. Hemorrhage more or less copious and generally arterial.
(AC
2. Marks of spouting of blood
from arteries.
3. Clotted blood
Post-mortem
Wound
. Hemorrhage slight or none at
all and always venous.
. No spouting of blood.
auc
. Blood is not clotted; if at all,
it is a soft clot.
4. Deep staining of the edges
and cellular tissues, which
is not removed by washing.
. The edges and cellular tissues
are not deeply stained. The
staining can be removed by
washing.
EfcrThe edges gape owing to the
reaction of the skin and
muscle fibers.
. The edges do not gape, but are
closely approximated to each
other, unless the wound is
caused within one or two
hours after death.
3*
. Nd^mflammation or reparative
6. Inflammation and reparative 6
processes.
processes.
Toxicology by N.J. Modi, 12th
(From: Medical Jurisprudence and
ed. p. 237).
y
LEGAL MEDICINE
292
Determinations whether the wounds are homicidal, suicidal or
accidental:
1. As to the Nature of the Wound Inflicted:
a. Abrasions:
Extensive abiasions on the body are always suggestive of
accidental death, especially in death due to traffic accident. In
suicidal death, abrasions are rarely observed. In case of murder,
abrasions are not common except when the body is dragged on
the ground. In homicide, abrasions may commonly be observed especially when the victim offered some degree of
resistance to the attacker.
b. Contusion:
Contusion is rarely observed in suicidal death, except when
the suicidal act was done by jumping from a height. A person
contemplating to commit suicide will not choose a blunt
instrument.
Contusion in accidental death may also be found in any
portion of the body. It is often due to a fall and due to a
forcible contact with some hard objects.
c. Incised Wounds:.
Incised wounds are commonly observed in suicide and
homicide.
The depth, location and other surrounding circumstances will differentiate one from the other. Accidental
cuts are frequent everyday occurrences, but rarely as a cause of
death.
Points to be Considered in the Determination as to whether the
Wound is Homicidal, Suicidal or Accidental:
1. External signs and circumstances related to the position and
attitude of the body when found.
2. Location of the weapon or the manner in which it was held.
3. The motive underlying the commission of the crime and the like.
4. The personal character of the deceased.
5. The possibility for the offender to have purposely changed the
truth of the condition.
6. Other information:
a. Signs of Struggle:
Absence of signs of struggle is more in suicide, accident or
murder.
Contusion or abrasion may indicate trauma due to fist,
finger or feet of the assailant.
MEDICO-LEGAL INVESTIGATION OF WOUNDS
Presence of hair or portion of the skin (epidermis) on the
nails of the assailant or deceased may be a clue in the determination whether death is suicidal, homicidal or accidental.
b. Number and Direction of Wounds:
Multiple wounds in concealed portions of the body are
generally indicative of homicide.
Single wound located in a position that the deceased could
have been conveniently inflicted is usually suicidal.
c. Direction of the Wound:
This is important in the case of cut-throat. It is generally
transverse in case of homicide while it is oblique in case of
suicide.
d. Nature and Extent of the Wound:
Homicidal wounds may be brought about by any wounding
instrument. Suicidal wounds are frequent due to sharp instruments. Accidental physical injuries may be of any kind.
e. Stare of the Clothings:
There is usually no change in the condition of the clothings
in suicide case. In homicidal death, on account of the struggle
which took place before death, the clothings of the victim are
in a disorderly fashion.
Length of Time of Survival of the Victim After Infliction of the
Wound:
In the approximation of the length of survival of the victim after
receipt of the physical injury, the following factors must be taken
into consideration:
1. Degree of Healing:
The injured portion of the body undergoes certain chemical
and physical changes as a normal course of repair. The capillaries
are dilated and edema develops at once. This is followed by the
migration of the white cells from the capillaries to the damaged
area. Fibroblasts begin to proliferate later with the formation of
the granulation tissues.
Signs of repair of the wound appear in less than a day after the
infliction of injury. By the degree of granulation tissue formation
and other reparative changes, the age of the wound may be estimated.
2. Changes in the Body in Relation to the Time of Death:
The length of time in the survival of the victim may be approximated from the systematic changes in the body. The degree of
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LEGAL MEDICINE
wasting, anemia, condition of the face, and bed sore formation
may be a basis as to how long a person survived.
3. Age of the Blood Stain:
The age of the blood stain may be determined from the physical color changes of the skin, although it is not reliable. Although there are some basis for such method, it must not be
relied upon because the physical changes of the blood is modified
by several external factors.
4. Testimony of the Witness When the Wound was Inflicted:
The actual witness may testify in court as to the exact time the
wound was inflicted by the offender. In this case, medical evidence as to the duration of survival is merely corroborative.
Possible Instruments Used by the Assailant in Inflicting the Injuries:
The determination of the wounding instrument may be made from
the nature of the wound found in the body of the victim:
1. Contusion — produced by blunt instrument.
2. Incised wound — produced by sharp-edged instrument inflicted
by hitting.
3. Lacerated wound — produced by blunt instrument.
4. Punctured wound — produced by sharp-pointed instrument.
5. Abrasion — body surface is rubbed on a rough hard surface.
6. Gunshot wound — the diameter of the wound of entrance may
approximate the caliber of the wounding firearm.
Could the injury have been inflicted by a special weapon?
A physician cannot determine definitely that a certain specific
weapon was used in inflicting a wound. He can only state that it is
possible that a certain injury is possibly caused by a certain instrument presented. He must be cautious in making a categoric statement.
Which of the injuries sustained by the victim caused death?
If there are several offenders who conspired with one another in the
commission of the offense, it is not necessary to determine who among
them gave the fatal blow. In the crime of conspiracy, the act of one
is the act of all. But if there is no conspiracy in the commission of
the offense it is necessary to determine who among the offenders
gave the fatal injury to the victim, because they are only responsible
for their individual acts.
In a case wherein the victim is a recipient of multiple injuries, the
determination as to which of the injuries caused death is dependent
on the testimony of the physician.
This can be ascertained by
MEDICO-LEGAL INVESTIGATION OF WOUNDS
examining individually the wounds and note which of them are involved in the injury to some vital organs or large vessels, or led to
secondary results causing death. When two or more wounds involved
the vital organs, it is difficult to ascertain which ^mong them caused
the death. It is important to determine the degree of the damage of
each of the wound caused on the vital organ.
Which of the wounds was inflicted first?
When there are several wounds present on the body of the victim,
it is important to determine which of them was inflicted first because
it may be necessary for the qualification of the offense committed.
If the first wound was inflicted in a treacherous way that the victim
after receipt is incapable of defense, then murder is committed, but
if the fatal wound was inflicted last, it is possible that the crime
committed is only homicide.
In the determination as to which of the wounds present was
inflicted first, the following factors must be taken into consideration:
1. Relative position of the assailant and the victim when the first
injury was inflicted on the latter.
2. Trajectory or course of the wound inside the body of the victim.
3. Organs involved and degree of injury sustained by the victim.
4. Testimony of the witness.
5. Presence of defense wounds on the victim. If the victim tried to
make a defensive act during the initial attack, then the defense
wounds must have been inflicted first.
Effect of Medical and Surgical Intervention on the Death:
If the death of the victim followed a surgical or medical intervention, the offender will still be held responsible for the death of
the victim if it can be proven that death was inevitable and that even
without the operation, death is a normal and a direct consequence
of the injuries sustained.
It must be shown that the physician
treating the victim must be competent and that in spite his exercise
of care and diligence, still death was the final outcome. A person
committing a felony shall be responsible for whatever will be the
outcome of his felonious act. The wound inflicted by him must be
the direct and proximate cause of the death of the victim.
On the other hand, if the victim merely received minor wounds
but death resulted on account of the gross incompetence or negligence of the physician, then the offender cannot be held responsible
for the death. The offender can only be made responsible for the
physical injuries inflicted on the victim and the physician must be
made to answer for the death.
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LEGAL MEDICINE
Effect of Negligence of the Injured Person on the Death:
If death occurred from complications arising from a simple injury owing to the negligence of the injured person in its proper care
and treatment, the offender is still held responsible for the death.
A person is not bound to submit himself to medical treatment for
the injuries received during the assault.
The fact that the victim would have lived had he received appropriate medical attention, is immaterial. Hence, the refusal of
the deceased to be operated does not relieve the offender of the
criminal liability for his death (People v. Sto. Domingo, C.A. —
G.R. No. 3783, May 1939).
But, if it could be proven that the negligence of the victim is
deliberate and that this intention is really the cause of death on
himself, then the offender cannot be held responsible for the death
but only for the physical injuries he had inflicted.
Power of Volitional Acts of the Victim after Receiving a Fatal
Injury:
Sometimes it is necessary to determine whether a victim of a fatal
wound is still capable of speaking, walking or performing any other
volitional acts. A dying declaration may be presented by the prosecutor mentioning the accused as the assailant; the offender may
allege that the physical injuries inflicted by him while the victim was
inside his house and that he walked for some distance where he fell,
or that the victim after the fatal injury made an attempt to inflict
injuries to the accused which justified the latter to give another fatal
blow. The determination of the victim's capacity to perform volitional acts rests upon the medical witness.
As a general rule, severe injury of the brain and the cranial box
usually produces unconsciousness, but after a while.the victim may be
capable of performing volitional acts. The power to perform volitional
acts is dependent upon the areas of the brain involved. Wounds of
the big blood vessels, like the carotid, jugular or even the aorta, do
not prevent a person from exercising voluntary acts or even from
running a certain distance. Penetrating wound of the heart is often
considered to be instantaneously fatal but experience shows that the
victim may still be capable of locomotion. Rupture of the organs
is not always followed by death. The victim has for sometime still
retains the rapacity to move and speak.
Extreme caution must be exercised by the physician in expressing
his opinion as to the limitation of powers possessed by the injured
person to perform acts of volition, locomotion, or speech subsequent
to receipt of extensive or fatal injury or wound.
MEDICO-LEGAL INVESTIGATION OF WOUNDS
Relative Position of the Victim and Assailant When Injury Was
Inflicted:
In the determination of the relative position of the victim and the
assailant when the wound was inflicted, the following points must be
considered by the physician:
1. Location of the wound in the body of the victim.
2. Direction of the wound.
3. Nature of the instrument used in inflicting the injury.
4. Testimony of witnesses.
Extrinsic Evidences in Wounds:
1. Evidences from the Wounding Weapon:
a. Position of the Weapon:
The location and position- of the weapon at the scene of the
crime may afford strong evidence in the court. As a rule, in
cases of accidental or suicidal death, the wounding weapon is
found near the body of the victim, but it is not uncommon to
find the victim at some distance from the weapon when the
victim is capable of walking. If the wounding instrument is
firmly grasped by the victim, it is a strong presumption that it
is a suicidal case.
b. Blood on Weapon:
The weapon responsible for the production of wound may be
stained with blood. In some instances, the wounding weapon
does not show blood stains because of the rapidity of the blow
and compression of the blood vessels. Even if the weapon is
stained with blood, it may be wiped out by the clothings in the
process of withdrawal.
The weapon must be subjected to a complete examination to
determine whether it is the one used in the commission of the
offense.
c. Hair and Other Substance on Weapon:
Hair or fibers of cotton, silk, linen and other fabrics may be
found adhering on the weapon. It must be preserved and submitted for comparison with the clothings or hair found at the
site of the injury on the victim's body.
2. Evidences in the Clothings of the Victim:
Injuries inflicted on the covered portions of the body may also
show injury on the covered apparel. In gurrhot wound, the hole
in the clothings may be a factor in the determination of the site of
the wound of entrance. Occasionally, two or more tears or holes
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LEGAL MEDICINE
are produced on the dress by a single wound. This can be explained
by the presence of folds on the clothings.
In gunshot wound, determination of the presence of gunpowder
at the hole of entrance may show distance. The presence of cleancut tear in the clothings shows that a sharp-edged instrument was
used. The presence of severe tearing of the clothing shows struggle.
The degree of soaking of the clothings with blood may depict the
degree of hemorrhage.
3. Evidences Derived from the Examination of the Assailant:
The clothings of the assailant may be stained with blood from
the victim. Tear may be present on account of the struggle which
existed at the time of the commission of the offense. The fingernails may show foreign substances coming from the body of the
victim.
The offender may also show to a certain degree marks of violence.
Paraffin test of the assailant's hands may be useful to
determine whether he fired the gun in case of shooting.
Determination of the degree of intoxication, mental condition,
physical power, etc. of the offender may be necessary in the
solution of the crime.
4. Evidences Derived from the Scene of the Crime:
The condition of the surrounding objects, the amount of
hemorrhage, the presence of identifying articles belonging to the
victim or assailant, the wounding instrument, all these must be
observed or collected by the investigator.
Chapter XI
PHYSICAL INJURIES IN THE DIFFERENT
PARTS OF THE BODY:
1. HEAD AND NECK INJURIES:
Injuries of the head must not be underestimated. They must
be treated with extreme care. The absence of an external wound
on the head does not itself permit a conclusion that there is no
internal damage. Contusion and hematoma of the scalp may only
be appreciated during the post-mortem examination. The presence of hair further augments the difficulty of appreciating
head injuries.
The presence of bleeding from the ear, nostrils and mouth may
be associated with basal fracture. Fracture of the vault and other
portions of the cranial box may cause unconsciousness and this
may be mistaken for simple intoxication. It is preferable to have
the patient under careful, intelligent and continuous observation
for at least twelve to twenty-four hours to avoid risk to the life
of the patient. X-ray examinations may be useful in order to
determine the presence of fracture. However, it is not uncommon
that no fracture is observed, and yet the intracranial injury is
quite severe.
Factors Influencing the Degree and Extent of Head Injuries:
a. Nature of the Wounding Agent:
Weapons with a small striking face usually produce a localized depressed fracture with laceration of the scalp. The degree
of injury depends upon the degree of violence applied, the
thickness of the scalp struck and the weight of the weapon.
Violent contact with the wheel of a motor vehicle causes
fissure or comminuted fracture of the cranial box. There is
always an associated injury of the brain substance and laceration of the meninges.
Penetrating injuries of the skull like those caused by a dagger,
a nail or a bullet, may leave a clean-cut opening with the shape
and size of the wounding weapon. A glancing hit of a bullet
may cause a gutter-like depressed fracture of the vault of the
skull.
299
300
LEGAL MEDICINE
b. Intensity of the Force:
As a general rule, the intensity of force is proportional
to the degree of damage it will produce. However, in cases
where the striking face is small, the amount of force which
produces the same injury is smaller. This is, however, qualified
by the part of the skull involved. For example, less force is
required to produce injury when applied at the temple than
when it is applied elsewhere in the exposed surface of the skull.
Heavy agents may require less force to produce extensive
damage to the skull although the point of impact is wide.
c. Point of Impact:
There are areas in the cranium wherein if force is applied to
them, the injuries are extensive. Fractures of the vaults, either
on the side or at the back, usually causes a stellate comminution
at the point of impact with linear extensions to some other areas.
Basal fractures are often caused by transmitted force from some
points of impact.
d. Mobility of the Skull at the Time of the Application of Force:
If the head is mobile, unsupported and free, the principal
effects on the brain is due to the shearing movement imparted
to the brain. It may produce contusion, laceration or hemorrhage without any fracture on the skull.
If the head is fixed and supported, as when the head is caught
by the wheel of a vehicle, jarring movement of the brain is
absent but the fracture is extensive. Usually the fracture forms
a line from the point of contact with the wheel up to the point
of support of the head. There may be complete separation of
the naso-facial mass from the rest of the skull.
Head Injuries are Classified as to the Site of the Application of
Force:
a. Direct or Coup Injuries:
These are injuries which occur at the site of the application
of force and will develop as a natural consequence of the force
applied.
Direct Injuries may Result to:
( 1 ) In compression of the head by the wheel of a vehicle.
( 2 ) When the head strikes an object in motion, as bullets.
( 3 ) When the head is in motion and strikes an object, as in
vehicular accidents.
b. Indirect Injuries:
These are injuries in the head which are not found at the site
of the application of force. The injury may be at the opposite, or
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
301
in some areas offering the least resistance, or in areas which have
no relation with the site of the impact.
( 1 ) Contre Coup Injuries:
These are injuries which develop opposite the site of the
application of force. A blow on the occiput may produce
laceration or contusion of the frontal lobe of the brain.
This is observed when the head is free and mobile.
( 2 ) Remote
Injuries:
Remote
applied in
the head.
fracture of
injuries are produced in cases where the force is
some areas of the body which have no relation to
A fall on the feet or buttocks may cause basal
the skull.
( 3 ) "Locus Minoris Resistencia":
The injury sustained in the head may not be at or opposite the application of force but may be found in some
areas of the skull offering the least resistance. A blow on
the head may cause a linear fracture of the roof of the orbit
on account of the papyraceous nature of the bone.
c.
Coup-contre-coup Injuries (Direct and Indirect Injuries):
The injuries may be at the site of impact and at the same
time found in some other pafts of the head which may be
opposite the site of application of force, or elsewhere.
A
hammer blow in the frontal portion of the head may cause
depressed fracture of the frontal bone and at the same time
fracture of the roof of the orbit and laceration of the posterior
lobe of the cerebrum.
Wounds of the Scalp:
A wound of the scalp although small and negligible is always
potentially serious because:
a. It is difficult to prevent the spread of infection.
b. There is proximity of the scalp to the brain.
c. There is a free vascular connection between the structures inside
and outside the cranium.
d. It is frequently difficult to determine the extent of damage of
the skull.
Abrasion of the scalp is commonly unnoticed because of the
protective covering of the hair. Contusion may not be visible
because of the thick resistant scalp and may only be noticed on
autopsy.
Hematoma easily develops in the scalp because the cranium is
located superficially and the subaponeurotic tissue is loose.
LEGAL MEDICINE
302
The most common lesion of the scalp is a lacerated wound. There
may or may not be involvement of the skull. Difficulty is sometimes experienced in differentiating a lacerated from an incised
wound of the scalp. With the aid of a hand lens, the laceration
shows irregular borders and hair bulbs are preserved. Laceration
of the scalp may be due to the impact of a blunt force or to the
sharp edges of the fractured skull.
Incised wounds of the scalp in general involve the cranium.
The force necessary may not be so strong as to produce a cleancut fracture of the cranium.
Fractures of the Skull:
Fractures of the skull may or may not be associated with
injury on the scalp, but usually there is an accompanying injury
inside the cranial box.
Meningeal vessels are so situated in the
furrows of the cranium that fracture of the cranium will always
lead to laceration of the blood vessels.
a. Fissure Fractures:
Fissure or linear fracture involves the inner and outer table.
It is usually caused by the impact of a blunt object and may
appear as a radiating crack from the site of the application of
force and may involve the base of the cranial fossae.
b. Localized Depressed
Fracture:
Localized depressed fracture is sometimes called "Fracture a
La Signature". It invariably shows the nature of the instrument
that causes the fracture. The round face of the hammer may
show a round depressed fracture in the cranium.
c. Penetrating Injuries of the Skull:
Sharp-edged instrument produces clean-cut fracture of the
skull. The size and shape of the fracture may correspond to the
shape of the wounding instrument. A gunshot produces an oval
or round hole with bevelling of the inner table at the wound
of entrance. The blade of the wounding weapon may be left
inside without causing trouble but complications like infection
may later develop and may cause a fatal consequence.
d. Comminuted Fractures:
Comminution of the skull may develop as a result of a fissure
or a depressed fracture. The presence of comminuted fracture
is an indication of the severity of force applied or the use of a
heavy weapon.
Majority of comminuted fractures are caused by motor
vehicle accidents. In a near shot with a firearm, there is usually
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
303
a radiating fissure fracture from the point of impact which
forms a "spider w e b " comminution of the cranium.
e. Pond or Indented Fracture:
In the skull of infants wherein there is undue elasticity, the
production of a pond or indented fracture is common. It may
be a result of a simple compression of the skull, as in a pingpong
ball. Fissure fracture is likely to develop around the periphery
of the dent.
f. Gutter Fractures:
A tangential or glancing approach of a bullet may cause the
production of a furrow in the cranium. It may involve both
the outer and inner tables. The furrow may cause injury on
the blood vessels causing intracranial hemorrhage or laceration
of the brain.
g. Bursting Fractures:
It is an extensive fracture running parallel to the two points
of contact, if mechanical force is applied on one side of the
head, while it is pressed on the other side against a hard substance, such as a wall, while the individual is standing, or against
the hard ground or floor, when he is in a lying posture. In such
cases the fracture may extend transversely to the base of the
skull. The passage of the wheel of a heavy vehicle over the head
often causes a complete division of the skull into two parts.
The direction of the burst correspond to that in which the
wheel passed over the head.
(From:
A Handbook of Medical Jurisprudence & Toxicology
with State Medicine & Post-Mortem Techniques by C.C. Mallik,
p. 206).
Intracranial Hemorrhages:
Intracranial hemorrhages may occur even in the absence of a
fracture. Hemorrhage may be present without trauma. The blood
vessels of the brain may be diseased and may rupture spontaneously,
a. Extradural or Epidural Hemorrhage (almost exclusively due to
trauma):
Extradural hemorrhage is caused by a fracture of the skull.
The fracture will cause laceration of the blood vessels which are
grooved at the inner table of the skull. The branches of the
meningeal vessels are usually involved, the most frequent of
which are the branches of the middle meningeal vessels. The
laceration is commonly unilateral except when the fracture
extends to the opposite side.
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LEGAL MEDICINE
Severe extra-dural h e m o r r h a g e w i t h compression of the brain
Hemorrhage at the region of the vault produces a discusshaped clot with compression of the brain substance and this
may cause neurologic disturbance.
If the patient lives for
sometime, there will be an organization of the clot and a
fibrous thickening of the dura.
A person suffering from extradural hemorrhage may complain of headache, vomiting and drowsiness. The pupils may be
dilated on the side of the hemorrhage. Examination of the
cerebro-spinal fluid shows absence of blood, unless it is complicated with hemorrhage in other regions in the cranial cavity.
b. Subdural Hemorrhage:
Unlike extradural hemorrhage, subdural bleeding is essentially venous or capillary. It is the most common cause of cerebral
compression. It may be a consequence of fracture of the skull,
laceration of the brain, spontaneous rupture of the blood vessels
on the surface of the brain or laceration of the dura and meningeal vessels. It usually comes from the small blood vessels
which cross the subdural space to the subarachnoidal area.
Majority of subdural hemorrhages are traumatic in origin
although a few may be due to a natural disease of the blood
vessels of the brain. There are difficulties in ascertaining the
cause and source of such hemorrhage.
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
305
Extensive s u b d u r a l h e m o r r h a g e
Ageing Subdural Hematoma
Munro-Merritt Method:
In the determination as to how long subdural hematoma
existed, the study of the structure of its membrane is made as
a basis (Munro-Merritt Method).
1st 24 hours
— Deposit of fibrin at the margin of the clot
with red blood cells and leucocytes well
preserved.
24 — 36 hours — Fibroblast found at the junction of the
dura mater and the blood clot.
4 days
— Definite histological evidence of 2 to 3
layers of cell thickness neomembrane. The
red blood cells have begun to lose their
sharp contour.
4 to 5 days
— Increasingly prominent membrane with extension of the fibroblasts into the underlying
clot.
— The membrane has become 12 — 14 cells in
thickness.
Pigment-laden phagocytes are
found.
— Clot broken up into islands by the invasion
of strands of fibroblasts.
8th day
11th day
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15th day
- Membrane has formed on the undersurface
of the clot and strands of fibroblasts. Red
blood cells have broken up. The outer layer
of the neomembrane is 1/3 to 1/2 the thickness of the overlaying dura.
26th day
— Neomembrane is about the thickness of the
overlying dura.
Blood has liquified. Red
blood cells not clearly apparent.
1 to 3 months — Progressive decrease in the number of nuclei
of the fibroblasts and progressive hyalinization
of the membrane. Large blood spaces ("sinusoidal vessels") filled with red blood cells
have become increasingly prominent in the
new-formed connective tissue.
6 to 12 months — Neomembrane has become thick and fibrous,
blood has disappeared leaving only a few
scattered pigment-laden phagocytes.
The
new-formed membrane is distinguishable
1 to 2 years
—
from the overlying dura only by the parallel
arrangements of the connective tissue fibers
which have become more or less completely
hyalinized.
(GradwohVs Legal Medicine by F.E. Camps ed., 3rd ed., p. 316).
c. Subarachnoidal Hemorrhage:
Subarachnoidal hemorrhage may be due to trauma or to
spontaneous rupture of blood vessels. Its causes may be summarized as follows:
( 1 ) It may be produced by severe head injury especially in
contre coup kind.
(2) It may be due to ruptured cerebral aneurysm and is commonly seen at the base of the brain.
(3) It may be an extension of the spontaneous hemorrhage of
the brain which extends to the subarachnoid space.
(4) In asphyxia there may be subarachnoidal hemorrhage in the
form of petechial hemorrhage.
d. Cerebral
Hemorrhage:
Cerebral hemorrhage may be traumatic or spontaneous in
origin.
If a person develops rupture of a blood vessel and
suddenly collapses and falls on the ground producing a certain
degree of head injury, it is quite difficult to ascertain the exact
origin of the hemorrhage.
A careful dissection of the brain
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
307
tissue involved is necessary to determine the presence of pathology of the blood vessel.
Traumatic cerebral hemorrhage is usually due to laceration or
contusion of the brain in contre-coup injuries. Severe crushing
of the skull in vehicular accident cases may cause the sharp
fractured edges of the bone to lacerate the brain and produces
severe cerebral hemorrhage. It may involve the gray matter
only but in severe cases the hemorrhage extends up to the white
matter.
Distinction between Cerebral Apoplexy and Post-traumatic Intracerebral Hemorrhage:
a. In traumatic intracerebral hemorrhage the interval between the
injury and onset of "stroke" (symptoms) is usually a week or
less.
b. In traumatic intracerebral hemorrhage, the injury to the head
must be sustained when the head is in motion and the hemorrhage is the result of the coup-contre-coup mechanism.
c. The location of traumatic intracerebral hemorrhage is in the
central white matter of the frontal or temporo-occipital region.
Cerebral apoplexy is usually at the basal ganglia, a very uncommon site of traumatic intracerebral hemorrhage.
d. History of hypertension prior to the "stroke" and evidence of
degenerative disease are present in cerebral apoplexy. There
is a history of head trauma in traumatic intracerebral hemorrhage.
(Gradwohl's Legal Medicine, 2nd ed. by F.E. Camps, p. 312).
Brain:
a. Laceration of the Brain:
Lacerations of the brain may be:
(1) Direct or Coup Laceration:
This is produced by the fracture of the skull. The edges
of the fractured bone lacerate the arachnoid and the underlying brain tissue. It may occur any where in the brain but it
usually follows the line of fracture. The most frequent
sites are the parietal and the frontal lobes.
( 2 ) Contre-coup Laceration:
Contre-coup laceration occurs usually directly across the
point of impact and fracture. Contre-coup injuries occur
only when the head is free to move at the time of the
impact. If the head is held immovable the mechanism of
contre-coup will not operate. A frontal impact may pro-
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LEGAL MEDICINE
duce laceration of the cerebellum while an impact in the
occipital region may cause contre-coup laceration of the
fronta-. and temporal lobes of the brain.
Brain laceration may lead to granulation tissue formation and ultimately to fibrosis in the absence of infection.
Histo-pathological changes following contusion and laceration of
the cerebral cortex:
Within 3 hours — Minimal alteration of the cellular elements at
the margin of the wound. Microglia may show
slight swelling of the cytoplasm of the dendrites.
There is fracturing of the myelin sheath. Cortical
nerve cells may show pyknotic changes.
6 to 12 hours — Pyknotic cells become more apparent and
blood pigment is found between cortical neurons. Glial cells look swollen especially oligodendroglia in the white matter and perineuronal
satellite cells in the gray matter, as cerebral
edema begins to develop.
12 — 24 hours — Cortical nerve fibers show fairly numerous
end-bulbs and early degeneration of the interrupted fibers. Microglia continue to show early
swelling of their processes. Pyknotic change and
pigmentary infiltration of the nerve cells are still
present at the margin of the contusion. Loss of
Nissl substance may be detected in larger nerve
cells.
1—2 weeks — Increase in the number of granular corpuscles in
activity of phagocytic action.
Astrocytes are
plump and the nuclei are very prominent.
Cerebral edema is well shown by the spongy
appearance of the white matter.
Nerve cells
in the border zone may show fatty degeneration
or cytoplasmic vacuolation.
1 month
— Scarring process becomes fairly static.
The
gliotic astrocytic scar shrinks and appears gray
or brownish in color. Blood vessels are thickened, hyalinized coats owing to increased
density of astrocytic end-process attached to
them.
(GradwohVs Legal Medicine by F.E. Camps ed., 2nd ed., pp. 317319).
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
309
b. Edemas of the Brain:
Edema of the brain which is usually the effect of trauma may
be localized or generalized.
( 1 ) Localized Edema:
Localized edema is observed in deep brain lacerations.
The edematous area is soft, swollen, gelatinous and yellowishred in appearance. It is observed in abscess and neoplasm.
( 2 ) Generalized Edema:
This is usually associated with severe trauma of the head.
The brain has a swollen appearance, with flattening and
broadening of the convolutions and diminution of the
sizes of the ventricle.
Microscopically, there is an intracellular, pericellular and perivascular accumulation of
fluid.
Edema of the brain of the generalized type may also
be observed in a prolonged convulsive seizure, a sudden
death due to tetanus antitoxin, an encephalitis, and in an
excesssive hydration.
c. Concussion of the Brain:
Concussion of the brain is a transitory period of unconsciousness resulting from a blow on the head, unrelated to any injury
to the brain which is apparent to the unaided eye. The cause of
cerebral concussion is still undetermined.
Some authorities
consider it to be a rotational injury as it will occur only when
the head is free to move but not when it is fixed.
The symptoms of concussion vary upon the degree of injury.
In a severe injury the patient may fall down and becomes unconscious. There is flaccidity of the muscles and sphincters are
relaxed. The face is pale, pupils are dilated and insensible, skin
is cold and clammy, the pulse is rapid, the respiration is slow,
irregular and sighing and the temperature is subnormal.
In cases of recovery, there is usually a retrograde amnesia of
the accident and even events before and after it. The patient
may also develop automatism and may perform criminal acts
which may be mistaken to be volitional or voluntary.
d. Compression of the Brain:
On account of the severe intracranial hemorrhage, depressed
fracture of the skull, or edema of the brain, compression of
some vital areas of the brain may lead to paralysis or loss of
consciousness. Natural diseases, like newgrowth, abscess and
hydrocephalus may also cause compression of the brain.
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In traumatic compression, the symptoms do not appear
immediately after the injury. The symptoms depend upon the
area of the brain involved but signs of increased intracranial
pressure are always present.
Vomiting, headache, irregular
breathing, incontinence of urination and defecation, and
paralysis are usually present. Recovery develops when the cause
is completely removed but usually the patient has loss of
memory, epilepsy, paralysis, or insanity as a sequelae.
Medico-Legal Questions in Intracranial Injuries:
a. Is the origin of the intracranial hemorrhage due to trauma or
disease?
Extradural or epidural hemorrhage is always caused by
trauma. The blood vessels causing the hemorrhage which are
grooved at the inner table of the skull are usually lacerated by
the fractured skull.
Subdural hemorrhage is, as a rule, traumatic in origin but it
may also be caused by some diseased condition of the blood
vessels or by a local inflammatory process.
Subarachnoidal hemorrhages are usually spontaneous and are
usually caused by ruptured aneurysm or sclerotic vessels at the
circle of the Willis.
Hemorrhage in the brain substance is usually spontaneous
and usually involves the deep tissues of the brain, pons and
cerebellum. Age, blood pressure, chronic alcoholism, kidney
disease must be taken into account to determine whether it is
traumatic or spontaneous in origin.
b. In cases of cerebral concussion, can the victim remember the
incidents before, during or after the accidents?
In mild form of cerebral concussion or after a psychological
treatment, 'the victim may be able to recall the incident.
A
person may suffer from severe concussion and still retain a
good memory of the past. In severe form of concussion, the
victim may totally lose the recollection'of past events.
c. Can the victim of head injuries still retain voluntary movement and speech?
In severe head injuries with comminuted fracture of the skull
there is immediate loss of consciousness such that voluntary
movement and speech are no longer possible. Depressed fracture of the skull may cause also immediate loss of consciousness
that may develop sometime after the impact.
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
311
The capacity of the victim to retain voluntary movements
and speech depends upon the loss of consciousness and the
area of the brain involved.
d. Post-traumatic Automatism:
A person while under the state of post-traumatic automatism may commit a crime while in an unconscious state. He is
considered to be exempted from criminal liability because he
did not act with intelligence. There can be criminal intent if
a person acted with voluntariness or with intelligence.
A
person under the state of post-traumatic automatism acted
involuntarily.
e. In gunshot wounds of the head, how can the point of entrance
be determined?
In some instances the gunshot wound on the head may not
clearly show characteristic findings of a wound of entrance. The
examiner must resort to the examination of the fracture of the
skull. At fhe point of entrance, the injury at the outer table is
oval or round while there is bevelling fracture at the inner table.
The opposite is true at the point of exit.
f. Post-traumatic Irritability:
The victim of a head injury may suffer post-traumatic irritability and may lead to do acts of impulsive violence.
If
irritability develops after a head injury, it is doubtful if it will
be a valid defense following the doctrine of acting under an
irresistible impulse. But, if genuine traumatic psychosis develops
later, the responsibility is evaluated in accordance with the
general principle of appraisal of responsibility of insanity
(Medical Trial Technic, Mar. 59, p. 32).
Face:
Generally, wounds on the face heal relatively faster as compared
with wounds of the other parts of the body on account of its great
vascularity. Most often, injuries on the face are serious because
they produce ugly scars or other forms of deformity. Because of
their proximity to and the presence of free communication with
the brain, facial injuries are always a threat to life. As a whole,
wounds on the face may be due to a blow, vehicular accident,
kick, sharp instrument, gunshot, or a blunt weapon. Fractures of
the facial bones, especially of the nasal bone and mandible, are
quite frequent,
a. Eye:
Contusion of the soft tissue about the eyes is sub-conjunctival. Hemorrhage is frequently observed in a fist blow. Fracture
LEGAL MEDICINE
312
of the base of the anterior cranial fossa may also produce contusion of the eyelids, and this may be distinguished from contusion due to a blow by the absence of swelling and skin injuries
in the former.
The eye may be lacerated by a blunt weapon or by a piece of
stone. Acute inflammatory changes usually occur with injury
of the cornea, iris and lens and may require total enucleation of
the eyeball. Penetrating wounds due to sharp instruments or
bullets may cause meningitis or total blindness.
b. Nose:
Fracture of the nasal bone is a common sequelae of fist blows,
and may cause severe epistaxis and facial deformity. The nose
may be bitten in a quarrel, cut with a sharp-edge instrument,
and contused, abraded or lacerated by a blow. In suicide, the
muzzle of the death gun might be placed in the nostril and may
cause no visible wound of entrance.
Injuries of the nose are usually dangerous to life on account
of the extension of infection to the brain.
c. Ear:
A blow on the ear may produce a rupture of the tympanic
membrane leading to permanent or temporary deafness. Hemorrhage coming from the ear may suggest fracture of the base of
the middle cranial fossa. In a quarrel, the pinna of the ear may
be cut off or markedly lacerated or contused by a strong blow.
The trauma in the ear may cause septic infection and may
extend to the brain and causes death.
d. Mouth:
Contusion, laceration and swelling of the lips are usually
observed in a fist blow, kick or bite. It may or may not be
associated with fracture of the teeth or injury of the gum.
Fracture of the lower jaw is usually due to direct violence
and the most common site is at the region of the insertion of
the canine and at the region of the condyle. Fracture of the jaw
is always associated with laceration of the gums which may
extend to the floor of the buccal cavity.
Occasionally a gunshot wound in suicidal case is found
inside the mouth and investigators are usually at a loss in the
examination and location of the wound of entrance.
Infections following injury of the mouth may extend to the
upper respiratory system and cause edema or gangrene of the
glottis.
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
313
Neck:
Abrasions of the neck may be present in cases of manual
strangulation. Ligature marks are present in death by hanging or
strangulation by ligature. Incised wounds may be homicidal or
suicidal. Suicidal cut-throat wounds are usually diagonal while
homicidal wounds are usually horizontal. Incised and stab wounds
of the neck may involve the trachea and the big blood vessels and
nerves and in most cases, end fatally.
Asphyxia, pneumonia,
hemorrhage and shock are the common causes of death from
neck injuries.
Wounds of the esophagus are not common. They are usually
accompanied by wounds of the trachea and large blood vessels
of the neck. Severance of the recurrent laryngeal nerve causes
aphonia.
Contusion or rupture of the muscles, severance of the nerves are
sometimes observed in severe trauma applied to the neck. Forcible blow in the anterior portion of the neck may cause unconsciousness or even death due to reflexed inhibitory action on
the vagus nerve.
Vertebral Column and Spinal Cord:
a. Fracture of the Vertebrae:
Fracture of the vertebrae is dangerous to life because of the
involvement of the spinal cord.
Injury of the cord due to
fracture of the upper four cervical vertebrae causes paralysis of
the phrenic nerve, while those due to fractures of the fifth cervical vertebra to the first dorsal vertebrae may cause paralysis of
all the extremities. Injury of the cord at other levels may not
cause immediate death but complications like hypostatic
pneumonia, bed sores and other secondary infections may set
in and cause death.
The causes of the fracture of the spine may be:
( 1 ) Direct Violence:
The fracture of the spine may be due to a blow by a
heavy instrument coming from the back, fall from a height,
collision with motor vehicles and hit of a projecting instrument.
(2) Indirect Violence:
Indirect violence may be due to a fall on the feet or
buttocks, forcible bending of the body as in wrestling, a
blow on the chin or forehead, forcible bending of the head
towards the sternum, and slight twist of the body if the
person is suffering from Pott's disease.
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Recovery from spinal fracture may cause deformity or
paralysis of certain areas of the body. Injury of the spine is
usually associated with considerable, pain.
b. Concussion of the Spine:
Concussion or jarring of the spinal cord may occur even
without any visible signs of external injuries. A physician
usually has much difficulty making diagnosis of concussion of
the spine.
The usual complaints are headache, restlessness, pain and
tenderness over the spine, loss of sexual power, irritability of
the bladder, inability to walk, weakness of the limbs, and
derangement of the special senses.
Concussion of the spine may be sustained in a motor vehicle
collision and in a railway accident.
2. INJURIES IN THE CHEST:
Injuries in the chest are important because vital organs are
inside the chest cavity, namely: the heart, lungs and the principal
blood vessels.
Injuries to the Chest Wall:
The chest wall is easily contused by the application of moderate
force on account of the superficial location of the ribs. Lacerated
wounds are rarely observed as a direct effect of violence, but are
observed when the fractured ends of the ribs pierce the skin in
severe crush injuries due to motor vehicle accidents.
Stab wounds on the chest are quite common on account of its
accessibility when both the assailant and the victim are in a standing position.
The intercostal vessels may be involved, causing
considerable hemorrhage. Stab wounds of the chest, as a general
rule, involve the lungs, heart and the big blood vessels in the chest
cavity.
Bullet wounds of the chest may be superficial or may involve
the pleural viscera. Hemorrhage, collapse of the lungs due to the
removal of the negative intrathoractic pressure and pneumonia
may develop if the victim does not die immediately.
Fracture of the ribs causes severe pain during each phase of
respiration and if complete, it may be associated with laceration of
the parietal pleura or of the skin. The lungs and the heart may
also be lacerated when there is an inward displacement of the
fractured ends.
Fracture of the Ribs may be Caused by:
a. Direct Violence:
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
315
The fracture of the ribs is at the site of the application of
force as in cases of blow, stab, or bullet wounds,
b. Indirect Violence:
The fracture of the ribs is not at the point of the application
of force, as in crush injuries in vehicular accidents, a pressure on
the chest by heavy objects, a fall of earth or pressure with the
knee. Fracture of the ribs is usually along the mid-axillary line
or may run obliquely in the chest depending upon the manner
the force was applied.
Fracture of the ribs lacerates the parietal pleura and the sharp
ends of the ribs cause injury to the lungs, heart and big blood
vessels. The laceration of the skin may cause collapse of the
lungs and the victim dies of asphyxia.
The usual site of fracture of the sternum is the junction of
the manubrium and the gladiolus.
The fracture is usually
transverse and most often associated with fracture of the ribs.
It results from a sudden impact of heavy, blunt object or
compression of the chest due to a fall or a vehicular accident.
Fracture of the sternum may be associated with laceration of
the pericardium and injury to the heart.
Injuries to the Lungs:
Hemorrhage in the pleural cavity coming either from the intercostal vessels or from the lung tissue itself may cause compression
and collapse of the lungs and the patient may die of respiratory
embarrassment or anemia.
Contusion of the lungs may be caused by a blunt instrument
with or without fracture of the ribs, or by compression of the
chest. The lungs may be injured by a sharp-pointed instrument or
by a bullet. Injury of the lungs may cause bloody froth coming
out of the mouth.
Severe traction exerted at the region of the hilus may tear the
lungs at the point of attachment. Death is usually due to a severe
shock or a rapid hemorrhage.
Application of a severe crushing or grinding force in the chest
wall causes extensive fracture of the ribs and may results to
contusion and crushing injury to the lungs. The laceration may not
be so severe but later the victim succumbs to lobar pneumonia.
Complications of Lung Injuries:
a. Hemorrhage — Injury to the lung may cause severe hemorrhage
and about 1,500 cc. of blood may be recovered free in the
pleural cavity.
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LEGAL MEDICINE
b. Compression of the lungs — The hemorrhage or the compression
of the chest wall may cause limitation of the excursion of the
lungs during respiration and ultimately the victim dies of
asphyxia.
c. Severe Pneumothorax — Laceration of the bronchi leads to the
escape of air into the pleural cavity and embarrasses the respiration.
d. Cerebral air embolism — Laceration of the lungs may also cause
laceration of the pulmonary veinB and causes cerebral air embolism.
e. Hemoptysis — The blood from the injured lungs may find its
way to the bronchial tubes to the trachea and be spilled out
through the mouth. If hemorrhage is severe, the blood may
clot inside the bronchial tubes and causes acute asphyxia.
f. Subcutaneous emphysema — Laceration of the parietal pleura
and the lung tissue may cause the escape of air which finds its way
into the subcutaneous tissue causing crepitation of the skin.
Injuries to the Heart:
The heart may fail and causes death due to an existing natural
disease independent of trauma. Coronary insufficiency, myocardial
fibrosis, valvular lesion or tamponade due to the rupture of the
ventricle are common lesions.
Wounds of the heart are produced by sharp instruments, bullets
or the sharp ends of the fractured ribs. Contusion of the heart is
easily produced on slight trauma on account of its vascularity.
Wounds of the ventricle if small and oblique are less dangerous
than those of the auricle because of the thickness of its wall. The
right ventricle is the most common site of the wounds due to
external violence, because it is the most exposed part of the heart.
Foreign bodies like bullets, shrapnels, fragments of a shell may be
embedded in the myocardium without any cardiac embarrassment.
The person may live for a long time and may die of some other
causes.
Tearing of the heart from its attachments may be due to violent
compression of the chest with the pressure forcing the organ
downward and away from the neck The severe traction may
cause the laceration of the aorta.
v
Rupture of the heart is usually produced by a blunt instrument
or by a crushing injury due to vehicular accidents. The heart is
commonly ruptured at the right side towards the base. Death is
due to severe hemorrhage, cardiac tamponade or shock.
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
317
Crushing injuries of the heart are due to compression of the
chest with the fractured fragments injuring the heart as in vehicular accidents, violent dynamite blast, or crushing of the chest
between hard object.
Wounds of the aorta and pulmonary vessels are rapidly fatal.
Rupture of the aorta may be traumatic or spontaneous. Spontaneous rupture may be due to aneurysm. The cause of death is
either the profuse hemorrhage or cardiac tamponade.
Injuries of the Diaphragm:
Wounds of the diaphragm due to a sharp instrument and bullets
are caused by injuries either of the chest or abdomen. Their fatal
effect is not on the injury to the diaphragm but on the accompanying injuries to the other organs. A n y penetrating wound in
the diaphragm may cause a potent rent for diaphragmatic herniation.
Rupture of the diaphragm is due to a sudden increase of intraabdominal pressure crushing injuries caused by vehicular accidents
or traumatic compression of the chest.
Death in diaphragmatic injuries may be due to shock, hemorrhage, intestinal obstruction caused by herniation, or the accompanying injuries.
3. ABDOMINAL INJURIES:
Abdominal Wall:
The skin may remain unmarked inspite of extensive internal
injuries with bleeding and disruption of the internal organs. The
areas most vulnerable are the point of attachment of internal
organs, especially at the source of its blood supply and at the
point where blood vessels change direction.
The area in the middle superior half of the abdomen, forming
a triangle bounded by the ribs on the two sides and a line drawn
horizontally through the umbilicus forming its base, is vulnerable
to trauma applied from any direction. In this triangle are found
several blood vessels changing direction, particularly the celiac
trunk, its branches (the hepatic, splenic and gastric arteries) as
well as the accompanying veins. The loop of the duodenum, the
ligament of Treitz and the pancreas are in the retroperitoneal
space, and the stomach and transverse colon are in the triangle,
located in the peritoneal cavity. Compression or blow on the area
may cause detachment, laceration, stretch-stress, contusion of
the organs (Legal Medicine 1980, Cyril H. Wecht ed., p. 41).
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LEGAL MEDICINE
Stomach:
Spontaneous rupture of the stomach may be observed in cases
of gastric ulcer or new growth. A blunt force applied at the upper
portion of the abdomen may cause bruising or even rupture. The
pyloric end and the greater curvature are the most frequent sites
of a rupture.
Penetrating stab wounds of the stomach are dangerous to life
on account of a hemorrhage, infection and injury to the adjacent
organs like the liver. Tearing of the stomach is common when
the person is run over by a motor vehicle at the region of the
abdomen.
Intestine:
Ulcer at the duodenum may rupture spontaneously. The same
is true in cases of tuberculous, amoebic, cancerous or typhoid
ulcerations. Peritonitis and hemorrhage are the common causes
of death.
Traumatic rupture may be due to a blow, kick, fall or vehicular
accident. When force is applied to the front portion of the abdominal wall, the intestine may be pressed between the vertebral
column and the force applied, producing either partial or complete
severance or laceration.
Its septic contents will scatter in the
abdominal cavity and cause generalized peritonitis.
Injuries caused by sharp instruments or by gunshots usually
cause multiple lesions in the intestine and may also involve other
visceral organs. The intestine may be involved in vehicular accidents and on account of the grinding force of the wheel, severe
hemorrhage, laceration and herniation in the abdominal wall are
usually observed.
The mesentery may be contused, lacerated or crushed but in
most cases its involvement is secondary to lesion in the intestine.
Liver:
The liver is one of the most vulnerable organs in the abdominal
cavity because of its size, weight, location, friability, and fixed
position. Injuries are frequently met in cases of blow, kick, crush,
fall or sometimes in sudden contraction of the abdominal wall.
The right lobe is more frequently involved than the left owing to
its size and exposed location. Rupture is usually transversely or
anteroposteriorly.
On account of its extreme vascularity, the
victim usually dies of severe hemorrhage, shock and very rarely of
supervening infection.
Sometimes recovery occurs after slight
laceration but occasionally, abscess develops.
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
319
Stab and gunshot wounds of the abdomen may involve the liver.
Severe hemorrhage or shock usually causes the death. It may be
lacerated by the fractured ends of the lower ribs in crush injuries.
The gall bladder may be ruptured as a result of a kick, blow or
crush injury. It may be inju*ed-by penetrating weapons. Death
is due to hemorrhage and the effusion of bile into the peritoneal
cavity.
Spleen:
The spleen usually suffers traumatic rupture resulting from the
impact of a fall or blow and from the crushing and grinding
effects of wheels of motor vehicles. Although the organ is protected at its upper portion by the ribs and also by the air-containing visceral organs, yet on account of its superficiality and
fragility, it is usually affected by trauma. Congestion and diseased
condition of the spleen, as in malaria, typhoid, kala-zar, make it
more easily susceptible to slight trauma.
Laceration of the spleen is more common at the region of the
hilus and the lesion may be longitudinal or transverse. Lesion on
the convex surface is also common especially when the force is
applied to the left flank. On account of the vascular nature of
the organ and its proximity to the plexuses of nerves, the victim
usually dies of severe shock or hemorrhage.
Penetrating stab wounds of the spleen are common but most
often other visceral organs are also involved. Death is due to
hemorrhage.
Kidney:
Traumatic injury of the kidney may be due to a blow at the
lumbar region somewhere at the region of the 12th rib. It may be
ruptured at the slightest violence when it is diseased as in cases of
hydronephrosis, pyelonephritis, tuberculosis, abscess or tumor.
The kidney may also be ruptured when the individual is run over
by a vehicle or severely crushed from a fall
Injury of the kidney is accompanied by peri-renal hematoma
which consists of blood and urine. Death is due to a severe
hemorrhage, loss of kidney functions and shock. Abdominal
hemorrhage is present only if there is injury to the peritoneum
concomitant to the lesions in the kidney.
The adrenals may be contused, crushed or lacerated by severe
violence. The right is more prone to injury of its vulnerable
location.
"Crush syndrome" — These are secondary kidney changes in
crush injuries. Edema and anuria follow a crush. If death super-
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LEGAL MEDICINE
venes, the kidneys are found to be swollen, pale with marked
degeneration of the cells lining the tubules (Taylor's Principles
& Practice of Medical Jurisprudence by Simpson, 12th ed.. Vol II,
p. 332).
Pancreas:
The pancreas may be injured by a violent blow at the epigastric
region.
Death may be due to hemorrhage, shock, or insulin
insufficiency. If death does not occur immediately, fat necrosis
is observed in the abdominal cavity on account of the leakage of
the lipolytic enzyme.
Spontaneous hemorrhage of the pancreas is frequently observed
in the tropics. Its exact cause is still a matter of medical research.
4. PELVIC INJURIES:
Fracture of the pelvic bones, especially of the pubis, is common
in vehicular accidents and crush injuries. Separation of the symphysis may be observed without any external sign of injury.
The patient may show difficulty of locomotion, and to a certain
degree, damage to the urinary bladder.
Urinary Bladder:
The bladder may be involved in a blow, crush, or kick at the
hypogastrium especially when distended with urine.
Among
parturient women, the bladder may rupture in the course of
delivery. It may also be involved in fractures of the pubic bones.
Spontaneous rupture is rare when it is over-distended due to
urethal stricture, enlargement of the prostate, or tumor. Symptoms of rupture of the bladder are pain, tenderness at the lower
portion of the abdomen, bloody urine, difficulty in urination
and rigidity of the abdominal muscles.
Death may be due to
shock or super-imposed infection.
Uterus:
A non-gravid uterus is rarely involved in pelvic injuries, but a
gravid uterus is likely to be ruptured in a blow, kick, or crush
injuries. Spontaneous rupture of the uterus is commonly observed
among pregnant women due to the injudicious use of drugs or
abnormal presentation. Partial separation of the placenta may be
spontaneous or due to trauma. Death is due to shock, hemorrhage, peritonitis or septicemia.
Vagina:
Laceration of the vagina may be due to a sexual act or a faulty
instrumentation to induce a criminal abortion. The vaginal wall
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY
321
may be lacerated during parturition.
5. EXTREMITIES:
Physical injuries on both upper and lower extremities are usually due to direct violence, crushing or some indirect force.
a. Direct violence will result in a contusion and when the force
applied is severe it may cause interstitial muscular hemorrhage
and fractures of the underlying bone. Direct violence may be
due to a fall, a vehicular accident, or a direct application of
force.
b. Indirect violence, such as twisting or pathological fracture of
the bone underneath, causes laceration of the muscles around
with marked hemorrhage.
A patient may suffer deformity,
shortening of the extremity and shock.
c. Crushing injuries of the limb can result in severe soft tissue
trauma and are most commonly caused by vehicular accidents
or fall of heavy materials. These are usually accompanied by
marked swelling, comminution of the bone and extravasation
of the blood.
Contusions and abrasions are frequent lesions of the extremities.
Lacerated wounds are commonly observed in portion where the
bones are superficially located as in the anterior aspect of the leg.
Incised and punctured wounds of the hand are quite common on
account of its utility and movability.
Crushing injury of the extremities may cause laceration of the
blood vessels and nerves. Injury of the intima of the blood vessels
causes thrombus formation and in severe cases aneurysm may
develop. Extravasation of the blood into the muscles causes swelling
and pain.
Fracture of the bones may be due to a direct violence, an
indirect violence or a muscular action.
Injury of the extremities may cause shock, hemorrhage and
infection. The shock is principally due to the injury on the nerve,
hemorrhage and fracture of the bones. Infection may be severe
and may require amputation of the extremities.
Chapter XII
DEATH OR PHYSICAL INJURIES
CAUSED BY EXPLOSION
Explosion is the sudden release of potential energy producing a
localized increase in pressure.
Investigation of death or physical injuries that is produced by explosion must be concerned in determining the following:
1. What exploded?
2. What caused it to explode?
3. H o w it produced the injury?
4. H o w was it initiated?
Classification of Explosion as to the Source of Energy:
1. Mechanical (Hydraulic) Explosion — This occurs when the pressure inside a container exceeds its structural strength. Explosions
of air pressure tanks for cleaning or paint spray, water pressure
tanks to establish water pressure, and the air pumped kerosene
burner are examples of mechanical explosions. These explode
when the pressures applied are in excess of the strength of the containers. As the container disintegrates, there is a rapid localized
increase in pressure resulting in the characteristic explosive sound.
2. Electrical Explosion — When electricity arcs through the air, a
phenomenon that occurs when two objects of different electrical
potential are brought close to one another, a large amount of heat
develops. This heat rapidly expands the air in and around the arc
which produces the popping sound of an arc. Lightning though
it occurs in a much complex form with extremely high temperature,
may be an example of an electrical explosion.
3. Nuclear Explosion — The release of a significant amount of energy
by fusion or fission and consequently with a significant increase of
destructiveness.
Atomic Explosion — Atomic nuclei can be regarded as stored
condensed energy. The uncontrolled release of this energy constitutes atomic explosion.
4. Chemical Explosion — Chemical explosion occurs when a chemical
reaction'produces heat and gas at a rate faster than the surroundings
can dissipate. At the start of the reaction the initial heat or gas
322
DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION
323
pressure increases the rate of reaction, which progresses at a faster
rate until the explosion results.
Types of Chemical Explosion:
a. Diffused Reactant Explosion — This is caused by the mixture
of gas and air. If the gas and air are mixed in correct proportion, product of heat and subsequent pressure is produced.
Explosion of diffused reactants must be initiated by flame,
spark or sometimes heat. Mixture of gases with other materials
may cause production of flame. The most common example
of dispersed gas explosion is in the internal combustion engine.
b. Condensed Reactant Explosion — This chemical explosion
occurs when large quantity of heat and gas is produced as a
result of rapid chemical reaction in a solid or liquid material. It
has a point of origin so that the most severe damage is closest to
the source and the effects diminish as the distance from the
center increases. There is no need of atmospheric oxygen and
if oxygen is required in the reaction it is incorporated into the
explosive. Condensed reactant explosives may be classified as:
( 1 ) Low Order Explosive (Deflagrating Explosive) — Those
which rely on burning and confinement to produce explosions. When the reaction is confined, the built-up of heat
and pressure causes the reaction rate to increase rapidly to an
explosion. Gunpowder is the best known low order explosive.
When sufficiently heated the nitrate content is decomposed
to nitrate and oxygen. The oxygen reacts with sulfur and
carbon producing sulfur oxide, sulfur dioxide, carbon
monoxide and carbon dioxide in various combinations.
( 2 ) High Order Explosive — This is the kind that detonates.
Detonation is a chemical process which results in the extremely rapid decomposition of nitrogenous compounds.
Releasing heat and gas is its reaction by-product. It is the
shock wave spreading out of the explosion that causes the
destructive effect of high explosive. Dynamite is an example
of a high order explosive.
(a) Stable High Order Explosive — This compound will
not detonate unless they are subjected to detonation.
This includes dynamite (nitroglycerin made stable by
clay absorption).
( b ) Unstable High Order Explosive — Easily detonates from
heat, flame, spark or percussion. This includes trinitrobenzene (Picric acid), fulminate of mercury, lead,
antimony or bismuth and nitroglycerine (Clinics in
324
LEGAL MEDICINE
Laboratory Medicine by V. Di Maio, Vol. 3, No. 2,
June 1983, pp. 309-314).
Death or physical injuries due to detonation of high explosives
may be due to the following causes:
The destructive effects varies with the kind and amount of
explosive used and the location of the victim at the time of the
explosion. The explosion is accompanied by blast, flame and
fragment primarily.
The nature and extent of the injuries
suffered by the victim may be:
(a) If the victim is in contact with the explosive, as when he is
manipulating, carrying or sitting on it at the time of the
explosion, there is complete disruption or fragmentation of
the body. Pieces of the body may be found several meters
away from the site of explosion. Some parts of the body may
be found hanging on the electric power line, bones completely
shattered, skin and other soft tissues may be found scattered at a certain distance from the site of the explosion.
Burns a n d other injuries b r o u g h t a b o u t b y d y n a m i t e e x p l o s i o n .
The explosion causes sudden increase of atmospheric
pressure which is immediately followed by a sudden fall.
This compression-decompression effect causes displacement,
distortion and bursting effects on body parts, especially in
the brain and abdominal visceral organs. Aside from these
injuries, there is rapid development of scattered foci or small
DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION
325
hemorrhages mostly in organs which easily change in shape
and which are rich in blood supply.
( b ) If the victim is not so close to the site of explosion, the
body though badly injured may remain in one piece. Some
parts may be dismembered but may be recovered within a
few meters.
Certain areas of the body may show severe
injury, but the triad of punctate bruises, abrasions and
lacerations may be found distributed all over the body.
(All of these injuries have still the effect of the blast wave
with a diminishing intensity.)
(c) The peppering kind of injuries may be observed as the
distance from the site of explosion increases. The density
and severity becomes less until it disappears. However, one
or more metallic fragments travelling with moderate
velocity may strike the vital parts of the body and may
cause death.
( d ) Other effects of the blast wave:
i.
The impact of the high pressured wave can knock down
the person.
ii.
In the respiratory organ, the bronchus may be lacerated
or the mucosa of the trachea may develop petechial
hemorrhages. This effect is not due to the entry of the
high pressured wave along the trachea and bronchi but
by its passing directly on the body wall.
iii. The ear is the organ most vulnerable to the blast. Most
person at the vicinity of the explosion may suffer from
slight reddening of the tympanic membrane which
signifies that the cochlea has been damaged
(e) Burns from the flame or heated gas — The instantaneous or
momentary flame of high intensity during explosion may
cause singeing of the eyebrow, scalp hair and eyelashes.
Clothings may also be burned. Body surface in contact with
the flame or exposed to the heated air may develop burns,
the degree of which depends upon the intensity and duration
of exposure.
(f) Asphyxia due to lack of oxygen — Explosion causes consumption of oxygen in the surrounding atmosphere, thereby
limiting the amount available for human consumption.
(g) Poisoning by inhalation of carbon monoxide, nitrous or
nitric gases, hydrogen sulfide, sulfur dioxide, or hydrocyanic gas — The by-products of combustion may be protoplasmic poison or may cause death by interfering with the
326
LEGAL MEDICINE
normal transportation and utilization of air by the tissues
of the body.
(h) Direct injury by the flying missiles — The injury due to
flying missiles is influenced by the proximity of the individual to the site of explosion, velocity of the missiles,
manner or approach of the missiles on the body surface
involved and the subsequent complications arising from
such injuries.
The shrapnel wound may go much deeper or the foreign
body may lodged inside the body. The edges of the missiles
may be irregular or smooth so that the lesion on the skin
may appear like an incised wound. If lacerated, the surrounding tissues may be contused.
The following explosives may cause shrapnel wound:
Grenade
— Rifle or hand.
Bomb
— Demolition or incendiary.
Mine.s
— Underground or submarine.
Exploding missiles — Anti-aircraft
( i ) Injuries from the falling debris — If the explosion took place
in a building the victim may be injured and buried under the
rubbles. The victim may suffer from multiple injuries of
whatever description or die of traumatic or crash asphyxia.
Identification of the Site of Explosion and Collection of Evidences:
The site of explosion may be identified by the presence of a crater.
The original location of other objects located near the blast may be
useful clues in the determination of the site of explosion. Soil and
other debris may be collected for laboratory examination.
The entire area must be systematically searched for traces of the
detonation mechanism. All blown out materials must be tested for
explosive residues.
If the investigator arrived at the site immediately after the explosion, he may be able to smell the odor of the gas. One of the simplest
way of collecting gas samples for analysis is to take a bottle full of
water in the area where odor is the strongest and pour the water out
of the container. The surrounding air will immediately replace the
water removed from the bottle. Then the bottle must be tightly
sealed and sent to the laboratory for examination.
Scrapings from the debris and other materials at or near the site of
the explosion may be subjected to extensive stereoscopic and microscopic examination.
Particles of unconsumed explosive may be
recovered.
DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION
327
Fragments of the explosive materials and debris recovered may be
rinsed with hot water so that water-soluble inorganic substances
(nitrates and chlorates) may be extracted. The materials may be
rinsed with acetone inasmuch as most explosives are highly soluble
to acetone. The extract is concentrated and analyzed.
Color Spot Tests for Common Chemical Explosives:
Substances
Chlorate
Nitrate
Nitrocellulose
Nitroglycerin
PETN
RDX
TNT
Tetryl
Griess
Diphenylamine
No color
Pink to red
Pink
Pink to red
Pink to red
Pink to red
No color
Pink to red
Blue
Blue
Blue-black
Blue
Blue
Blue
No color
Blue
Alcoholic KC
No color
No color
No color
No color
No color
No color
Red
Red-violet
Griess Reagent:
Solution 1 — Dissolve 1 mg. sulfanilic acid in 100 ml. of 30% acetic
acid.
Solution 2 — Dissolve 1 g. alpha-naphthylamine in 230 ml. of boiling
distilled water, cool.
Decant the colorless supernatant liquid and mix with 110 ml. of
glacial acetic acid. A d d solutions 1 and 2 and a few milligrams of
zinc dust to the suspect extract.
Diphenylamine Reagent:
Solution 1 — Dissolve 1 g. diphenylamine in 100 ml. concentrated
sulfuric acid.
Alcoholic KOH Reagent:
Solution 1 — Dissolve 10 g. of potassium hydroxide in 100 ml. of
absolute alcohol.
(Criminalistics by Richard Saferstein, p. 242).
Other Tests on Extract:
1. Infra-red spectrophotometry.
2. X-ray diffraction.
3. Gas chromatographic analysis.
ATOMIC B O M B E X P L O S I O N :
Atomic nuclei can be regarded as storage of highly condensed
energy and that the uncontrolled release of this energy constitute an
atomic explosion. The explosion is caused by the fission of about
100 pounds of uranium and liberates energy equal to that of a
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LEGAL MEDICINE
million tons of T N T . It produces millions of pounds per square
inch of gas pressure, with heat comparable to the sun and light of
more than 30 times as bright as the sun at noontime. After explosion, it produces a luminous ball of fire containing radioactive
fission products, which increases upward in size and creates shock
waves moving sidewards in all directions. The fireball may have the
diameter of 7,200 feet in ten seconds and in one minute time it may
reach a height of 4-1/2 miles.
Place of Atomic Explosion:
1. Aerial Explosion — The bomb is made to explode on the air.
2. Ground Explosion — Explosion is made when the bomb reaches
the ground.
3. Submarine Explosion — Explosion takes place underneath the
surface of a body of water.
Rays Emitted by Radioactive Substances During Explosion:
1. Alpha Rays — Composed of positively charged helium, having a
high linear energy transfer and with a poor penetrating power
that can be stopped by a sheet of paper.
2. Beta Rays — Composed of positively or negatively charged electrons with a higher penetrating power than the alpha rays but the
ionizing power is much less. The electrons are travelling at a very
high velocity and in some cases approaching the speed of light.
3. Gamma Rays — Composed of short rays with high energy and
greater penetrating power and like neutrons it extends a significant
distance and causes much damage to the human body.
4. Neutron Rays — Uncharged and composed of highly penetrating
particles and basic element in nuclei of atoms.
Characteristics of Nuclear B o m b Explosion that Distinguishes it from
Conventional High Explosive B o m b Explosion:
1. It is many thousand times as powerful as a highly conventional
bomb explosion and the effects of the blast are very prominent.
2. A large proportion of its energy is emitted as thermal radiation,
causing skin burns and it is capable of starting a fire at a considerable distance.
3. The explosion emits a highly penetrating and harmful radiation,
and the substance which remains after the explosion continues to
emit radiation over a long period of time.
(Forensic Medicine by Tedeschi, Eckert & Tedeschi, Vol. 1, p. 633).
Effects of Atomic Explosion to the Human Body:
The effects of atomic explosion of the human body are inversely
proportional to the distance. One megaton of atomic bomb exploded
DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION
329
in air can cause fire of up to a 10 miles radius. The pressure front of
the blast can be felt one mile away in 2 seconds time. The blast
wave is of sufficiently long duration which is accompanied by
transient blast winds causing damages to the people and the surrounding structures.
Other effects of atomic explosion are the same as that of ordinary
chemical bomb explosion but of a much more severe intensity.
Aside from the immediate traumatic effects, the radiation emitted
by the radio-active substances can also have an effect which may be
local or general.
1. General Effects:
Massive dose causes generalized
followed by coma and death.
erythema,
disorientation
Lesser dose may-cause nausea, vomiting followed by prostration
and rapidly developing and persistent leukemia.
Later symptoms may develop in the form of rise of temperature,
ulceration of lymphoid, easy fatigability, oro-pharyngeal ulceration and severe leukopenia.
2. Local
Effects:
a. Individual Cells — It causes retardation of cell division, structural
changes in the chromosomes and cytoplasm, vacuolization, and
with evidence of maturation. There is loss of the supporting
mesenchymal cells.
b. Skin — Epilation of the hair with the follicles remaining intact,
sweat glands lose their function, erector pili muscles not much
affected. The skin become edematous and later disquamated
and ulcerated. Radiation dermatitis is persistent, usually painful with patchy keratitis and foci of ulceration. Hyperpigmentation or depigmentation may later develop.
c. Blood Vessels — There is endothelial necrosis and localized
thrombosis. The blood vessels thicken because of the hyalinization of the collagen. Some blood vessels are occluded with
the loss of the muscular layer.
d. Eye — Cataract develops.
e. Genital Organ — In female it causes sterility, abortion or stillbirth.
In men, it also causes sterility without loss of sexual
potency.
•
Factors Responsible for the EffectB of Radiation:
1. Age — Children and old persons are more susceptible to radiation.
2. Dosage — Bigger dose of radiation will cause more damaging
effects on the body tissues.
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LEGAL MEDICINE
3. Kind of Radiation — The biological damage is not always proportional to the energy absorbed, but it depends on the kind of
energy emitted. Gamma and neutron radiations are most destructive.
4. Fractional Doses — A single dose may be lethal when administered
fractionally over a long interval of time.
5. Sensitivity — Muscles and connective tissue are radioresistant while
actively dividing tissues like blood forming organs, intestinal
epithelium are quite radiosensitive.
Other Sources of Radiation:
1. Natural Source:
a. Cosmic Origin — Radiation from the sun or from outer space.
b. Terrestial Origin — Chiefly from radiothorium series of granite
rocks.
2. Man-made Source:
a. Diagnostic X-ray Equipment:
The filament inside a vacuum tube is heated by a strong
electric current so that it will emit electrons. The electron is
driven on an anode target (Rhenium and molybdenum) which
causes the development of electromagnetic energy, the wave
length and the ability to penetrate depends on the kilovoltage
applied. The higher the voltage, the shorter is the wave length
and the more penetrating are the X-rays.
As the X-ray passes the tissues of the body, the degree of
absorption depends on the density. The bones absorb more
X-ray than the air containing tissues. Naturally the film behind
receives a differential amount of X-ray. The denser substance
like the bone, will be represented by a lighter image while the
less denser organs will have a darker image.
In a fluoroscope, the X-ray after passing the body goes to a
screen and the differential absorption of X-ray by the body is
reflected in the fluoroscopic screen (Legal Medicine by Tadeschi
p. €86).
b. Clinical nuclear pharmaceutical agents.
c. Therapeutic radiation apparatus.
d. Radiation sources used in industry, like nuclear power plant
The problem of the use of nuclear power in generating plants
is the disposal of the radioactive waste which may be in the
form of:
( 1 ) Gases chiefly emitted from the vapor.
Chapter XIII
/ G U N S H O T WOUNDS
D E A T H O R P H Y S I C A L INJURIES B R O U G H T A B O U T B Y
POWDERED PROPELLED SUBSTANCES
Death or physical injuries brought about by the powder propelled
substances may be due to the following:
1. Firearm Shot — The injury is caused by the missile propelled by
the explosion of the gunpowder located in the cartridge shell and
at the rear of the missile. The direction of the movement of the
missile is influenced by the desire of the person firing the firearm. The missile may be single as in the case of a pistol or revolver
or may be of multiple shots or pellets as in the case of a shotgun.
The cartridge shell is physically preserved after the fire.
2. Detonation of high explosives, as in grenades, bombs and mine
explosion. Explosion of the gunpowder inside the metallic container will cause fragmentation of the container. Each fragment or
shrapnel is moving with certain velocity without any predetermined direction.
I. FIREARM W O U N D
Definition of Firearm:
1. Technical
Definition:
A firearm is an instrument used for thejpropulsion of a projectile_7
by the^expansive force of gases^coming from the burning of gunpowder.
2. Legal Definition:
Section 877, Revised Administrative Code — "Firearm" defined:
"Firearm" or "arm", as herein used, includes.jrifles,^muskets,
shotguns, revolvers,^pistols, and jill other deadly weapons from
"which a bullet, > a l l , shot, shell, or pfher missile may be discharged
by means of gunpowder or other explosives. The term also
includes air rifles except such as being of small caliber and limited
range are used as toys. The barrel of any firearm shall be considered as a complete firearm for all purposes thereof.
w
Penal Provisions of Laws Relative to Firearm:
Section 2692, Revised Administrative Code:
332
GUNSHOT WOUNDS
333
Unlawful manufacture, dealing in acquisition, disposition, or
possession of firearms, or ammunitions therefor, or instrument
used or intended to be used in the manufacture of firearms or
ammunition:
yj<KL
A n y person who manufactures, deals in, acquires, disposes, or
.possesses any firearm, parts of firearms, or ammunition therefor, or
instrument or implement used or intended to be used in the manufacture of ammunition in violation of any provision of sections eight ^To-ltfv
hundred seventy-seven to nine hundred and six, inclusive, of the
code, as amended, .shall, upon conviction, be punished by imprisonment for a period of not less than pjie year and one day nor more*^' \^<ku\
than five years, or both such imprisonment and a fine of not less^^*
than one thousand pesos nor more than five thousand pesos, in the
discretion of the court. If the article illegally possessed is a rifle,
carbine, grease gun, bazooka, machine gun, submachine gun, hand
grenade, bomb, artillery of any kind or ammunition exclusively
intended for such weapons, such period of imprisonment shall be not
less than five years nor more than ten years. A conviction under this
section shall carry with it the forfeiture of the prohibited article or
articles by the Philippine Government.
R
Section 2690, Revised Administrative Code: ^
Selling of firearms to unlicensed purchaser:
It shall be unlawful for any dealer in firearms or ammunition to
sell or_deliver any firearms or ammunition or any part of a firearm
to a purchaser or other person until such purchaser or other person
shall have obtained the necessary license therefor. A n y person
violating the provisions of this section, upon conviction in a court of
competent jurisdiction, shall be punished by a fine not exceeding
two thousand pesos, or by imprisonment not exceeding two years,
or both.
U 11**
Section 2691, Revised Administrative Code: /
Failure of personal representative of deceased licersee to surrender
firearm:
When a holder of any firearm license shall .dfc ° r become subject
to legal disability and any of his relatives, or his legal represenative,
or any other person shall knowingly come into_j>ossession of any
firearm or ammunition covered by such license, such person, upon
failure to deliver the same to the Chief of .Constabulary in Manila
or to the senior officers of Constabulary in the province, shall be
punished by a fine not exceeding five hundred pesos or by imprisonment not exceeding six months, or both. If £r**
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LEGAL MEDICINE
Art. 155, Revised Penal Code:
Alarms and Scandals:
The penalty of arresto menor or fine not exceeding 200 pesos shall
be imposed upon:
1. Any person who within any town or public place, shall discharge
any firearm, rocket, firecracker, or other explosive calculated to
cause alarm or danger;
2
Art. 254, Revised Penal Code:
Discharge of firearms:
A n y person who shall shoot at another with any firearm shall
suffer the penalty of prision correccional in its minimum and medium
periods, unless the facts of the case are such that the act can be held
to constitute frustrated or attempted parricide, murder, homicide or
any other crime for which a higher penalty is prescribed by any of
the articles of the code:
Classification of Small Firearms:
y
Small firearms are those whichQpropel projectile] of less than one
inch in diameter.
1. As to Wounding Power:
a. L o w Velocity Firearm — These are firearms with muzzle velocity of not more than 1,400 feet per second.
Example: Revolver,
b. High Power Firearm — These are firearms with muzzle velocity
of more than 1,400 feet per second. The usual muzzle velocity
is 2,200 to 2,500 feet per second or more.
Example: Military Rifle.
2. As to the Nature of the Bore:^*a. Smooth Bore Weapon — This firearm has the inside portion of
the barrel that is perfectly smooth from the firing chamber to
the muzzle.
Example: Shotgun,
b. Rifled Bore Firearm — This is a firearm with the bore of the
barrel with a number of spiral lands and grooves which run
parallel with one another, but twisted spirally from breech
to muzzle.
Example: Military Rifle.
3. As to the Manner of Firing:
a. Pistol — Firearm which may be fired only by a single hand.
Example: Revolver.
GUNSHOT WOUNDS
335
b. Rifle — Firearm which may be fired from the shoulder.
Example: Shotgun.
4. As to the Nature of the Magazine:
a. Cylindrical Revolving Magazine Firearm — The .cartridge is
located in a cylindrical magazine which ^ t a t e s at the rear
portion of the barrel.
Example: Revolver.
b. Vertical or Horizontal Magazine — The cartridge is held one
after another vertically or horizontally and also held in place
by a spring side to side or end to end.
Example: Automatic Pistol.
Types of Small Firearms which are of Medico-legal Interests
1. Revolver — A revolver is a firearm which has a cylindrical magazine situated at the rear of the barrel, capable or revolving motion
and which can accommodate five or six cartridges; each of which
is housed in a separate chamber. After a shot, the circular magazine
rotates by the cocking of the hammer in a way that the next
cartridge is brought in the proper position for firing. The usual
muzzle velocity of a revolver is 600 feet per second.
Kinds of Revolver as to Construction or Mechanism:
a. Revolver with the barrelffirmly fixed to the frame and the
revolving cylinder may swing oufjto the side for the purpose
of loading or extraction of the spent shell.
b. Revolver with the barrel Vhinged to the frame and the revolver
cylinder may be brokerfjto load by releasing the barrel latch.
c. Revolver with barrel£firmly fixed to the frame and the revolving
cylinder may be removed} by taking out the cylinder pin on
which it rotates.
2. Automatic Pistol — This is a firing weapon in which the empty
shell is ejected when the cartridge is fired and a new cartridge is
slipped into the breech automatically as a result of the recoil.
The cartridge is contained in a vertical magazine which holds six
to seven cartridges. It is not automatic in action in the sense that
a continuous pressure on the trigger will not make the firearm
fire continuously. It is more correct to call it a "self-loading
firearm." It has a usual muzzle velocity of 1,200 feet or more per
second.
3. Rifle — A rifle is a firearm with a long barrel and butt. It may be
a military rifle or a miniature rifle. A military rifle has a magazine
and volt action of various types. The miniature rifle is a single
self-loading weapon. A military rifle usually has a muzzle velocity
LEGAL MEDICINE
336
of 2,500 feet per second and a range of 3,000 feet. Unlike a
revolver or automatic pistol which can be fired by a single hand,
a rifle is fired from a shoulder.
4. Shotgun — A shotgun is a firearm whose projectile is a collection
of lead pellets which varies in sizes with the type of the cartridge
applied.
A Weapon, In Order to Cause Injury must have T w o Principal Component Parts, Namely:
1. The Cartridge or Ammunition — a complete unfired unit consisting of bullet, primer, cartridge case and powder charge.
2. The Firearm — the instrument for the propulsion of a projectile by
the expansive force of gases from a burning gunpowder.
CARTRIDGES OR AMMUNITION
The Principal Parts of a Cartridge or Ammunition are:
1. The cartridge case or shell.
2. Primer.
3. Powder or propellant.
4. Bullet or projectile.
1. Cartridge Case or Shell:
The cartridge case or shell is a cylindrical structure with a base
which houses the powder, the primer at the base and with the
bullet attached at the tip. In ordinary hand guns the cylindrical
structure is made of brass while in shotguns it is usually made of
cardboard. The base is always made of metal. Inscription at the
base may show the manufacturer, the caliber and even the date it
was manufactured.
Depending upon the relationship of the diameter of the base
with that of the cylindrical portion, a cartridge may be classified
as:
a. Cartridge With a Rim — The base of the cartridge has a diameter more than the cylindrical portion. The rim is used to
prevent the cartridge from going through the barrel. This is
common among revolvers.
b. Rimless Cartridge — The base or head of the cartridge has the
same diameter as that of the cylindrical body. There is a groove
cut between the base and the cylindrical body for the extractor
to hook into. This is usually found in self-loading firearms.
c. Semi-rimless Cartridge — This looks like a rimless at first glance
but actually the rim does project very slightly above the line of
the cylindrical part.
GUNSHOT WOUNDS
337
d. Belted Cartridge — The cartridges are attached in a series in a
canvass belt for successive fires.
2. Primer:
The primer compound is located and sealed at the cartridge
base covered by a small disc of soft metal, which is usually a lead-tin
alloy known as percussion cap or primer cap. The main function
of the primer is the transformation of mechanical energy by the
hit of the firing pin on the percussion cap to chemical energy by
its rapid combustion. As the firing pin hits the primer cap (percussion cap), the primer compound hits the anvil which causes the
generation of a flash which in turn ignites the powder. The time
of the primer activation is approximately 0.00001 second.
Although, there are variations in the chemical constituents of
the primer in the past, it is composed of a mixture of mercury
fulminate, stibnite (antimony sulfide), potassium chlorate and
powdered glass. Later, mercury fulminate is partially or completely replaced by lead azide and lead stypnate together with
potassium chlorate which are replaced by barium nitrate to
reduce the development of rust. Lead stypnate is utilized as base,
tetracene is sometimes added to control sensitivity and barium
nitrate acts as moderator and oxidizer. The most common constituents of primer are lead, antimony and barium.
As to the location of the percussion cap at the base, cartridge
may be:
a. Cartridge with Center Fire — The percussion cap is located at
the center of the base of the cartridge. This is the most common.
b. Cartridge with Rim Fire — The primer is placed inside the rim
of the shell. This is common in 0.22 caliber firearms.
c. Firearm with Pin — The firing pin strikes a needle which is
placed at the rim of the shell. The needle will then press on the
percussion cap which is inside the cartridge. This type is
obsolete and now rarely found.
3. Gunpowder or Propellant: ^
The propellant is the primary propulsive force in a cartridge
which when exploded will cause the bullet to be driven forward
towards the gun muzzle.
There are Different Types of Powder Propellant Used:a. Black Powder — A mixture of potassium nitrate (75%), sulfur
(15%) and charcoal (10%).
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Explosion of one grain of black powder (one grain = 0.065
gm.) will produce 200 to 300 cc. of gas composed of carbon
dioxide (50%), carbon monoxide (10%), nitrogen (35%),
hydrogen sulfide (3%) and traces of methane and oxygen. The
solid residues following its combustion are potassium sulfate,
potassium sulfide, potassium carbonate together with its original
components.
b. Smokeless Powder — It may be:
(1) Single Base — When it contains either cellulose nitrate or
nitroglycerine.
( 2 ) Double Base — When the powder is composed of both
cellulose nitrate and nitroglycerine.
Explosion of one grain (one grain = 0.065 gm.) of smokeless
powder will cause the development of 800 to 900 cc. of gas
consisting of carbon dioxide, nitrogen, hydrogen with some
unburnt powder in the form of nitrate and cellulose nitrate
which can be detected chemically.
c. Semi-smokeless Powder — This is a mixture of 80% of black and
20% of the smokeless powder.
Smokeless powder causes development of less flame and less
powder residue as compared with black powder.
There is more complete burning of gunpowder in smokeless
as compared with the black powder.
Inasmuch as the gas produced by combustion of smokeless
powder is three times more than the black powder, the muzzle
velocity of bullets with smokeless powder is also approximately
three times greater than the bullets using black-powder.
Smokeless powder granules are usually coated with graphite
and consequently form different shapes. They may appear as
a ball, square, cylinder, disc or flakes. Consequently when
discharged from the firearm after explosion they will cause
individual shapes of tattooing. The flake or disc shape powder
may cause varying shapes of the tattoos depending upon how the
grain struck the skin. Ball powder may cause small, hemorrhagic punctate marks. The cylindrical shape powder grains
may cause heavy tattooing with deposition of soot at 6 inches
range.
4. Bullet (Slug, Missile, Projectile):
It is the metallic object attached to the free end of the cylindrical tip of the cartridge case, propelled by the expansive force
of the propellant, and responsible in the production of damages
in the target. In some instances bullets are not metallic but made
Bullets lodged and extracted from a victim
of rubber, plastic, or even paraffin, but their uses are primarily
confined to target practice.
Classification:
a. Shape of the free end:
(1) Conical — The free end of the bullet is tapering and pointed.
The purpose is to minimize the resistance offered by the
atmosphere, to increasing its penetrating power and to
minimize deflection upon hitting the target.
( 2 ) Hemispherical — The free end is dome-like and commonly
observed in short firearms.
( 3 ) Wad-cutter (Square Nose) — The free end is flattened
commonly used in target practices.
(4) Hollow-point — There is a depression at the tip to expand
or "mushroom" at impact on hard object, to slow its speed
in the body so that more kinetic energy will be released
thereby increasing its shocking effect.
b. As to presence or absence of jacket:
(1) Naked Lead Bullet — Bullet without outer coating.
(2) Jacketed Bullet — Bullet with external coating usually
copper, nickel, steel or zinc. The purpose of the coating
are to:
(a) To prevent fouling of the barrel;
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LEGAL MEDICINE
( b ) To withstand deformity in automatic loading process;
and
(c) To prevent deformity when carried and exposed to
rough handling.
A jacketed bullet may be:
i. Full Jacketed Bullet — the whole bullet up to the
base is enveloped with a metallic jacket.
ii. Semi-jacketed Bullet — The nose or free end is partly
or fully exposed while there is relatively thin but
tough coating of the base and the cylindrical portion.
This is made to permit expansion of the bullet when
it hits hard objects. Semi-jacketed bullets may be
hollow-point.
The general rule is that soft-metal, round nose
bullets are fired from a revolver; full-jacketed bullets
are fired from a rifle and self-loading firearm; semijacketed bullets are fired from an automatic (selfloading) firearm or rifle.
Special Bullets:
a. Armour Piercing Bullet — made of steel with copper coating
(jacket).
b. Phosphorus Flare or Tracer Bullet — This consists of an aluminum tip and is packed with incendiary (phosphorus) which
burns during flight. It is used to determine the direction of the
fire. The speed of sound in air is 1,087 feet per second or 331.3
meters per second.
c. Plastic Bullet — used for target practice.
d. Bullet with Plastic Sabot — The bullet together with the sabot
travel up to the bore. The bullet never comes in contact with
the barrel and therefore there will be no rifling marks imparted
in the bullet but on the sabot. The front half of the sabot has
six slits. As the sabot leaves the barrel it offers resistance and
the slit part of the sabot will fold backward, causing resistance
and falls away.
At three feet, the sabot and bullet are still in line.
At 6 to 7 feet, they strike the target separately.
The sabot itself travels approximately 50 feet.
e. Bullet with Secondary Explosion — The bullet may leave the
barrel and upon reaching a certain distance it produces secondary explosion and shrapnel splinters.
f. Soft Point Bullet — A bullet which is easily flattened upon
hitting the target to increase the wounding effect.
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343
FIREARM
For purposes of Medico-legal Investigation, the following Parts of a
Firearm are important:
1. The trigger with the firing pin.
2. The barrel.
Other Parts of a Firearm:
1. Handle or Butt — The portion of the firearm used for handling it.
It may house the magazine.
2. Firing Chamber — The place where the cartridge is held in position
before the fire mechanism starts.
3. Breechblock — The steel block which closes the rear of the bore
against the force of the charge. The face of this block which comes
in contact with the base of the cartridge is known as the breechface.
4. Trigger Guard.
5. Front and Rear Sight.
6. Safety Device like safety lock.
7. Sling.
In a Self-loading Firearm, the following are the Additional Parts:
1. Extractor — The mechanism by which the spent shell or ammunition is withdrawn from the firing chamber.
2. Ejector — The mechanism by which the empty shell or ammunition is thrown from the firearm.
1. Trigger:
This is a part of the firearm which causes firing mechanism.
Except in a single action firearm, pressure on the trigger is the
commencement of the whole firearm mechanism. To avoid accidental firing, the trigger is surrounded by a trigger guard.
Classification of Firearm Based on Trigger Mechanism:
a. Relation of Cocking and Trigger Pressure:
(1) Single Action Firearm — The firearm is first manually
cocked then followed by pressure on the trigger to release
the hammer.
Example: Home-made "Paltik".
( 2 ) Double Action Firearm — A pressure applied on the trigger
will both cock and fire the firearm by release of the hammer.
Example: Standard Revolver.
b. Number of Shots on Pressure on the Trigger:
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(1) Single Shot Firearm — A pull or pressure on the trigger will
cause only one shot.
Example: Revolver.
(2) Automatic Firearm — A continuous pressure on the trigger
will cause a series of shots until the trigger pressure is
released.
Example: Machine gun.
Trigger pressure is the amount of force (pressure) on the trigger
necessary to fire a gun.
Its determination is necessary in the
assessment of whether the firing can possibly be accidental.
"Hair trigger" is a vague term used when the firearm trigger
pressure is 1.0 lb. (pound) or less. It is intrinsically unsafe and
should only be used under rigorously controlled situations because
of the possibility of unintended or accidental fire.
In general, the single action firearm varies from 3-1/2 to 10
pounds and in double action, it varies from 6 pounds to as much
as 18 pounds. The following are the approximate trigger pressures
of certain types of firearms.
a.
b.
c.
d.
Shotgun
Self-loading pistol
Revolver
Service rifle
4
3
3
6
lbs.
to 4 lbs.
to 5 lbs.
to 7 lbs.
2. Barrel:
a. Riflings:
The inner surface of a shotgun and that of a home-made
gun is smooth while single shot standard firearms are with
riflings.
The inner surface of the barrel has a series of parallel spiral
grooves on the whole length called riflings. The space between
the two grooves is the land. The riflings are made to have a
strong barrel grip on the bullet, to stabilize its movement and
to impart a rotational movement on the bullet. Incidentally,
the rifling reflected on the bullet becomes an important factor
in the identification of firearms.
Gun manufacturers vary the way the riflings are imprinted
in the inner surface of the barrel on the following aspects:
(1) Number — The number of lands and grooves varies from 2
to 12.
Most high velocity firearms have 4 to 6 grooves. Some
firearms have multiple shallow grooves and this is known
as microgroove6 rifling.
GUNSHOT WOUNDS
345
( 2 ) Twist or Rate — This is the expression for one complete
turn of the rifling on a certain length of the barrel. We say
the twist rate is 1:12 when there is one complete spiral
groove in 12 inch of the barrel. Spiral groove twist or rate
may be:
(a) Fast Twist — When the number of inches of the barrel
required for a complete turn is small, like 1:8.
( b ) Slow Twist — When a greater number of inches in the
barrel is necessary to have one complete turn, like
1:14.
( 3 ) Direction — The direction of rifling may either be righ£
(clockwise) or left (counterclockwise).
( 4 ) Width of the Groove and Land — The width of the groove
varies with the manufacturer and caliber.
Some have
the width of the groove different with that of the land while
others are the same or equidistant.
Example:
Colt 0.32 has 6 lands and grooves, twist to the left, the
width of the land and groove are 0.048 and 0.108 respectively.
Smith and Wesson 0.32 has 5 lands and grooves, twist to
the right and are equidistant at 0.095 inch.
Table of Number of Grooves and the Direction of Riflings
No. of
Grooves
Direction of
Riflings
1. Revolvers:
- Webley, 455, .38, .32
— Colt, all calibers
— Smith and Wesson, .45, .32
- J.T. & S. & W. model
7
6
5
4
right
left
right
right
2. Automatic Pistols:
- Webley, .455, .32, .25
— Browning
— Mauser, .25
- Colt, .45, .38, .25
— Delta
— Victoria (Spanish make)
— Luger P-08, 9 mm. (German)
— Fibrique National, 9 mm. (Belgian)
6
6
6
6
6
6
6
6
right
right
right
left
left
left
right
right
Aside from those marks previously mentioned, the bullet or the
shell shows individual or accidental characteristics which are deter-
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LEGAL MEDICINE
mutable only after the manufacture. They have characteristics whose
existence is beyond the control of men and which have a random
distribution. Their existence in a firearm are brought about through
the failure of a tool in its normal operation, through wear, abuse,
mutilation, corrosion, erosion, or other fortuitous causes. Those
marks may be imprinted in the bullet or shell and may be used for
identification purpose.
When the bullet or the shell or both has been recovered and a
suspected firearm has been found in the possession of a person, the
procedure is to fire the suspected firearm at a recovery box and compare the shell and bullet in the comparison microscope with the one
in question.
How to Determine the Caliber of Firearm:
The caliber is the diameter of the barrel between two lands.
Table showing the relation between American, English and Continental Caliber:
American Caliber
English Caliber
Continental Caliber in Mm.
.22 Inch
.220 Inch
5.6
.25 "
.250
6.5(6.35)
.28
.280
7.0
.30
(.32 Rev.)
.300 " (.303)
7.65
.32
.320 "
8.0
.35 •• (.351)
.350
9.0
.38 »
.360 "
9.3
.38
.370 »
9.5
.38-.40-.41 Inch
410 ••
10.0
.405 Inch
10.5
.44 "
.440 "
11.0
.45
.450 " (.455)
11.25
(From:
Modern Criminal Investigation by Harry Soderman and
John O'Connell, 4th ed., p. 201).
To convert millimeter calibration to inches, multiply the caliber
in millimeters by 0.03937 or divide by 25.4.
To convert inches calibration to millimeters, multiply by 25.4 or
divide by 0.03937.
M
M
M
M
M
MECHANISM OF FIREARM ACTION:
Generally, the principles involved in all firearm actions are the
same. When the firearm is cocked and ready to fire, a pull on the
trigger will cause the firing pin of the hammer to hit the percussion
cap of the cartridge in the firing chamber which is aligned with rear
GUNSHOT WOUNDS
347
portion of the barrel. The hit by the firing pin on the percussion
cap will cause generation of a sufficient heat capable of igniting the
primer. The primer will in turn ignite the gunpowder or propellant
which will cause evolution of gases under pressure and temperature.
The marked expansion of the gases will force the projectile forward
with certain velocity. Owing to the presence of the rifling at the
inner wall of the bore, the barrel offers some degree of resistance
to the projectile. Inasmuch as the rifling marks are arranged in a
spiral manner, the projectile will produce a spinning movement as
it comes out of the muzzle.
Together with the bullet passing out of the barrel are the highpressured heated gases, unbumt powder grains with flame and
smoke.
During explosion, there is a backward kick of the firearm which
in an automatic firearm causes the cocking and the empty shell thrown
out by the ejector. The backward movement is called recoil of the
firearm.
Things Coming Out of the Gun Muzzle After the Fire: ^
1. Bullet.
2. Flame.
3. Heated, compressed and expanded*gas.
4. Residues coming from:
a. Bullet:
(1) Fragment (jacket, lead).
(2) Lubricant.
b. Powder particles:
( 1 ) Powder grains (unbumed, burning).
(2) Soot.
(3) Graphite.
c. Primer:
( 1 ) Lead, barium, antimony, etc..
d. Barrel:
(1) Lubricant.
(2) Rust, dust, etc..
(3) Scraping from bullet by previous fire.
e. Cartridge case:
( 1 ) Copper, zinc.
Bullet's Kinetic Energy:
Kinetic energy is energy associated with motion. In the English
system it is express in foot pound or the work of a force resulting
when a weight of one pound is brought to a height of one foot.
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In ballistics, the wounding power of a bullet is due to the mass
(weight) and its velocity, with the velocity playing a very important
role.
Kinetic Energy =
MV
2
M = Mass (Weight)
V = Velocity
G = Gravity
2G
Tissue damage of a bullet of a very high velocity is very much
greater than those with much less velocity.
The damage cause by a bullet with impact velocity similar to
muzzle velocity is greater than when the impact occurred at a reduced speed after the bullet has travelled a distance.
Bullet Efficiency:
The cartridge powder charge can be burned in approximately
0.00001 second. The conversion rate by combustion of the gunpowder to bullet energy is about 30 to 32 percent. The loss of
some energies from the gunpowder explosion may be due to:
a. Loss of energy to force the bullet out of the cartridge case,
rifling and friction in the barrel.
b. Heating of the barrel and chamber.
c. Escape of some of the compressed gasses at the breech and
barrel.
d. N o t all gunpowder are ignited.
Obturation:
This is the sealing or prevention of gunpowder gas after explosion from escaping so as to maintain high pressure in the
firing chamber thereby increasing the propulsive power on the
bullet. This is maintained:
a. By insuring that the bullet tightly fits the bore throughout its
entire length;
b. By sealing the cartridge case to the chamber wall; and
c. By preventing leakage between the primer cap and its retaining
wall in the cartridge.
Ballistics Coefficient:
This describes the ability of a bullet to maintain its velocity
against air resistance. It may be expressed in the following formula:
C — ballistic coefficient
m — mass
i — form factor
d — diameter
GUNSHOT WOUNDS
349
The larger the coefficient, the more efficient is the bullet or
projectile. The better the ballistic coefficient of a bullet, the less
velocity loss it will suffer over a given resistance.
Movements of the Bullet as it Moves Out of the Muzzle:
1. Forward Movement — The velocity depends upon the propulsion
created by the ignition of the propellant.
2. Spinning Movement — This is due to the passage of the bullet at
the spiral landings and groovings of the barrel. The ratio depends
on the twist and length of the barrel.
3. Tumbling Movement (End-over-end
flotation/-The
bullet may be
rotating on the long axis of its flight while the nose and the base
are alternating ahead in its flight. This accounts why in some
instances, the bullet hits the skin with its base.
4. Wabbling Movement (Tailwag) — The rear end of the bullet aside
from spinning may also vibrate vertically or sidewise in its flight.
Like tumbling movement, it may cause hitting the target sidewise.
5. Pull of Gravity — As the bullet is moving forward, it gradually
goes downward on account of the pull of the force of gravity.
As the bullet looses its kinetic energy, the pull of the force of
gravity becomes dominant until it falls on the ground.
Flame:
Ignition of the propellant will cause the production of flame. It
is conical in shape with the vertex located at the gun muzzle. The
flame does not usually go beyond a distance of 6 inches and in pistols or revolvers the flame is often less than 3 inches.
The flame causes scorching or burning of the skin and searing of
the hair at the target in a very near shot. In contact fire, the edges of
the wound of entry may be burned.
Heated, Compressed and Expanded Gas:
Ignition of the gunpowder will cause production of heat and gas.
Considering the limited space of the firing chamber and barrel, the
compressed gas propels the bullet to move forward. The volume
of the gas generated is dependent on the nature and quantity of the
propellant. Thus a 50 grain gunpowder in a cartridge with black
powder (one grain producing 200 to 300 cc. of gas) will cause the
production of 10 to 15 liters of gas while the same amount of
cartridge with smokeless powder (one grain producing 800 to 900 cc.
of gas) will cause production of 40 to 45 liters of gas confined in a
very limited space. This is on the presumption that all of the gunpowder were ignited.
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LEGAL MEDICINE
The sudden release of the expanded gas from the muzzle following the bullet is known as a muzzle blast.
Smoke (Soot, Smudging, Fouling, Smoke Blackening):
This is one of the byproducts of complete combustion of the
gunpowder and other elements with the propellant. It is light,
almost black, and lack sufficient force to penetrate the skin. It is
merely deposited on the target and readily wiped off. It may be seen
with a distance of up to 12 inches.
The presence of smudging at the wound of entrance infers
a near shot. The shape may also be useful in determining the trajectory. A circular shape deposition may be typical of a perpendicular approach of the bullet while in case of an acute angle the
deposition may appear to be elliptical.
Powder Grains:
This consists of the unburned, burning and partially bumed
powder, together with graphite which come out of the muzzle.
Inasmuch as it is relatively heavier than smoke, it leaves the barrel
with appreciable velocity and in near shot, it is responsible to the
production of tattooing (stippling, peppering) around the gunshot
wound of entrance.
In close range, the powder grains penetrate the dermal and epidermal layers of the skin and may cause hemorrhage in deeper tissue
which cannot be removed by ordinary wiping. Microcontusion may
be observed around the punctured area and the shape of the puncture
may denote the shape of the penetrating grain. As the distance of
the gun muzzle to the target increases, the area of destruction increases, but the density of tattooing decreases.
In case of black powder, the residue is composed of nitrates,
thiocyanates, thiosulphates, potassium carbonates, potassium sulphate
and potassium sulphide, while in smokeless powder, the residue is
composed of granules with nitrites and cellulose nitrates with graphite.
The presence of tattooing or stippling may be seen around the
wound of entrance up to a distance of 24 inches, although there may
be considerable variation from gun to gun.
Powder Burns:
Powder burns is a term commonly used by physicians whenever
there is blackening of the margin of the gunshot wound of entrance.
The blackening is due to smoke smudging, gunpowder tattooing and
to a certain extent burning of the wound margin. It is the combined
effects of these elements that are considered to be powder bums.
Actually, such blackening is primarily due to smoke smudging and
GUNSHOT WOUNDS
351
gunpowder tattooing so that the term sotting of the target rather
than powder bums is more appropriate to describe the condition.
Factors Responsible for the Injurious Effects of Missile:
1. Factors Inherent on the Missile:
a. Speed of the Bullet — The greater the muzzle velocity, the
greater is the destruction inasmuch as more kinetic energy
can be liberated.
b. Size and Shape of the Bullet — The bigger the diameter or the
more deformed the bullet is, the greater are the injuries in the
body tissues.
c. Character of the Missile's Movement in Flight — Spinning movement will increase the wounding power; "Yawing" and stumbling
movement may cause sidewise penetration and entry and cause
more destruction; and ricochette may alter tissue involvement
in its course.
2. Nature of the Target:
a. Density of Target — The greater the density of the tissue struck,
the greater will be the damage. More energy will be spent by
the bullet in its course in penetrating skin, bones and clothes.
Heavy thick clothes may prevent penetration of missile; fragile
bone may fragment when hit and each fragment may act as a
secondary splinter to cause further injuries.
b. Length of Tissue Involvement in its Course — The longer the
distance of travel of the missile in the body, the more kinetic
energy it liberates, and the more destruction it will produce.
c. Nature of the Media Traversed — Bullet passing air spaces is less
destructive inasmuch as air is relatively compressible however,
bullet traveling in a liquid or solid media may accelerate transmission of force to the surrounding tissue thus, causing more
destruction.
d. Vitality of the Part Involved — There is more likelihood for a
fatal consequence when vital organs are involved than those in
other parts of the body.
Abrasion Collar (Contuso-abradded Collar, Marginal Abrasion):
The pressure of the bullet on the skin will cause the skin to be
depressed and as the bullet lacerates the skin, the depressed portion
will be rubbed with the rough surface of the bullet. A perpendicular
approach will produce an even width of the collar. An acute angle
of approach will cause an abrasion collar wider at the acute angle of
approach.
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Destructive Mechanism of Gunshot:
The following physical phenomena are responsible for the causation
of injury in the body of the victim:
1. Laceration and Permanent Cavity in the Bullet Trajectory:
The pressure of the speeding bullet produces severe pressure on
the tissues and organs causing laceration and mechanically creates
a permanent cavity. High velocity bullets can cause bigger damage
and wider cavity formation.
2. Temporary Cavity:
This is the instantaneous radial displacement of the soft tissues
during the passage of the bullet due to the liberation of kinetic
energy. The size of the cavity is dependent on the velocity of the
bullet and elasticity of the tissues. The greater the velocity, the
larger the temporary cavity formed. The diameter and volume
of the temporary cavity are many times greater than the diameter
and volume of the projectile that produces it.
Although the
development is transient during the passage of the missile, it causes
loss of function to the part involved and further act as a secondary
missile to involve other areas.
3. Hydrostatic
Force:
When the bullet traverses organs filled with fluid, like a full
stomach, cerebral ventricle, heart chambers, the liquid contents
within the lumen of these organs are displaced radially away from
the bullet path producing extensive laceration.
The displaced
fluid carries with it the kinetic energy which in turn acts as a
secondary projectile causing destruction of tissues not on the path
of the bullet.
4. Shock Wave:
This is the dissipation of kinetic energy in a radial direction
perpendicular to the path of the bullet when the bullet velocity is
more than the speed of sound (the speed of sound is 1,087 feet
per second).
The severe intensity of the wave causes severe
shocking effect on the adjacent tissues and may cause actual
destruction or lessening of function.
5. Fragmentation or Disintegration of the Bullet:
When the bullet hits a hard object (bone), it fragments to
several pieces.
When the bullet velocity is more than 2,000
ft/sec. it disintegrates and each fragment has sufficient kinetic
energy to cause injuries similar to the mother bullet. It may cause
laceration, fracture and shocking effect, thus increasing the
destructive effect of gunshot. This causes more "shocking power"
or "knockdown power" of the bullet.
GUNSHOT WOUNDS
353
6. Fragmentation of Hard Brittle Object in the Trajectory:
Bone involvement along the trajectory may cause comminuted
fracture and each bone fragment may cause additional damage on
the surrounding tissues and even in the wound of exit.
Passage of the bullet causes a clean-cut hole at the point of initial
contact and beveling at the point of exit. The beveling is due to
the absence of a hard support as the bullet leaves the bone.
In the skull a through and through wound will produce a round
or oval hole at the outer table with leveling of the inner table and
at the point when a bullet makes the exit, the clean cut hole will
be at the inner table and beveling will be at the outer table.
7. Muzzle Blast in Contact Fire:
When the gun muzzle is pressed on the skin when fired, all of
the products of combustion primarily the muzzle blast will penetrate the tissues causing severe mechanical destruction on account
of pressure. The explosive effect will cause extensive laceration of
soft tissues and fracture of bones.
8. Other Consequential Effects on the Body of the Victim:
Aside from direct involvement of vital structures of the body,
pressure to other organs and tissues, the gunshot wound may be
the source of hemorrhage, infection, paralysis, shock, loss of
functioning etc. which may cause disability or death on the
victim.
/
Gunshot Wound of Entrance (Entrance Defect, Inshoot):
The appearance of the gunshot wound of entrance depends upon
the following:
1. Caliber of the Wounding Weapon:
Excluding other factors which may influence the size of the
wound of entrance^ the higher the caliber of the wounding bullet
the greater will be the size of the wound of entrance'/ It must not
be overlooked that the manner of approach of the bullet to the
skin, the distance of the muzzle of the firearm to the skin surface,
the deformity or splitting of the bullet and the portion of the skin
surface involves modification of the size and shape of the entrance.
2. Characteristics Inherent to the Wound of Entrance:.
The wound of entrance, as a general rule, is»'oval or circular
with inverted edges,' except in near shot or in grazing or slap
wounaT'^ATUieTDuiret approaches the skin, there is an indentation
of the skin surface but later, on account of the extreme pressure;
the skin tissues give way. The rough surface of the bullet comes
in contact with the skin thereby producing a contusion or abrasion
LEGAL MEDICINE
354
collar. In most cases,' the size of the wound of entrance is smaller
than the caliber of the wounding bullet'on account of the retraction
of the connective tissues.
0
The wound of exit is usually larger than the wound of entrance*—'
It may be stellate, slit-like, cruciform, or markedly lacerated. The
deformity of the bullet in its course inside the body, the lack of
support beyond the skin, and the velocity of the missile are
responsible for the increase in size of the exit wound.
3. Direction of the Fire:
A* right angl£ approach of the bullet will make the wound of
entrance circular in shape, except when the missile is deformed
or the fire is in contact or near. In cases of an acute angle of approach of the bullet, the wound of entrance is oval in shape with the
contusion or abrasion collar widest on the side of the acute angle
of approach. There is more likelihood for deflection of the bullet
course wherever it hits the bony tissue.
4. Shape and Composition of the Missile:
Deformity of the bullet modifies the shape of the wound of
entrance. Some missiles are purposely made to enhance deformity
upon hitting hard objects like hollow-point, dum-dum and soft
point bullets.
Hard or armor-piercing bullets are not usually
deformed on account of their hard metallic constituents.
5. Range:
In close range fire, the injury is not only due to the missile but
also due to the pressure of the expanded gases, flame and other
solid products of combustion. Distant fire usually produces the
characteristic effect of the bullet alone.
6. Kind of Weapon:
High power weapon has more destructive effect as compared
with low power one. The shape of the bullet also plays an important role. Conical shape free end bullets have more piercing
power without marked tissue destruction while missiles with
hemispherical free ends are more destructive.
Contact F i r e : ^
The nature and extent of the injury is caused not only by the
force of the bullet but also by the gas of the muzzle blast and part of
the body involved. T h e following factors must be taken into consideration:
1. The Effectiveness of the Sealing Between the Gun Muzzle and the
Skin:
If all the gaseous product of combustion is prevented from
GUNSHOT WOUNDS
355
being spilled out, there will be more destructive effects on the
tissues.
2. The Amount of Gas Liberated
pellant:
by
the Combustion of the Pro-
The volume of gas liberated after explosion of the propellant is
dependent on the amount and nature of the powder, and the
extent of powder combustion. The greater is the amount of gas in
a confined area, the greater will be the tissue destruction.
3. Nature of Bullet:
Bigger caliber bullet is obviously more destructive than smaller
ones. Soft or hollow point bullet has the tendency to flatten and
causes more damage to tissues.
4. Part of the Body Involved:
The nature, character and extent of injury in contact fire is
different
( 1 ) when the bone is superficially located under the
skin, and ( 2 ) when the bone is deeply located in loose or soft
parts of the body.
Pressed and Firm Contact Fire: S
1. On Parts of the Body Where Bone is Superficial:
This is commonly observed on the head where the skull is just
underneath the scalp. The following are the characteristics of the
injuries:
a. The wound of entrance is* large," frequently star-shaped due to
tear radiating from the entrance wound caused by the blast
effect which follows the sudden release of gases into a confined
area between the skin and the underlying bone.
b. Edges of the wound may be" everted.' The creeping of the gases
between the skull and the scalp causes the skin to move towards
the muzzle.
c. Areas in the entrance wound is^ blackened by burns, tattooing
and smudging . Singeing of the hair is confined only at the site
of wound of entrance.
d. Muzzle imprint, Barrel impression (Profile of the muzzle) on the
skin — The outward movement of the skin caused by the imprisoned gas will add more pressure to the gun muzzle coupled
with the heat of the explosion and will cause iron-like effect on
the pressed skin.
1 1
Causes of Muzzle Imprint:
(1) The gun muzzle is pressed on the body at the time of the
fire and the heated muzzle during the blast produced an
ironing effect on the skin.
356
LEGAL MEDICINE
(2) The gun muzzle is pressed on the body, pushed momentarily away and then hit the body again because of the
continuous inward pressure.
( 3 ) When the gun is fired on areas of the body where bony
tissue is superficial, like the scalp, the muzzle blast has the
tendency to creep in the loose connective tissue between
the skull and the skin thereby pushing the skin outward
to press on the gun muzzle.
e. The bullet may cause radiating fracture and the pressure of the
gases may cause fragmentation of the skull and a severe laceration of the brain and its meninges.
f. Blood and tissue become pink due to carbon monoxide.
g. Fragments of lead and bullet jacket may be found.
Metal Fouling — When the bullet travels the whole length of the
tight fitting barrel, it is rotated by the lands and grooves. Its surface
is scraped by the lands and the scraping is ejected from the barrel and
strikes the target. It may lodge on the clothings or may cause small
abrasions or superficial lacerations on the skin around the main
wound.
h. Singeing of hair.
Gunshot wound of entrance with contusion collar, powder burns and tattooing.
2. Parts of the Body Where the Bone is Deeply Located:
a. Wound of entrance is usually large, circular and without radiating
GUNSHOT WOUNDS
357
laceration.
The gas from the muzzle can easily penetrate
deeper structures.
b. Edges are everted due to outward slapping of the skin. In some
instances, soft tissues (blood, fibrous and muscular tissues)
may be found inside the gun barrel. This is due to the negative
pressure created in the barrel after the blast.
c. Singeing of the hair, blackening of the wound due to fouling,
burn, and tattooing.
d. Muzzle imprint due to outward slapping of the skin and heat.
e. Pinkish color of the deeper structures due to carbon monoxide.
Loose Contact or Near F i r e : ^
1. Entrance wound may be^large circular or oval depending upon the
angle of approach of the bullet.
2^Abrasion collar**or ring is distinct.
3^Smudging, burning and tattooing are prominent with singeing of
the hair.
4. Muzzle imprint may be seen depending upon the degree of slapping of the skin of the gun muzzle.
5. There is^blackening of the bullet tract to a certain depth.
6.TJarboxyhemoglobin is present in the wound" and surrounding areas.
Short Range Fire ( 1 to 15 cm. distance): ^
1. Edges of the entrance wound is inverted.
2. If within the flame reach (about 6 inches in rifle and high powered
firearms and less than 3 inches from an ordinary handgun), there is
an area of burning.
S.^mudging is present'due to smoke.
4. "Powder tattooing* is present (dense and limited dimension of
spread).
S.'vAbrasion ring'br collar is present (contact ring).
Medium Range Fire (more than 15 cm. but less than 60 c m . ) : ^
1. Gunshot wound with* inverted edges'and with abrasion collar is
present.
T
2. Burning effects (skin bum and hair singeing) is absent.
3. Smudging may be present if less than 30 cm. distance.
c
4. Gunpowder tattooing" is present but of lesser density and has a
wider area of distribution.
o. Contact ring is present.
358
LEGAL MEDICINE
Fired More Than 60 cm. Distance: /
1. Gunshot wound is'circular or ovaf depending on the angle of
approach with abrasion collar.
2. Wound of entrance has°no* burning, smudging or tattooing.
3. Contact ring is present.
Microscopic Examination of Gunshot Wound of Entrance:
1. In Contact or Near Contact Fire:
a. Epithelial damage and powder residue deposit are present.
b. Massive heat may carbonize the epithelial cells.
c. The hot bullet may produce coagulation necrosis.
d. Basilar cells are swollen and vacuolated.
e. The corium may show thermal changes manifested by nuclear
shrinkage, pyknosis and vacuolization.
2. In far Distant Fire:
a. There may be a spotty deposit of powder on skin and subcutaneous tissue.
b. There is cellular destruction along the course of bullet.
^instances When the Size of the Wound of Entrance Do N o t Approxi' m a t e the Caliber of the Firearm:
In distant fire, the rule is that the diameter of the gunshot wound
of entrance is almost the same as the caliber of the wounding firearm,
but in the following instances, the rule is not followed:
1. Factors which make the wound of entrance bigger than the caliber:
a. In contact or near fire — The size of the entrance wound in
contact and near fire is caused by the force of the expanded
gases of explosion and by the bullet.
b. Deformity of the bullet which entered — The bullet might have
hit a hard object before it pierces the skin thereby making the
wound of entrance bigger than the caliber of the missile.
c. Bullet might have entered the skin sidewise — Ordinarily, it is
the ogival portion which pierces the skin first, but occasionally
it may hit the skin sidewise on account of the inequality of
resistance of the surrounding media in its flight. The spinning
movement and the tail wag ( w o b b l e ) may cause the bullet to
enter in its vertical axis.
d. Acute angular approach of the bullet — Due to the sliding
trajectory of the bullet, the wound becomes oval in shape with
prominence of the contusion collar at the side of the acute
angle of approach.
GUNSHOT WOUNDS
359
2. Factors which make the wound of entrance smaller than the
caliber:
a. Fragmentation of the bullet before penetrating the skin — If in
the flight of the bullet it hits a hard target which causes its
fragmentation and only the fragments pierce the skin, the
wound produced will be smaller than the caliber of the firearm
which causes the fire.
b. Contraction of the elastic tissues of the skin — The form of the
bullet may be preserved but the entrance wound may be smaller
than the caliber on account of the contraction of the elastic
tissues of the skin.
In shotgun fire, the size of the wound of entrance is dependent
upon the distance of the fire.
Near fire causes concentration
of entry of the pellets, and as distance increases the pellets disperse with individual pellets causing individual wounds of entry.
Only in this instance may the wound of entrance of the same
size as the gauge of the shotgun pellets.
Other Evidences or Findings Used to Determine Entrance of Gunshot:
When the course of the bullet is through and through and there is
difficulty in the determination as to which is the entrance because
it does not show characteristic findings, or it has been modified by
healing, infection or surgical intervention, the medical examiner must
resort to the following:
1. Examination of the clothings, if involved in the course of the
bullet:
a. The fabric of the clothings may show punch in destruction at
the site of the wound of entrance.
b. Examination for particles of gunpowder on the clothings at the
site near the wound in question. If the clothings give a positive
test for gunpowder, then it must be the wound of entrance.
This is only true if the fire is near.
2. Examination of the internal injuries caused by the bullet:
a. In case where the missile hits a bone, the bone fragments are
driven away from the wound of entrance.
b. Destruction of the bone at the surface facing the wound of
entrance is oval and with sharp edges, while the surface facing
the wound of exit is bigger, irregular and bevelled.
c. Direction of the cartilage and other soft tissues will be driven
away from the gunshot wound of entrance.
LEGAL MEDICINE
360
3. Testimony of witnesses:
The testimony of the witness as to the position of the victim
and the assailant when the firearm was fired may determine which
of the wounds is the entrance wound.
Determination of the Trajectory of the Bullet Inside the Body of
the Victim:
The following must be taken into consideration to determine the
course of the bullet inside the body of the victim:
1. External
Examination:
a. Shape of the Wound of Entrance — When the bullet is fired at
right angle with the skin the wound of entrance is circular
except in cases of near fire. If fired at another angle, the wound of
entrance is usually oval in shape. When the bullet is deformed,
no such characteristic findings will be observed.
b. Shape and Distribution of the Contusion or Abrasion Collar —
As a general rule, the contusion (abrasion) collar is widest at
the side of the acute angle of approach of the bullet. If the
bullet hits the skin perpendicularly, then the collar will have a
uniform width around the gunshot wound, except when the
bullet is deformed or in near fire.
c. Difference in Level Between the Entrance and Exit Wounds —
The difference in height between the gunshot wound of entrance
and exit may be determined by measuring those wounds from the
fixed references in the body, e.g. sole of the foot, or by drawing
a horizontal line across the body and using it as a reference
point.
d. By Probing the Wound of Entrance — The probe must be
applied without too much force so as not to create a new
course in the soft tissues. Care must be observed in cases of
deflection of the course due to some hard objects that might
have been involved.
2. Internal
Examination:
a. Actual Dissection and Tracing the Course of the
Autopsy:
Wound at
The tissues involved are hemorrhagic and bone spicules and
lead particles may be seen or felt.
b. Fracture of Bones and Course in Visceral Organs:
Occasionally, the nature of the bone fracture may show the
direction, especially when the bullet is not deformed before
causing the fracture. Injuries in solid visceral organs may clearly
manifest the course because of the absence of contractility.
GUNSHOT WOUNDS
361
c. Location of Bone Fragments and Lead Particles:
The bone spicules and lead fragments go with the flight of
the bullet and may be utilized in the determination of the
trajectory.
d. X-ray
Examination:
Bone spicules and lead fragments may be observed and their
exact location determined in relation with the wound of entrance.
3. Other Evidences to Show Trajectory:
a. Relative difference in the vertical location of the entrance from
the exit in the clothings.
b. Relative position and distance of the assailant from the victim
in the reconstruction or reenactment of the crime.
xi. Testimony of witnesses.
Exit (Outshoot) Wound: ^
An exit wound does not show characteristic shape unlike the
wound of entrance. It may be slit-like, stellate, irregular or even
similar to the wound of entrance. This is due to the absence of
external support beyond the skin so the bullet tends to tear or
shatter the skin while sufficient amount of kinetic energy is still
in the bullet during the process of piercing the skin.
^ • T h e edges of the wound are everted and occasionally portions of the
inner tissues are protruding. Aside from the bone, the skin is one of
the most resistant to penetrate in the course of the bullet so that
most often the bullet is lodged just underneath the skin. It may
only be noticed by the presence of contusion over the area wherein
it is lodged or its presence may be noticed by palpitation. The bullet
may have lost its^monierj^um after piercing_the_skin and just fall
without perforation of the clothing.
Bones may be involved in the trajectory and its spicules may
create additional injury to the wound of exit.
Variation on the shape of the wound of exit may be attributable to
the deformity of the bullet in its passage in the body and to the wabbling and stumbling movement of the bullet during its course and
fragmentation of the missiles.
Shored Gunshot Wound of Exit — If the place where the gunshot
wound of exit is pressed on a hard pbject as when the victim is lying
on his back on a hard object or in small caliber shots (like 0.22) the
wound of exit tends to be circular or nearly circular with abrasion at
its border. It is also observed that tight-fitting clothings, waist band,
belt collar, brassiere may also support the skin to enhance formation
LEGAL MEDICINE
362
of a circular wound of exit. This is known as a shored gunshot
wound of exit.
Shored gunshot wound of exit is produced when the outstretched
skin is impaled, sandwiched and crushed between the outgoing bullet
and the unyielding object is over the exit site, thus making the
wound to be circular with abrasion collar at its margin. Proper coaptation of the wound margin is impossible because of the loss of
skin just like those observed in entrance wound. In contrast with
the entrance wound, the supported exit wound shows a scalloped or
punched-out abrasion collar and sharply contoured skin in between
the radiating skin lacerations marginating the abrasion (Journal of
Forensic Medicine and Pathology, Vol. 4, Sept. 1983, p. 99).
G u n s h o t w o u n d o f exit o f the skull w i t h p u n c h out edges
stinction Between Gunshot Wound of Entrance and Wound of
Exit:
Entrance Wound
Exit Wound
1. Appears to be smaller than the
missile owing to the elasticity
of the tissue.
1. Always bigger than the missile.
2. Edges are inverted.
2. Edges are everted.
3. It does not manifest any definite shape.
3. Usually oval or round depending upon the angle of approach
of the bullet.
4. "Contusion collar" or "Con-
4. "Contusion collar" is absent.
GUNSHOT WOUNDS
363
tact ring" is present, due to
invagination of the skin and
apiInning of the missile.
4. Tattooing
Tat
or smudging may be
present when firing is near.
.5v Always absent.
6. Underlying
protruding.
6. Underlying tissues may be seen
protruding from the wound.
7. May be absent, if missile is
lodged in the body.
tissues
are
not
7. Always present after fire.
8. Paxaffin test may be positive.
8. Paraffin test always negative.
The "Odd and Even Rule" in Gunshot Wounds: ^
If the number of gunshot wounds of entrance and exit found in
the body of the victim is even, the presumption is that no bullet is
lodged in the body, but if the number of the gunshot wounds of
entrance and exit is odd, the presumption is that one or more bullets
might have been lodged in the body.
The rule is merely presumptive and actual inspection and autopsy
will verify the truth of the presumption. It may be possible that all
of those wounds or a majority of them are entrance wounds with
some bullets lodged, yet the number may still be even.
Sometimes it is difficult to locate the lodged bullet but with the
help of a portable X-ray, its location and extraction can be facilitated.
How to Determine the Number of Fires Made by the Offenderrr
1. Determination of the Number of Spent Shells:
Search must be made at the scene of the crime or at the place
where the offender made the fire, for spent shells, if the weapon
used is an automatic pistol or rifle. In case of revolver fire, the
empty shells may be found still inside the cylindrical magazine.
In machine gun fire, the spent shells may still be attached to the
cartridge belt.
2. Determination of Entrance Wounds in the Body of the Victim:
Although most often erroneous, the investigator may be given
an idea as to the minimum number of shots made. The number of
wounds of entrance may not show the exact number of fire
because:
a. Not all the fire made may hit the body of the victim.
b. The bullet may in the course of its flight hit a hard object
thereby splitting it and each fragment may produce separate
wounds of entrance.
c. The bullet may have perforated a part of the body and then
364
LEGAL MEDICINE
made another wound of entrance in some other parts of the
body; thus a single shot may produce two wounds of entrance.
3. Number of Shots Heard by Witnesses:
The witnesses might be able to count the number of shots
heard especially if the shots were made at sufficient intervals of
succession. However in cases of machine gun fire, there is difficulty
in ascertaining the number heard and the testimony of witness
as to the number of shots heard must be admitted with caution.
Mutilating gunshot wound of exit
^Distances when the Number of Gunshot Wounds of Entrance is Less
than the Number of Gunshot Wounds of Exit in the Body of the
Victim:
1. A bullet might have entered the body but split into several fragments, each of which made a separate exit.
2. One of the bullets might have entered a natural orifice of the
body, e.g. mouth, nostrils, thereby making it not visible and then
producing a wound of exit.
3. There might be two or more bullets which entered the body
through a common entrance and later making individual exit
wounds.
4. In near shot with a shotgun, the pellets might have entered in a
common wound and later dispersed while inside the body and
making separate wounds of exit.
GUNSHOT WOUNDS
365
yInstances when the Number of Gunshot Wounds of Entrance is More
than the Number of Gunshot Wounds of Exit in the Body of the
Victim:
1. When one or more bullets are not through and through and the
bullet is lodged in the body.
2. When all of the bullets produce through and through wounds but
one or more made an exit in the natural orifices of the body, e.g.
eyes, mouth, nostrils.
3. When different shots produced different wounds of entrance but
two or more shots produced a common exit wound.
/'Instances when there is No Gunshot Wound of Exit but the Bullet
is N o t Found in the Body of the Victim:
1. When the bullet is lodged in the gastro-intestinal tract and expelled
through the bowel", or lodged in the pharynx and expelled through
the mouth by coughing.
2. Near fire with a blank cartridge produced a wound of entrance
but no slug may be recovered.
3. The bullet may enter the wound of entrance and upon hitting
the bone the course is deflected to have the wound of entrance as
the wound of exit (cited by Modi, A Textbook of Medical Jurisprudence & Toxicology, 10th ed.).
Trajectory of a gunshot w o u n d In the head.
366
LEGAL MEDICINE
Determining Whether the Wound is Ante-mortem or Post-mortem:
If the wound indicates that there has been profuse hemorrhage, or
there are signs of vital reactions in the tissue, then the gunshot
wound is ante-mortem. The presence and degree of vital reactions
depends upon the period of survival of the victim. It may be manifested in the form of swelling, effusion of lymph or other evidences
of repair. Microscopically, there is congestion and leucocytic infiltration.
Wounds inflicted after death show no evidence of profuse hemorrhage, no retraction of the edges, and there are no vital reactions.
Problems Confronting Forensic Physician in the Identification of
Gunshot Wounds:
1. Alteration of the Lesion Due to Natural Process:
The drying of the margins of the wound opening may modify
measurements.
The size and shape is considerably altered by
decomposition.
Healing process and infection may modify its
appearance and it may be mistaken for some other types of injuries.
2. Medical and Surgical Intervention:
The wound may be scrubbed, medication applied, or surgically
debridded, extended, excised or sutured. This problem is properly
solved by having access to the clinical record of the patient.
3. Embalming:
Embalming trocar may be introduced on the gunshot wound itself or the trocar mark itself may be mistaken for a gunshot wound.
The gunshot wound may be extended to reach the principal artery
for the embalming fluid to enter. The passage of the embalming
fluid may wash out the product of the gunpowder combustion,
The trajectory of the bullet may be modified by the trocar thrust.
The suturing of the gunshot wound and the application of "makeu p " may modify the actual appearance of the wound.
4. Problem Inherent to the Injury Itself:
The gunshot wound may be covered with clotted blood or with
scab to make it not visible. Grazing injury caused by glancing of
the bullet on the skin may appear like abrasions or lacerations.
Wound brought about by screw drivers, icepicks or other sharp
pointed instruments might be considered to be gunshot wounds.
Bullet might have entered or made its exit in the natural openings,
like mouth, nostril, ear, etc. making its identification difficult.
The wound may be located in thick haired scalp, skin fold and
make visibility difficult.
GUNSHOT WOUNDS
367
5. X-ray Examination:
The use of an X-ray is almost indispensable in the examination
of gunshot injuries. The use of the apparatus will facilitate recovery of the lodged bullet together with the location of its
fragments.
The body might have been X-rayed with unspent and spent
ammunition clinging on the clothings and may be mistaken to
be inside the body; teeth fillings or crown may resemble bullet on
X-ray examination of the skull. "Migratory" bullets may be found
in some parts of the body away from the bullet tract. Victim
may have "bullet souvenir" on account of a previous gunshot
injury and may confuse the examiner as to be an effect of recent
shot.
Clothings:
The effects of the garments on the movement of the bullet depend
upon:
1. The number of layers of fabric between the muzzle and subjacent
skin;
2. Nature of the fabric which may be closely woven or loose mesh,
light or heavy, cotton or synthetic fibers.
3. Muzzle-clothings distance.
Examination of the External Wearing Apparel of the Victim of
Gunshot maybe Significant in Investigation because:
1. It may establish the possible range of the fire:
a. Contact Fire:
(1) There is a tear of the clothings covering the skin at the site
of the gunshot wound with fusion of its fibers in case of
artificial fabric. Fibers are turned outward away from the
body.
(2) Soot deposit and gunpowder tattooing around the torn
fabric. Burning of the fibers are visible.
(3) Muzzle imprint (profile of the muzzle) especially in artificial fabric may be present.
(4) Dirt and greasy deposit is carried by the bullet and may be
wiped out and be visible on the torn clothing.
b. Not Contact but Near Shot:
The same findings as in contact shot except when it is beyond the flame range and absence of muzzle imprint.
c. Far Fire:
There is a hole tear with inward direction of the thread.
368
LEGAL MEDICINE
2. It may be useful in the determination as to which is the point of
entry and of exit of the bullet:
The direction of the fibers will be inward or inverted at the
point of entry, while it is outward or everted at the point of
exit. Care must be exercised in making the inference inasmuch
as improper handling may change the direction of the fibers.
3. It may be useful in locating the bullet:
The clothings, like skin and bone are not easily perforated. It
is frequently observed that the bullet is recovered just underneath
the clothings of a dead victim at the crime scene.
Special Consideration on Bullets:
1. Souvenir Bullet:
Bullet has been lodged and has remained in the body. Its long
presence causes the development of a dense fibrous tissue capsule
around the bullet causing no untoward effect. It may be located
just underneath the skin to be easily palpated and may cause
inconvenience and irritation. Deep seated location may not cause
any problem to warrant its immediate removal.
2. Bullet Migration:
Bullet that is not lodged in a place where it was previously
located. A bullet which strikes the neck may enter the air passage,
and it may be coughed out or swallowed and recovered in the
stomach or intestine.
Bullets Embolism — a special form of bullet migration when
the bullet loses its momentum while inside the chamber of the
heart or inside the big blood vessels and carried by the circulating
blood to some parts of the body where it may be lodged. It may
cause sudden loss of function of the area supplied or death if vital
organs are involved.
3. Tandem Bullet:
T w o or more bullets leaving the barrel one after another. In
cases of misfire or a defect in the cartridge, the bullet may be
lodged in the barrel and a succeeding shot may cause the initial and
the succeeding bullet to travel in tandem. There is a strong
possibility for them to enter the target in a common hole. This
might create doubt to the statement made by the firer that he
made only a single shot, but ballistic examination can show as
to whether the bullet travelled in tandem.
GUNSHOT WOUNDS
)<GUNSHOT WOUNDS MAY BE SUICIDAL,
HOMICIDAL OR ACCIDENTAL
369
.
Evidences that tend to show that the Gunshot(s) Wound is Suicidal.
1. The shot was fired in a closed or locked room, usually in the
office or bedroom. If in the bedroom, the shot was fired while
the victim was lying in bed and the weapon covered with pillow
or bedding to muffle the sound. It may be committed in an
open isolated or uninhabited place.
2. The death weapon is almost always found near the place where
the victim was found. When a light, low caliber hand firearm was
used and the shot was made in parts of the body where death
may develop almost instantaneously, the victim may be seen with
the grip of the firearm firmly held in the palm of the wounding
hand (cadaveric spasm).
3. The shot was fired with the muzzle of the gun in contact with
the part of the body involved or at close range. The wound of
entrance may show signs of muzzle impression, burning, smudging and tattooing.
4. The location of the gunshot wound of entrance is in an accessible
part of the body to the wounding hand. It may be at the temple,
roof of the mouth, precordial or epigastric region. A person
committing suicide will do the act in his most convenient way,
unless he has the intention of deceiving the investigator.
5. The shot is usually solitary. If the shot is made on the head
involving the brain, the shocking effect of the injury will not
make him capable of firing another shot. However, shots in some
parts of the body which may not produce immediate death or
sudden loss of consciousness, the possibility of additional shots is
not remote. The victim may be determined to die and had fired
additional shots to insure realization of his intention.
6. The direction of the fire is compatible with the usual trajectory
of the bullet considering the hand used and the part of the body
involved. A shot on the temple is usually directed towards the
opposite temple and upwards, while a shot in the precordium
and epigastrium is usually backwards and downwards.
7. Personal history may reveal social, economic, business or marital
problem which the victim cannot solve. He may have history
of mental disease, depression, severe frustration or previous
attempt of self-destruction.
8. Examination of the hand of the victim may show presence of
gunpowder.
9. Entrance wound do not usually involve clothings.
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10. Fingerprints of victim on the butt.
11. Search of the place where the shot took place may reveal a
suicide note which usually mentions among other things the
reason why the victim committed suicide.
12. No disturbance in the place of death.
''Russian Roulette:
A group of persons may agree to load a revolver with a single
live cartridge and each member of the group will cock and pull the
trigger with the muzzle pressed or directed to the temple or towards
other vital parts of the body. The person who will pull the trigger
with the live cartridge in the firing chamber will suffer the fatal
consequence. Although it may be considered suicidal because any
person who participates to such an agreement may have the desire
to commit it, the unfortunate victim has no predetermined desire
of self-destruction.
idences to show that the Gunshot Wound is Homicidal:
1. The site or sites of wound of entrance has no point of election.
2. The fire is made when the victim is usually at some distance from
assailant.
3. Signs of struggle (defense wounds) may be present in the victim.
4. There may be a disturbance of the surroundings on account of
previous struggle.
5. Wounding firearm usually is not found at the scene of the crime.
6. Testimony of witnesses.
-Evidences to show that the Gunshot Wound is Accidental:
1. Usually there is but one shot.
2. There is no special area of the body involved.
3. Consideration of the testimony of the assailant and determination
as to whether it is possible to be accidental by knowing the relative position of the victim and the assailant.
4. Testimony of witnesses.
Points to be Considered and Included in the Report by the Physician:
1. Complete description of the wound of entrance and exit.
2. Location of the wound:
a. Part of the body involved.
b. Distance of the wound from the mid-line.
c. Distance of the wound from the heel or buttock.
3. Direction and length of the bullet tract.
4. Organs or tissues involved in its course.
GUNSHOT WOUNDS
5. Location of the missile, if lodged in the body.
371
(
6. Diagram, photograph, sketch, or drawing showing the location
and number of wounds.
Questions that a Physician is Expected to Answer in Court:
1. Could the wound or wounds be inflicted by the weapon presented
to him?
2. At what range was it fired?
3. What was the direction of the fire?
4. May it be possible that those gunshot wounds are self-inflicted?
5. Are there signs of struggle in the victim?
6. May it be possible for the victim to fire or resist the attack after
the injury was sustained by him?
7. Did the victim die instantaneously?
8. Where was the relative position of the assailant and the victim
when the shot was fired?
Can the Caliber of the Wounding Firearm be Determined from the
Size of the Gunshot Wound of Entrance?
Although the size of the gunshot wound of entrance is influenced
by several factors, the caliber may be inferred from the diameter of
the gunshot wound. In most cases, especially when the wound is
circular, the caliber is almost the same as the diameter of the wound
of entrance.
Determination of the Length of Survival of the Victim:
The length of survival of the victim may be inferred from the
following:
1. Nature of the gunshot wound.
2. Organs involved.
3. Presence or absence of infection or other complications.
4. Amount of blood loss.
5. Physical condition of the victim.
Capacity of the Victim to Perform Volitional Acts:
The power of the victim to perform voluntary acts depends upon
the area of the body involved, involvement of vital organs, and the
resistance of the victim. Injuries which will cause incapacity to do
voluntary acts as those involving the brain and the spinal cord
definitely inhibits volitional acts.
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Determination as to the Length of Time a Firearm had been Fired s
Physical and chemical examinations of the residue inside the
barrel does not give a conclusive evidence as to how long the
firearm has been discharged. Most often the examiner does not
know whether the barrel was cleaned immediately after the discharge. Smokeless powder which is now commonly used does not
leave much residue for such determination. However, inferences
may be drawn from the following:
1. Odor of the Gas Inside the Barrel:
Explosion of the gunpowder produces considerable evolution of
gases consisting of nitrogen, hydrogen sulfide, carbon dioxide,
carbon monoxide and methane. This mixture of gases has a
peculiar characteristic odor which may be noticed several hours
after the discharge. Later, it will disappear as gases usually evaporate or chemically transformed to other odorless compounds.
2. Chemical Changes Inside the Barrel:
Black powder is a mixture of charcoal, sulfur and nitrates of
sodium or potassium. One of the products of combustion is
hydrogen sulfide. Hydrogen sulfide is rapidly converted to thiosulfate, thiocyanate and finally to sulfates of potassium or sodium.
The absence of the peculiar characteristic odor and the presence
of thiosulfate and thiocyanate which is increasing in amount
shows that the discharge occurred in a matter of few days. Later
the thiosulfate and thiocyanate of sodium or potassium will be
chemically transformed to sulfates and its presence shows that
firing occurred for sometime.
The iron salts in the ferrous state are found during the early
stage and may be transformed to ferric salt after a lapse of a
certain period.
The residue produced by smokeless powder explosion as nitrates are not liable to undergo changes even after a lapse of time,
hence approximation of the time of the discharge is much more
difficult.
The main difficulty in the determination is that the length of
such physical and chemical transformation of the residue of
combustion from one compound to another, cannot be definitely
ascertained. It is dependent upon several factors.
3. Evidences that may be Deduced from the Wound:
Approximation of the age of the wound also infers the time of
discharge. The degree of healing in the absence of subsequent
infection must be considered. If an infection is present, then the
degree of infection may be utilized in the approximation.
GUNSHOT WOUNDS
373
Determining Whether the Wounding Weapon is an Automatic Pistol
or a Revolver:
The following must be taken into consideration to determine
whether the wounding weapon is an automatic pistol or a revolver:
1. Location of the Empty Shells:
In a revolver, the empty shells are found in the cylindrical
magazine chamber after the fire, but in cases of automatic pistol
the empty shells are driven out of the weapon after the shot, to
give way to live cartridge to be in the firing chamber. Thus, in
cases of automatic pistol, the empty shells are found a few yards
away from the place of the firing.
2. Nature of the Spent Bullet:
As a general rule, in automatic firearm, the bullet is copper
jacketed or cupro-nickel jacketed, while in cases of revolver, no
such coating is observed. This is not true in all cases.
3. Nature of the Base of the Cartridge or Spent Shell:
The base of a revolver has a wider diameter than that of the
cylindrical body to keep the cartridge stay in the magazine chamber. There is no such difference in the diameter in case of shells
of automatic pistol.
Can the Direction of the Shot be Determined from the Direction
from which the Sound Came From?
Not possible, unless the flash or the person firing the shot is «een
at the time the shot was fired. The ear is usually at a loss as to
where the shot was fired.
Can the Firearm be Identified by the Sound of the Discharge?
It is impossible to distinguish and memorize the report from two
firearms of the same caliber. It may be possible for a person who is
accustomed to the sounds of firearms of different calibers to identify
the firearm by the sound produced.
Example: The sound of a shotgun may be distinguished from
the sound of a caliber 0.22 pistol.
Gunshot Wound may Not be a Near Fire or may Not Appear to be a
Near Fire:
1. When a device is set up to hold the firearm and to enable it to be
discharged at a long range by the victim.
2. When the gunshot wound of entrance does not show characteristics
of a near shot because the clothings are interposed between the
victim and the firearm.
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LEGAL MEDICINE
3. When the examining physician failed to distinguish between a near
or far shot wound.
4. When the product of a near shot has been washed out of the
wound.
X-ray:
The use of the x-ray must not be overlooked in a gunshot wound
investigation. Several exposures at different angles must be made to
determine the precise location of the bullet, trajectory, position of
the slug, and other injuries.
X-ray Examinations may:
a. Facilitate location and extraction of the bullet lodged.
b. It will reveal fragmentation and their location.
c. It will show bone involvement like fracture.
d. It will reveal trajectory of the bullet.
e. It will show the effects of the bullet wound, like hemorrhage,
escape of air, laceration and other injuries.
SHOTGUN WOUNDS
A shotgun is a shoulder-fired firearm having a barrel that is smoothbored and is intended for the firing of a charged compound of one or
more round balls or pelletsClasses of Shot in a Shotgun Shell:
1. Birdshot — The shot are small ranging in sizes from 0.05 inch to
0.15 diameter and loaded from 200 to 400 shots in the shell.
Birdshots are small and are commonly used for hunting fowls
and other small animals.
2. Buckshot — The shot ranges from 0.24 to 0.33 inch in diameter
and obviously fewer in number in a shot. A standard 12-gauge
shotgun contains only nine shots.
3. Single Projectile (Rifled Slug) — There is only a single shot or slug
in a shell.
Systems Employed in the Determination of the Diameter of the
Barrel of a Shotgun:
1. Gauge System — Determination of the number of lead balls, each
fitting of the bore totals to one pound in weight. The smaller
the gauge designation, the larger is the bore. If twelve balls can
be made from one pound of lead, each fitting the inside of the
barrel of a shotgun, the gun is called 12-gauge or 12-bore shotgun. 12-gauge shotgun is the most commonly used.
GUNSHOT WOUNDS
375
2. Expression of the Bore Diameter in Inches — The 0.410 bore
shotgun is the only shotgun at present to be so designated.
3. Metric System — The bore is expressed in millimeters.
Length of the Barrel:
There is no standard length of the barrel but modem barrels
measure 26, 28, and 30 inches in length.
Grade of Choke:
A shotgun is choked when the muzzle end of the barrel is a diameter smaller than the rest of the barrel. The main purpose of the
constriction is to minimize the dispersal of the pellet or buckshots
after the shot. It is based on the presence or absence of choke and
the degree of choking, that shotguns are classified as:
1. Unchoke — The diameter of the barrel from the rear end up to
the muzzle is the same.
2. Choke — The diameter of the barrel at the muzzle end is smaller
than the rest of the barrel.
a. "Improved Cylinder" — The narrowing of the barrel by 3 to 5
thousands of an inch.
b. Half Choke — narrowing by 15 to 20 thousands of an inch.
c. Full Choke — narrowing from"35 to 40 thousands of an inch.
The lethal range is normally in an area of 30 inches in diameter
at 30 to 40 yards according to the degree of choking.
Types of Shotgun:
1. As to the Number of Barrel:
a. Single Barrel Shotgun:
There is only one barrel and basically the original type.
b. Double Barrel Shotgun:
(1) Side-to-side barrel.
(2) Over-and-under barrel.
2. As to the Manner of Firing and Reloading:
a. Bolt Action:
The action of the bolt ejects the fired shell and loads the
next one.
b. Lever Action:
When the lever is swing down it ejects the fired shell and
loads the next shot.
c. Pump Action:
There is a cylindrical magazine which can accommodate
up to six shells, end to end, beneath the barrel.
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LEGAL MEDICINE
d. Autoloading:
A pull of the trigger not only fires and ejects the shell but
also reloads the next shot and locks it for firing.
Shotgun Cartridge:
A shotgun cartridge is usually 2-3/4 or 3 inches long and the
diameter depends on the gauge of the firearm. The base and the
lower portion of the cylindrical portion is made of brass with the
primer cap at the center of the base. Attached to the free end of
its cylindrical portion is the cylindrical laminated paper tube to
complete the shell casmg.
When the trigger is pulled, the firing pin activates the primer
which in turn ignites the powder charge. Explosion of the gunpowder will cause propulsion of the wad and pellets (shot) in front.
The muzzle velocity of the pellet is relatively smaller as compared
from those discharged from rifled firearms.
Except for the presence and nature of the slug, the component
of the shotgun blast is almost the same as that of a rifled firearm.
It also consists of gunpowder, flame, smoke, pellets and wad.
Shotgun Wound of Entrance:
1. Contact or Near Contact Shot (not more than 6 inches):
On account of the greater quantity of gunpowder in the shotgun cartridge, there is relatively more damage due to muzzle
olast, flame and gunpowder at the site of the wound of entrance
as compared with rifled fire.
a. If the shot is made perpendicular to the skin surface, the wound
of entrance is round but if the shot is made with an acute angle
with the skin the wound is oval. In both instances, the wound
border may be smooth or slightly rugged.
b. The entrance wound is burned, the width of which increases
as the muzzle-skin distance increases but does not exceed 6
inches.
c. There is blackening due to smoke.
d. Gunpowder tattooing is densely located in a limited area. The
area of spread is directly proportional to the muzzle skin
distance.
e. There is contusion of the tissue that has been blackened by
gunpowder.
f. There is singeing of the hair (less than 6 inches).
g. Subcutaneous and deeper tissues are severely disrupted.
h. Blood and other tissues along the bullet tract shows presence
of carbon monoxide.
GUNSHOT WOUNDS
377
i..Wad or its fragments together with shot (pellets) may be recovered from the bullet tract.
2. Long Range Shot (more than 6 inches skin-muzzle distance):
a. At 2 to 3 feet muzzle-skin distance, there is still a single wound
of entry although there may be isolated shots causing independent entry.
b. At 3 to 4 feet distance the wound of entry is usually serrated
or scalloped circumference and often referred to as a "rat
hole".
c. At about 5 to 6 feet distance, the wad tends to produce an
independent injury usually an abrasion at the vicinity of entry
of the shots. The wounding capacity of the wad is very much
less as compared with the shot on account of its lightness and
size.
d. At 6 feet, the shots begins to separate from the conglomerate
shot and at 10 feet each shot already produces independent
wounds of entry.
As the shot begin to separate from one another, there is
the tendency for one shot to strike another causing changes
of the shot course. This phenomena is called "billiard ball
ricochette effect".
e. Smudging due to smoke may be observed up to 15 inches.
f. Gunpowder tattooing may be detected up to 24 inches.
g. In an unchoked shotgun, to estimate the muzzle-target distance,
the following rule must be applied.
Measure the distance between the two farthest shot (pellets) in
inches and subtract one, the number thus obtained will give the
muzzle-target distance in yards.
The character of the wound and the degree of dispersal is influenced by the muzzle-target distance, gauge of the shotgun, degree
of choke and the type of ammunition. However, it is highly recommended to have an experimental shot with the firearm using similar
cartridge and under the same environmental conditions.
A close shot produces more serious injuries because the shots
are concentrated on a specific target and because of greater kinetic
energy of the pellets.
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I / D E T E R M I N A T I O N O F T H E PRESENCE O F
G U N P O W D E R A N D PRIMER C O M P O N E N T S
The Importance of Determining the Gunpowder on the Skin of the
Victim:
1. Determination of the distance of the gun muzzle from the victim's
body when fired:
As discussed previously, the explosion of the powder in the
cartridge expels particles which may be embedded in the skin or
just clinging on the surface at a distance of not more than 24
inches. The distribution of the gunpowder is more at the upper
portion of the wound of entrance, due to the upward position
of the muzzle of the gun when fired. The presence of gunpowder
at or near the wound of entrance shows that the gun muzzle
when fired is not more than 24 inches but its absence will not
preclude near fire because other factors might have intervened.
Less powder particles at the wound of entrance is observed in
smokeless powder as compared with black powder.
2. Determining whether a person has fired a firearm:
The dorsum of the hands are the ones examined to determine the presence of gunpowder. When a person fires a gun, the
powder particles which escape may cling on the dorsum of the
hand. The presence of gunpowder at the dorsum of the hand
may infer that a person has fired a gun.
Basis of the Tests:
When a gun is discharged two types of residues are liberated
namely, the metallic residues from the primer which is not only
blown forward towards the target from the muzzle but also
backward in the direction of the shooter, and also the particles
of burned, burning and unburn ed gunpowder (propellant) moving
also in the same directioni as the metallic residue of the primer.
All of these residues are deposited on the back of the firing hand
of the shooter.
Detection of metallic residue of the primer on the palm of the
hand may also indicate that the individual was making a defensive
movement, such as trying to ward off or grab the weapon at the
time of the discharge. In suicide, residue may be deposited on
the palm of the hand used to steady the barrel at the time of the
discharge.
Procedures in Determining the Presence of Gunpowder:
1. Gross Examination or Examination with the Use of Hand Lens:
Fine black powder particles of varying sizes may be seen at the
GUNSHOT WOUNDS
379
region of the gunshot wound of entrance, on the dorsum of
the hands or at the outer surface of the wearing apparel of the
victim. This examination is not conclusive because other foreign
particles may be mistaken for gunpowder or primer components.
2. Microscopic
Examination:
Fine particles may be magnified but there are no characteristic
shape, color or consistency of gunpowder.
3. Chemical Tests:
a. Laboratory Test to Determine Firearm Residues:
There is inference of contact or near distance of the gun
muzzle to the skin when there is burning, tattooing and smudging
visible through the naked eye. The burning and then the
tattooing will gradually disappears as the muzzle distance increases. The powder tattooing will gradually spread out to a
greater area until it is no longer detectible. Minute particles of
burning and unburned residues and the primer constituents can
be detected in the laboratory.
The same tests may also be applied on the dorsum of the
hand of the persons suspected to have fired the gun. Although
the test is not conclusive, it may be a corroborative evidence
in the determination as to whether a person has fired a gun.
The tests may involve the determination of the presence of
gunpowder residues of primer components.
Tests for the Presence of Powder Residues:
l.On the Skin (Dorsum of the Hand or Site of the Wound of
Entrance):
Dermal nitrate test (Paraffin test, Diphenylamine test, Lung's
test or Gonzales* tests) — The back of the fingers and of the hand
up to the region of the wrist is coated with melted paraffin, heated
at a temperature of 150 degrees fahrenheit. To avoid heat injury
to the skin, a low melting point paraffin is used. The melted
paraffin penetrates the minute crevices of the skin and when
hardened and cooled off, some of the powder particles will be
extracted and embedded in the paraffin cast. After the cast is
built with layers of cotton and paraffin to a thickness of about
1/8 inch and solidified, it is then removed from the hand or from
the site of the wound of entrance and the inner aspect of the
cast is treated by means of a dropper with Lung's reagent.
The presence of small particles containing either nitrate or
nitrite will be indicated by a blue reaction of the particles upon
contact with Lung's reagent.
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LEGAL MEDICINE
The test is not conclusive as to the presence of gunpowder
because fertilizers, cosmetics, cigarettes, urine and other nitrogenous compounds with nitrites and .nitrates will give a positive
reaction. A negative result is not also conclusive that the person
did not fire a gun for a well constructed hand gun will not discharge any residue on the hand or the hand might have been
subjected to extensive washing.
The test usually gives a positive result even, after a large lapse
of three days or even though the hand has been subjected to
ordinary washing.
Subjection of a suspect to the test is not self-incriminatory as
the act is purely mechanical and does not require the use of
mental faculties.
2. On Clothings (Especially Colored Ones):
Walker's test (C-acid test, H-acid test) — A glossy photographic
paper is fixed thoroughly in hyposolution for 20 minutes to
remove all the silver salts and then washed for 45 minutes and
dried.
The dried photographic paper may be treated with any of the
following:
a. Warm 5% solution of " C " acid (2 naphthalamine 4-8 disulfonic
acid) for 10 minutes and dry.
b. Warm 5% solution of " H " acid (l-amino-8-naphthol-3,6 disulfonic acid) for 10 minutes and dry.
c. Warm 0.5% solution of sulfanilic acid for TO minutes,,dry and
then swab with a 0.5% solution of alpha naphthalamine in
methyl alcohol and dry.
The sheet of the prepared paper of sufficient size is placed face
up on a towel or pad of cotton and the material to be tested is
placed on top, face down on the paper.
The preparation is then covered with a thin dry cloth or towel
slightly moistened with 20% solution Of acetic acid, and another
layer of dry cloth.
The entire pack is pressed with a hot iron for two minutes.
The paper is removed, washed with hot water and methyl
alcohol to remove excess reagent and dried.
If unburned powder grains are present, it will result to the
production of dark red or orange-brown spots on the prepared
paper.
GUNSHOT WOUNDS
381
Tests for the Presence of Primer Components:
When an individual fires a weapon, the metallic primer residue
(barium, antimony and lead) may be deposited on the back of the
hand with the residue most likely deposited on the skin web, the
hand between the thumb and index finger. The test for the presence
of the metallic constituent of the primer may be done through any
of the following:
1. Harrison and Gilroy Test:
A cotton swab moistened with 0.1 molar hydrochloric acid is
used to gather antimony, barium and lead.
The cloth is then treated with various reagents to detect the
presence of a primer component. The reagent sodium rhodisonate yields a red color in the presence of lead and barium.
Addition of 1.5 hydrochloric acid to the red area that yields
a blue-violet color in the presence of lead while a bright pink
color is developed in the presence of barium.
The test is simply applied but does not enjoy substantial utilization in forensic laboratory because:
a. It lacks specificity of the color reaction for the trace of the
element.
b. It is inadequately sensitive.
c. There is interference of the color reaction among the three
elements themselves.
d. There is instability of the color that developed.
2. Neutron Activation Analysis (NAA):
A sample is obtained from the hands by the use of paraffin or
by washing the hand with dilute acid.
It is then exposed to
radiation from a nuclear reactor emitting neutrons. Secondary
radioactivity is induced in the materials removed from the hand.
By making an appropriate counts at different energy levels, the
elemental composition of the residues can be determined with
precision and accuracy.
The technique is extremely sensitive and a very small quantity
can be detected, but only few laboratories can afford to undertake the procedure because it is very expensive and the test is
unable to detect the presence of lead. The test requires access
to a nuclear reactor.
Principle: Barium and antimony are converted into isotopes by
means of neutron bombardment, afterwards their
quantity is measured.
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382
3. Flameless Atomic Absorption Spectroscopy (FAAS):
The sample of handwashing is subjected to a high temperature
to vaporize the metallic elements of the primer residue. This in
turn is detected and quantitated by absorption spectrophotometry.
This method is quick, sensitive and employs equipment within
the economic means of a modern-size crime laboratory. It can
detect the presence of barium, antimony and lead.
4. Use of Scanning Electron Microscope
Analyzer:
with
a Linked X-ray
Adhesive material is used to remove any residue particles from
the hand.
The material is then examined under the scanning
electron microscope with a linked X-ray analyzer. Particles of
the primer residue have the characteristic size and shape which
can easily be distinguished from other materials. Analysis of the
particles with X-ray analyzer will confirm their identification.
While this method appears to be more specific than the-previously mentioned methods, it is seldom used because the initial
equipment is expensive and it requires a longer period of time to
analyze a case.
FIREARM IDENTIFICATION
The following factors must be utilized in the identification of the
firearm used in the commission of crime:
1. Caliber of the Weapon:
A firearm may be identified by its caliber and it may be determined from the firearm itself, from the shell, bullet, cartridge
or from the character of the wound of entrance.
2. Fingerprints:
Fingerprint marks may be found in the butt of the firearm or
at the trigger and its guard. Care must be observed by the investigator in handling the firearm at the scene of the crime. The
fingerprints found at the butt may distinguish homicidal or
suicidal nature of death.
3. Fouling of the Barrel:
The firearm which is recently fired may have a characteristic
odor of the smoke inside the barrel. Chemical analysis of the
washing from the interior of the barrel will show whether the
weapon was recently fired.
4. Serial Number:
All firearms bear serial numbers for purposes of identification.
The offender may erase the number or may try to change it.
GUNSHOT WOUNDS
383
Procedure of Restoring Serial Number if Tampered:
The procedure of restoring the obliterated numbers involve
three steps, namely:
a. Cleaning — The site of the number should be carefully cleaned;
all oil, dirt, grease, and paint should be removed with gasoline,
xylol and acetone.
b. Polishing — This operation is by far the most important. The
whole surface should be smoothly polished, using a fine file
followed by a medium to fine grade carborondum cloth. When
the area is large or the scratches are deep, a mechanical polisher
may be used to save time. The time of polishing depends on
the hardness and granularity of the metal. However, the area
should always have the mirror-like surface.
c. Etching — For all iron or steel materials, the following etching
solution may be used:
Hydrochloric acid
Distilled water
Ethyl alcohol
Copper chloride
80 cc.
60 cc.
50 cc.
10 grams
The solution is swabbed on continuously until the numbers
appear. This may take several hours (Modern Criminal Investigation by Harry Soderman, p. 229).
5. Ballistics Examination:
Ballistics is the study of physical forces reacting on projectiles
or missiles.
Forensic ballistics is conventionally known as firearm identification. It deals with the examination of fired bullets and cartridge cases in a particular gun to the exclusion of all others.
Ballistics May Be Subdivided into Three Separate and Distinct Area
of Study, Namely:
1. Interior Ballistics (Internal Ballistics) — It is a branch of the
science of Ballistics which deals with what happened to the
cartridge and its bullet from the time the trigger of the gun is
pulled until the bullet exits from the barrel. It deals with the
study of what happened in the chamber and gun barrel after the
pull of the trigger.
2. Exterior Ballistics (External Ballistics) — It deals with what
happened to the bullet or projectile from the moment it leaves
the gun barrel to the moment of impact on the target or object.
It is concerned with the flight of the bullet and the influence of
all factors in its flight.
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LEGAL MEDICINE
Ballistic c o m p a r i s o n m i c r o s c o p e
3. Terminal Ballistics — This concerns with the effect of the bullet
on the target or until it comes to rest.
Medical Ballistics — A form of terminal ballistics wherein the
target is a person. It is concerned with the penetration, severity
and appearance of the wound due to bullet or missile.
Basic Principles Involved in Firearm Identification:
1. T h e quality of metal in the manufacture of the firearm is very
much harder and resistant to deformity as compared with the
quality of metal used in the manufacture of the cartridge, so
that in the process of contact between the part of the gun involved and the cartridge, the surface condition of the part of the
gun can easily be impressed on the shell or bullet.
2. For
reasons
known only to the manufacturer, firearms have
GUNSHOT WOUNDS
385
certain physical characteristics of certain type of caliber which
differentiate it from others. This includes the number of lands
and grooves, the direction of the twist, width of the individual
land or groove, style of the cannelure, etc., which become the basis
of class characteristics in firearm identification.
3. No two firearms can be manufactured with identical surface
characteristics. Each firearm on close examination will show the
differences. Marks on the different bullets or shells fired from one
firearm have similar characteristics when viewed in the comparison microscope. Marks on different bullets or shells fired from
different firearms will show variation in the findings. This is
referred to as individual characteristics.
Instruments Use in Firearm Identification:
1. Comparison Microscope — This is an instrument which consists of
two compound microscopes which allows comparison of two
objects by looking through a single eyepiece. On each of the
stages, the compound microscope is placed on the object to be
compared and by manipulation of the mechanical rack and pinion
gear the class characteristics of the object may be observed. When
two objects are being compared, the individual or accidental
characteristics may be compared. There is an attachment for
photographic camera to facilitate the taking of pictures of the
findings.
2. Bullet Recovery Box — It is an instrument or device for the
purpose of recovering the test bullet and shell. In the N.B.I., it
is a long cylindrical container filled with cotton and an open
shooting end. The suspected firearm is fired at the open end and
the bullet may be recovered in the layers of cotton and the shell
may be found in the area where it is fired, in cases of automatic
firearm or in the cylindrical magazine inside the cases of the
revolver. The test shell and bullet may be used for comparison
with the evidence bullet or shell.
There are other ways of recovering test bullet which are used
in other countries, it may be:
a. Shot may be fired on a box with oil and sawdust.
b. Vertical or horizontal shot on a water tank.
c. Shot-fired on a block of ice.
3. Hand lens.
4. Sharp pointed instrument for scraping I.D. marks.
5. Caliper.
6. Analytical Balance.
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LEGAL MEDICINE
GUNSHOT WOUNDS
387
Types of Marking on the Examination through the Comparison
Microscope:
1. Impression Type Mark (Stamp Mark) — This is the forcible application of a hard surface against a softer one leaving an impression
on the harder surface.
Example:
a. The striking of the firing pin on the percussion cap.
b. The impact of the base of the cartridge on the breach block of
the gun.
2. Striation or Serration Mark — These are produced by a harder
surface scraping, dragging, sliding or slipping across a softer one
leaving a series of abrasions, serrations and scrapes.
Example:
a. The bullet surface may show rifling marks on its surface as it
passes the spiral landings and groovings of the inner surface of
the barrel.
b. The extractor produces striations as it slips over the cartridge
groove.
c. The ejector may cause striation markings on the cartridge case
in the process of ejection of the spent shell.
When a cartridge is fired from a firearm, the following marks
may be found in the shell and from the bullet,
a. Marks Found in the Shell:
(1) Marks of the Firing Pin:
The firing pin leaves impressions in the percussion cap.
The depth, location and the size may be the individual
characteristic of a firearm, although the hardness of the
metal in the cap may cause certain degree of variation of
the impression.
(2) Marks from the Extractor:
The extractor mark is found in front of the rim of the
shell. The scratch impressed by the extractor is a characteristic in a particular firearm.
( 3 ) Marks of the Ejector:
This mark is found at the head of the shell. Generally
the ejector mark has a position opposite the extractor
mark, although it is not always the case.
(4) Marks from the Breechblock:
The impact of the shell to the breechblock in the recoil
impresses the ridges of the breechblock and often gives
identification marks characteristic of a firearm.
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LEGAL MEDICINE
(5) Marks on the Cylindrical Surface of the Shell:
The marks are brought about by the surface of the firing
chamber or by the magazine,
b. Marks Found in the Bullet:
(1) Number of Lands and Grooves:
The number of grooves, depth, and width depend upon
the manufacturer of the firearm.
( 2 ) Direction of the Twist of the Rifling Marks:
The direction of the spiral lands and grooves may be a
twist to the right or to the left.
Manufacturers of firearms made certain marks which may distinguish firearms manufactured by them from that of the other
manufacturers. Each manufacturer makes specific number of spiral
grooves and direction of the twist in the barrel of the firearm. A
bullet recovered at the scene of the crime or from the body of the
victim may show those marks in the examination, the examiner may
have a presumption to where the firearm came from. Thus, if in
the examination of the recovered bullet, it was found out that there
are 6 grooves and the rifling marks are twisted to the left, then it is
possible that it came from a Colt firearm.
In the firearm identification, the examiner must take into consideration the following:
1. Gross examination or examination with the use of magnifying
lens:
a. Caliber of the bullet — this may be determined by:
(1) Simple inspection by an experienced examiner.
( 2 ) Weighing of the bullet.
( 3 ) Determining the diameter of the bullet by the use of a
caliper.
b. Presence or absence of deformity or loss of part.
c. Presence of foreign elements, like blood, flesh, connective
tissues, soil, etc.
d. Identifying marks placed by previous possessor.
2. Examination with the use of comparison microscope:
This is a comparison between evidence shell or bullet with the
test shell or bullet.
a. Determination of the class characteristics — Physical characteristics of a certain caliber of firearm used by the manufacturer:
( 1 ) Number of riflings.
(2) Direction and rate of the rifling marks.
GUNSHOT WOUNDS
389
(3) Dimension of the lands and grooves.
(4) Depth of the grooves.
( 5 ) Style of the cannelure.
b. Determination of individual or accidental characteristics:
(1) The rifling of the barrel is reflected in the bullet as it passes
through it.
Repetition of the fire will cause the same
marking, except those where the rifling of the barrel has
been changed.
( 2 ) Firing Pin mark — When the base of the cartridge is hit by
the firing pin, the pin produces distinct markings which can
be reproduced by succeeding shots.
(3) Breechblock Mark — As the bullet is propelled forward by
the force of the expanded gas, the casing is forcibly moved
backward against the breech face or recoil plate. The backward force transfers the marking on the breechblock to
the base of the cartridge.
(4) Extractor Mark — The mark made by the extractor on the
cartridge rim when pulled away from the firing chamber.
( 5 ) Ejector Mark — Mark produced by the ejector in the process
of throwing away the spent shell.
GUNSHOT WOUNDS IN DIFFERENT
PARTS OF THE B O D Y
Head and Neck:
1. Cranium:
Close or near contact fire in the head may produce marked
laceration of the skin, burning and tattooing of the surrounding
skin.
The skull is fractured without any definite shape with
linear extensions to almost all of the bones comprising the cranial
box.
Fire from a distance with the bullet having a right angle of
approach to the skull, the fracture is oval at the outer table.
There will be radiating linear fractures from the point of entrance.
The wound of exit will be clean-cut oval or round opening at the
inner table with a bevelled fracture at the outer table.
Grazing approach of the bullet may produce an elongated
gutter-like depressed fracture of the cranium. The tangential
impact of the bullet may cause it to split and it is not uncommon
to see a fragment lodging in the brain substance while the other
ricochette outside hitting other objects nearby:
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LEGAL MEDICINE
2. Brain Substance:
Bullet wound in the brain substance is usually a rugged tunnel
with a diameter larger than that of the caliber of the bullet, with
marked ecchymosis of the surrounding area and filled with fresh
and clotted blood. Fragments of bones may be felt in the tunnelled bullet tract. In most cases, injury of the brain causes
sudden loss of consciousness and incapable of voluntary movement.
L a c e r a t i o n of the brain en route of a gunshot
Injury of the cerebral hemispheres is as a rule not immediately
fatal and the victim may survive the injury, however, a bullet
course which includes the medulla, pons and other vital centers
causes immediate death.
Some victims may live for sometime
but may develop epileptiform convulsions as a sequela.
3. Face:
Firearm wound on the face may not cause serious trouble
except that it becomes a potential avenue of infection and may
cause marked deformity.
In suicidal shot, the muzzle of the firearm may be placed inside
the mouth or nostrils that no visible wound of entrance is appreciable. The course of the bullet is usually upwards and in
most cases the brain is involved.
GUNSHOT WOUNDS
391
4. Neck:
The bullet may pierce the front portion of the neck and may
involve the cervical portion of the spinal cord; thus causing instantaneous death if the upper portion is involved. The course of the
bullet may involve the carotid or jugular vessels and death may be
due to profused hemorrhage. The anterior wall of the esophagus
may be perforated and the bullet may enter into the gastrointestinal tract and expelled through the bowel. Injury to the
trachea and upper bronchi may cause asphyxia or aspiration
pneumonia.
Chest:
1. Chest Wall:
The bullet wound on the chest wall usually has an upward course
and may involve both sides. The bullet may strike the rib, sternum or the body of the vertebra and may cause deformity or
deflection of its course. When the intercostal or mammary vessels
are injured, there will be profused hemorrhage. Hemothorax of
more than a liter is observed in fatal cases.
2. Lungs:
The passage of a bullet in the lungs produces a cylindrical tunnel
much larger than the diameter of the projectile with bloody
contents and ecchymotic borders. When the pulmonary vessels
are involved, profused hemorrhage is observed which produces
death before medical or surgical intervention can be instituted.
If only one lung is involved, the profuse hemorrhage may cause
collapse of the lung, displacement of the heart, and mediastinum
towards the uninjured side. Emphysema is present when there is
marked injury to the air sacs. Involvement of the bigger bronchi
may cause asphyxia with the lung partially atelectatic and emphysematous.
The victim may not die immediately but later may
develop aspiration pneumonia or cerebral embolism.
3. Heart:
Bullet wound of the heart may be circular or stellate witn
subepicardial hemorrhage in the surrounding tissue. The course
may be of any direction but the right ventricle is often involved
because of the large surface area of exposure in front.
Gunshot wound of the heart as a general rule does not prevent
the victim from running, walking, climbing stairs, or do other
forms of volitional acts for death-is not usually instantaneous.
Wound of the auricle is more rapidly fatal as compared with the
wound of the ventricle on account of the thickness of the musculature of the latter which produces temporary closure of the
wound. Bullet may lodge in the musculature of the ventricle and
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becomes encapsulated by fibrous tissue. Death in firearm wound
of the heart may be due to the loss of blood or tamponade.
Abdomen:
Abdominal gunshot wounds are quite frequent but not as serious
as those of the chest and head because of its amenability to surgical
operation. In most cases injuries are not only limited to one organ
but to several organs. Injuries to the visceral organs may not be
found along the course of the bullet on account of their mobility
and their capacity to change their forms. Involvement of the vertebral column may cause injury to the spinal cord. The mesenteric
vessels, aorta, vena cava, and other big abdominal blood vessels
may be lacerated and cause severe hemorrhage.
Bullet wound of the liver and other parenchymatous abdominal
organs may cause stellate perforations which are usually larger than
the caliber of the bullets that cause them. The tunnel which is also wide
may contain fragmented tissue, fresh and clotted blood. On account
of the richness of the blood supply of the parenchymatous organs,
profuse hemorrhage is the natural sequela. Loss of function, especially of the kidneys, pancreas, etc. may lead to fatal results.
Bullet wounds of the stomach and other hollow organs are usually
small on account of the contractility of the walls. The wound of
entrance is smaller than the wound of exit. Grazing injury may
simulate a lacerated wound. Injury of the viscus is usually multiple
and with less hemorrhage except when it involves the mesenteric
vessels.
Timely surgical intervention may prevent untoward complications. However, death due to peritonitis is not rare on account
of the spilling of its contents into the abdominal cavity.
Spine and Spinal Cord:
Injury of the spine may not involve the spinal cord, but injury
of the spinal cord may be due to:
1. The bullet may directly affect the canal and the spinal cord
causing either partial or complete severance.
2. The bullet may not hit directly the spinal cord but may cause
injury in the body or other parts of the vertebra and contusion,
concussion or compression on account of the impact.
Injury
of the upper cervical spinal cord may cause immediate death
because the vital nerve tracts may be involved.
Lower spinal
cord injury may cause motor or sensory paralysis and may later
succumb to hypostatic pneumonia, suppuration or other complications.
GUNSHOT WOUNDS
393
Extremities:
Bullet wounds in the extremities may show the characteristic lesion
of gunshot wounds.
Usually the wound is not so serious except
when it involves the principal blood vessels and nerves. The bony
tissue may be involved producing comminuted fracture of the bone
and deflection of the course of the bullet. Septic infection, thrombosis, hemorrhage, deformity are not unusual after-effects.
Chapter XIV
THERMAL INJURIES OR DEATHS
^ffiermal injuries are those caused by an appreciable deviation
from normal temperature, capable of producing cellular or tissue
changes in the body. Thermal death is one primarily caused by
thermal injuries.
Exposure to severe cold may cause frost-bite, while exposure to
high temperature may cause burning or scalding.
I. DEATH OR INJURY FROM COLD
Death or injury due to a cold is not common in tropical countries.
The primary cause of death is attributed to the decreased dissociation of oxygen from hemoglobin in the red blood cells and diminished
power of the tissue to utilize oxygen. Cold produces a vascular
spasm which results to anemia of the skin surface followed by
vascular dilatation with paralysis and increased capillary permeability. Prolonged exposure may cause necrosis and gangrene.
The degree of damage depends upon the severity of the cold, the
duration of exposure, area of the body involved, sex and humidity.
Cold damp air is more fatal than cold dry air. A short exposure to
cold temperature may not be deleterious to the body as long exposure to low but not to freezing temperature. Children and aged
individuals are more susceptible to cold weather on account of their
limited thermotaxic reserved. Individuals whose vitality have been
diminished by fatigue, lack of food, alcoholism, and previous illhealth are less able to withstand the effects of cold. Women are
more resistant to cold than men on account of their greater deposits
of subcutaneous fat.
The action of cold in the body is partly local and partly reflex in
the circulatory system. Exposure to cold will diminish the dissociation power of oxygen from hemoglobin, thus starving the brain
and other nervous center with oxygen.
The effect of low temperature consists of a local damage to the
exposed tissue and systemic change involving the whole body
Effects of Cold:
y . Local Effect (Frostbite;
First
394
Immersion foot; Trench foot):
— There is blanching and paleness of the skin due to
vascular spasm.
THERMAL INJURIES OR DEATHS
395
Second — The vascular spasm is followed by erythema, edema and
swelling due to vascular dilatation, paralysis and increased capillary permeability.
Third
— In advanced stage of vascular paralysis, there will be
blister formation.
Fourth — Continued exposure to severe cold will later lead to
necrosis, vascular occlusion, thrombosis and gangrene.
On account of the expansion of the tissue and individual cells
in the process of solidification, the cell membrane may rupture,
tissue and organ may rupture, and the skull may be fractured.
Microscopically:
There is vacuolization and degeneration of the epidermal cells,
necrosis of the collagen of the subcutaneous tissue, perivascular
exudates of red and white cells, occlusion of vessels lumen by
clump of red blood cells, and prolification of the endothelium.
2. Systematic Effects:
The systemic effects are reflex in nature brought about by the
stimulation and paralysis of the nerves. Respiration, heart action,
metabolic processes are slowed down on account of cerebral
anoxia. There is a cold stiffening of the body with blister formation and gangrene of the exposed part of the body.
Signs and Symptoms:
1. Gradual lowering of the body temperature is accompanied by
increasing stiffness (cold stiffening), weariness and drowsiness.
2. The person may be lethargic, passing the stage of coma to death.
3. Person may suffer from delusion, convulsion and delirium.
4. Palpation of the cutaneous surface shows hardening and coldness.
Post-mortem Findings:
1. Externally: Nothing characteristic.
a. Cold stiffening.
b. Surface of the body is pale.
c. Reddish patches especially in exposed portions of the body
(frost-erythema).
d. Onset of rigor mortis delayed.
2. Internally: Nothing characteristic.
a. Blood is generally fluid in the heart and blood vessels with a
bright red color.
b. Parenchymatous organs are congested with occasional petechial
hemorrhage.
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c. Audible cracking sound on flexing the knee and other big joints
apparently due to the breaking down of the frozen synovial
fluid.
d. Petechial hemorrhage in the lungs, brain and kidneys.
e. If death occurs after sometime, pathological findings related to
complications, like bronchopneumonia, toxemia due to gangrene, etc. may be found.
The body tissue fluid evaporates slowly if the body is frozen,
hence, mummification develops later.
However, the individual
cell, tissues and organs are well-preserved.
II. DEATH OR INJURY FROM HEAT
The effects of heat in the body may be local at the application, or
general when the whole body is affected.
Classifications of Heat Injury:
1. General or Systemic Effects:
a. Heat cramps.
b. Heat exhaustion.
c. Heat stroke.
2. Local
Effects:
a. Scald.
b. Burns.
( 1 ) Thermal.
( 2 ) Chemical — acids and alkalies.
( 3 ) Electrical and lightning.
( 4 ) Radiation — X-ray, ultraviolet, etc.
G E N E R A L OR SYSTEMIC EFFECT:
1. Heat Cramps (Miner's Cramp, Fireman's Cramp, Stoker's Cramp):
This is the involuntary spasmodic painful contraction of muscles
essentially due to dehydration and excessive loss of chlorides by
sweating. This is seen among laborers working in rooms with high
temperature and with profused perspiration.
Symptoms:
a. The -onset is usually sudden as muscles cramp with agonizing
pain.
b. The cramp is accompanied by headache, dizziness and vomiting.
c. The face is flushed, pupils are dilated with tinnitus and abdominal pain.
THERMAL INJURIES OR DEATHS
397
d. The amount of chloride excretion through the urine is markedly
diminished.
Usually, the condition does not end fatally. A liberal administration of fluid with chlorides relieves the patient. However, intravenous administration of saline solution rapidly restores the patient
to normal.
2. Heat Exhaustion (Heat Collapse, Syncopal Fever, Heat Syncope,
Heat Prostration):
This is due to a heart failure primarily caused by heat and
precipitated by muscular exertion and warm clothing.
Symptoms:
a. Sudden attack of syncope, general body weakness, giddiness
and staggering movement.
b. The face is pale, the skin is cold, and the temperature is subnormal.
c. The pupils are dilated, pulse weak and thready, and respiration
is sighing.
d. There may be diarrhea, dimness of vision and dilated pupils.
e. Exhaustion comes gradually with throbbing in the temple.
f. The patient usually recovers, if made to rest, but occasionally
the condition may become worse and the patient dies of heart
failure.
The treatment is purely symptomatic and removal from heated
area.
Post-mortem finding is nothing typical, except probably cloudy
swelling of the heart musculature.
3. Heat Stroke (Sunstroke, Heat Hyperpyrexia, Comatous Form,
Thermic Fever):
This usually occurs among those working in ill-ventilated
places with dry and high temperatures or due to a direct exposure
to the sun.
Symptoms:
a. Sudden onset that may be followed by premonitory symptoms
of headache, malaise, giddiness and weakness of the legs.
b. Temperature rises suddenly and the skin becomes dry, with
burning sensation and flushed skin and complete cessation of
sweating.
c. Face is congested.
d. Pulse is full and pounding .
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e. Respiration later becomes irregular.
f. The pupils are usually contracted.
g. Death occurs in 1/2 to 1 hour after the onset of symptoms.
Post-mortem Findings:
a. Cadaveric rigidity comes soon and passes off soon.
b. Putrefaction occurs early.
c. Lividity is marked.
d. Petechial hemorrhages may be found in the brain and in the
heart.
e. Congestion of the internal organs.
f. The temperature may rise after death.
Medico-Legal Importance of Heat Cramps, Heat Exhaustion and
Heat Stroke:
If ever death occurs, it is most often accidental.
Laborers
who are working under the sunshine, in a heated room, or in a
poorly ventilated place may suffer from any of the conditions.
Alcoholism, ill-health, disease and fatigue may be some of the
predisposing factors. Although mostly accidental, physician must
perform the necessary post-mortem examination in the bodies
to eliminate the possibility of foul play. However, it may be
homicidal or suicidal in rare instances. Children may be victims
of infanticidal acts when subjected to conditions promoting
their development.
L O C A L EFFECTS OF HEAT:
Scald (caused by hot liquid):
Scalds are injuries produced by the application to the body,
liquids at or near boiling point, or in its gaseous state. The term
applies to tissue destruction by moist heat. The injury by scalding
is not as severe as burns because ( a ) the scalding liquid or vapor runs
on the body surface, thereby distributing its heat, ( b ) the scalding
material easily cools off, and (c) the temperature of the scalding
substance is not as high as those producing burns, except oils and
molten metals. The effect on scalding is the same as burns.
icteristics of Scalds:
a. Scalds often have a distribution called a "geographical lesion."
It follows the portion involved in the splashing of the scalding
fluid together with the rule of gravity.
b. The skin lesion may be located in covered portions of the body
without affecting the clothings.
THERMAL INJURIES OR DEATHS
399
Extensive scalding
c. There is neither burning of the hair nor deposit of carbonaceous
material on the skin surface.
d. The lesion is usually first, second or third degree, except in
cases of heated oil or molten metals.
e. Inhalation of the heated vapor may lead to inflammatory
reaction in the air passage which may lead to respiratory obstruction due to edema of glottis.
f. Usually, there is redness of the skin immediately after the
application, later a blister is formed. Pricking of the blister and
removal of the epidermis will show a pink raw surface from
which the fluid will ooze. The base will later become red in
about six hours.
There will be leucocytic infiltration and
granulation tissue will develop.
g. Sepsis with development of pus may appear in one or two days.
Healing may be accompanied by the formation of scars, which
may result in contracture or keloid formation.
Scalds are usually painful specially the second and third degree
types.
It is less fatal as compared with burns except when it involves
a great area of the body surface.
Death is usually due to septic complications which occur
after a day.
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Scalding is usually accidental in kitchens. Homicidal scalding
caused by throwing boiling water on the face and body is quite rare.
2. Thermal Burns (dry heat):
Burns are lesions which are caused by the application of heat or
chemical substances to the external or internal surfaces of the
body, the effect of which is destruction of the tissue of the body.
It includes all lesions produced by fire, radiant heat, solid substances, fire, friction and electricity.
Most burns caused by localized source of heat are accidental.
It may occur in the kitchen, by contact with heated solids or
live flame.
Most of the victims of burns are recovered in conflagration of
buildings which are either accidental or intentional.
Purposes of Intentional Fire:
a. Destruction of the victim of a criminal act to conceal identity
and true cause and manner of death.
b. The building was set on fire to kill or with homicidal intent
(torch murder).
c. To perpetuate insurance fraud both property and life.
d. A person might have committed suicide by other means and
tried to hide the cause and manner of death by setting fire on
the surroundings.
e. Victim might have been trapped in the building set afire accidentally or intentionally.
f. A person in pursuance of a cause may soak himself with an
inflammable substance (accelerant) and burn himself to death.
Classification of Bums:
a. Thermal
b. Chemical
c. Electrical
d. Radiation
e. Friction
Characteristics of Bums:
a. The lesion varies from simple erythema to complete carbonization of the body.
b. Usually, there is singeing of the hair and carbon deposits on the
area affected.
c. The area involved is general and usually without any demarcation line of the affected and unaffected parts.
THERMAL INJURIES OR DEATHS
401
Burns w i t h c a r b o n i z a t i o n o f the b o d y
d. Lesions in covered portions of the body, also involved burning
of the clothings over it.
e. In death by burning in a conflagration, it is necessary to identify
the victim and determine whether burns are ante-mortem or
post-mortem.
Classification of Bums by Degree (Dupuytren's Classification):
a. First Degree:
There is erythema or simple redness of the skin associated
with superficial inflammation and slight swelling which may
subside after a few hours or may last for several days. It may
be produced by momentary application of flame, or hot solid
or liquid much below boiling point. It is also produced by
mild irritant.
b. Second Degree:
There is vesicle formation with acute inflammation. If the
burns are caused by flame or heated solid substance, the skin
is blackened and the hair singed at the seat of lesion. The
vesicle can be produced by strong irritants or vesicants. Scars
are not present after healing. The superficial layers of the epithelium are destroyed,
c Third Degree:
There is destruction of the cuticle and part of the true skin.
The burned area is very painful owing to exposure of the nerve
LEGAL MEDICINE
402
endings. Healing may leave a scar which contains all the elements of the true skin, consequently without contracture.
d. Fourth Degree:
The whole skin is destroyed with formation of slough which is
yellowish-brown or parchment-like. The surface is ulcerated and
on healing a dense fibrous scar tissue develops. The scar may
subsequently contract and cause deformity of the part. On
account of the complete destruction of the nerve endings, this
kind of burn is not very painful.
e. Fifth Degree:
There is involvement of the deep fascia and muscles. This
may result to severe scarring effect and deformity.
f. Sixth Degree:
There is charring of the limb involving subjacent tissues,
organs and bone.
If death does not ensue immediately inflammatory changes may develop in the surrounding tissues.
Distinctions Between Burns and Scald:
Burns
Scalds
a. Caused by dry heat (flame,
heated solid or radiant heat).
a. Caused by application of moist
heat (liquid, steam at or near
boiling point).
b. Occurs at or above the site
of contact of the flame.
b. Occurs at or below the site of
the application or contact
with liquid.
c. Singeing of hair is present.
c. Singeing of hair is absent.
d. Boundary of the affected
and unaffected area is not
so clear.
d.-Boundary distinct, usually like
a geographical relief map of
the affected area.
e. Usually, limited on account of
the dissipation of heat in the
tissue.
e. Injury may be severe.
f. Clothings are involved.
f. Clothings
burned.
are
not
usually
Factors Influencing the Effect of Bums in the Body:
a. Degree of Heat Applied:
The effect in body tissue by heat varies with the temperature
of the heated object causing it. The effect will be more severe,
if the heat applied is great.
b. Duration of Exposure or Contact:
The longer is the time of exposure or contact, the greater
THERMAL INJURIES OR DEATHS
403
will be the destruction. The underlying tissue will be liable to
be subjected to the high temperature.
c. Extent of the Surface Involved:
Involvement of more than one-third of the body surface to
a second and third degree burns usually ends fatally. This is
due to pain, hemoconcentration and shock.
d. Portion of the Body Involved:
Burns of the extremity is not as serious as that of the head,
neck and trunk. Burns of the genital organs and that of the
lower portion of the abdomen are usually serious. Burns in
serous cavities are graver than in the skin.
e. Age of the Victim:
Adults can withstand burns longer than the children and
the aged individuals.
Children can withstand suppuration.
f. Sex of the Victim:
Men can resist burns better than women.
g. Septic Infection:
This may bring about complication in other parts of the
body and may lead to death.
h. Depth of Burns:
In 6th degree burns, whereby the muscles and bones are
involved, it is more likely that a person is terminated due to
shock.
Healing of extensive
burns with leucoderma, epidermal desquamation and
formation.
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LEGAL MEDICINE
Causes of Death in Bums and Scalds:
a. Immediate Fatal Result:
(1) Death from shock.
(2) Death from concomittant physical injuries with burns.
(3) Suffocation.
b. Delayed Fatal Result:
(1) Exhaustion.
(2) Dehydration with hemoconcentration.
(3) Secondary shock.
( 4 ) Hypothermia.
(5) Complications:
(a) Septicemia.
( b ) Pneumonia.
(c) Nephritis.
( d ) Inflammation of serous cavities and internal organs.
( 6 ) Changes in the blood due to heat:
In conflagration, the early death is due to a primary or
neurogenic shock, following a painful irritation of the
multiple nerve endings in the skin.
The suffocation is brought about by the formation of
carbon monoxide, hemoglobin or by the action of other
noxious gases of the fume.
Death may occur from an accident occurring in an
attempt to escape from the burning house or from injuries inflicted by the wall and timbers falling on the body.
The loss of body fluid, blood plasma, chlorides and
other substances of the blood is due to evaporation from
the raw skin surface.
Absorption of toxic materials from the site of the injury
may lead to necrosis of the liver, renal tubular degeneration,
and cloudy swelling of other organs.
Inhalation of the fumes may cause inflammatory reaction
of the respiratory passages.
Secondary infection of the wound may lead to septicemia
and inflammation of other organs and serous cavities.
Time Required to Completely B u m a Human Body:
The time required to transform the human body to ashes is
dependent upon several factors, namely:
a. Degree or intensity of heat applied.
b. Duration of the application of heat.
c. Physical condition of the body.
THERMAL INJURIES OR DEATHS
405
d. Presence of clothings and other protective materials.
About 72% of the human body weight is. water and this is
responsible for the delay in its combustion, however, there is
about 5% fat which may enhance combustion on account of
its combustibility.
In a gas furnace incinerator, it requires about four hours of
continuous application of heat to transform the body into ashes.
Age of the Burns:
A very recent burn will show no pus, or much healing, or
edema.
When the pus is already present and the red inflammatory zone
has disappeared, it is about 36 hours or a few days old.
There is a superficial sloughing in a third degree burn in about
a week.
The deeper sloughs are thrown off in two weeks and are attended with suppuration.
When the red granulation tissue is present, it is about two
weeks old.
The age of older burns is estimated by the amount of granulation tissue present, by its depth, and by the extent of the growth
of epidermis from circumference.
Proofs that the Victim was Alive Before Bumed to Death:
a. Presence of smoke in the air passage — There is grayish-black
or black amorphous material adherent to the mucosa of larynx,
trachea, and bronchi. The quantity of the soot in the air
passage depends on the type of fuel, amount of smoke produced and duration of survival in the smoke contaminated
atmosphere.
b. Increase carboxy-hemoglobin blood level — Carbon monoxide
enters the body through the respiratory tract. The presence
of carboxy-hemoglobin is responsible for the cherry-red color
of the fire victim.
c. Dermal erythema, edema and vesicle formation — Erythema
and edema show that circulation was present when heat was
applied.
d. Subendocardial left ventricular hemorrhage.
Is Burning the Cause of Death?
The physician must determine whether the lesions due to
burning are by themselves sufficient to cause death. He must
406
LEGAL MEDICINE
also determine whether there are evidences of other lesions which
may account for the death.
The following findings may prove that death is due to burning:
a. Presence of vital reaction at the heated areas.
b. Presence of carboxyhemoglobin in the blood.
c. Presence of carbon particles in the tracheo-bronchial lumina.
Scars of Bums:
Scars of superficial burns are thin and pliant. In severe burns,
these are irregularly thick with patches and bonds of fibrous
tissue causing contractions. Keloid formation is common in scars
from burns.
Distinction Between Ante-mortem from Post-mortem Bums:
The principal basis of the distinction is the presence or absence
of vital reaction, like inflammation, vesicle formation, congestion
and granulation tissue. The principal points of distinctions are:
a. The blister formed in ante-mortem burns contains abundant
albumen and chlorides, while in post-mortem burns, the blister
contains scanty albumen and chlorides.
b. There is an area of inflammation around an ante-mortem bum
which is not present in the case of post-mortem bums.
c. The base of the vesicle is red in ante-mortem bums while there
is not much change in color in the case of post-mortem burns.
d. In burns due to conflagration, the tracheo-bronchial lumina
may contain particles of soot or carbon, while in the case of
post-mortem burns there is no finding.
e. Blood will show presence and abundance of carboxyhemoglobin
in cases of ante-mortem burns, but not in cases of post-mortem
burns.
The absence of signs of vital reactions at the site of the bums
does not necessarily indicate that the lesion is post-mortem.
Death may have occurred too quickly for those changes to develop,
or the injuries might be ante-mortem but the body resistance is
so diminished to produce the vital reactions.
Distinctions Between Ante-mortem from Post-mortem Blisters:
a. Ante-mortem blisters contain fluid rich with albumen and
chlorides, while post-mortem blisters may contain air or scanty
amount of albumen and chlorides.
b. Heating the fluid contents of an ante-mortem blister will cause
solidification, while heating of a post-mortem blister will show
slight cloudening but not solidification.
THERMAL INJURIES OR DEATHS
407
c. The base of an ante-mortem blister is reddish with signs of
inflammatory changes in the periphery, but there is no such
finding in case of post-mortem blister.
d. Fluid content of an ante-mortem blister is abundant, while in
the case of post-mortem blister is scanty.
Differential Diagnosis of Blister Due to Heat:
a. Blister Due to Putrefaction:
The fluid content is blood-stained watery fluid and accompanied by putrefactive changes in other parts of the body.
b. Blister Due to Disease:
This can be differentiated from blister due to heat by the
size, distribution and absence of other signs of the effect of
heat application.
c. Blister Due to Friction:
History and absence of signs of the application of heat in the
neighborhood will differentiate it from blister due to burns.
Heat Rupture:
This is the splitting of the soft tissues of the body, like the skin,
due to exposure before or after death of the body to considerable
heat.
Differential Diagnosis:
a. Incised Wound — A heat rupture may be mistaken for an
incised wound. It may be distinguished by the absence of
blood inasmuch as heat coagulates blood inside the blood
vessels. In heat rupture, the blood vessels and nerves are kept
intact at the point of the rupture. On close inspection, the
margins are irregular unlike those in the case of incised wounds.
b. Lacerated Wound — In lacerated wound, there is contusion and
other vital reactions at the margin, which is not present in
cases of heat rupture. The roasted condition of the skin is
prominent in cases of heat rupture.
Heat Stiffening:
This condition is found in dead bodies which have been subjected to heat. The heat coagulates the albuminous materials
inside the muscle making it stiff and contracted. The limbs are
flexed and the fingers partially clenched simulating a "pugilistic"
position of a boxer. There is flexion of the limbs and fingers on
account of the fact that the flexor muscles are stronger than the'
extensors. The heat stiffening remains for sometime until the
body softens due to the onset of decomposition.
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LEGAL MEDICINE
Investigation of Death in a Conflagration:
Examination of the burnt body should be directed to obtain
the following informations:
a. Identity, which may be established from:
Clothing.
Careful handling must be stressed, as charred
materials can yield considerable information in expert hands,
but can also be easily destroyed. The size of footwear may be
of importance.
Property in the pockets such as key, money, papers and the
like.
Height — Sex — Age — Color of eyes — Color of hair.
Natural disease or stigmata such as scars, old deformities or
injuries and dentition.
b. Whether the person was alive in the fire, which can be decided
from the presence of carbon particles in the air passages, and
the estimation quantitatively of carbon monoxide in the blood.
c. Cause of death.
d. Information indicating a possible cause of the fire, as shown
by examination of the deceased. Evidences of the following
should be noted.
Alcoholic
alcohol).
intoxication
(Blood and urine estimation for
Natural disease which might have caused collapse, such as
epilepsy, hypertension, myocardial fibrosis.
Site of origin of the fire, as shown by maximal effects in
relation to position of the body.
Demonstration of injuries which could have been sustained
before the fire commenced.
(From:
Practical Forensic Medicine by Camp & Purchase, p.
236).
Post-mortem Findings (Burns and Scald):
a. External Findings:
( 1 ) Presence of external lesion depending upon the degree of
burning and scalding of the body.
(2) "-Pugilistic position" or "fencing posture" of the body.
(3) Blackening of the body surface in case of burns.
( 4 ) Rupture of skin, muscles, or destruction of limbs or skull.
(5) Exposure of internal organs.
( 6 ) Singeing of the scalp and other hairs of the body.
THERMAL INJURIES OR DEATHS
409
b. Internal Findings:
( 1 ) Blood is cherry-red in color owing to the presence of
carboxyhemoglobin.
( 2 ) Increase in the lymphoid tissue, especially of the intestine
and lymph glands.
( 3 ) Marked dehydration.
( 4 ) Hemoconcentration with increased capillary permeability.
( 5 ) Congestion of visceral organs.
( 6 ) Cloudy swelling of liver and kidneys.
(7) Enlargement
infarcts.
of the adrenal glands with hemorrhagic
( 8 ) Lungs are shrunken, mucous membrane of the bronchi
are congested and sub-serous hemorrhages present.
( 9 ) Intestinal mucous membrane are congested
the Brunner's glands of the duodenum.
especially
(10) Spleen enlarged and soft.
(11) Brain and spinal cord shrunken and hyperemic.
(12) Presence of carbon particles in the respiratory tract.
(13) Fatty degeneration in the liver.
Medico-Legal Aspect of Burns and Scalds:
During the ancient and medieval times, branding is a means to
secure identity. Red-hot metals shaped in letters or figures are
pressed in the arm and thigh. With the improvement of the
present method of identification, branding is now only made on
domestic animals.
Extraction of confession by burning the fingers, application of
heated metals on the skin, or pouring boiling water on the body is
now punishable.
Killing of a person and setting afire the building for the purpose
of concealing the crime or for the purpose of destroying the body
of the victim is quite common. It is in this connection that the
physician must exert all efforts to determine the true nature of
the case.
Burning and scalding is usually accidental, but occasionally
homicidal or suicidal.
Accidental cases are common among women and children on
account of their loose garments which easily catch fire. Children, mentally deficient persons and intoxicated individuals may
expose their bodies to boiling water or live flame.
LEGAL MEDICINE
410
A number of persons may die from burns when fire breaks out
in an inhabited house, or when an explosion occurs in a factory.
The Revised Penal Code considers the killing of a person by
means of fire as murder. The setting of a building on fire must be
an intentional means to kill the person inside the building to make
it a murder (Art. 248). There should be the actual design to kill
and that the use of fire should be purposely adopted as a means
to that end (People v. Burns 41 Phil. 418).
ontaneous Combustibility:
It is claimed by some authorities that the human body can
ignite itself spontaneously and b u m itself to death. This is hardly
possible on account of the high percentage of water in the human
body. Spontaneous combustibility may be utilized as a defense
in cases of homicidal burns if it is really probable.
-eternatural Combustibility:
It is claimed that the human body is inflammable on account of
the presence of gases which easily ignite. The gases are said to be
the products of the action of microorganisms in the body. This
explains the presence of phosphorescent light in the graveyard
during night time. If ever the theory is true, then there can only
be a partial combustion of the human body.
Chemical Burns (Corrosive Burns):
Chemical burns are the action of strong acids and alkalies and
other irritant chemicals which cause extensive destruction of the
tissue. Healing is quite slow and may require plastic surgery. The
most common of the chemicals are concentrated sulfuric acid,
nitric acid, hydrochloric acid, caustic soda and potash, lysol, etc.
Chemical burns may be followed by keloid scars.
Characteristics of Lesions:
a. Absence of vesication.
b. Staining of the skin or clothing by the chemical.
c. Presence of the chemical substance.
d. Ulcerative patches of the skin.
e. Inflammatory redness of the skin surface.
f. Healing is quite delayed on account of the action of the chemicals to the underlying tissue.
Distinctions Between Thermal and Chemical Burns:
a. There is an absence of blister in case of chemical bums while
blister may be present in thermal burns.
Extensive b u r n s by strong acid
b. The skin and clothings may be stained with chemical in case
of chemical burns, but there is no such staining in thermal
burns.
c. Analysis of the substances around the lesion will show the
chemical causing the corrosion. Nothing of this nature is found
in thermal burns.
d. In thermal burns, the lesion is diffused while in chemical burns
the borders are distinct and simulating a geographic appearance.
Characteristic Lesions by Different Chemicals:
a. Sulphuric Acid (Oil of Vitriol), which has the most intense
action, causes a considerable amount of destruction of the
tissues with the formation of a blackish-brown sloughs. The
face or other part will show splash marks where the acid has
fallen, and usually there will be lines of ulceration where the
acid run down the surface of the body.
The clothing will be destroyed in the places where the acid
has spilled.
b. Nitric Acid causes a yellow or yellowish-brown slough, and the
spot of yellow color will be seen .on the skin. The clothing is
destroyed and the color becomes brown.
c Hydrochloric Acid, though not so destructive as either sulphuric or nitric acid, causes as intense irritation and localized
ulceration of a red or reddish-gray color.
LEGAL MEDICINE
412
d. Caustic Soda and Potash have a corrosive action on the tissues,
giving a bleached appearance and greasy feeling to the skin.
The skin subsequently becomes brown and parchment-like.
(From: Taylor's Principles & Practice of Medical Jurisprudence
by S. Smith, 10th ed., p. 327).
Severe
burning
and
staining
of
the
skin
of
the face in suicidal poisoning
b y muriatic acid.
Treatment:
a. Neutralization of the corrosive substances.
b. Protection of the eye from involvement.
c. Prevention of infection of the lesion.
d. Other supportive or symptomic treatments.
Burns from corrosive fluids are quite rare and are usually due to
accidents in chemical laboratories. Vitriol throwing is common in
England. Intentional spilling or throwing of corrosive fluid causes
physical injury and on account of the deforming scar it produces,
it becomes a serious physical injury. Corrosive burns are commonly observed in suicidal ingestion with spilling of the chemical
around the mouth and neck.
4. Electrical Bums:
There are three kinds of electrical burns, namely: — contact
burns, spark burns, and flash burns. The characteristic feature of
all of them is that their depth is greater than the surface appear-
THERMAL INJURIES OR DEATHS
413
ance this would suggest that severe sloughing of the tissues may
occur later.
a. Contact Burn — due to a close contact with an electrically live
object, and the degree will vary from small and superficial
lesion to charring of skin if contact is maintained.
b. Spark Burn — due to a poor contact and the resistance of dry skin
and shows a pricked appearance with a central white zone
(parchment) and surrounding of hyperemia. This burn, which
may be essential to the proof of electrical contact, can be very
difficult to identify, and sections should be cut in an attempt
to establish their nature.
c. Flash Burn — the appearance varies from the arborescent
pattern of lightning burns to the "crocodile skin" appearance
of high voltage flash
(From: Practical Forensic Medicine by
Camp and Purchase, p. 238-239)
5. Radiation Burns:
a. Burns from X-ray:
The burns from X-ray depends upon the degree of intensity
and period of exposure. Slight-exposure will produce reddening and inflammation of the skin which will pass away within
a short period of time leaving a bronze color on the skin.
Higher degree of over-exposure may produce blister, atrophy
of the superficial tissue and obliteration of the superficial blood
vessels. In very severe cases, there may be ulceration of the
tissue which may later lead to malignancy.
b. Ultraviolet Light Burns:
Overdose of ultraviolet light may lead to severe and persistent dermatitis. There is uncomfortable irritation of the skin
and may later develop into a blister.
Chapter XV
PHYSICAL INJURIES OR DEATH BY LIGHTNING
AND ELECTRICITY
DEATH OR PHYSICAL INJURY BY LIGHTNING:
slAghtning is an electrical charge in the atmosphere. Its place of
occurrence and intensity are unpredictable. The flash of lightning is
due to the passage from a thunder cloud to the earth of a direct
electric current of enormous potential, amounting to something
like 1,000 million volts and about 2,000 amperes. Along the path
of the current, a great portion of its energy is liberated, most of
which is converted into heat. The size of the tract is variable and
may produce branching flash along its course. Because of the enormous power of destruction, it is capable of producing injury to
the human body.
Elements of Lightning that Produce Injury:
1. Direct effect from the electrical charge:
The electrical charge of lightning may pass to the body producing electrocution. The human body especially its nerves, is a
good conductor of electric current.
2. Surface "flash" burns from the discharge:
Some of the electrical energy in a lightning is transformed to
heat energy. The superheated air may cause burning of the skin
of the victim. The flash burn may produce arborescent marking
but are by no means typical.
3. Mechanical effect:
The expansion of the air on account of the superheated atmosphere may bring about mechanical injury. It may result to laceration of the body surface, severe tearing of the clothings and
displacement of parts of the body.
4. Compression effect:
The compressed air pushed before the current with superheated atmosphere may produce a backward wave. This causes
the "sledge hammerblow" on the body of the victim, thereby
producing concussion, shock, or unconsciousness to the victim.
414
DEATH BY LIGHTNING AND ELECTRICITY
415
Points to be Considered in Making a Diagnosis of Death from Lightning:
1. History of a thunderstorm that took place in the locality.
2. Evidences of the effects of lightning are found in the vicinity,
like damages to houses, trees, and other objects; death of other
person and animals nearby.
3. Metallic articles are fused and magnetized.
4. Fusion of glass materials on account of severe heat.
5. Absence of wound and other injuries indicating suicidal or homicidal death.
6. Skin often shows arborescent markings due to superficial erythema which disappear in a day or two if the person lives.
7. Burns may be present, but may be limited to the part under the
pieces of metals such as watch, knife or bunch of keys. The burns
are superficial or may be very deep.
Classes of Burns Due to Lightning:
1. Surface burns — These are superficial burns usually seen under
metallic objects worn or carried by the victim.
2. Linear burns — These are found where areas of the skin offer
less resistance, notably in the moist creases and folds of the skin
and may vary in length from one to twelve inches.
3. Arborescent or filigree burns — These are radiating burns from a
point, similar to electrocution.
Effects of Lightning in the Human Body:
Death is usually the immediate effect due to the involvement of
the central nervous system. The shock is produced by the instantaneous anemia of the brain brought about by the spasmodic contraction of the cerebral vessels. The lightning may cause immediate
loss of consciousness and because of the intense disturbance of the
air, the clothings may be removed from the body or severely torn.
Occasionally, a person may recover from the effect of the lightning stroke but in most cases suffer from certain degree of neurological disturbances.
1. Symptoms of Mild Attack:
a. External lesion of almost any description.
b.
c.
d.
e.
f.
Unconsciousness.
Slow, deep and interrupted respiration.
Pulse is slow and weak.
Pupils are dilated and sensitive to light.
Relaxation of the entire muscular system.
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LEGAL MEDICINE
A victim of lightning
g. Headache, dizziness and noise in the ears.
h. In severe cases, it may lead to blindness, deafness and loss of
speech.
2. Delayed Effects:
a. Insomnia and defective memory.
b. Irritability and inability to concentrate.
c. Paralysis or an increasing weakness of the limbs with progressive wasting of the muscles.
d. Hemiplegia, aphasia, deafness, epilepsy.
e. Progressive cerebellar syndrome.
Treatment:
1. Artificial respiration.
2. Air passage must be kept free.
3. Lumbar puncture to release the tension in the cerebrospinal
fluid.
4. Rectal hypnotic to combat delirium.
5. Treatment to combat shock.
6. Treatment to build resistance of the victim.
DEATH BY LIGHTNING AND ELECTRICITY
417
Post-mortem Findings:
1. External:
— Marked tearing of the wearing apparel.
— Burns of different degrees on the skin surface.
— Wounds of almost any description.
— Magnetization of metals in the wearing apparel.
— Fusion of metals and glasses.
— Singeing of the hair of the scalp and other parts of the body.
2. Internal:
— Fracture of bones.
— Hemorrhage due to the laceration or the rupture of organs.
— Petechial hemorrhages of the lungs, pericardium, brain.
— Rupture of the blood vessels and the internal organs.
Medico-Legal Aspect:
Investigation of death due to lightning is not by itself of any
medico-legal interest for it is an accidental death. No one can be
held responsible to the effect of a fortuitous event. However, its
investigation may be useful to eliminate the possibility that death is
due to the felonious act of another person.
DEATH OR PHYSICAL INJURIES F R O M ELECTRICITY:
The main cause of death in electricity is shock. Ordinary domestic
line is from 100 to 250 volts and it is sufficient to produce death.
The effect of 300 volts and above may be similar to lightning stroke.
Voltage is not only the factor causing the injury. As a matter of fact,
amperage or intensity of the electrical current is the principal factor.
The damage to the body by an electrical discharge depends upon
several factors which may increase or decrease the electrical conductivity of the body. The presence of moist skin, wet floor, barefoot and proximity of metals, increase the conductivity of the body
to electricity. Dryness of the skin, presence of rubber boots or
shoes, dryness of the floor and better insulation of the metallic
conductor increase the resistance. An increase in the conductivity
of the body will promote more injury.
Factors which Influence the Effect of Electrical Shock:
1. Personal idiosyncracy — Individual personality, physical condition, and the existence of mental or bodily distress at the time,
influence the effect of a shock.
2. Disease — A person suffering from cardiac disease is predisposed
to death from electrical shock.
418
LEGAL MEDICINE
3. Anticipation of a shock — When a person is aware of the possibility
of a shock, the victim can withstand one which might otherwise
be dangerous.
4. Sleep — Sleep increases the resistance to an electrical current.
5. Electrical voltage or tension — Most fatalities are followed by a
shock from a current at a tension of 220 — 250 volts, although
50 volts which are used for therapeutic purpose also show
fatality.
6. Amperage or intensity of electric current — This is the principal
factor. This is determined by dividing the voltage with the resistance of the conductor. Amperage of 70-80 in alternating current
or 250 in direct current is dangerous to man.
7. Density of the current.
8. Resistance of the body — Factors that will reduce the resistance
of the body to electrical flow will promote more injury.
9. Nature of the current — It is claimed that the alternating current
is more dangerous than direct current.
10. Earthing— The development of shock is enhanced, if the victim
is grounded or earthed. Earthing will promote continuous flow
of electric current.
11. Duration of contact — L o w tension may kill when contact is
maintained for several minutes. A shorter duration of contact
is enough for high tension to produce death.
12. Kind of electrodes — Some electrodes conduct a free flow of
electric current while others do not.
13. Point of entry — Contact of the left side of the body is claimed
to be more dangerous than that of the right side.
Mechanism of Death in Electrical Shock:
1. Ventricular fibrillation which may lead to the rupture of some of the
muscle fibers and focal hemorrhages in low voltage.
2. Respiratory failure due to bulbar paralysis in high voltage.
3. Mechanical asphyxia due to violent and prolonged convulsion.
Nature of Electrical Burns:
The electrical burns is sometimes called "electrical necrosis/'
Some calls it electric marks or "current markings," and may be seen
at the point of entrance and exit to the current. The skin is puckered
with gray color and traversed by deep impressions arranged at right
angle.
The electric marks are painless and show no vital reaction. When
unaccompanied by burns, the hair in the region of the mark is intact.
DEATH BY LIGHTNING AND ELECTRICITY
419
Repair is by a process of aseptic necrosis, followed by luxuriant
granulation and healing leaves a smooth, thin, pink scar.
The absence of mark does not exclude electrocution but the
presence raises a strong presumption of death from electrocution.
Microscopically:
There is compression of the stratum corneum. There is also
superficial carbonization. It is deeper in the epidermis and there is
a focal cavitation due to the sudden production of steam by the
current. The papillae of the corium are flattened with vascular
contraction, especially at the center of the mark.
Symptoms:
If death does not occur after contact, the person may show the
following symptoms:
— Surface of the body is cold and moistened.
— Breath is stertorous.
— Pulse is rapid, filiform and may be irregular.
— Pupils are dilated and insensitive.
— Pale face.
Metallization:
This is claimed to be a specific feature of electrical injury. The
metal of the conductor is volatilized and particles of the metal are
driven into the epidermis.
Extensive areas of the body may be
darkened by metallization. The color may vary from brown to
black. If the conductor is iron, it is usually yellow-brown while if
it is copper, copper salts may be produced to yield a blue mark.
Delayed Effects of Electrical Injuries:
Necrosis of the area involved, may later develop into gangrene.
Because of the arterial damage, the gangrenous area may be far
more extensive than the electrical injury.
The damaged arteries may become brittle and friable that it is
liable to a rupture at a slight provocation causing a severe hemorrhage.
The late nervous injuries may be manifested in the form of retrograde amnesia, changes in personality, hemiplegia, aphasia, and postconcussional syndrome.
The current might have entered the head and produce cataract
of the lens in the form of flaky opacities.
Post-mortem Findinge:
There is nothing specific, or may show no lesion at all.
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LEGAL MEDICINE
— Electrical arborization.
— Bums with metallization.
— Intense vascular congestion of the dura mater.
— Eyes congested and pupils dilated.
— Trachea may be congested.
— Lungs deeply engorged and edematous.
— Congestion of visceral organs.
Treatment:
1. Remove the victim from live wire installations. Close the switch
and remove the victim and in which case, care must be exercised
by the rescuer.
2. Artificial respiraton which must continue for about an hour until
positive proof of death is present.
3. Treatment of shock or coma. As soon as spontaneous respiration
is established, raise the temperature of the patient by the application of hot water in bottles and blankets. Cerebral edema may
be treated by lumbar puncture. Stimulant may be given to improve the health.
Medico-Legal Aspect:
Death by electrocution is mostly accidental.
They are very
rarely, suicidal or homicidal.
Accidental electrocutions usually
occur in grounded laundry line, electric stoves and outlets.
Chapter XVI
DEATH OR PHYSICAL INJURIES DUE TO CHANGE
OF ATMOSPHERIC PRESSURE (BAROTRAUMA)
The normal atmospheric pressure at sea level is 760 millimeters
of mercury. A person is subjected to an increase of atmospheric
pressure as he goes deeper in a body of water and a decrease as he
ascends higher in the atmosphere.
I N C R E A S E O F A T M O S P H E R I C P R E S S U R E (Hyperbarism):
This condition is observed underwater by scuba divers, pearl
divers, salvage divers, treasure hunters, pleasure swimmers, etc..
Henry's law provides that "at constant temperature, the amount
of gas dissolved in a liquid is directly proportional to the pressure."
As the diver goes deeper into the body of water, the atmospheric
pressure he is subjected to increases. The atmospheric pressure is
doubled at 10 meters and this increases further as he goes deeper.
As a consequence of this, there is an increase in the amount of gas
dissolved in the blood and other body fluids.
Before a diver enters a body of water he breaths deeply to fill
up his lungs with an estimated volume of six liters. This air is gradually absorbed by the body fluid so that at a depth of six meters the
diver needs twice the volume of air normally required when on the
surface with an increase fourfolds at a depth of 33 meters.
The longer the diver remains under pressure and the deeper is
the descent, the greater is the degree of gas saturation of the tissue
and the greater the length of time required for subsequent decompression.
In the process, nitrogen, an inert gas which constitute approximately 80% of the air in the lungs is also dissolved in the body fluid
and this causes the so-called "nitrogen narcosis" (rupture or drunkenness of the deep). This condition is preceded by a feeling of euphoria.
The absorption of gas in the lungs will cause decrease pressure on
the pulmonary tissue as compared with that of the pulmonary
circulation and this difference in pressure will cause transfer of
fluid from the pulmonary capillaries into the alveolar space causing
pulmonary edema. A rapid descent may cause rupture of the blood
vessels and hemorrhage.
421
422
LEGAL MEDICINE
The ear drum may bulge inward resulting to stretching, pain,
hemorrhage and ultimate perforation of the tympanic membrane.
Aside from the effects of the increase atmospheric pressure, the
diver may suffer from:
1. Cerebral anoxia due to a prolonged stay under water;
2. Muscular cramp;
3. Physical injuries in the process of diving and hitting hard objects;
4. Injuries caused by aquatic animals, like shark or stings of venomous fish and coelenterates;
5. Effects of the changes of atmospheric pressure in a pre-existing
disease like hypertension or a coronary affection.
During Ascent from a High Atmospheric Pressure of the Deep Sea
to the Surface Atmosphere:
If ascent is made gradually, the chances of untoward effects may
not be observed. However, if ascent is made rapidly, the diver may
suffer from the effects of the sudden release of the gases from the
body fluid. Released air bubbles may be present in the circulation
and become potent emboli in different parts of the body.
In the chest, it may cause interstitial emphysema at its wall and
also at the neck and face. Pneumothorax and pulmonary air embolism may also be present.
Air emboli during decompression may lodge in the capillaries of
the big joints causing it to adopt a semi-flex position, hence called
"bends." The affected areas by the air embolism cause ischemia,
pruritus and pain. Air embolism may be fatal if it lodges in the vital
organs of the body.
Post-Mortem Findings:
1. If Death has been Immediate:
Subcutaneous emphysema, generalized visceral congestion and
the presence of gas bubbles.
Extra-vascular bubbles and hemorrhages in adipose tissues, like
the mesentery and omentum.
2. If Death Occurred After a Lapse of Several Days.
Degeneration and softening of the white matter of the spinal
cord.
Fat necrosis of the liver.
Osteonecrosis.
D E C R E A S E O F A T M O S P H E R I C P R E S S U R E (Decompression):
1. Hypobarism — At a higher altitude the atmospheric pressure
ATMOSPHERIC PRESSURE (BAROTRAUMA)
423
becomes lower and more gas will be liberated by the body fluid.
The release of gases from the body fluid will cause:
a. "Bends" — Joint and muscular pain due to the presence of air
bubbles.
b. "Chokes" — Substernal distress, a non-productive coughing and
respiratory distress. This is the result of bubble formation in
the pulmonary capillaries or from the effects of extravascular
mediastinal bubbles exerting pressure on the mediastinal contents and adjacent pulmonary tissue.
c. Substernal emphysema — Accumulation of bubbles underneath
the skin and is observed as a crepitation on palpation of the
skin.
d. Trapped gas — may result in the doubling of the size of hollow
viscus, like the stomach and intestine at 18,000 feet level. The
size quadruples at 33,000 feet. Expansion of the size of the
stomach may cause diaphragmatic herniation.
Modern aircraft flying at high altitude have been pressurized to
remove the ill-effects of low atmospheric pressure.
2. Anoxia — At higher
phere becomes lesser
8,000 to 15,000 feet
above sea level must
human demand.
altitude the oxygen content of the atmosand lesser. Hypoxia will be felt between
level. Aircraft flying beyond 34,000 feet
be provided with oxygen to maintain the
A I R C R A F T INJURIES A N D F A T A L I T I E S :
Causes of Injuries and Fatalities in Aircraft are:
1. During the Flight:
a. Altitude:
Hypobarism (Decompression).
b. Speed — Passengers and crew may suffer from spatial disorientation and windblast.
The sudden change of direction at a speed of 500 miles
tends to drain blood from the brain to the lower parts of the
body resulting to a momentary black-out or unconsciousness.
c. Toxins — Carbon dioxide, carbon monoxide, and other irrespirable gases may saturate the cabin compartment and cause
asphyxia.
d. Temperature — At high altitude, the temperature falls and at
the height of 25,000 feet, it is 40° below zero.
Death may be due to frostbite or freezing of the body.
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LEGAL MEDICINE
e. Pre-existing disease — Coronary disease or hypertension may
cause fatality due to the sudden change of environment.
2. During the Crash:
Most of the aircraft fatalities occur during the take-off and
landing. During the crash, the whole plane bursts into flame due
to its high octane fuel content. If a passenger or crew survives
the crash, he will suffer from severe thermal injuries.
Modern high speed turbojet or jet aircraft have a velocity of
not less than 500 miles per hour as much as that of the terminal
velocity at the time of the impact which causes widespread destruction of the aircraft and also of the ground. Potential survivor
may be those who were trapped within the cabin but are rescued
before a fire develops or those who are fortuitously thrown from
the aircraft.
a. Fracture of the tibia and fibula is due to the presence of the
horizontal bar at the rear of the front seat;
b. Fracture of the femur is due to the high vertical force and the
front bar of the seat;
c. In the chest, the common site is the upper half and is frequently associated with sternal injuries indicating that it is of a
flexion type;
d. Cranio-facial injuries is due to the impact of the head to the
seat in front when subjected to a vertical hit. There may be a
fracture of the classical ring type surrounding the foramen
magnum due to the vertical force.
e. Rupture of the heart or aorta is quite common as this is due to
compression of the heart between the sternum and spine
during the flexion or the mobile heart is torn from the static
aorta during deceleration of the body in the vertical fall of the
body.
HELICOPTER:
A helicopter is a rotary-wing airplane. The rotor is the source of
power and its aerodynamics causes its lift. The bulk of its weight is
on the rotor, gear box and gear train and* engine. All of these parts
are located above the center of gravity of the helicopter so that when
the helicopter drops down, the aircraft will be in an inverted position.
Most of the helicopter accidents are due to structural failure,
engine and control failure. Other causes are the unseen obstacles
such as wire, weather and error of judgment.
Because of the low speed, accidents do not take place during take
off or landing, but during flight.
Chapter XVII
DEATH BY ASPHYXIA
'•Asphyxia is the general term applied to all forms of violent death
which results primarily from the interference with the process of
respiration or the condition in which the supply of oxygen to the
olood or to the tissues or both has been reduced below normal level.
Types of Asphyxial Death:
1. Anoxic Death:
This is associated with the failure of the arterial blood to
become normally saturated with oxygen. It may be due to:
a. Breathing in an atmosphere without or with insufficient oxygen,
as in high altitude.
b. Obstruction of the air passage due to pressure from outside, as
in traumatic crush asphyxia.
c. Paralysis of the respiratory center due to poisoning, injury or
anesthesia, etc.
d. Mechanical interference with the passage of air into or down
the respiratory tract due to:
( 1 ) Closure of the external respiratory orifice, like in smothering and overlaying.
( 2 ) Obstruction of the air passage, as in drowning, choking with
foreign body impact, etc.
( 3 ) Respiratory abnormalities, like pneumonia, asthma, emphysema and pulmonary edema.
e. Shutting of blood from the right side of the heart to the left
without passage through the lungs as in congenital anomalies
like potent foramen ovale.
2. Anemic Anoxic Death:
This is due to a decreased capacity of the blood to carry
oxygen. This condition may be due to:
a. Severe hemorrhage.
b. Poisoning, like carbon monoxide.
c. L o w hemoglobin level in the blood.
3. Stagnant Anoxic Death:
This is brought about by the failure of circulation. The failure
of circulation may be due to:
426
DEATH BY ASPHYXIA
427
a. Heart failure.
b. Shock.
c. Arterial and venous obstruction, incident to embolism, vascular
spasm, varicose veins, or the use of tourniquet.
4. Histotoxic Anoxic Death:
This is due to the failure of the cellular oxidative process, although the oxygen is delivered to the tissues, it cannot be utilized
properly. Cyanide and alcohol are common agents responsible for
histotoxic anoxic death.
Phases of Asphyxial Death:
1. Dyspneic
Phase:
The symptoms are due to the lack of oxygen and the retention
of carbon dioxide in the body tissue. The breathing becomes
rapid and deep, the pulse rate increases, and there is a rise in the
blood pressure. The face, hands and fingernails become bluish,
especially in the case of infants.
2. Convulsive Phase:
This is due to the stimulation of the central nervous system by
carbon dioxide. The cyanosis becomes more pronounced and the
eyes become staring and the pupils are dilated. Examination of the
visceral organs shows small petechial hemorrhages, commonly
known as Tardieu Spots.
The TardieuSpots are caused by the
hemorrhage produced by the rupture of the capillaries on account of the increase of intra-capillary pressure. It usually appears
in places where the tissue is soft and the capillaries are not well
supported by the surroundings, as in visceral organs, skin, conjunctivae, and capsules of glands.
The victim may become unconscious during the convulsive
stage.
3. Apneic Phase:
The apnea is due to the paralysis of the respiratory center of
the brain. The breathing becomes shallow and gasping and the
rate becomes slower till death. The heart later fails.
Recovery at this stage is almost nil due to the permanent
damages inside the brain on account of prolonged cerebral anoxia.
Classifications of Asphyxia:
1. Hanging.
2. Strangulations:
a. Strangulation by ligature.
b. Manual strangulation or throttling.
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c. Special forms of strangulations:
(1) Palmar strangulation.
(2) Garroting.
( 3 ) Mugging or yoking.
(4) Compression of the neck with stick.
3. Suffocation:
a. Smothering or closing of the mouth and nostrils by solid
objects.
b. Choking or closing of the air passage by obstruction of its
lumen.
4. Asphyxia by submersion or drowning.
5. Asphyxia by pressure on the chest (Traumatic crush asphyxia).
6. Asphyxia by irrespirable gases.
A. ASPHYXIA BY HANGING
Asphyxia by hanging is a form of violent death brought about by
the suspension of the body by a ligature which encircles the neck and
the constricting force is the weight of the body.
It is not necessary that the whole body will be left suspended.
The victim may be sitting or lying with the face downward provided
that the pressure is present in front or in the side of the neck.
Classification of Asphyxia by Hanging:
1. As to the location of the Ligature and Knot:
a. Typical — When the ligature runs from the midline above the
thyroid cartilage symmetrically encircling the neck on both
sides to the occipital region.
b. Atypical — When the ligature is tied or noosed and present on
one side of the neck, in front or behind the ear, or on the chin.
2. As to the Amount of Constricting Force:
a. Complete — When the body is completely suspended and the
constricting force is the whole weight.
b. Partial — When the body is partially suspended as when the
victim is sitting, kneeling, reclining, prone or in any other
positions.
3. As to Symmetry:
a. Symmetrical — When the knot or noose is at the midline of the
body either at the occiput or just below the chin.
b. Asymmetrical — When the knot or noose is not in the midline
but on one side, with the head tilted to the side opposite the
location of the noose or knot.
DEATH BY ASPHYXIA
429
Suicidal hanging w i t h the use of b a r b e d w i r e
Mechanism of Death:
There is a ligature around the neck with a knot or with a sliding
noose, and the other end is fastened to an elevated object like peg,
nail, window casing, door knob, tree, etc..
Upon suspension of the body, the weight causes the noose or band
to tighten, producing pressure at the region of the neck.
The pressure of the band will cause the air passage to constrict, the
larynx is pushed backwards and its opening is closed by the contact
of the anterior to the posterior laryngeal wall producing asphyxia.
The pressure of the ligature may also cause compression of the
superior laryngeal nerve, carotid arteries and jugular veins producing
cerebral anoxia.
The form of furrow that develops in the neck depends upon the
type of ligature, the number of loops around the neck and the point
of suspension.
Protrusion of the tongue depends upon how pressure is applied
around the neck. If above the larynx and in an upward direction,
the tongue will be pushed outward and will protrude from the mouth,
but if the pressure is below the larynx, the tongue is kept inside the
buccal cavity.
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LEGAL MEDICINE
Ligature in Hanging:
1. Materials used in Ligature:
The thinner the ligature and the tougher the material, the more
pronounced will be the mark on the skin of the neck. If the
material is soft and broad the ligature impression on the neck is
less marked.
If hanging is done with evident premeditation as in the case of
suicide, a special quality of material may be used. Rolled beddings, leather belts joined together, rope, electric wire and vines
are oftenly used. The rope is commonly used as a ligature because
it is easily available and strong.
2. Noose:
There may be no sliding noose at the end of the ligature. It
may be tightened after it has been encircled around the neck and
the pressure on the air passage, blood vessels and nerves of the
neck is established when the body is suspended. Metal buckle,
ring, or sliding noose may be attached to the end to make it slide.
3. Mode of Application of the Ligature:
The ligature may be placed around the neck with a single loop
or with two or more loops. This can be distinguished on the
nature of the ligature marks. In single loop, there is but one
ligature furrow, but if there are several loops, there will be several
ligature marks with an intervening redness between the furrows.
There is more tendency to have more pressure in single loop ligature
on account of the concentration of force at the weight as compared with two or more loops.
4. Position of the Knot:
The knot or joint is usually located on either side of the neck.
The head is flexed opposite the location of the knot. The level
of the ligature around the neck may differentiate hanging from
strangulation by ligature.
In hanging, the ligature is usually
found above the thyroid cartilage on account of the upward
pull of the constricting force, while in case of strangulation by
ligature, the loop is found below the thyroid cartilage. It is not
easy to retain the knot beneath the chin."
5. Course of the Ligature around the Neck:
The .usual appearance is that the groove or ligature mark is
deepest opposite the location of the knot. However, if the knot
is just underneath me chin, the groove at the back of the neck is
not deep on account of the firmer skin and muscular tissue. The
course of the ligature forms an inverted V-shape with the vertex as
the location of the knot.
DEATH BY ASPHYXIA
431
Symptoms:
1. Gradual loss of sensibilities.
2. Sensation of constriction of the neck.
3. Loss of consciousness and muscular power.
4. Numbness of the legs and clonic convulsion.
5. Sensation of ringing inside the ear.
6. Sensation of flash of light before the eyes.
7. Face becomes red, with eyes prominent and feeling of heat in the
head.
If the victim is timely rescued and revived after artificial respiration,
he will suffer the following symptoms:
1. Whistling sensation inside the ear.
2. Watering of the eyes.
3. Difficulty of breathing and swallowing.
4. Sensation of numbness of both legs.
All of the above symptoms may last for 12 days after the rescue.
Amount of tension in the ligature sufficient to occlude the vital
structures of the neck:
Jugular veins
2 kilos (4.4. lbs.).
Carotid artery
5 kilos (11.0 lbs.).
Trachea
15 kilos (33.0 lbs.).
Vertebral artery
30 kilos (66.0 lbs).
Causes of Death in Hanging:
1. Simple asphyxia by blocking the air passage.
2. Congestion of the venous blood vessels in the brain.
3. Lack of arterial blood in the brain due to pressure on the carotid
arteries.
4. Syncope due to pressure on the vagus and carotid sinus which
leads to reflex irritation and paralysis of the medullary autonomic
centers.
5. Injury on the spinal column and spinal cord.
6. It may be any combination of the above-mentioned causes.
Time Required in the Process of Death:
The time required to produce death in hanging is influenced by
the following factors.
1. Severity of the Constricting Force:
If the constricting force is only sufficient to occlude the windpipe, death may be delayed; but if the pressure is sufficient to
LEGAL MEDICINE
432
occlude the carotid arteries, jugular veins and vagus nerve, then
unconsciousness develops immediately and death is accelerated.
2. Point of Application of the Ligature:
When the ligature is made below the larynx, death is almost
instantaneous, but when applied above the larynx, death may not
occur for three to five minutes. Hanging with the knot situated
on one side of the neck may delay death because the closure of
the cerebral vessels cannot be completely maintained. If the knot
is just below the jaw, maximum pressure is at the back of the
neck causing merely partial occlusion of the windpipe and blood
vessels of the neck, thereby delaying death.
3. Other Factors:
a. Physical condition of the subject.
b. The rate of consumption of oxygen in the blood and tissues.
The loss of sensibility is due to the pressure of the ligature on
the blood vessels causing disturbance in the cerebral circulation.
Ordinarily'respiratory movement may persist one to two minutes
and the heart action for 15 to 30 minutes so that artificial resDiration mav successfully revive the victim.
Ligature mark in hanging with the use of thin tough material.
Treatment:
1. Induce the Natural Acts of Respiration:
a. Ligature must be loosened and the mouth must be wiped to
DEATH BY ASPHYXIA
433
remove all obstacles' to free air.
b. Tongue must be pulled forward and the body must be laid on
back rest.
c. Place the patient where there is a free current of fresh air.
d. Electrical stimulation of the phrenic nerve.
e. Administration of respiratory stimulant, like ammonia.
2. Stimulate the Heart to Renew Action if it Ceases to Beat:
a. Apply heat at the region of the precordium.
b. Hypodermic injection of coramine, strychnine, or other stimulants.
c. Administration of brandy.
3. Maintain the Natural Body Temperature:
a. Cover the body with blanket.
b. Place the patient in a warm room.
Post-mortem Findings in Death by Hanging:
1. General
External Appearance:
a. Neck elongated and stretched with the head inclined on the
side opposite the knot or noose.
b. Eyes closed or partially opened with pupils usually dilated on
one side and small on the other side (facies sympathetic).
c. Lividity or pallor of the face with swelling and protrusion of
the tongue.
d. Hands are clenched firmly and purple colored fingernails.
e. Lips livid or blue.
f. Saliva dribbled from the mouth with froth.
g. State of erection or semi-erection of the penis with seminal
fluid in the urethral meatus.
h. Post-mortem lividity with ecchymosis are mostly marked at the
legs.
i. Urination or defecation due to the loss of power of the sphincter
muscles.
2. Internal Findings:
a. Engorgement of the lungs.
b. Venous system contains dark-colored fluid blood.
c. Right side of the heart and the big blood vessels connected with
it are distended with blood.
d. Blood vessels of the brain is generally congested.
e. Kidneys are congested.
f. Sub-pleural, sub-pericardial punctiform hemorrhages (Tardieu
spots).
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3. Findings in the Neck:
a. Neck is flexed opposite the side where the knot is located.
b. Ligature mark which forms a groove and deepest mark opposite
the knot. The width of the groove is about or rather less than
the width of the ligature. The skin of the groove is pale o'r
parchment-like.
Microscopically, there is a characteristic
abrasion with slight desquamation and flattening of the cells
of the epidermis.
c. The course of the ligature is inverted V-shape with the apex of
the " V " at the site of the knot. There may be an interruption
of the ligature marks.
d. The skin at the site of the ligature is hard with red line of
congestion and hemorrhage in some points.
e. Ecchymosis of the neck depends upon the width and softness
of the ligature.
f. There may be rupture of the underlying blood vessels, muscles
and other soft tissues.
g. The lining membrane of the blood vessels may be lacerated.
h. The fracture of the upper cervical vertebrae and the injury of
the spinal cord is due to long drop hanging or to judicial hanging.
i. Fracture of the hyoid bone or the tracheal rings.
Ligature m a r k in hanging with the use of soft and b r o a d ligature.
DEATH BY ASPHYXIA
435
j . Contusion of the inner wall of the trachea.
Differential Diagnosis:
1. Fold markings on the neck of an obese individual — In this case
the marks are not continuous and removed on stretching the skin
of the neck.
2. Marks of tight neckwear — The location and history will differentiate this from ligature marks.
Determinations Whether Hanging is Ante-mortem or Post-mortem:
The principal criterion in the determination whether hanging is
ante-mortem or post-mortem is the vital reaction. But, hanging made
immediately after death may also show to a certain extent vital
reaction, while hanging of a living subject whose bodily resistance has
been markedly weakened may show only slight vital reaction.
The Following Findings Show that Hanging is Ante-mortem:
a. Redness or ecchymosis at the site of ligature.
b. Ecchymosis of the pharynx and epiglottis.
c. Line of redness or rupture of the intima of the carotid artery.
d. Subpleural, subepicardial punctiform hemorrhages.
It is advisable to look for other injuries which are capable of
producing death to eliminate the possibility of hanging as the cause
of death.
Determinations Whether Hanging is Accidental, Homicidal or
Suicidal:
1. Evidence in support of homicidal hanging:
a. Nature of the windows and doors — See whether the entrance
was forcibly opened or have been used as an escape by the
offender in homicidal case.
b. Presence of signs of struggle in the clothings, furniture, and
beddings — The furniture and beddings may be disturbed
whenever there was previous struggle before hanging.
c. Presence of stains, bodily injuries in the body of the victim.
d. Presence of defense wounds in the body of the victim.
"Lynching" is a form of homicidal hanging usually found in
southern states of the United States. It is usually practiced by
Americans against the Negroes who commit crime against the
white-American. Whenever, the colored offender are apprehended,
they are hanged by means of a rope on a tree or some similar
objects. The Negroes are executed without due process of the
law.
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LEGAL MEDICINE
2. Evidences in support of suicidal hanging:
a. Findings at the place where the dead body was found is compatible with self-suspensions.
A chair may be found where he can stand to tie the rope at
a higher level. The chair or stool may be kicked away and the
body becomes suspended on a rope. A hammer to fix the nail
may be found near the place where the body was found.
b. Unusual position of the body when found:
The feet or the knees may be found partially touching the
floor if the body was found in a reclining position to make part
of the body weight as the constricting force on the neck. The
clenching of the hand and absence of signs of struggle to free
himself from the effects of ligature may infer the desire of
self-destruction.
c. Absence of signs of struggle:
There are no marks on the body that may cause unconsciousness to infer homicidal hanging.
d. Signs of vital reaction in the ligature marks around the neck:
The furrow may be deep, congested and papyraceous with
abrasions on account of the slide of the ligature as pressure on
the neck is produced by the weight of the body.
e. Signs of previous ineffective suicide attempt.
Like incised wound at the wrist, cutting the throat, ingestion
of poison may be present.
f. Presence of a suicide note written by the victim.
g. The materials used are those that are easily accessible, like
handkerchief, mosquito net, beddings, etc..
h. The history of reverses in life, like financial loss, love, studies,
etc. his mental condition,
i. The presence of suicidal note infer that hanging is suicidal,
j . No disturbance in the place where death took place.
k. The rule is that hanging is suicidal unless there are evidences to
show that it is not.
3. Accidental hanging is very rare.
B. ASPHYXIA BY STRANGULATION
STRANGULATION BY LIGATURE:
Strangulation by ligature is produced by compression of the neck
by means of a ligature which is tightened by a force other than the
weight of the body. Usually, the ligature is drawn tight by pulling
DEATH BY ASPHYXIA
437
the ends after crossing at the back or front of the neck, or several
folds of the ligature may be around the neck tightly placed and the
ends are knotted, or a loop is thrown over the head and a stick
inserted beneath it and twisted till the noose is drawn tight.
If the ligature is made of a soft material and is applied smoothly
around the neck, no visible mark will be observed after death. Hard
rough ligature applied with force more than that required to kill may
produce extensive abrasion and contusion at the area of application.
Strangulation by ligature may be observed in infanticide using the
umbilical cord as the constricting material. This must be differentiated from accidental strangulation by- the umbilical cord during
child birth. In accidental strangulation during child birth, the umbilical cord is abnormally long and there is no disturbance in the
wharton's jelly.
Strangulation by ligature is commonly observed in rape cases, but
the presence of findings in the genitalia and other physical injuries
are the distinctive findings.
Distinctions in the Post-mortem Findings in the Neck between Death
by Hanging and Death by Strangulation with Ligature:
Hanging
Strangulation with Ligature
1. Hyoid bone is frequently
injured.
2. Direction of the ligature mark
is inverted V-shape with the
apex as the site of the knot.
1. Hyoid bone is frequently
spared.
2. Ligature mark is usually horizontal and knot is on the
same horizontal plane.
3. Ligature is usually at the level
of the hyoid bone.
4. Ligature groove is deepest
opposite the site of the knot.
3. Ligature is usually below the
larynx.
4. Ligature groove is uniform in
depth in its whole course.
5. Vertebral injury is not observed.
5. Vertebral injury is frequently
observed.
Causes of Death in Strangulation by Ligature:
1. Asphyxia due to the occlusion of the windpipe.
2. Coma due to arrest of cerebral circulation.
3. Shock or syncope.
4. Inhibition of the respiratory center due to the pressure on the
vagus and sympathetic nerves.
Treatment:
1. Removal of the ligature.
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LEGAL MEDICINE
2. Artificial respiration, and if there is a block in the laryngeal
passage, tracheotomy must be performed.
3. Prevention of complications:
a. Edema of the glottis.
b. Pneumonia.
c. Abscess formation at the site of injury.
Post-mortem Findings:
1. External Examination:
a. Face is livid and swollen.
b. Eyes are wide open, prominent, congested and pupils are dilated.
c. Tongue swollen, dark colored and protruded.
d. Bloody froth may escape from the mouth and nostrils.
e. Tardieu's Spots are found beneath the conjunctivae, face, neck,
chest and lungs.
2. Internal Examination:
a. Intense venous congestion of both lungs with numerous petechial hemorrhages.
b. Blood-stained froth is found in big bronchi.
c. Right side of the heart is filled with dark fluid blood.
d. Congestion of the brain.
e. Congestion of the visceral organs.
3. Examination of the Localized Lesion in the Neck:
a. Mark of violence on the neck is in the form of ligature mark,
abrasion, or ecchymosis.
b. Fracture of the larynx or tracheal rings.
c. Laceration of the tunica intima of the carotid and jugular
vessels.
Accidental, Homicidal or Suicidal Strangulation by Ligature.
Homicidal strangulation is the most common of the three forms of
strangulation by ligature. Aside from the ligature mark in the neck,
there are evidences of struggle or marks of violence in other parts of
the body. A person may be rendered helpless by a blow, intoxicating
liquor or by initial throttling. The ligature may be passed around the
neck and then the feet and hands are bound together. Smothering
may be done by placing a handkerchief gag in the mouth.
Suicidal strangulation by ligature is quite rare. It may be done by
placing a ligature around the neck and tightened by means of twisting a piece of stick.
DEATH BY ASPHYXIA
439
There are a few instances of strangulation which are accidental
and most of the victims are children or epileptics who are helpless
and incapable of extricating themselves.
MANUAL STRANGULATION OR THROTTLING:
This is a form of asphyxial death whereby the constricting force
applied in the neck is the hand.
Methods of Throttling:
1. Using one hand, the neck may be grasped in front with the
thumb exerting pressure on one side and the other fingers on the
other side. The palm may exert pressure in front of the neck.
2. Using both hands with assailant in front. The thumbs digging in
over the anterior part of the larynx and pressing the air passage
back while the rest of the fingers are pressing on the sides and
back of the neck.
3. Using both hands with the assailant at the back. The fingers of
both hands grasp the throat in front and exerting a backward and
medial compression while the thumbs press against the side and
back of the neck.
Manners of Death in Manual Strangulation:
1. The air passage may be blocked and death is due to asphyxia.
2. The pressure on the neck may cause compression of the blood
vessels and disturb the blood supply of the brain.
3. The nerves of the neck may be traumatized especially the superior
laryngeal branch of the glossopharyngeal, hypoglossal nerves and
the plexus surrounding the bifurcation of the common carotid
artery or of the vagus producing shock.
Post-mortem Findings:
1. Cyanosis of the face.
2. Subpleural and subpericardial hemorrhage is not so conspicuous.
3. Heart, especially the right side is distended with blood.
4. Overdistention of the lungs with interstitial emphysema is occasionally observed in children.
5. Findings on the neck:
a. There may be no external injury on the skin but there may be
contusion with the form and shape of the fingers.
b. With curved thumb nail or a group of fingernails, abrasions may
be found in front or at the back of the neck.
c. Interstitial hemorrhages in the muscles of the neck.
d. Fracture of the laryngeal cartilage may occasionally be found.
440
LEGAL MEDICINE
e. Petechial hemorrhages and congestion of the larynx and pharynx.
f. There may be bruising of the tongue at its anterior border and
the tongue itself may be bitten and protruded.
g. Hemorrhages present in the capsule of the thyroid, submaxillary
and even in the parotid glands.
Accidental, Homicidal or Suicidal Manual Strangulation:
1. Suicidal throttling is not possible because the pressure of the
person's own hand must be maintained for sometime but when
unconsciousness begins, the hands are relaxed and the victim
recovers.
2. Accidental throttling may occur but the victim never died of
asphyxia but of some other causes.
A sudden application of
manual pressure in the neck during the moments of excitement
or passion may cause cardiac inhibition or cerebral apoplexy.
3. Homicidal manual strangulation is the most common. It is a
method of choice in infanticide. In most cases there are evident
signs of struggle.
Special Forms of Strangulation:
a. Palmar Strangulation:
The palm of the hand of the offender is pressed in front of the
neck without employing the fingers. The pressure must be sufficient to occlude the lumen of the windpipe.
2. Garroting:
A ligature, a metal collar or a bowstring is placed around the
neck and tightened at the back. The subject may be placed with
the back to the post and a spike may be placed in the post to
force into the nape of the neck when the constricting band is
tightened.
Garroting is a mode of judicial execution during the 19th
century and it is still being practiced in Spain and Turkey.
3. Mugging (Strangle-hold):
This is a form of strangulation with the assailant standing at
the back and the forearm is applied in front of the neck. The
pressure on the neck is brought about by the pressure of the
flexed elbow.
Mugging may be the cause of death in wrestling. The knee
may also be used and it will produce the same effect as that of
the elbow.
The foot or knee may be applied on the victim's
neck.
DEATH BY ASPHYXIA
441
4. Compression of the Neck with a Stick;
The victim may be forced to place his back behind a post.
The assailant with a piece of stick placed in front of the neck
pulls with two hands passing on both sides of the post backwards
with sufficient strength to occlude the trachea.
C.
ASPHYXIA BY SUFFOCATION
Asphyxia by suffocation is exclusion of air from the lungs by
closure of air openings or obstruction of the air passageway from
the external openings to the air sacs.
SMOTHERING:
This is a form of asphyxial death caused by the closing of the
external respiratory orifices, either by the use of the hand or by
some other means. The nostrils and mouth may be blocked by the
introduction of foreign substances, like mud, paper, cloth, etc..
If the buccal and nasal orifices are occluded by the hand, there
may be abrasion and contusion of the nose and mouth. The findings
in death by smothering will be that of asphyxia.
Suicidal smothering by means of his own hand is not possible.
The moment the victim becomes unconscious, the instinctive release
of the pressure will save him.
Homicidal and accidental smothering is frequent. Accidental
smothering may occur when a person is under the influence of
alcohol, epilepsy or in any other helpless state. Accidental smothering is common among children.
Overlaying is the most common accidental smothering in children.
The children may be suffocated either from the pressure of the
beddings and pillows or from the pressure of unconscious or a
drunk mother.
Accidental smothering of epileptic — A person may suffer from
epileptic or epileptiform fit and accidentally bury his face on soft
object like pillow, bedding or sand and die.
The same is true with pregnant women who may suffer from
eclamptic fit.
Gagging — The application of materials, usually handkerchief-,
linen or other clothing matters to prevent air to have access through
the mouth or nostrils. The pressure might be so severe that it may
cause injury to the buccal mucosa arfd teeth. It is homicidal.
Plastic bag suffocation — Plastic bags are made of synthe'tie
polyethylene that is transparent, tough and waterproof material
commonly used as a container. Children may place the bag over
LEGAL MEDICINE
442
their head and go down to the face covering the nostrils and mouth
and consequently cause suffocation because of the inability of the
children to extricate themselves by tearing it.
CHOKING:
This is a form of suffocation brought about by the impaction of
foreign body in the respiratory passage.
The most common foreign bodies impacted are:
a. Vomitus, especially when the person is under the influence of
alcohol.
b. Regurgitation of food from the stomach, as coagulated milk in
children.
c. Bolus of food.
Cafe' coronary — A restaurant patron apparently has a
sudden heart attack in the middle of his dinner and dies without
much untoward symptoms. Autopsy may reveal a large mass of
food lodged in his throat and the cause of death is in.fact
asphyxia by choking. This usually happens when the person has
a high blood alcohol level which apparently anesthetized his
gag reflex. It is an accidental rather than a natural death.
d. Detached membrane in diphtheria.
e. False set of teeth.
f. Blood in tonsillectomy operation.
g. Respiratory hemorrhage as in tuberculosis.
Most of suffocation by choking is accidental, although it may be
utilized in suicide or in homicide.
The post-mortem finding in suffocation by choking is the same as
other forms of asphyxia plus the presence of the foreign body in the
respiratory tract.
D. ASPHYXIA BY SUBMERSION OR DROWNING
This is a form of asphyxia wherein the nostrils and mouth has
been submerged in any watery, viscid or pultaceous fluid for a time
to prevent the free entrance of air into the air passage and lungs. It
is not necessary for the whole body to be submerged in fluid. It is
sufficient for the nostrils and mouth to be under the fluid. Children
may be drowned in an ornamental pool or "tilapia" pond, and an
epileptic or a drunk person may be found drowned in a shallow
creek.
Mechanism of Drowning:
When a person does not know how to swim and falls into a deep
body of water, his body will sink on account of the momentum of
DEATH BY ASPHYXIA
443
the fail and because the specific gravity of the human body is slightly
more than that of the water. Later, the body will be buoyed because
of the instinctive movement of the individual, coupled with the
presence of air underneath his clothings. While under water, the
breath is held but upon reaching the surface there i6 an attempt to
breathe. Air and water then gets into the mouth and nostrils. Then,
he will endeavor to raise his hand which will cause him to sink under
water. He then alternately appears and disappears on the surface and
everytime he attempts to breathe, water will get in. Because of the
entrance of the fluid, there will be violent coughing which will expel
the air in the lungs and creates an imperative desire to breathe,
during which more water is drawn in. The drawn-in water may go to
the lungs or to the stomach. The water fills the bronchioles forcing
the residual air to be in the lung surface and causing the lungs to
balloon and become soggy and edematous. Death usually occurs 2
to 5 minutes later.
Phases of Drowning:
1. "Respiration de surprise" occurring at the moment when the
mouth and nose are covered with fluid consisting of one deep
inspiration.
2. Phase of resistance which consists* of a short period of apnea due
to the irritation of the sensory laryngeal nerve endings by the cold
water.
3. Dyspneic phase with a forceful respiratory movement.
4. Another apneic phase.
5. Terminal respiration, after which the breathing stops permanently.
(Brouandel cited on Gradwohl's Legal Medicine by Camps, p.
277).
Causes of Death in Drowning:
1. Typical Drowning:
The primary cause of death in ordinary submersion in water is
asphyxia. The water interferes with the free exchange of air in the
air sacs.
2. Atypical Drowning:
In atypical drowning cases, the causes of death may be due to
the following:
a. Cardiac inhibition following submersion due to the stimulation
of the vagus nerve.
b. Laryngeal spasm due to submersion. The inhaled water may
cause spasm of the larynx.
444
LEGAL MEDICINE
c. Submersion when unconscious. A person may be drunk, or
suffering from cerebral aneurysm, cerebral hemorrhage, heart
disease, and suddenly collapse and falls in a body of water and
be unconscious when submerged.
A complete picture of
drowning may not be found at the autopsy table.
3. Other Conditions Associated with Drowning:
a. The person might have fallen into the water and his body strikes
on a solid hard object which is capable of producing death by
itself.
b. The person might be under the influence of alcohol or other
depressants and incapable of helping himself.
c. Cramps might have prevented him from saving himself.
d. Shock due to fright or sudden exposure to cold might have
caused sudden heart failure.
e. The person might have died of some other causes independent
of drowning, like apoplexy, cardiac failure, etc..
f. The person might have been dead and thrown into the water.
Time Required for Death in Drowning:
Submersion for 1-1/2 minutes is considered fatal, if ordinary
efforts for respiration is made, however, a person may survive even
after 4 minutes of submersion. The average time required for death
in drowning is 2 to 5 minutes. It has been claimed that the length of
survival in drowning is proportional to the amount of froth in the
respiratory tract.
The power of recovery of human beings in drowning is inversely
proportional to the amount of froth in the air passage and the
penetration of water into the lung tissue. The amount of mucous
froth and the degree of penetration of water into the lungs as well
as the degree of subpleural ecchymosis is proportional to the effort
made to save himself.
If a dead body was recovered in water, the physician must be able
to answer the following questions:
1. Did death occur prior to entry in the water? If so, what was the
cause of death?
2. Did drowning cause death? If so, was it fresh or salt water?
3. Were there any ante-mortem injuries? If so, did they play any part
in the death?
4. Were there any post-mortem injuries? If so, did they play any part
in the death?
5. Was there any natural disease or any evidence of poisoning? If so,
did the findings contribute to the death in any way?
DEATH BY ASPHYXIA
445
6. What was the manner of death?
Emergency Treatment in Drowning:
Remove the bodily clothings especially the tight ones and wrap
the body with blanket.
Place the face down and perform artificial respiration, using any
of the following methods:
1. Schaefer's Method:
With the face down, the patient must be in a prone position.
The operator kneels astride the body and exerts pressure on the
lower ribs at the rate of 12 to 15 times a minute.
2. Sylvester's Method:
With the patient lying on his back, and the operator astriding
over the body, swinging the arms forward up and then pressing the
chest wall. This is repeated every 3 to 5 seconds.
Administration of stimulants as ammonia, aromatic vinegar, etc..
Injection of strychnine, coramine, caffeine, etc..
Inhalation of oxygen combined with 5% to 8% carbon dioxide
to stimulate respiration.
Post-mortem Findings:
1. External Findings:
a. Clothes are wet, face is pale and with foreign bodies clinging
on the skin surface.
b. Skin is puckered, pale, contracted in the form of "cutis anserina," or "goose-skin," or "gooseflesh" particularly those of the
extremities and when the body is submerged in cold water. This
is due to the contraction of the arector pili muscles. This is not
diagnostic of drowning because it may appear before or after
death.
The arector pili muscles may contract during the
process of rigor mortis so that "cutis anserina" may develop
after death.
c. Penis and scrotum may be contracted and retracted especially
when the body is found in cold water.
d. Washerwoman's hand and feet. The skin of the hands and feet,
is bleached, corrugated and sodden in appearance. This is not
diagnostic of drowning but proves only that the body has remained in water for some time without reference as to the cause
of death.
e. Eyes are half-opened or closed, with eyelids livid, conjunctivae
injected and pupils dilated.
446
LEGAL MEDICINE
f. The mouth may be closed or half-opened with the tongue
protruding.
g. Post-mortem lividity is mostly marked in the head, neck and
chest. This is due to the gravitation of blood in those areas
when the body was immersed in water.
h. Presence of firmly-clenched hands with objects as weeds, stones,
sand, etc., indicative that the person was alive when placed in
the water (cadaveric spasm). This is also indicative that there
was struggle of the victim for life.
i. Physical injuries may be present on the body surface which may
be indicative of previous struggle with an offender, effort of the
victim to save himself, hitting on hard and rough objects while in
water by the force of the current, or some other causes.
j. In suicidal drowning, pieces of stone or other heavy objects may
be recovered in pockets or clothings to facilitate submersion.
2. Internal Findings:
a. Respiratory System:
(1) "Emphysema aquosum" — The lungs are distended like
balloons, overlapping the heart, with rib markings on the
surface and protruded out of the chest upon removal of the
sternum. This is due to the irritation made by the inhaled
water on the mucous membrane of the air passage which
stimulate the secretion of mucous. The lungs are progressively distended and the emphysema is due to the fact that
the air is driven by the fluid on the lung surface.
( 2 ) "Edema aquosum" — This is due to the entrance of water
into the air sacs which makes the lung doughy, readily pits
on pressure, and exudes water and froth on section.
( 3 ) "Champignon d'ocume" — This is the whitish foam which
accumulates in the mouth and nostrils. It is due to the
abundant mucous secretion of the respiratory passage which
by respiratory movement whips up the substance into foam.
Removal of the foam and followed by pressure on the chest
will produce further foam in the mouth and nostrils. This
finding is considered to be one of the indications that death
was due to drowning.
( 4 ) Tracheo-bronchial lumina is markedly congested and filled
with fine froth with foreign bodies that are also found in
the fluid medium where the body is recovered.
( 5 ) Blood-stained fluid may be found inside the chest cavity
and this is due to the permeation of water trapped inside
the air sacs.
DEATH BY ASPHYXIA
447
(6) The whole lung field may be congested but if there is an
abundance of water in the air sacs, it may appear pale.
(7) Section of the lungs shows the presence of fluid with bloody
froth.
b. Heart:
( 1 ) Both sides of the heart may be emptied or filled with blood.
The right side may be distended with blood while the left
may be emptied on the account of the distention of the air
sacs, thereby limiting the capillary flow.
(2) If drowning took place in salty water, the blood chloride
content is greater in the left side of the heart than in the
right, but if drowning took place in fresh water, the blood
chloride is more in the right than in the left. This is one
way to determine the place where a victim was drowned.
Gettler's Test:
This is a quantitative determination of the chloride content
of the blood in the right and left ventricle of the heart. The
demonstration of the difference of at least 25 mg. proves that
death occurred in fresh or salt water pool and drowning is the
cause of death.
Basis of the Test:
Normally, the chloride contents of the blood is the same in
both sides of the heart. But when water enters the alveoli it
goes with the circulation and is diffused with the blood. So
that if drowning took place in salty water pool the chloride
content in the right side of the heart will be less as compared
with the left, and the reverse is true when the victim was
drowned in fresh water. The test will not only determine the
cause of death as drowning but also where such drowning
took place — in fresh or salty water pool.
Fallacies of the Test:
(1) The victim might have been drowned in a salty water pool
where the chloride content of the water is quantitatively
similar as that of the blood. Inhalation of such fluid will
not make any difference in the chloride contents of the
left or right side of the heart. However, the cellular
count and hemoglobin percentage may be different.
(2) Reduction of blood chloride after death is a common
post-mortem phenomena. It could be possible that the
rate of reduction may not be the same on the right and
on the left side of the heart, thereby producing a difference although death was not due to drowning.
448
LEGAL MEDICINE
(3) Blood chloride estimation obtained twelve or more
hours after death from drowning in fresh water are of
little diagnostic value on account of the diffusion of the
fluid on both chambers of the heart.
c. Stomach:
There are plenty of fluid and other foreign materials that are
also found in the case of drowning. The absence of water shows
that death is rapid or submersion is made after death. It is
impossible for water to get into the stomach if the body is
submerged after death.
d. Brain:
The brain is congested and the big blood vessels are engorged.
e. Blood:
Aside from the difference in the chloride contents, the blood
becomes dark on account of the absorption of all its available
oxygen. There is a reduction of its hemoglobin contents on
account of dilution. The red blood cells may be crenated.
f. Other Organs:
The liver is engorged with dark fluid blood. The spleen and
the kidneys are dark in color and congested. Water may be
present in the middle ear due to violent inspiration when the
mouth is full of water.
Findings Conclusive that the Person Died of Drowning:
1. The presence of materials or foreign bodies in the hands of the
victim. The clenching of the hands is a manifestation of cadaveric
spasm in the effort of the victim to save himself from drowning.
2. Increase in volume (emphysema aquosum) and edema of the lungs
(edema aquosum).
3. Presence of water and fluid in the stomach contents corresponding
to the medium where the body was recovered.
4. Presence of froth, foam or foreign bodies in the air passage found
in the medium where the victim was found.
5. Presence of water in the middle ear.
Floating of the Body in Drowning:
The body may not immediately be recovered after drowning
because it is under the water. The specific gravity of the human
body is slightly more than that of the water. Within 24 hours, on
account of the decomposition which causes the accumulation of gas
in the body, the body floats. The floating of the body is markedly
influenced by the weather, condition of the fluid medium where
0
DEATH BY ASPHYXIA
449
drowning took place, presence of wearing apparel, age, sex and body
built. The body when recovered, floats usually with flexed extremities. This is due to the dominance of the flexor muscles over the
extensors in the process of rigor mortis. The head is submerged
because it has a higher specific gravity than the rest of the body.
And because the head is now the most dependent portion of the
body, more blood accumulates in the face. This explains the dark
bloated condition of the face during the early stage of decomposition,
otherwise known as "fete de negri" or the bronze color of the head
and neck of a person who died in water during the process of decomposition.
Determinations
Accidental:
1. Suicidal
Whether
Drowning
is
Suicidal,
Homicidal
or
Drowning:
a. Heavy articles or weight may be found in the pocket of clothings.
b. Presence of a suicidal note.
c. Determination of the strong reason for him to commit suicide.
d. Mentality of the person.
e. Study of the character and manner of the person previous to
the commission of suicide.
f. History of previous attempt to commit suicide.
2. Homicidal
Drowning:
a. There are evidences of struggle like physical injuries and destruction of the clothings of the victim.
b. Articles belonging to the assailant may be found near the place
where the deceased was recovered.
c. Presence of a motive for the killing.
d. Presence of ligature on the hands or legs which could not
possibly be applied by the victim himself.
'
J
I
\
\
e. Presence of physical injuries which could not have been selfinflicted, like gunshot wound at the back, severe injuries in the
head, etc..
f. Testimony of witnesses.
3. Accidental Drowning:
a. Absence of mark of violence on the body surface.
b. Condition and situation of the victim immediately before death
which may make one inclined to believe that it is accidental.
c. Exclusion of suicidal or homicidal nature of the drowning.
d. Testimony of a witness or witnesses who saw the incident
happened.
450
LEGAL MEDICINE
E.
COMPRESSION A S P H Y X I A , (TRAUMATIC
OR
CRUSH ASPHYXIA)
This is a form of asphyxia whereby the free exchange of air in the
lungs is prevented by the immobility of the chest and abdomen due
to external pressure or crush injury.
In homicidal cases, the assailant may kneel on the chest of the
victim or squeeze the victim between the arms and legs as in wrestling.
In accidental cases, the body may be pinned between two big
objects or collapsing building on the ground.
Very rarely is traumatic asphyxia attempted in suicide.
It may be caused by:
1. Sudden fall of earth or masonry or when the victim is buried
under a pile of sand.
2. The victim might be pinned under the rubble of a collapsed
building.
3. Crushed in a highway accident.
4. Sudden fall of materials from the roof of a road in mines.
5. Crushed in a crowd, usually accidental.
Post-mortem Findings:
1. The body exhibits a purplish-black cyanosis of the face and neck.
2. Clothings may produce irregular pattern on the skin and areas
where buttons are located may look pale.
3. Small subcutaneous petechial hemorrhages on the skin of the
face, chest, shoulder and neck.
4. Congestion and
junctiva.
petechial hemorrhages of the sclera and con-
5. Compression might be sufficient to fracture the ribs.
6. Heart and big blood vessels engorged with dark fluid blood.
7. Contusion with petechial hemorrhage of the lungs.
8. Other signs of physical injuries brought about by the
material.
compressing
Burking:
This is a form of traumatic asphyxial death invented by Burke and
Hare for the purpose of murdering people to be sold to medical
schools for dissection. The murderer kneel or sit on the chest and
with his hands close the nostrils and mouth of the victim. By this
method, there will be no external marks to indicate how respiration
has been obstructed.
Internal examination may show signs of
asphyxia.
DEATH BY ASPHYXIA
451
Death by Crucifixion — When a person is nailed on a cross the weight
is supported by the nailed feet. In order to breathe, the person had
to raise his body and then throw his weight on his feet. When on
the cross, the intercostal muscles are stretched and the chest cage is
fixed. The alternative raising and lowering of the body lead to exhaustion, unconsciousness and death from asphyxia. Because of the
difficulty of the chest movement, this type of death may be classified
as traumatic asphyxia.
F. A S P H Y X I A BY B R E A T H I N G IRRESPIRABLE GASES
CARBON MONOXIDE (CARBONIC OXIDE GAS, CO "SILENTKILLER "):
Carbon monoxide is formed from the incomplete combustion of
carbon fuel. The fatal carbon monoxide poisoning usually involves
burning of wood, oil, coal, kerosene and charcoal used in heating
or cooking, or gasoline engines in cars.
Carbon monoxide, is sometimes called the "silent killer", it is a
colorless gas, insoluble in water and alcohol. When inhaled it combines with hemoglobin to form carboxyhemoglobin.
Carboxyhemoglobin is 250 times more stable than oxyhemoglobin. When
carbon monoxide is in circulation, aside from limiting the oxygen
carrying capacity of the blood, it further prevents the release of oxygen
from oxyhemoglobin, thereby increasing the insufficient oxygen
supply to the tissue. The occurrence of symptoms in carbon monoxide poisoning depends on the rapidity of intoxication, ability of
the individual to tolerate the lack of oxygen and the presence of
other depressant drugs, usually alcohol. The main action of carbon
monoxide is oxygen deprivation and not its toxic manifestation,
so the oxygen deprivation of the tissue is the degree of saturation of
hemoglobin with the gas.
Accidental and suicidal death by carbon monoxide poisoning is
common. Victims may be accidentally imprisoned or deliberately
enclose themselves in a room or garage with motor engine running
or slow burning is present.
Judicial death execution by gas chamber is utilized in some states
of the United States. Sudden exposure to high concentration of the
gas will cause almost a painless death.
Relationship of Carboxyhemoglobin and Symptoms:
Level of CO-H in a
% Saturation
Less 10
10 — 20
Symptoms
None.
Tightness across the forehead, mild headache,
breathlessness on exertion.
452
LEGAL MEDICINE
20-30
Throbbing headache, emotional instability,
irritability, fatigue, lethargy (may be mistaken
for intoxication).
30-40
Severe headache, nausea and vomiting, dizziness
and confusion, ataxia, dyspnea.
Syncope, coma with convulsion, tachycardia.
50-60
Increasing coma with incontinence.
60-70
Profound coma with convulsion.
70-80
Above 80
Rapid death from a respiratory arrest.
(From:
GradwohVs Legal Medicine by Camps, Robinson & Lucas,
3rd ed., 1976, John Wright & Sons Ltd.).
Qualitative Test for Carbon Monoxide in the Blood:
1. KunkeVs Test — The suspected blood, diluted with 4 volume of
water is mixed with three times its volume of 1% tannic acid
solution and shaken well. If carbon monoxide is present, a crimson-red coagulum which retains its color for several months will
develop. Normal blood forms a coagulum, which is, at first red,
and becomes brown in the course of one to two hours and then
gray up to 24 to 48 hours.
2. Potassium Ferrocyanide Test — 15 cc. of blood is mixed with
equal amounts of 20% potassium ferrocyanide solution and 2 cc.
of dilute acetic acid and shaken gently. A bright red coagulum
will be formed if the blood contains a carbon monoxide, while a
dark brown coagulum will be formed if the blood is normal.
3. Examination Through a Spectroscope — The characteristic bands
of car boxy hemoglobin will be shown.
4. Gas Chromatograph.
5. Infra-red Analysis.
CARBON DIOXIDE (C0 , CARBONIC ACID GAS):
2
Carbon dioxide is the gas blown out of the lungs during respiration,
product of complete combustion of carbon containing compounds,
and the end result of fermentation and decomposition of organic
matters.
It is a colorless, heavy gas often mixed with carbon monoxide and
hydrogen sulfide and is often found in drainage pipes, deep wells,
sewage taftks and other places where decomposing organic matters
are present. Some refrigerants and dry ice is composed of carbon
dioxide.
A small amount of gas which is mixed with air (2%) is a potent
stimulant to increase rate and depths of breathing, however, stronger
DEATH BY ASPHYXIA
453
concentration (10% or more) may cause ataxia, fall of blood pressure,
loss of reflexes, anesthesia, diminished respiration, dyspnea, discomfort and muscular weakness. Greater concentration (60%) may
cause immediate loss of consciousness, with or without convulsion
and death. The inhalation of pure carbon dioxide may cause immediate vagal inhibition with spasm of the glottis and death. Ordinarily,
the cause of death is asphyxia due to deficiency of oxygen supply to
the brain (anoxia).
The concentration of carbon dioxide is more in manhole, deep
well, brewery bat and poorly ventilated rooms.
Tests for the Presence of Carbon Dioxide:
1. Barium nitrate gives a white precipitate of barium carbonate with
carbonic acid.
2. Silver nitrate gives a white precipitate of silver carbonate when
carbonic acid is added.
Post-mortem Appearance:
Face is cyanosed, markedly blue and may be swollen, mouth may
be frothy and with congestion of the eyes.
Pupils are dilated and lungs is markedly congested.
Right side of the heart contains dark fluid blood with venous
engorgement.
Ecchymotic patches in small intestine, pericardium, pleura and
galea of the scalp.
Internal organs are dark in color and congested.
Blood examination shows quantitative increase of carbon dioxide
content.
Blood shows an increase amount of carbon dioxide.
HYDROGEN SULFIDE (SULPHURETTED HYDROGEN, H£):
Hydrogen sulfide is formed during a decomposition process of
organic substances containing sulphur. It is found in large quantities
in a sewer, septic tanks, drainage pipes, and deep wells. It may be a
by-product in some industries, like tannery, rayon factories, petroleum refineries, sulfur dye work, etc..
It is a colorless, transparent gas, sweetish taste and emiting an odor
similar to a rotten egg. The gas is soluble in water to form carbonic
acid and it burns in the air with a pale blue flame.
A dilute solution produces irritation of the eyes, nose, throat
and air passages, followed by dizziness, headache, nausea, vomiting,
abdominal pain, cyanosis, dilated pupils, cold extremities and labored
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breathing. Prolonged exposure on a diluted atmosphere may cause
tetanic convulsion, delirium, stupor, coma and death.
Inhalation of a very dilute amount of gas may pass into solution
in the blood where it is rapidly oxidized by the oxygen of hemoglobin to form a harmless or relatively non-toxic substance. Concentrated solution may cause immediate death.
Detection:
1. The offensive odor may be recognized even if the dilute gas is
one part in 10,000 part of air.
2. A piece of filter paper moistened with lead acetate will turn black
if it was brought in contact with the stomach or other organs
containing the gas.
Post-mortem Findings:
Putrefaction sets rapidly.
Offensive odor is noticed on opening the body.
Blood in fluid state, dark-brown in color is due to conversion of
hemoglobin to sulmethemoglobin.
Lungs are congested and edematous.
Other organs are congested and dark colored.
HYDROGEN CYANIDE:
Hydrogen cyanide is one of the most toxic and rapid acting gases.
It is formed by addition of acid to potassium or sodium salt of
cyanide. It is naturally found in leaves of cherry-laurel, in bitter
almond, in kernels of common cherry, plum, peaches, in ordinary
bamboo shoots, and in certain oil seed and beans. These plants
contain a crystalline glucoside known as amygdalin which, in the
presence of water and natural enzyme, called emulsin, is readily
decomposed into hydrocyanic acid, glucose and benzaldehyde.
Orally, the equivalent of 60 — 90 mg. of hydrogen cyanide is
fatal.
As a vapor cyanide produces the following symptoms at
different level:
Amount in ppm
Effect and Duration of Life
10 ppm
20 ppm
100 ppm
200 — 400 ppm
2,000 ppm
Maximum permissible concentration.
Slight symptoms after several hours.
Very dangerous within 1 hour.
Lethal within 30 minutes.
Lethal immediately.
In a large dose, the symptoms appear within a few seconds or even
during the act of swallowing. It is rarely delayed beyond one or two
minutes.
DEATH BY ASPHYXIA
455
In smaller dose, the patient may be able to walk and speak or
perform volitional acts before death takes place.
In still smaller dose, the patient may still manifest symptoms such
as loss of muscular power, giddiness, slow and stertorous breathing,
with loss of consciousness which may or not be preceded by convulsion before death. The average span of life after partaking the
drug is two to ten minutes. It is possible that life may be prolonged
for two to three hours, but in most cases the patient will recover,
if death does not occur within an hour.
For reasons that only a small quantity is needed to end ones life,
hydrogen cyanide is often used for suicide purpose.
Post-mortem Findings:
Body is livid or violet in color.
Post-mortem lividity is bright red or pink due to the formation of
cyanmethhemoglobin.
Fingers are clenched, fingernails are blue and jaws are firmly
closed.
Eyes are bright and glistening and pupils are dilated.
Odor of the acid may be noticed on opening the body.
Heart is engorged with bright red blood.
If the chemical is taken orally, mucous membrane of the esophagus
and the stomach may be congested and covered with froth.
SULFUR DIOXIDE:
Sulfur dioxide is a colorless gas, which is heavier than air and with
pungent odor. It is employed as a disinfectant, as a bleaching agent,
a powerful reducing agent, and found usually in eruption of volcanoes.
The gas produces irritation of the respiratory passage, thus causes
sneezing, coughing, spasm of the glottis and suffocation.
It also irritates the eyes and causes congestion and lacrimation.
Post-mortem findings is not characteristic. There may be cyanosis,
with signs of asphyxia.
W A R GASES
Although, the term signifies its use in time of war, it may be also
used in riots, mobs or in any other situation where control or suppression of the activities of the people on a specific area is desired.
Some of the agents included may cause death, however, when
applied in a lesser concentration it may only cause irritation, inconvenience, weakening of resistance of defense and physical damages
on the victims.
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Although, the term signifies true gas it may be a smoke, volatilized
liquid or finely divided solids.
Essential Characteristics of a Substance to be Considered as War Gas:
1. It must be a substance heavier than air. If it is lighter than air then
it will have the tendency to concentrate at a higher level of the
atmosphere, thereby it serves not its purpose.
2. It must be capable of spreading rapidly on the area where the
chemical effects is desired.
3. It must be capable of producing effect even in low concentration
on a specified area.
4. It may be a true gas, smoke, volatilized liquid or finely divided
solid.
5. It can be manufactured in big quantity in a relatively cheap price.
6. It must be a stable substance or not easily made non-toxic by
rapid chemical reaction.
7. It is capable of storage for an ample length of time.
react freely with the container in which it is stored.
It must not
Classification Based on the Physiological Action:
1. Lacrimator or Tear Gas:
An exposure of the eye to the substance will cause irritation
with copious flow of tears. The most commonly used during the
last wars were:
a. Chloracetophenone ( C . A . P . ) — Finely divided powder with sour
fruit odor;
b. Bromobenzyl Cyanide ( B . B . C . ) — Heavy oily, dark brown
liquid with penetrating bitter-sweet odor;
c. Ethyl Iodoacetate ( K . S . K . ) — Dark brown, oily liquid with pear
odor.
They are fired from an artillery shell and an exposure to the
substance causes severe lacrimation, spasm of the eyelids, congestion
of the conjunctivae and temporary blindness.
In high concentration, the vapor causes irritation of the respiratory passages and lungs and produces a burning sensation in
the throat and discomfort on the chest.
A lo"rjg time exposure may cause vomiting, nausea, bronchitis
and blistering of the skin.
Gas mask may be used as a preventive measure and washing of
the affected eyes with boric acid solution. Sodium bicarbonate
solution may be applied in other affected areas.
DEATH BY ASPHYXIA
457
2. Vesicant or Blistering Gas:
Contact with the skin may cause bleb or blister formation.
a. Mustard Gas (Diehlordiethyl Sulfide, Yellow Cross, "Yperite"):
It is a heavy, oily liquid, having a mustard-like or garliky
odor and gives vapor at an ordinary air temperature. It is
insoluble in water but dissolves freely in paraffin, ether, benzene, alcohol, acetone and carbon disulfide and it readily
penetrates clothings, leather, wood or brick, etc..
Contact with the liquid or vapor causes profuse lacrimation
and nasal secretion, laryngitis, nausea, vomiting and gastric pain.
It enters deeply into the clothings and skin causing intense
itching, redness, vesication and ulceration.
Axilla, groin,
perineum and scrotum which are moist due to perspiration were
chiefly attacked.
Exposed parts of the body, like the face,
neck and hands are also affected.
b. Lewisite
(Chlorovinyl-dichlorarsine):
This is a heavy liquid having an odor of geraniums. It is
insoluble in water but rapidly dissolves in benzene, oil and other
organic solvents.
Contact with the skin causes erythema, vesicle with cloudy
fluid containing arsenic and leucocytes. As an asphyxiant it
acts more rapidly than mustard gas and produces more discomfort.
3. Lung Irritants (Asphyxiant or Choking Gas):
These substances are released from tanks, canisters and gas
shells. When inhaled, they cause dyspnea, tightness of chest and
coughing, varying degree of conjunctival irritation, vomiting, coma
and death.
a. Chlorine (Cty ~~ A yellowish-green gas, about 2-1/2 times
heavier than air, with pungent and irritating odor.
Exposure to the gas produces irritation of the conjunctivae.
It causes laryngeal spasm, irritative cough, dyspnea, pain in the
chest, cyanosis, asphyxia, weak pulse and collapse. Death may
occur rapidly due to the spasm of the larynx.
Autopsy reveals massive edema of the lungs, with scattered
areas of pneumonic process.
Pulmonary edema may cause
obstruction of the pulmonary circulation. Mucous membrane
of the air passage may show catarrhal inflammation.
b. Phosgene (COCI2) — It is a colorless gas, 3-1/2 times heavier
than air, decomposed in water into hydrochloric acid and
carbonic acid. It is ten times more toxic than chlorine, but
owing for its poor solubility its action is delayed.
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LEGAL MEDICINE
c. Chloropicrin — An oily liquid, smells like chlorine and about
four times more toxic than chlorine.
d. Dipho&gene — An oily liquid, heavier than phosgene and an
intense lacrimator.
Treatment consists of the removal of the victim from the
vitiated atmosphere, absolute rest, administration of oxygen
by inhalation aside from the symptomatic approach.
4. Sternutator (Nasal Irritants or Vomiting Gases):
Any person inhaling the air or swallowing food or water contaminated with the chemical would be stricken with coryza, nausea,
malaise, headache, vomiting, salivation and pain in the chest,
and prostration.
Some of the Compound Used During War Time are:
a. Diphenyl chlorarsine (D.A.) — Colorless, crystalline solid,
slightly soluble in water but dissolves in diphosgene and dichloropicrin.
b. Diphenylamine chlorarsine (D.M.) or Diphenylarsine-chlorasine
— yellowish crystalline solid.
c. Diphenyl (cyanarsine (D.C.) — White, odorless crystalline solid.
5. Paralysants (Nerve Gas):
N e w drugs which cause inactivation of cholinesterase and consequent increase of acetylcholine causing paralysis at the myoneural junction. The manner of action is similar to organophosphates and carbamates insecticides.
6. Blood Poisons:
a. Hydrocyanic Acid (Hydrogen Cyanide or Prussic Acid) — a
powerful protoplasmic poison that prevents the tissue from
utilizing the oxygen of the blood.
b. Hydrogen Sulfide (Sulphurated Hydrogen) — When inhaled,
it passes into solution in the blood to form a harmless and
relatively non-toxic substance. If in a pure form or at a higher
concentration, it causes paralysis of the respiratory center,
giddiness, nausea, abdominal pain and irregular heart action.
c. Carbon Monoxide (Carbonic Oxide, CO) — This gas is combined
with hemoglobin of the red blood cells to form a stable compound known as carboxyhemoglobin and reduces the oxygencarrying capacity of the blood.
Chapter XVIII
DEATH OR PHYSICAL INJURIES DUE TO
AUTOMOTIVE CRASH OR ACCIDENT
AUTOMOTIVE CRASH:
Factors Responsible to an Automotive Crash:
1. Human Factor (Driver):
a. Mental Attitude — reckless driving, showing of, inattention,
fatigue, inexperience.
b. Perceptive Defect — Defective vision incapable of seeing an
impending crash or defective hearing, unable to perceive whistle
of train or automotive horn.
c. Delayed or Sluggish Reaction Time — Reaction time is the
space of time the driver perceives an impending danger and the
actual application of the brake. A quick reaction time may
prevent the occurrence of a crash by sudden deceleration before
the impact occurs.
d. Disease — The driver may develop an epileptic fit or suffer
from a heart attack while on the steering wheel.
e. Chemical Factor — Alcohol is the most common. It blurs and
diminishes the field of vision, blunts the senses of hearing and
makes sluggish response to an impending danger.
Depressant drugs, like sedatives, tranquilizers, and narcotics
do prolong the reaction time, impairs the power of decision and
rational thinking.
Smoking marijuana may interfere with time and space perception, and attention to complicated task of driving.
A leak in the exhaust system of the vehicle may cause entry
of carbon monoxide into the passengers compartment, especially in the air-conditioned cars, and may cause unconsciousness
of the occupants including the driver due to poisoning.
Other drugs, especially psychotrophic, may cause delirium,
unconsciousness which may cause impairment of reaction to a
traffic situation.
2. Environmental Factor:
Bad or poorly maintained roads, poor visibility, atmosphere,
rain, blind intersection, parked vehicle obstructing the view, trees
too close to the road, absence of road signs, etc. have contributed
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LEGAL MEDICINE
to the occurrence of crash. In highways, the absence of railing on
the side of the road beside a deep ravine, precaution signs and
speed limits, curve or narrow strip have been responsible for
many fatalities.
Stiff and slippery road may prolong the sked time. Sked time
is the space of time between the actual application of the brake and
the stopping of car. Sked time is influenced by the condition of
the tire, condition of the ground and the amount of weight of
the load. Cars moving with worn out tires, on a sloping and slippery road have the tendency to prolong the sked time.
3. Mechanical Factor:
Defect in the steering wheel, poor brake, transmission failure,
worn out tires, unstable body are potential source of vehicular
crash. The advent of modern high power engine and high octane
fuel are conducive to high speed sometimes beyond the control
of the driver. This is further enhanced with automatic transmission which diminishes human factor in the control of the
vehicle.
4. Social Factor:
a. Speed is an added dimension in our life. Modern car manufacturers develop high compression, fuel economy and high speed
which are improvements of their new cars.
b. Does car insurance develop "devil may care" attitude on the
driver inasmuch as he will not be financially held liable for
damages as a consequence of a crash?
Statistics has shown
that automotive accidents have increased tremendously recently.
5. Pedestrian.
Injuries and Death on the Driver and Passengers.
In automotive crash, there are two collisions that take place, namely:
1. First Collision — the impact of the moving vehicle with another
vehicle or a fixed object. The moving vehicle rapidly decelerates
and stops after the impact. The degree of damage on the vehicle
depends on the speed and part of the vehicle involved.
2. Second Collision — This is the impact of the unrestrained occupants with the interior of the vehicle. Immediately, after the first
collision, the occupants move in the same direction and at the
same velocity towards the point of impact. That is, in the front
impact, the occupants moves forward and in the side impact the
passengers or driver moves towards the side that was involved
in the first collision. If the vehicle is not put into a stop after the
first collision, the unrestrained occupants will continue to strike
to some parts of the interior of the vehicle.
AUTOMOTIVE CRASH OR ACCIDENT
461
Factors Responsible for Passenger and Driver Injury:
1. Displacement of the occupants within the vehicle with impact
against structures.
2. Ejection.
3. Distribution of the passengers in the compartment resulting in
direct impact injuries.
Front Impact Crash:
1. Driver — The driver may strike, the steering wheel, the hub of the
steering column, the windshield, the rear view mirror, the column
between the windshield and the side window, or the dashboard.
Severe impact of the driver's head on the windshield may cause
laceration of the scalp, face or neck. Skull fractures are often
observed.
The windshield glass is manufactured as two glass shields
separated by and adherent to a sheet of plastic. It is so made to
prevent breaking into pieces when force is applied on it.
Impact of the lower extremities against the dashboard may
cause fracture of the tibia, fibula, femur or pelvis as well as lacerations and abrasion of the skin of (he area.
When the car is running with a high velocity before the impact, the front portion of the car may be shortened or "accordioned" and the steering wheel may be driven back into the
passenger compartment. As a result this may cause severe chest,
neck or facial injury. The impact of the face to the circular
rim of the steering wheel may cause fractures of the teeth, jaw and
facial bones.
2. Front Seat Passenger — Like the driver, the front seat occupant
may strike the dashboard, windshield, rear view mirror, radio,
air conditioner or the windshield wiper knobs which may protrude
from the dashboard.
Pattern of Injuries on the Front Occupants:
a. Abrasion of the face and scalp.
b. Laceration of the face and scalp.
c. Fracture of the skull.
d. Crashing injury of the neck.
e. Laceration or rupture of the heart.
f. Laceration and contusion of the lungs.
g. Fracture of the ribs and sternum.
h. Laceration of the liver and/or spleen.
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3. Rear Seat Occupants:
They may strike the back of the front seat, the pillar between
the front and rear side doors, or may be propelled over the front
seat striking the front seat passenger and driver, dashboard or
windshield.
Side Impact Crash:
Side impact crash may occur when a vehicle strikes on the side of
another vehicle or when a vehicle 6kids sideways into another fixed
object. This is a common impact in street intersections. The injuries are more severe because the car has less crushable structural
components to absorb the force of the impact and the side of the car
are less rigid to prevent intrusion into the passenger compartment.
Since the side glass windows are not laminated with plastic control
layer, any force applied on it will result to large pieces of glasses
which cause laceration of the skin area in contact with it.
Since the passengers during the impact move towards the side of
the impact, the passenger nearest to it will suffer most. The lateral
impact to the chest may cause fracture of the ribs, contusion with
laceration of the lungs. Laceration of the spleen and kidneys and
pelvic fracture may also be observed in side impact.
Rear Impact Crash:
High velocity rear impact may occur following change of lane in
an express way or crash at the rear of a parked vehicle. With the
impact at the rear, the head moves backward or hyperextended.
Then, the head will move forward until the chin strikes the front
portion of the chest and with the neck hyperflexed. The backward
and forward movement of the head is known as "acceleration-deceleration injury" or "whiplash". It may result to muscle spasm or
injury to the ligament of the neck resulting to pain.
The rear impact crash may involve the gas tank. It may deform
or puncture the tank, dislodges its connection and causes spillage of
the gas on the road. The spark from a metal part dragging on the road
may ignite the leaking fuel and consequently burns the car.
The striking vehicle may intrude into the passenger compartment
and causes injury to the persons at the back seat.
Roll Over Crash (Tum-turtle Impact):
In the process of rolling, the occupants may be pinned, crushed
or may be thrown away and fall on the ground.
On account of the long period of the process of rolling, the
passenger usually does not sustain severe injuries. The rolling process
causes the different sides of the vehicle to absorb the force of the
impact.
AUTOMOTIVE CRASH OR ACCIDENT
463
While rolling, the unrestrained passenger may tumble inside the
vehicle and may sustain injuries from striking the interior of the
vehicle.
Ejection of the Occupant:
The primary impact of the vehicle may forcibly open the unlocked
door. Ejection may increase further the injury sustained by the
occupant. The acceleration of the body after the second collision
may subject a person to his impact on the ground.
Means Employed to Minimize Injury to Driver and Passenger:
1. The interior surface of the car is so designed to be less hostile to
the person striking them. The use of soft padded dashboard,
windshield safety glass, dashboard with perforation to allow
metal to deform easily, enlarged and padded central steering
wheel hub and collapsible steering column are now parts of
modern built cars.
2. The interior of the passenger compartment, including the steering
wheel, dashboard, side doors are prevented from intruding into
the passenger compartment and strike the occupants.
3. The fender, bumper and other parts of the car commonly involved
in the impact are made of metal which can absorb energy, dissipate such force and prevent its transmission to the driver and
passengers.
4. Special restraint to the occupants are being applied to reduce the
severity of the second collision in the forms of lap and shoulder
belt and air bag.
But, the use of seat belt is not absolutely considered as a safety
device.
It may cause injuries to the abdominal wall, visceral
organs and vertebral column. The acute flexion of the trunk
(jacknifing) with the belt as the central fulcrum may cause fracture of the trunk with the visceral organs in forward motion, may
stretch the mesentery and causes injury to the intestine and
mesentery itself. There may be abrasion, contusion and hematoma of the lower portion of the abdomen. All of these possible
injuries is known as seat belt syndrome.
Suicidal Crash:
This i6 usually a single vehicle and single occupant crash. It is a
head on collision with roadside object, pole or bridge support at a
high speed. There is no evidence of any effort to apply the brake or
to avoid striking the object. Crime scene investigation may show the
foot still on the accelerator pedal. History may reveal previous
attempts to commit suicide, as the presence of incised wounds,
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LEGAL MEDICINE
scars at the wrist or stab wounds in the chest and abdomen. Prior
psychiatric evaluation may reveal pathological findings and suicidal
tendency.
Homicide by Motor Vehicle:
Death by motor vehicle is usually on account of negligence and
rarely intentional. The driver may be reckless, lack the necessary
skill, aggressive, under the influence of drugs as the proximate cause
of the crash.
The simulation of a crash may occur to conceal a prior homicide.
Victim of other means of violent death (stabbing, shooting, mauling)
may be placed on the road to simulate that he is a victim of "hit and
run".
The driver may be shot while driving and lost control of the
vehicle to crash with another vehicle or fixed objects.
A careful investigation and post-mortem examination will reveal
the manner of death.
PEDESTRLAN-VEHICLE COLLISION:
Death or Physical Injuries to Pedestrian:
Pedestrian's injury or death is usually the result of two impacts
both of which are capable of causing severe trauma.
1. Primary Impact:
This is the first violent contact between the pedestrian and the
motor vehicle. Usually, the front bumper hits the leg of the victim.
The severity of the injury depends on the position of the victim
when the impact occurred, speed of the moving vehicle, and the
amount of bodily support (clothings and other apparel the victim
was wearing).
The movement of the body after the primary impact depends
on the location of the impact. If the contact is below the center
of gravity, the tendency of the body is to move backwards to
hit the hood, windshield or even the top of the car. The average
height of the bumper is 40 to 60 cms. from the ground and
considering the pedestrian with shoes on, the most common site
of the impact is the upper portion* of the leg. However, if the
driver had effectively applied the brake before the impact occurred, the place of contact will be on a much lower level. This
is due to the downward dive of the front end of the vehicle
immediately following the application of the brake.
Fracture of the leg bones as a consequence of the primary
impact is called bumper fracture.
The leg carrying the body
weight has more tendency to be fractured. If the victim is stand-
AUTOMOTIVE CRASH OR ACCIDENT
465
ing and the body weight is supported by both legs, there is more
chance for the bones of both legs to be fractured. The end of the
fracture usually protrudes through the skin opposite the place
of contact of the leg with the bumper.
If the primary impact is above the center of gravity of the
pedestrian, the tendency of the body is to move away from the
vehicle and fall on the ground.
If the brake was applied during or immediately after the crash
the car slow down faster than the movement of the pedestrian
who continues moving forward and land on the road. If no
brake was applied during the accident and at high speed, the
pedestrian will pass over the top of the hood, windshield and
windshield frame.
2. Secondary Impact:
This is the subsequent impact of the pedestrian to .the ground
after the first impact. The injury sustained by the pedestrian
depends mostly on the force of the ground impact, nature of the
road and part of the body involved. It is the secondary impact
that accounts for the multiple abrasions and contusions on the
body of the pedestrian-victim.
3. Run Over Injuries:
Children who receive the primary impact above the center of
gravity may fall on the ground with the car wheel passing over
the body. The pedestrian may be run over by the moving vehicle
during the initial impact or thereafter. Crash fracture, skid or tire
marks, rupture of organs and internal hemorrhage may be seen at
autopsy. Usually, the victim dies of shock and death that in most
cases it is instantaneous, especially when there is a crashing injury
on the head.
4. Hit-and-run Injuries:
A fast moving vehicle may run over, hit or side-swipe a pedestrian
or collide with another vehicle or fixed object and get away from
the scene without regard to the unfortunate victim. This usually
happens when the driver is drunk or "high", at night time, in an
isolated road and with no eyewitnesses or someone who could
take note of the identity of the vehicle.
Tire thread marks, abrasion prints of parts of the vehicle in
contact with the victim and paint detached from the vehicle found
in the crime scene or body of the victim may be submitted for
laboratory analysis, for comparison with that one of the suspect
car.
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LEGAL MEDICINE
The suspected car may be examined for the presence of blood
stains, hair or clothings of the victim for comparison with that
one of the victim.
If the car has been damaged as a result of the impact, the
investigator must make a diligent search of it in the motor shops.
Eyewitness may be able to take note of the plate number and the
identity of the vehicle can be checked at the Land Transportation
Commission.
Evidences in Vehicular Crash:
1. From the Scene of the Crime:
a. The area of the road where the collision took place and the
point of impact on the vehicle. A photograph or sketch must
be taken to determine who violated the traffic rules and regulation.
b. The skid and tire marks on the road must be noted and preserved to determine identity of the vehicle and whether the
driver stepped on the brake immediately before the crash.
c. Condition and position of the victim (pedestrian or occupants).
d. Condition of the vehicle involved in the crash and of other
structures in the vicinity.
e. Blood, paint stains, pieces of clothings that may be found in the
body of the victim, ground or on the vehicle.
f. Narrations of witnesses as to how the incident took place
including the identity of the vehicle and the victims.
2. From the Driver:
a. Fitness to drive — Capacity to manipulate the steering wheel,
step on the brake and accelerator, visual and hearing perception, reflex time, heart condition, history of epileptic seizure,
etc..
b. Alcoholic drunkenness — A person with at least 0.15% alcohol
in the blood is considered drunk. Some countries consider it
a crime driving with only 0.05% blood alcohol.
Examination for the presence of psychotropic, sedative or
narcotic drugs in the blood may be useful.
c. Injuries due to second collision — Like steering hub imprint,
fractured skull, multiple abrasions and laceration of the face
and scalp, fracture of the leg bones, ribs and sternum.
3. From the Victim in Vehicle-Pedestrian Collision:
a. Crush Injury:
The victim may manifest crushing injuries on the head with
multiple fractures at different parts of the body. Usually, the
AUTOMOTIVE CRASH OR ACCIDENT
467
injuries are localized in certain areas of the body, especially
when the victim is run over by the vehicle. All ribs may be
fractured.
Injuries of whatever description may be found.
b. Tire Thread Marks:
The pressure of the tire on the body surface may produce
abrasion marks.
This may be utilized in the identification
of the vehicle in "hit and run" cases.
c. A brasion Marks:
The most common is the mark of the radiator, if the portion
of the body of the victim hits the radiator of the vehicle.
d. Paint Marks:
Occasionally, the portion of the car that produces the injury
leaves its paint on the skin or clothings of the victim. The paint
may be scraped for the purpose of comparing it with the suspect's car.
e. Blood, Hair or Clothings of the Victim:
These may be found sticking on the part of the vehicle which
hit the victim. A careful removal and submission to the laboratory for comparison with that of the victim's is important.
f. Physical Defects of the
Victim:
This may diminish the power of the victim to prevent the
injury like poor eyesight, sluggish response to a given stimulus,
etc..
g. Inebriation of the Victim:
The victim might have been under the influence of alcohol
and other depressant drugs. If dead, the organs principally the
blood and brain must be submitted for quantitative determination of alcohol.
Purposes of the Autopsy of Victims of Vehicular Accidents:
Although, it may appear incontrovertibly clear as to the cause of
death of a victim of vehicular crash, it is still imperative to perform
the routine post-mortem examination for the following reasons:
1. The examiner can give his opinion as to the deceased's position in
the vehicle or the pattern of the injuries correlated to the point
of contact with the vehicle.
2. Examination will determine whether death occurred as a result
of the crash and not due to a natural disease, poisoning, gunshot
wound or other causes prior to the crash.
3. In cases when more than one member of the family died in a
crash, the examiner can form an opinion as to who from among
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them survived the longest. The question of survivorship may be
important in the settlement of the estate.
4. The size of the monetary reward in a civil suit may depend on the
nature and extent of the injuries suffered. The injuries that was
found will determine the pain and suffering of the victim and
may be one of the basis of damages.
MOTORCYCLE CRASH:
Reasons Why there is a High Percentage of Motorcycle Crash:
1. A motorcycle can attain a high speed compared with other ordinary road vehicle.
2. It has a small profile that the driver of other vehicles may fail to
see it.
3. At high speed and frequently in curves, the cyclist may lose control of the bike. It may hit a fixed object, the tire may skid, or
the cyclist may be drunk.
Whenever the motorcycle strikes another vehicle or a fixed object
the injuries is quite severe because:
1. There are so little crushable materials to absorb the impact that
the motorist himself is subjected to the severe force.
2. No restraint system is available to keep the operator and the
passenger on the bike and as a result, ejection from the motorcyle
is common.
The most common injuries sustained are on the head and legs.
Fracture of the skull and fractures of the leg bones are quite common. Most of the injuries are caused by the impact of the cyclist
on other objects.
Inasmuch as the cyclist i6 exposed to crashes, the only alternative
approach is the protective wearing apparel.
1. Leather jacket, thick pants, and gloves to protect the skin from
injuries that result from ejection.
2. Leather boots to protect from injuries of the bones of the feet
and legs.
3. Motorcyclist helmet which must be buckled to protect the head.
Chapter XIX
DEATH OR PHYSICAL INJURIES
DUE TO ATHLETIC SPORTS
In line with the physical fitness program, an appreciable number
of people are now involved in athletic sports of their own choice.
This incidentally increases the number of injuries and fatalities.
Although most injuries and fatalities are, as a rule, due to accident
or from natural cause, inquiries as to the adequacy of the medical
supervision, sufficiency of training of the contestants, utilization of
the safety measures and proper observation of the rules may be the
subject-matters of medico-legal investigation.
Some Aspects of Sport Development:
1. Training Method:
To develop weight-lifting,
a lifter must lift a very heavy
weight during his practice. To develop speed, a runner must run
very fast during his practice.
Besides, two or three intense workout each week, an athlete
also needs one endurance workout.
2. Injuries:
If the athlete is injured, he is rehabilitated by not allowing him
to participate in the sport that caused the injury and by finding
another sport that does not cause pain.
Every time the muscles are exercised intensely, injuries occur
and it will take at least 48 hours for the muscles to heal.
Future recurrence is being prevented by correcting the cause
of the injury.
Although, continuous exercise despite the pain
will result in further injury, neither is it necessary to stop exercising altogether. For in every week without exercise, it may
take several weeks of training to regain prior condition.
3. Nutrition:
Muscle endurance depends on how much glycogen can be
stored in the muscle cells. The glycogen storing capacity can be
increased by exercising the muscles until most of the glycogen is
depleted. Depletion, in the average top runner, occurs at 1-1/2
to 2 hours while on a bicycle racer it is 3 to 5 hours.
Competitive athletes need to eat large amount of carbohydraterich foods to help them store glycose as liver and muscle elvrn«w»n
470
LEGAL MEDICINE
Increase glycogen storage in muscle results in an increase of
muscle endurance.
The pre-game meal should be eaten 3 to 5 hours before competition. The liver can store enough glycogen to last for 12 to
15 hours. Skipping breakfast before competition can result in
hypoglycemia and tiredness during competition.
Food should be eaten within 3 hours before competition
because postprandial hyperinsulinemia last for 2 to 3 hours.
Hyperinsulinemia at the start of exercise can cause hypoglycemia
and fatigue. Athletes' greatest nutritional need is fluid. Athletes
should drink cold water because it is absorbed faster and less likely
to produce cramps ( J A M A , Oct. 25, 1985).
A. BOXING
Boxing as a sport is sometimes described as an "organized brutality", "slaughter" and "carnage". Unlike other sports, the primary
objective of the combatants is to knock out or win by decision by
delivering a stunning or weakening punches. Generally, in most
6ports, the infliction of physical injuries are purely accidental but in
boxing, it is the direct and primary objective of the combatants.
So in this respect, boxing is considered to be one of the most brutal
among the athletic sports.
Consequently, the public has a varied reaction as to whether it
must be legalized or prohibited a6 an athletic sport.
1. Reasons W h y Boxing Should N o t Be Prohibited:
a. It takes wayward youths who are victims of the educational
system off the streets;
b. It teaches them self-discipline and controls and reinforces the
adage that nothing of value is acquired without hardwork and
sacrifice.
c. Self-confidence can only be promoted through an individual
sport where the athlete must rely in his own talent and believes
in his own ability. Only through conflict can hidden resources
surface.
2. Reasons Why Boxing Should be Prohibited:
a. There is too much risk of death or injury to the participants.
b. Unlike other sports, the intention of the combatants is to
produce injury as a principal way to win the contest. So,
young men should be discouraged from a pugilistic career.
DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS
471
A
Rotational
Acceleration
B
Linear
Acceleration
C
Injury to Carotid
472
LEGAL MEDICINE
3. Potential Injuries Suffered by Combatants in Boxing:
a. Inasmuch as the face is the target of the attack by the combatants, the most common site of lacerated wound is the
region of the eyebrow and the cheek (malar region). Bleeding
comes from the small blood vessels which are crushed between
the superficial bone and the force applied. Bleeding from the
eyebrow may drip downwards to the eye and causes irritation
and blurring of vision. If bleeding cannot be controlled on
account of the severity of the injury, the referee may stop the
bout.
Protagonist may be knocked down or accidentally fall on
the canvass causing laceration of the scalp.
b. Serous effusion on the loose tissue around the eyeball and in
the eyelid may cause puffiness and closing of the eye. Hemorrhage due to the rupture of the blood vessels or the fracture of
the orbital plate of the frontal bone may cause swelling and
discoloration in or around the eye, known as spectacle hematoma may develop.
c. Trauma on the pinna of the ear may produce hematoma with
subsequent necrosis of the auricular cartilage. After healing
and scarring process, the pinnas appear to be thick and irregular,
known as cauliflower ears.
d. Fracture of the nasal septum, mandible and maxillary bone
may develop as a consequence of a hard hook or a straight
blow. Fracture of the skull is quite unusual to develop because
of the difficulty to do so with a gloved fist. However, an
unconscious fall on the canvass may cause it.
e. Retinal detachment is one of the serious hazards of boxing
as it may cause partial or complete loss of vision.
f. Muscle cramps, sprain and dislocation may occur and may
force the boxer to give up the fight.
g. A kidney punch may cause peri-renal hemorrhage or laceration
of the kidney that causes it to lose its function and subsequent
uremia.
h. A blow on the face may cause laceration of the lip and buccal
mucosa with loosening or detachment of the teeth.
i. Intracranial injuries may cause serious sequelae of death to the
boxer.
( 1 ) Cerebral concussion or the transitory period of unconsciousness is a result from a blow on the head that may last for
a few seconds or longer. The loss of consciousness should
DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS
473
never be dismissed lightly because recovery may only be an
interlude to some serious intracranial changes.
( 2 ) Subdural hemorrhage is the most common injury which
may be localized or extensive. The most common site of
hemorrhage is the middle cranial fossa. A blow on the jaw
is transmitted to the temporo-mandibular joint and then to
the middle cranial fossa. Repeated trauma on the skull
cause tearing of the dural emmissary veins.
( 3 ) Pontine hemorrhage, known to some as boxers hemorrhage
may be the result of severe beating.
The acute flexion
and extension of the head during a series of blows may
cause the brain stem to be pinched over the tentorium
causing hemorrhage.
The effect on the brain of a boxing blow depends on the
location, direction, intensity, velocity and number of blows.
(1)
Rotation
(angular) Acceleration:
A blow which causes the rotation of the movable head
will cause the inert brain to lag behind the accelerated skull.
This is particularly true to a groggy fighter who has lost
control of his neck muscles in the head which is most
susceptible to sudden acceleration. The effects are:
(a) Subdural Hematoma — The bridging veins that connects
the brain with the superior saggital sinus of the dura
mater is tightly bound to the skull. These veins are
stretched when the skull accelerates.
In turn, blood
accumulates in the subdural space causing compression,
edema and herneation of the brain.
( b ) Intracerebral Hemorrhage — The rotational movement
of the brain within the accelerated skull may tear vessels
within the brain. Such hemorrhage may develop in the
para-saggital regions of the cortex and subcortical white
matter. It may develop in the deeper white matter, the
corpus callosum and the cerebral peduncle.
(c) Diffused Axonal Injury — Damage to the axqn of the
white matter is common to head trauma. Microscopically, it is recognized by spherical enlargement of the
proximal and distal stumps. A few severed axons may
not be sufficient to produce clinical symptoms but their
number will increase with each bout and eventually
clinical deficits become apparent..
474
LEGAL MEDICINE
(2) Linear (Translational Acceleration):
A straight blow on the face may cause focal ischemic
lesions, notably in the cerebellum.
Vascular spasm associated with focal ischemia are known to occur after
subarachnoid hemorrhage and often manifest themselves
a few days after bleeding. In groggy boxers, sudden linear
acceleration also may produce hyperextension of the neck,
which is known to damage axons of the medullary-pontine
angle and the reticular substance, resulting to a knockout.
( 3 ) Injury to the Carotid:
Blows to the neck can damage the carotid. Dissecting
aneurysm or occlusion by thrombus may follow. Pressure
on the carotid sinus induces reflex mechanism that causes
hypotension and bradycardia associated with decrease
bloodflow to the brain. A loss of muscle tone and brief
fainting spell will contribute to a boxer's groggyness, and
increases his susceptibility to head acceleration by successive
blows.
( 4 ) Impact Deceleration:
After a knockout, the boxer hits the rope or mat. Fall on
the back produces rapid deceleration which typically results
in contre-coup contusions of the orbital surface of the
frontal lobes and the tips of the temporal lobes. The crest
of the convolutions are torn apart, which is associated with
parenchymal and sub-arachnoidal hemorrhage.
Furthermore, the inert brain will glide within the cranial cavity,
causing para-saggital gliding contusion (small hemorrhage in
the cortical and subcortical white matter as well as subdural hematomas).
Cerebral Edema, Ischemia and Herneation:
Severe trauma on the head is usually followed by cerebral
edema.
It increases pressure on the swollen brain within a
confined space of the cranial cavity which affects the blood
flow.
The vessels are squeezed resulting in ischemia which
further contributes to edema.
The mounting pressure intracranially causes the brain to
herneate over the edge of the tentorium and through the
foramen magnum. Hemorrhagic necrosis of the brain at the
point of herniation (inferior temporal lobes and cerebellar
tonsils) develops rapidly.
Death results from ischemia and
hemorrhage in the midbrain and upper pons after such herniation.
DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS
475
Cerebral Atrophy, Enlarged Ventricle and Septal Cavum:
Gross examination of the brain from punch-drunk boxer
reveals enlarged ventricle, widened sulci and narrowed gyri.
The most typical finding is the presence of a large cavum
septi pellucidi with multiple fenestration. The septal cavum
is not infrequently observed as an incidental finding in autopsy,
but in boxers the width of the cavum is much larger, and
fenestrations are unusual in non-boxers. The repetitive rotational acceleration of the head, in boxers, is believed to tear
the septal wall and causes spinal fluid to collect within the
cavum.
Ventricular engorgement and atrophy are expected
to develop as a consequence of axonal and neural degeneration
(JAMA, Vol. 251, No. 20, p. 2676 (May 25, 1984).
Delayed Consequence of Brain Damage:
The delayed sequelae of intracranial damages in boxing is
summed up to what is commonly known as punch-drunkenness
or traumatic or pugilistic encephalopathy. This is characterized
by slurred speech, slow clumsy movement, unsteadiness of gait,
tremor, progressive dementia, poor tolerance to alcohol and
symptoms of progressive ventricular dilatation.
In case of thr> hypothalamus, and the pituitary gland are involved on account of the fracture of the base of the skull, the
boxer may suffer from diabetes inspidus when the neuropituitary gland is involved and hypothermia if the hypothalamus
suffered injury.
Post-Mortem Findings:
( 1 ) In case of death after the injury due to intracranial hemorrhage:
(a) Generalized edema of the brain.
( b ) Presence of intracranial hemorrhage usually subdural.
(c) Compression of the brain on account of massive hemorrhage.
( d ) Petechial hemorrhage in the white matter.
(e) Compression of the brain stem at the region of the
foramen magnum.
(f) Small areas of contusion on the brain surface.
(g) Histologically:
i. Perivascular and pericellular space.
ii. Capillaries
show
congestion with endothelial
swelling.
iii. Axons are swollen and poorly stained.
476
LEGAL MEDICINE
iv. Astrocytes appear swollen and nerve cells show
chromatolysis and cytoplasm vacuolated.
( 2 ) In case of death after a chronic sequelae:
(a) Abnormality in the septum pellucidum.
( b ) Cerebellar and other scarring.
(c) Small areas of scarring in the cerebellar tonsil and
medulla oblongata.
(d) Reduction of the brain weight.
(e) Lateral ventricle widely dilated with thinning of the
corpus callosum.
(f) Loss of pigmented nerve cells in the substantia nigra.
4. Measures Which Are Adapted to Minimize Injuries in Boxing:
a. Use of an effective gum shielding to avoid injury to the structures of the buccal cavity.
b. Use of heavier or well-padded gloves.
c. Use of preliminary binding of the hands with cotton or zinc
oxide adhesive plaster to reduce incidence of fracture and
displacement of the metacarpal bones.
d. A boxer who is "knocked out" or is stopped from fighting to
prevent further punishment must be thoroughly examined with
an electrocardiogram and his license to participate in any ring
combats must be suspended until a new certificate of fitness
is issued.
e. Spacing between matches, usually not less than a month, to
avoid too much muscular strain and it should be a part of the
regulation.
f. Amateur bout must not last more than five minutes and there is
a move to reduce title bout from fifteen to only ten rounds.
g. Blow on the genital region is considered a foul.
h. The use of stimulants is prohibited.
B. WRESTLING
1. Common Injuries Suffered by Combatants:
a. Injury to the cervical spine (fracture and/or dislocation) especially when the wrestler forms a bridge during the contest. There is
a bridge when the trunk and neck is hyper-extended and the
D o d y weight is supported by the head which touches the
ground and the feet.
b. Knee injury, usually meniscus or ligament tear that follows
hyperextension and rotation of the leg.
DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS
477
c. Injuries to the shoulder joint and a rotator cuff result from
twisting of the trunk and upper extremities.
d. Facial injuries and mat burns due to contact of the face to the
floor.
e. Abdominal hemorrhage due to rupture of organs in violent
fall.
2. Regulations to Minimize Injuries:
a. Pulling of hair, ears and genitals, twisting of the digits, blows
with the fist, and kicking are forbidden.
b. Each contestant must have a medical examination immediately
before the combat.
c. A five minutes rest period must be allowed after any fall on the
head or any sign of bleeding from the nose.
d. The competitors must be freshly shaven, the hair must be short
and no grease or lubricant may be used in the body.
Chapter XX
CHILD ABUSE OR NEGLECTED CHILD
(Battered child, Battered child syndrome, Maltreatment syndrome,,
Maltreated child, Physically abused child, ni-treated syndrome.)
It is the physical and mental injury or maltreatment of a child by
a person who is responsbile for the child's welfare, under circumstances which will indicate that the child's health or welfare is
harmed or threatened thereby. The infliction must be willful and
not accidental.
The victim is of tender age, usually less than 3 years old. It occurs
in all levels of the economic strata. Usually, only one child is involved. Parents are frequently immature, self-centered, impulsive
and with poorly controlled aggression.
Duties of Parents:
Art. 46, The Child and Youth Welfare Code — General Duties:
Parents shall have the following general duties toward their children:
(1) To give him affection, companionship and understanding;
( 2 ) To extend to him the benefits of moral guidance, self-discipline
and religious instruction;
(3) To supervise his activities, including his recreation;
(4) To inculcate in him the value of industry, thrift and selfreliance;
(5) To stimulate his interest in civic affairs, teach him the duties
of citizenship, and develop his commitment to his country;
( 6 ) To advise him properly on any matter affecting his development and well-being;
(7) To always set a good example;
(8) To provide him with adequate support, as defined in Article
290 of the civil Code:
Support is everything that is indispensible for sustenance,
dwelling, clothing and medical attendance, according to the
social position of the family.
Support also includes the education of the person entitled
to be supported until he completes his education or training
for some profession, trade or vocation, even beyond the age
of majority. (Art. 290, Civil Code).
478
CHILD ABUSE OR NEGLECTED CHILD
479
(9) To administer his property, if any, according to his best
interest, subject to the provision of Article 320 of the Civil
Code:
The father, or in his absence the mother, is the legal administrator of the property pertaining to the child under
parental authority. If the property is worth more than two
thousand pesos, the father or mother shall give a bond subject
to the approval of the Court of First Instance (Art. 320,
Civil Code).
Rights of Parents:
1. Under the Child and Youth Welfare Code:
Art. 45, Right to Discipline the Child — Parents have the right
to discipline the child as may be necessary for the formation of
his good character, and may therefore require from him obedience
to just and reasonable rules, suggestions and admonitions.
2. Under the Civil Code:
Art. 316 — The father and the mother have, with respect to
their unemancipated children:
( 1 ) The duty to support them, to have them in their company,
educate, and instruct them in keeping with their means, and
to represent them in all actions which may redound to their
benefit;
(2) The power to correct them and to punish moderately.
Act or Omission Affecting the Child's Health or Welfare:
1. Physical Abuse — The law allows chastisement for discipline but
it may be physical abuse when it involves the use of instrument or
fist blow. It may include the act of physical or emotional persuasion that forces or places the child in a potentially dangerous
situation in which the subsequent and significant physical injuries
are severe enough to require medical treatment.
2. Physical Neglect — It is the failure to provide the child with the
necessities of life.
It may include inadequate or insufficient
medical care, nourishment, clothings, supervision, housing, or the
like. The failure to provide must be willful.
Causes of Child Abuse or Neglect:
1. Unwanted Child:
a. Husband disputing the paternity of the child.
b. Illegitimacy:
(1) Child born of unmarried woman.
(2) Wife committed adultery.
480
LEGAL MEDICINE
(3) Child born as a consequence of rape.
c. Congenital or acquired deformity of the child.
d. Child allegedly giving "bad luck" to the family.
2. Abusive Parent:
a. Uncontrollable abuse by psychotic, pervasively angry or temperamental parent.
b. Controllable abuse by compulsive disciplinarian or impulsive
but generally inadequate parents.
3. Child as a center of a triangle — In the case of a couple or mother
"live-in" boyfriend, more often the child is placed in the middle
of an emotional triangle. When resentment builds between them,
the child commonly becomes the target of man's hostility.
4. Child may be a hindrance to the socio-economic activities of the
parents.
Classification of Child Abuser:
1. Intermitent Child Abuser — Parents who periodically batter a child
with periods of proper care between battering. They do not
intend to hurt the child, but they are driven by panic or compulsion into abusive behavior. Apparently they become sincerely
remorseful afterwards.
2. One-time Child Abuser — Parents who manhandle their children
for a time and never repeat the act. However, there is more
likehood for a one-time abuser to repeat the act until the child
is killed or had experienced a sudden surge or self-restraint.
3. Constant Child Abuser — Parent who actually hates his or her
child and callously and deliberately beats and miscares for it.
Parent had the intention to hurt the child and be indifferent to
the child's sufferings.
These parents often have personality
disorders and are cooly indifferent to the destructive nature of
their action.
4. Ignorant Abuser — This group is perhaps the most tragic because
the parents "mean" well, but their attempts at rearing their
children result in a permanent injury or death of their children,
and they are "truly sorry" when the child dies (Battered Child
Syndrome, Legal Medicine 2980 Wecht & Lorkins, p. 32).
Medical Evidence Tending to Show Injuries Due to Abuse:
1. Skin imprints from forcefully striking objects — Hand, cord, chain.
2. Multiple bruises and/or scars, particularly on the trunk, head and
face.
3. Multiple small burns or emersion burn levels — cigarette. i ™
boilir>tr n r a + m .
n
CHILD ABUSE OR NEGLECTED CHILD
4R1
4. Multiple fresh healing fractures; "twist" fractures.
5. Trauma to the mouth, nose, ears and eyes.
6. In case of sexual abuse, injuries to the genitalia, peri-rectal and
peri-vaginal may be present.
7. In case of child neglect, signs of mainourishment, poor hygiene,
infection, poor growth and development may be observed.
Facts to be Considered to Suspect that a Child is a Victim of Abuse:
1. The child is emotional, fearful and with a vague history of injury.
2. The parents present a vague and defensive detail of the child's
"illness" or "injury".
3. Too many previous unexplained signs of injuries or history of
previous illness.
4. Parents have extended delay in seeking medical cure.
5. Poor growth and development of the child.
Social Reaction To Child Abuse and Neglect:
1. Report of Maltreated or Abused Child:
Art. 166, Child and Youth Welfare Code ( P . D . 603):
All hospitals, clinics and other institutions as well as private
physicians providing treatment -shall, within forty-eight hours
from knowledge of the case, report in writing to the city or
provincial fiscal or to the Local Council for the Protection of
Children or to the nearest unit of the Department of Social
Welfare (Ministry of Social Service and Development), any case
of a maltreated or abused child, or exploitation of an employed
child contrary to the provisions of labor laws. It shall be the
duty of the Council for the Protection of Children or the unit of
the Department of Social Welfare to whom such a report is made
to forward the same to the provincial or city fiscal.
Violation of this provision shall subject the hospital, clinic,
institution, or physician who fails to make such report to a fine of
not more than two thousand pesos.
According to Administrative Order No. I — A, series of 1981 of
the Ministry of Health, dated July 6, 1981:
The report shall be submitted directly to the nearest Ministry
of Social Services and Development Office copy furnished the
police authority concerned and the Provincial/City Fiscal.
The report shall include the following information:
a. Name of child.
b. Date of birth, age and sex.
c. Date and time of admission.
482
LEGAL MEDICINE
d. Name of person who brought the child to the health institution.
e. Address and relationship to the child.
f. Name and address of the father /mother /guardian of the child
if other than the person who brought the child.
g. Tentative date of discharge.
h. Medical findings/case summary relative to the maltreatment/
abuse/exploitation of the child.
i. Evidence of parent's/employer's negative attitude towards the
incident.
The health authority concerned shall ensure that the report is
acknowledged in writing by the Ministry of Social Services and
Development Office within 24 hours."
Art. 167, Child and Youth Welfare Code — Freedom from Liability of the Reporting Person or Institution:
Persons, organizations, physicians, nurses, hospitals, clinics and
other entities which shall in good faith report cases of child abuse,
neglect, maltreatment or abandonment or exposure to moral danger
shall be free from any civil or criminal liability arising therefrom.
The provision of the Child and Youth Welfare Code ( P . D . 603),
Art. 166 requiring mandatory reporting of child abuse by physician and medical institution has its advantages and disadvantages.
a. Advantages:
(1) It compels the hesitant physician or medical institution to
report such child abuse or neglect so that proper remedial
measures can be applied to protect the child.
( 2 ) The fact that the child under treatment due to the act of the
parent(s) was known by the physician in the process of
history taking, makes such information privileged or confidential and the physician normally has no right to disclose
such information. But Art. 167 of the Code provides for
freedom from liability of the reporting person, thereby
placing the traditional right of the child above the parent's
right to the privileged communication.
b. Disadvantages:
(1) It increases the health hazard of the child as the abusing
parents will be reluctant to seek medical aid for the abused
child.
( 2 ) The law's concentration on one child as seen by a physician
fails to concern itself with the possibility of danger to the
other siblings within the family.
(3) If the reported parents are exonerated, released and reunited with the family, the pent-up anger felt against the
CHILD ABUSE OR NEGLECTED CHILD
483
authority may be released against the vulnerable child.
2. The court may deprive parents of their authority over the child
or adopt other measures for the welfare of the child:
Art. 332, Civil Code:
The court may deprive the parents of their authority or suspend
the exercise of the same if they should treat their children with
excessive harshness or should give them corrupting orders, counsels or examples, or should make them beg or abandon them.
In these cases, the court . . . or adopt such measures as they may
deem advisable in the interest of the child.
The court has a wide range of powers designed to give the
highest practicable degree of flexibility in making dispositional
decision.
The judge may simply warn parents or counsel them. He may
order medical and psychiatric treatment for the child and/or
for the parents. He may order the child to be in a protective
supervision in a welfare home. Although the parents have the
right of custody of their children, the children have also the right
to live. The judge must exercise sound discretion in balancing
their respective interests.
3. Establishment of public and private welfare institutions for the
care of abused, neglected, abandoned, infirmed, or other conditions which require aid, support or treatment.
4. Abuse, neglect or abandonment of children is made a criminal act
or omission:
a. If the child dies, then the offender is guilty of parricide:
Art. 246, Revised Penal Code — Parricide:
A n y person who shall kill his father, mother or child, whether
legitimate or illegitimate, or any of his ascendants, or his
spouse, shall be guilty of parricide and be punished by the
penalty of reclusion perpetua to death.
b. If the child did not die but was a victim with physical injuries,
the offender can be charged with frustrated parricide, or physical injuries:
c. If the child is abandoned or neglected, the offender can be
charged for abandonment of minors:
(1) Art. 276, Revised Penal Code —Abandoninga minor:
The penalty of arresto mayor and a fine not exceeding
500 pesos shall be imposed upon anyone who shall abandon
a child under seven years of age, the custody of which is
incumbent upon him.
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LEGAL MEDICINE
When the death of the minor shall result from such
abandonment, the culprit shall be punished by prision
correccional in its medium and maximum periods; but if
the life of the minor shall have been in danger only, the
penalty shall be prision correccional in its minimum and
medium periods.
The provisions contained in the preceding paragraphs
shall not prevent the imposition of the penalty provided
for the act committed, when the same shall constitute
a more serious offense.
( 2 ) Art. 277, Revised Penal Code — Abandonment of minor by
person entrusted with his custody; indifference of parents:
The penalty of arresto mayor and a fine not exceeding
500 pesos shall be imposed upon anyone who, having
charged with the rearing or education of a minor, shall
deliver the said minor to a public institution or other
persons, without the consent of the one who entrusted
such child to his care or in the absence of the latter, without the consent of the proper authorities.
The same penalty shall be imposed upon the parents
who shall neglect their children by not giving them the
education which their station in life requires and their
financial condition permits.
Other Battered Victims:
1. Battered wife — The wife may be periodically subjected to maltreatment by the husband on the account of jealousy, infidelity,
or incompatability of character. Attempt of the husband on the
life of the wife is one ground for a legal separation.
2. Battered grannies (battered grandfather or battered grandmother)
— Elderly persons may be extremely demanding, seeking more
attention from the caring descendant or with child-like behavior
which may be irritating and which may cause infliction of physical
injuries. The same situation may happen where an over-demanding boarder may suffer maltreatment from the overworked caretaker of the home for the aged.
Chapter XXI
MEDICO-LEGAL ASPECTS
OF
SEX CRIMES
VIRGINITY A N D DEFLORATION
A. VIRGINITY
Virginity is a condition of a female who has not experienced
sexual intercourse and whose genital organs have not been altered
by carnal connection.
A woman is a "virtuous female" if her body is pure and if she has
never had any sexual intercourse with another, though her mind and
heart is impure (Thomas v. State, 19 Ga. App. 104, 91 S.E. 247,
250).
The presumption of a woman's virginity arises whenever it is
shown that she is single and continuous until overthrown by proof
to be contrary (U.S. V. Alvarez, 1 Phil. 242). A woman is presumed
to be a virgin when unmarried and of good reputation.
A defendant has the previous sexual intercourses with the
victim before he was charged'with consented abduction for acts
committed thereafter. The woman was considered "virgin" within
the meaning of the law (U.S. v. Casten, 34 Phil. 808). However, in
another case, it was established that the defendant's character,
before the alleged seduction, was opened to question. The woman
considered no longer a virgin (U.S. v. Suan, 27 Phil. 12).
of Virginity:
1. Moral Virginity — The state of not knowing the nature of sexual
life and not having experienced sexual relation. Moral virginity
applies to children below the age of puberty and whose sex
organs and secondary sex characters are not yet developed.
2. Physical Virginity — A condition whereby a woman is conscious
of the nature of the sexual life but has not experienced sexual
intercourse. The term applies to women who have reached sexual
maturity but have not experienced sexual intercourse.
There are no conclusive medical findings to show that a woman
is physically virgin. Reliance is given to the absence of laceration
of the hymen, but a woman might have had previous sexual
485
486
LEGAL MEDICINE
intercourse and yet the hymen was unruptured while others might
not have the experienced of sexual relations but have laceration
of the hymen.
If the findings show absence of laceration of the hymen, distinction should be drawn between true and false physical virginity.
a. True Physical Virginity — A condition wherein the hymen is
intact with the edges distinct and regular and the opening small
to barely admit the tip of the smallest finger of the examiner
e. n if the thighs are separated.
b. False Physical Virginity — A condition wherein the hymen is
unruptured but the orifice is wide and elastic to admit two or
more fingers of the examiner with a lesser degree of resistance.
The hymen may be laxed and distensible and may have previous
sexual relation. In this particular instance the physician may
not be able to make a convincing conclusion that the subject
is virgin.
3. Demi-Virginity — This term refers to a condition of a woman who
permits any form of sexual liberties as long as they abstain from
rupturing the hymen by sexual act. The woman may be embraced,
kissed, may allow her breasts to be fondled, her private organ to
be held and other lascivious acts. The woman allows sexual
intercourse but only "inter-femora" or even "inter-labia" but not to
the extent of rupturing the hymen.
4. "Virgo Intacta" — Literally the term refers to a truly virgin
woman; that there are no structural changes in her organ to infer
previous sexual intercourse and that she is a virtuous woman. Inasmuch as there are no conclusive evidences to prove the existence
of such condition, liberal authorities extend the connotation of
the term to include women who have had previous sexual act or
even habitually but had not given birth.
Parts of the female body to be considered in the determination of
the condition of virginity:
1. Breasts — The breasts (mammary glands) are functionally related
to the reproductive system since they secrete milk for nourishment of the young child. At their inner structures are 15 to 20
lobes of glandular tissues supported by conr>active tissue namework with variable amount of adipose tissue.
On the ventral surface of each breast is a cylindrical projection
called nipple and at its rounded tip are perforations which are the
openings of the ducts draining the milk glands. The nipple is
surrounded by a pigmented area called areola which becomes dark
brown during pregnancy.
VIRGINITY AND DEFLORATION
487
The size, consistency and shape of the female adult breast
varies with age, degree of physical development, stage in the
menstrual cycle, pregnancy, nutrition and hormonal factors.
A fully developed breast may be classified according to shape
as follows:
a. Hemispherical Breast — The breast is like a hemisphere. The
contour lines are not straight but form part of a circle or half
of a sphere.
b. Conical Breast — The breast has the shape similar to a cone.
The outline consists of two converging lines which meet at the
region of the nipple.
c. Infantile or Flat Breast — The breast is only slightly elevated
from the chest without distinct boundary and showing no
definite shape.
d. Pendulous Breast — The skin of the breast is loose making it
capable of swinging in any direction. This is commonly observed among parturient breast-feeding mothers. A pendulous
breast may be:
( 1 ) Hemispherical pendulous breast — It has the shape of a
hemisphere but with loose skin.
( 2 ) Conical pendulous breast — It has the shape of a cone and is
capable of swinging sidewise.
The condition of the breast is not a reliable evidence to determine virginity. The size, shape and consistency of the breast may
be hormonal or hereditary. The advent of artificial feeding makes
it possible for parturient women to preserve the condition of the
breast.
2. Vaginal Canal:
As a general rule, the vaginal canal of a virgin is tight and the
rugosities are sharp and prominent.
Insertion of a finger or
instrument may show certain degree of resistance. The wall of
the vagina is composed of smooth muscle and fibroelastic connective tissue so that its tightness and degree of resistance on
insertion of a finger or an instrument depends on the integrity of
its wall, as well as on the potency of its lubricating secretion. The
sharpness of the wall's rugosities may be diminished by insertion
of foreign bodies, passage of clotted blood, self-manipulation, etc.
and not by sexual intercourse. The canal may be inherently lax
and rugosities not prominent since "birth.
3. Labia Majora and Labia Minora.
The labia majora is firm, elastic and plump and its medial borders
are usually in close contact with each other so as to cover the labia
LEGAL MEDICINE
488
minora and the clitoris. The labia minora is soft, pinkish in close
contact with one another, and its vestibule is narrow. Entry of the
male organ may cause the labia to gape due to stretching of their
borders.
The condition of both labia is not a reliable basis in determining
virginity. A woman may be a virgin but with a gaping labia, while
others might have had previous delivery but the labia are still
coaptated. The condition of the labia is much more related to the
general physical condition of the woman rather than the absence
or the presence of previous sexual intercourse. A stout woman
usually can preserve the plump, coaptated and firm labia while
skinny women usually have gaping labia.
4.
Fourchette:
The fourchette present a V-shape appearance as the two labia
minora unite posteriorly. After severe distention, the sharpness
of the acute angle may become rounded with retraction of the
edges.
The rounding of the fourchette and the retraction of the edges
can be a consequence of so many causes. Stretching apart of the
thighs, instrumentation, horse or bicycle riding may produce the
condition other than sexual intercourse.
5. Hymen:
Physicians give much attention in the examination of the
hymen in the determination of virginity.
Classification
of Hymen:
a. As to shape and size of the opening:
(1) Annular or circular — The opening is oval or circular located
at the center of the hymen. There may be indentation of
the borders.
(2) Infantile — The opening is small, usually linear, fleshy and
resistant.
(3) Semilunar or crescentric — The concavity may be facing
either side or upwards or downwards. The tapering ends of
the crescent may be the frequent sites of laceration.
( 4 ) Linear — The opening is slit-like and usually running vertically.
(5) Cribiform — The hymen presents several openings instead of
a single one.
In several instances the openings are quite
small and will require the use of a hand lens to make them
visible.
( 6 ) Stellate — hymenal opening is like a star.
VIRGINITY AND DEFLORATION
489
(7) Septate — There are two openings which may be of equal
or different sizes separated by a bridge of hymenal tissue.
After a sexual act there may be complete rupture of the
bridging tissue or marked distention of one to make the
other opening almost invisible.
(8) Fimbriated — The border of the opening shows small irregular protrusion towards the opening. In some instances
the fimbriation may be big enough that the examiner may
mistake it to be a superficial laceration.
( 9 ) Imperforate — There is no opening on the hymen. When a
woman starts to menstruate, surgery may be necessary to
open the hymen to allow free passage of menstrual blood.
b. As to structure and consistency:
(1) Firm and with strong connective tissue and plenty of blood
vessels — This type has more tendency to lacerate during
the first sexual act and the laceration may produce relatively more hemorrhage.
LEGAL MEDICINE
490
Thin hymen
( 3 ) Membranous hymen — Hymen is parchment-like, may be
transparent and may lacerate without pain or appreciable
bleeding.
c. As to number of opening:
(1)
(2)
(3)
(4)
Single orifice — Having one opening.
Septate — Having two openings.
Multiple — Having several openings.
Imperforate — Without orifice.
Virginity is N o t Synonymous with Chastity:
A woman may resort to many forms of homosexual as well as
heterosexual practices without losing her virginity, yet she may be
unchaste.
A woman may have a ruptured hymen and other signs of loss of
physical virginity, yet she is chaste.
She may resort to masturbation with rupture of the hymen and
dilatation of the vaginal canal causing it to appear that she has had
several sexual intercourses, yet she may still be a virgin.
B. DEFLORATION
'efloration is the laceration or rupture of the hymen as a result of
sexual intercourse. All other lacerations of the hymen which are not
caused by sexual act are not considered as defloration.
VIRGINITY AND DEFLORATION
491
Parts of the female genitalia that must be examined to determine
defloration:
1. Condition of the Vulva:
Normally the labia majora and minora are in close contact with
one another covering almost completely the external genitalia.
After defloration, the labia may gape exposing the introitus
vulvae.
The finding may not be relied upon because some females may
have inherently gaping labia, especially, asthenic women although
there is no history of previous sexual act, while others may preserve
the coaptated labia even if there has been previous sexual act.
2.
Fourchette:
The normal V-shape of the fourchette is lost on account of the
previous stretching during insertion of the male organ. Withdrawal of the stretching force will cause retraction of its walls
with rounding of the base.
Retraction of the fourchette is not a good sign of defloration
inasmuch as it can be due to other causes. Ballet dancing, separation of the thighs, tree climbing, cycling, horse riding, insertion
of foreign body, etc. may cause retraction of the fourchette
without previous sexual act.
The fourchette, together with the perineum and lower portion
of the posterior vaginal wall, may be lacerated by sexual act or
some other causes.
3. Vaginal canal:
After repeated sexual acts, there is diminution of the sharpness
or obliteration of the vaginal rugosities. There will be laxity of
its wall so that insertion of a medium size tube during the medical
examination can be done with slight resistance.
The changes in the vaginal rugosities or the laxity of its wall
cannot be relied upon as a proof of defloration because instrumentation during medical examination, masturbation or insertion
of foreign bodies or other similar or related acts will cause the
development of such condition.
The vaginal wall, together with the vulva, may suffer injury
during defloration or some other causes.
Predisposing causes of vulvo-vaginal injuries during sexual act:
a. Virginity — Sex organ does not have previous experience to
stretching or coital act.
b. Prepuberty — The genital organ is not yet fully developed to
subject it to full physiological function.
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LEGAL MEDICINE
c. Genital disproportion — The male organ is unusually big or
female organ infantile in size in spite of adult age.
d. Unprepared or unaroused female — The vaginal secretion is
absent, causing more friction.
e. Position during the sexual act — Dorsal decubitus position with
the thighs hyperflexed predisposes to deep penetration by the
male organ and is contributory to vaginal vault lacerations.
Vaginal position may not be in harmony with the movement
of the penis.
f. Brutality of the male partner during the sexual act.
g. Recent vaginal surgery — The canal may become narrow and
fibrous scar may replace the muscular vaginal wall at the site of
surgery.
h. Excessive active involvement of the female partner.
i. Multiple sexual act among sex deviates (Nymphomaniac or
satyriatic) or multiple consort — Continuous stretching and
friction may weaken its wall.
j . Renewed sexual activity after prolonged abstinence.
k. Post-menopause.
1. Uterine retroversion.
4. Hymen:
The hymen is lacerated during the initial sexual act. However,
it is not always the case.
Some hymen are thick, elastic and
fleshy such that they can resist certain degree of distention without causing laceration. Some women may inherently have lacerated hymen probably on account of previous trauma during the
early age.
The fact that the hymen is intact does not prove
absence of previous sexual intercourse and the presence of laceration does not prove defloration.
Other Causes of Hymenal Laceration:
a. Passage of clotted blood during menstruation.
b. Ulceration due to disease, like diphtheria.
c. Jumping or running.
d. Falling on hard and sharp object.
e. Medical instrumentation.
f. Local medication.
g. Self-scratching due to irritation.
h. Masturbation.
i. Insertion of foreign bodies,
j. Previous operation.
In the medical examination of the hymen, the following facts
must be included:
VIRGINITY AND DEFLORATION
493
a. General condition of the hymen:
This includes the width, thickness, elasticity, vascularity, and
laxity.
It may include pathological condition, like inflammatory changes, signs of previous trauma, developmental
abnormality and foreign elements.
b. Original shape of the orifice (opening):
In case laceration is present, try to reconstruct the hymen by
means of a probe and determine the original shape of the opening.
It may be linear, circular, stellate, cresentric, septate,
cribiform, imperforate and fimbriated.
c. If lacerated, the following must be noted:
( 1 ) Degree of laceration:
This refers to the extent of damage to the hymen which
may be:
(a) Incomplete laceration — Rupture or laceration of the
hymen is considered incomplete when it does not involve the whole width or height of the hymen. Incomplete laceration may be:
i. Superficial — The laceration does not go beyond
one-half of the whole width of the hymen.
ii. Deep — The laceration involves more than one-half
of the width of the hymen but not reaching the
base.
( b ) Complete laceration — The hymenal laceration involves
the whole width but not beyond the base of the hymen.
(c) Compound or complicated laceration — The laceration
involves the hymen and also the surrounding tissues.
It may involve the perineum, vaginal canal, urethra or
rectum.
Notches — Indentation of the hymen simulating
lacerations. They may be symmetrical and may extend
to the vaginal wall. The mucous membrane over the
notch is intact. Notches may be mistaken for laceration.
(2) Location of laceration:
For the purpose of locating the site of the laceration, the
hymenal orifice is related to the face of a watch while the
subject is in lithotomy position. With the examiner facing
the female genitalia, the location of the laceration will be
described corresponding to the time in the face of a watch.
By this procedure, a laceration at the region of the fourchette may be described as a laceration at 6:00 o'clock
position in the face of a watch while on the horizontal
494
LEGAL MEDICINE
sides may be termed 9:00 (left side) and 3:00 (right side)
positions.
(3) Duration of the laceration:
The determination as to how long the laceration took
place can be approximated by the changes observed in the
lacerated tissue.
(a) Fresh bleeding laceration — The laceration is of recent
origin.
( b ) Fresh healing with fibrin formation and with edema of
the surrounding tissue — Usually after 24 hours.
(c) Healed laceration with congested edges and with sharp
coaptible borders — Depending upon the degree of
laceration and the presence or the absence of complications, the said laceration could have occurred
4 to 10 days. Sometimes, the said finding is termed
"recently healed" laceration.
( d ) Healed laceration with sharp coaptible borders without
congestion — Some times have passed by after the laceration has healed. Ordinarily it can be inferred that
hymenal laceration took place approximately more than
ten days or 2 to 3 weeks.
( e ) Healed laceration with rounded non-coaptible borders
and retraction of the edges — Laceration took place long
before the date of the examination which is probably
more than a month's time.
( 4 ) Complications of laceration:
A vast majority of laceration of the hymen healed uneventfully, although in rare instances complications set in.
The following are the possible complications:
( a ) Secondary infection — There may be activation of the
bacterial flora in the vaginal canal or a superimposed
infection may set in, especially among women with
poor hygienic habit. Gonorrheal infection is not uncommon when the offender is suffering from the disease
at the time of the sexual act.
( b ) Hemorrhage — This is a rare complication but this may
be present in severe compound laceration of the hymen.
Surgical intervention may' be necessary to control the
bleeding. Blood analysis to determine the presence of
blood disease may be indicated when there is disproportion between the injury and the amount of hemorrhage. Blood transfusion may be required when the
VIRGINITY AND DEFLORATION
495
condition of the patient demands replacement of the
blood loss.
(c) Fistulae formation — Recto-vaginal or vesico-vaginal
fistula may develop in the case of compound laceration.
This may require the services of a competent gynecologist to subject the patient to surgery.
( d ) Stricture — Hymenal laceration alone will not produce
stricture but in case of involvement of the vaginal wall
it may consequently result in narrowing of the canal on
account of the scar formation.
( e ) Sterility — Trauma and infection may further involve
the upper part of the female generative organ and may
cause loss of procreation power.
PHYSIOLOGIC CONSIDERATION:
A. During Sexual Excitement:
1. Local Changes:
The parasympathetic innervation of the sex organ is from
the 2nd, 3rd and 4th spinal sacral segments, and the sympathetic
innervation is from the 11th thoracic down to the 1st lumbar. In
the male, the stimulus may be central or somesthetic or local
tactile in origin.
In the male, stimulation will cause erection of the penis due
to active dilatation of the arteries through the nervus origentis.
The erection is also brought about by the contraction of the
ischiocavernous muscle producing compression of the dorsal
vein of the penis, thus causing accumulation of blood under
pressure.
More sexual stimulus will be attained through friction during
the sexual act coupled with the physical activities of the partner.
In the female, sexual stimulation will cause tomescence of
the clitoris, vestibule and labia minora.
There is spontaneous vulvar lubrication. The lubricant is a
transudate coming from the vaginal wall and its production
ceases when the stimulus is removed.
The lubricant dries
quickly.
There is labial engorgement and vaginal lengthening and
widening. During the excitement, the vaginal canal increases
in length from 7 to 8 cm. to 9.5 to 10.5 cm. At the level of
the cervix there is a transverse expansion of the vaginal canal
from 2 cm. to 4 cm. to 6.25 to 6.75 cm.
LEGAL MEDICINE
496
2. Systemic Effects:
a. An increase in the pulse rate;
b. Marked increased in blood pressure making its peak during
orgasm;
c. An increase of peripheral flow of blood experienced as an
increase of body warmth;
d. Tomescence (engorgement of blood), which is the consequence
of this peripheral flow concentrating on erectile tissue;
e. Increased respiration;
f. A decrease in bleeding during arousal, which is reversed
subsequently;
g. A decrease in sensory perception;
(1) There is blunting of the sense of touch.
( 2 ) Pain may be largely lost; sensation which could be
sharply painful may only be experienced as no more
than a mild touch stimulation.
( 3 ) Alertness of hearing and vision is clearly decreased.
B. During Orgasm:
In the male, orgasm is the sensation resulting from the contraction of the smooth muscles of the genitalia and the striated
muscles of the pelvic floor coinciding with ejaculation.
Seminal emission is carried on by the peristaltic action of the
vas deferens, seminal vesicle and prostate.
Ejaculation results from the contraction of the pelvic floor
muscle and the bulbospongiosus and ischiocavernosus muscles.
In the female, during orgasm, there is contraction of the smooth
muscles of the uterus and rhythmic contraction of the vaginal
sphincter, the ischiocavernosus and the pelvic floor musculature.
The physiological changes are similar in both male and female.
The difference is only in the speed of response. In the male,
sexual arousal is psychological followed by physical, while in the
female it is primarily physical.
DEATH RELATED TO SEXUAL ACT
1. Death of the Male Partner:
a. Death from natural cause:
During sexual intercourse, the male as an active subject
develops increase blood pressure, tachycardia and hyperventilation due to emotional response and muscular exertion.
If he is suffering from cardio-vascular disease or insufficiency
VIRGINITY AND DEFLORATION
497
of cardiac reserve, the increase demand on the cardiovascular
system may not be met and he may die. This is also true in
masturbation.
If a person died outside his conjugal home, the dead is generally referred to as "D.I.S." or "death in the saddle". Sometimes it is jokingly claimed that "he died with his boots on" or
"he died planting the Philippine flag". If death took place in a
prostitution house, the children's comment is "Daddy died in
the arms of a scarlet woman".
b. Death may be due to the defensive act of the woman-victim:
In cases of rape, the victim may be able to take hold of a
sharp instrument and inflict injuries to the offender which may
cause his death.
2. Death of the Female Partner:
Women almost never suffer death from natural causes during
the normal sexual act. The reason may be that they are less
susceptible to cardio-vascular disease and that they play a
passive role in sexual intercourse. Women can control their
tendencies to over-excitement and they exert less physical effort
in a sexual act than men do.
Death of the female partner is usually accidental and not on
account of a natural disease:
a. The sexual intercourse might be done in a relatively confined
space like the back seat of a car. Accidental strangulation or
suffocation of the female partner may be due to the undue
pressure applied on the chest, neck or face. The struggle of
the female partner may remain unnoticed on account of the
height of sexual excitement, and this may cause her death.
b. In case of oral sex (fellatio) wherein the male penis is placed in
the mouth of the female partner, the size and length of the
penis may cause partial or total block of the air passage, causing
asphyxia. Ejaculation of seminal fluid may oclude the lumen
of the respiratory tract as in drowning.
c. In case of cunnillingus (a perverted sexual act wherein the male
licks the female genital organ), the male partner may blow air
in the vulva and may cause air embolism especially when the
woman is pregnant. The air may enter the blood circulation
and causes immediate death.
d. Saddists who may not be sexually satisfied by sexual intercourse but by inflicting physical injuries to the partner may
cause death of the female partner.
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LEGAL MEDICINE
e. Death of the female partner may be deliberately done by the
male to conceal the crime of rape he has committed. The
male partner may inflict physical injuries, or may cause asphyxiation by strangulation or by other means.
f. The female partner may die of shock as a result of extreme
physical and mental trauma in case of rape.
g. Hemorrhage.
h. Infection.
3. Death of Both Partners:
a. Almost simultaneous death of both partners during sexual
intercourse may be due to the performance of the sexual act
in an enclosed place with carbon monoxide or other asphyxiant
gas. Examination of their respective blood will reveal the presence of the gas incompatible with life.
b. Homicide— suicide pact.
^SEX CRIMES
Criminological Characteristics:
1. It is one of the ancient and universal crimes. It existed since the
dawn of history.
Although considered a crime by almost all
countries of the world, society's reaction to its repression depends
on the moral value and its gravity as a social problem.
2. There is a close physical contact between the offender and the
victim.
Murder and homicide may be committed with the
offender at a distance from the victim. Estafa and many other
crimes may be committed even without the physical presence
of the victim.
3. As a general rule, it is a crime committed by one sex against
the opposite sex.
4. Sex is an inborn instinct. A n y person without sex desire is
considered abnormal.
Satisfaction of the sexual instinct must
be, in a way, acceptable by the moral standard. What is punishable is the anti-social means of attaining sexual gratification.
In other crimes, no man is normally born with such criminal
instinct.
Murderers, defrauders, and other violators of the
criminal law are not inborn characters of individuals.
5. Except probably the crime of rape and forcible abduction, most
of the sex crimes do not belong to the so called conventional
crimes.
Considering other sex acts as crime depends on the
moral value existing in a society.
Seduction and consented
abduction are considered as crimes in the Philippines but not in
other countries.
SEX CRIMES
499
6. Many sex crimes are committed but not reported; if reported
not investigated; if investigated, not prosecuted.
This is on
account of the fact that undue publicity may be prejudicial to
the reputation of the victim.
7. It is a crime committed in strict privacy. If committed in public
the offender must be a mental deviate. Reliance must therefore
be made by the investigating officer or court on the testimony
of the victim corroborated by the medical findings.
8. Although it is more frequent among the lower socio-economic
class those who belong to the middle and upper classes are not
immune in the commission of the crime.
9. Unlike other crimes, pardon, forgiveness or marriage between
the offender and the victim will extinguish the criminal liability
of the offender.
10. There is a seasonal variation in the frequency of commission. It
is not the season that causes the variation but the social forces
that may be present in a specific season. The month of May,
for example, has more cases of sex offenses because Mayflower
festivals, fiestas, picnics, excursions, etc. are frequent during
this month.
11. The severity of punishment does not deter its commission.
frequency has not been appreciably reduced by Martial law.
Its
12. Its occasional consequence (pregnancy) becomes a legal problem,
e.g. support, abortion, legitimacy, unwanted child, inability to
find a means of livelihood, etc.
13. If the offender is of past middle age, usually the victims are
children. The primary reason is that old men will be ignored
by elderly women so they focus their attention on children who
can easily be enticed by candies or other things of value.
14. The psychic trauma suffered by the victims of sex crimes varies
with the moral standard of the victim. Women of the "Maria
Clara" type with morality of the Puritan Standard, may inflict
fatal or serious injuries on the offender. Some may develop a
feeling of worthlessness and as a consequence, may lead to selfdestruction, while others may be mentally deranged. Others
may have a strong belief in the machinery of justice and file
the complaint, but a great number of those who seek justice
later become amenable to an amicable settlement.
i
Other victims suffer from fear of unfavorable consequence,
like pregnancy, social degradation and maltreatment by parents
and other relatives.
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LEGAL MEDICINE
When and H o w Rape is Committed — Penalties:
Art. 335, Revised Penal Code:
Rape is committed by having carnal knowledge of a woman under
any of the following circumstances:
1. By using force or intimidation;
2. When the woman is deprived of reason or otherwise unconscious;
and
3. When the woman is under twelve years of age, even though neither
of the circumstances mentioned in the two next preceding paragraphs shall be present :
The crime of rape shall be punished by reclusion perpetua.
Whenever the crime of rape is committed with the use of a
deadly weapon or by two or more persons, the penalty shall be
reclusion perpetua to death.
When by reason or on the occasion of rape, the victim becomes
insane, the penalty shall be death.
When the rape is attempted or frustrated and homicide is
committed by reason or on the occasion thereof, the penalty
shall be likewise death.
When by reason or on the occasion of the rape, a homicide is
committed, the penalty shall be death ( A s amended by Rep.
Act 2632 and Rep. Act. 4111).
Elements of the crime:
a. The offender had carnal knowledge of the woman. The victim
of the crime must always be a woman while the offender must
inferentially be a man because sexual act must be done by a
man and a woman.
b. The carnal relation must be made under any of the following
circumstances:
(1) Use of force or intimidation;
( 2 ) The woman is deprived of her reason or otherwise made
unconscious; or
(3) The woman-victim is less than 12 years of age.
Meaning of Carnal Knowledge:
Carnal knowledge is the act of a man
connection with a woman. There is carnal
slightest penetration in the sexual organ of
organ of the male. It is not necessary that
in having sexual bodily
knowledge if there is the
the female by the sexual
the vagina be entered or
SEX CRIMES
that the hymen be ruptured
Black, 4th ed., p. 268).
501
(Black's Law Dictionary by Henry C.
For the consummation of the crime of rape, it is not necessary
that there is rupture of the hymen. It is enough that the labia of
the female organ was penetrated (People v. Oscar, 48 Phil. 527).
Slightest penetration is enough, proof of emission is not necessary.
The absence of spermatozoa in the vagina does not negate the commission of the crime of rape (People v. Canastre, 82 Phil. 480).
Character of the Offended Party:
The fact that the offended party may have been unchaste before
alleged sexual act was consummated with force and intimidation
constitute no defense.
The person is guilty of rape if force and
violence were used regardless of the good or bad morals of the
offended party (People v. Blance, 45 Phil. 13).
Evidences of Force or Intimidation:
The mere initial reluctance of the offended party or verbal refusal
alone will not prove force. It must be a manifested and tenacious
resistance that is required by law (People v. Lago, C.A. 45 O.G.
1356).
When force is an element in the crime of rape, it need not be
irresistible. As long as it brings about the desired result, all consideration whether it is more or less irresistible are beside the point.
When the offeflftied girl stated that she defended herself against
the accused as long as she could, but he overpowered her and held
her till her strength yielded, then accomplished his desire, there is
evidence of sufficient force (People v. Mono, 56 Phil. 86).
The offended woman shouted, struggled and kicked the accused
but the offender pressed a hunting knife on her throat, overcame
her resistance and succeeded in having sexual intercourse with her.
Rape was committed (People v. Lago, C.A. 45 O.G. 1356).
If the offender is the father of the girl who is of a tender age, it
is not necessary that there are signs that she put up a determined
resistance (People v. Alinea, C.A. 45 G. 140).
The employment of force is established not only by the testimony
of the injured girl but also by the signs of finger grips on the front
part of her neck, on the arms and the fact that the garments worn
at the time were torn and heavily stained with blood (People v.
Lucero, 61 Phil. 361).
A strong evidence of force is the presence of physical injuries
found on the person of the victim in the course of medical examination. Contusions may be found on the face, arms and thighs.
502
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When a woman has been forcibly made to lie down, she will utilize
her elbow as the fulcrum so that abrasions will be observed on both
elbows. In the attempt of the victim to stand, she will flex her neck
forward. The offender will then push her head backwards, causing
hematoma at the region of the occiput. To prevent penetration of
the male organ she will try to flex her thighs and knees. The offender
will give a strong blow to the inner aspects of both thighs so that the
victim will be compelled to straightened them.
The victim may suffer all types of physical injuries depending
upon the resistance offered by her and the degree of force applied
by the offender.
Rape Committed by Employment of Intimidation:
The application of threat will cause fear in the victim of the
untoward consequence.
If she will not accede to the will of the
offender, the crime may constitute intimidation.
Inasmuch as intimidation is purely subjective it cannot be proven
by medical evidence.
Rape Committed by Depriving the Victim of Her Reason or Otherwise Made Unconscious:
1. Deprival of Reason:
a. Rape committed on insane or mentally deficient woman:
The fact that the victim is a woman, 14 years of age, feebleminded and can only speak mono-syllables is sufficient to
constitute the act committed to be rape (People v. Doing, C.A.
49 O.G. 2331).
Sexual intercourse with an insane woman is considered rape
(People v. Layson, C.A. 37 O.G. 318).
But, sexual intercourse with a deaf-mute woman is not rape,
in the absence of proof that she is an imbecile (People v. Nava,
C.A. 40 O.G. 4237).
The proof of the mental condition of the victim is the
medical findings of the physician who must certify whether the
woman-victim of rape is suffering from insanity or mental
deficiency which is sufficient to deprive her of her reason.
b. Rape committed while the woman is under the influence of
alcohol or other depressant drugs:
Inasmuch as the woman is not in possession of her rational
mental faculties, in the absence of a decided case, this may also
be rape.
c. Sexual act on a woman under the influence of sex stimulating
drugs:
SEX CRIMES
503
In the case of U.S. v. Lung (28 p. 235, 37 A.M. St. Rep. 505),
cited by Reyes, where the consent of the woman was induced
by the administration of drugs which incited her passion and
the drug dose did not deprive her of her reason, the accused
was not guilty of rape. But if this case should happen in the
Philippines and would be decided by our local court, I think it
would be a rape case because the stimulating drug actually
deprived her of her reason.
2. The woman-victim is unconscious:
a. Sexual act committed while the woman is on her natural sleep:
The woman while asleep felt the weight of a man in carnal
relation with her. Believing that he was her husband, she called
him by his name but received no answer. She again called him
and found out that the voice was different from that of her
husband. She then pushed him and then ran after him. The
offended party was a deep sleeper in the first hour of the night
and it was not impossible for the accused to insert his organ
into her genitalia before she awoke. The crime of rape was
committed (People v. Gorcino, 53 Phil. 234).
b. Sexual act on a woman suffering from sleeping sickness is also
rape because the woman is unconscious.
c. Sexual act on a woman who is unconscious because she was
knocked-out:.
If the offender inflicted physical injuries on a woman sufficient to make her unconscious before the sexual act was done,
it is rape.
On seeing a lavishing figure of a woman taking a bath, the
accused hit her and after she became unconscious, he had sexual
intercourse with her. The accused was found guilty of rape
(People v. Sanico, C.A. 46 O.G. 98).
d. Sexual act after administration of narcotics or other "knockout" drugs:
The sexual act made on a woman while she is under the influence of narcotics or other depressant drugs is rape because
the woman is unconscious.
3. When the woman is under 12 years of age:
If the carnal relation is made on a female below 12 years of
age, it is always rape regardless of whether or not force or intimidation is applied or the child is.not deprived of her reasons or
otherwise unconscious. Rape of a woman below 12 years old is
also called statutory rape. The sexual act is still rape even if the
child consented or even if the child is a prostitute.
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LEGAL MEDICINE
The reason for penalizing carnal relation is that one must not
take advantage of the meager intelligence and incomplete physical
development of a child below the age of 12.
When the offended party is a girl less than 12 years old, rape is
committed although she consented to the sexual act (People v.
Villamora C.A. 37 O.G. 497). It is also rape even if the girl less
than 12 years of age is a prostitute (People v. Perez, C.A. O.G.
6337).
Perineal laceration on a sexually a b u s e d child
Multiple rapes committed by each accused was independent
of the others, because the essence of the crime of rape consists
of carrying out carnal act of the offender with a woman against
her will and each carnal access consummated is a complete attack
on the honor, person and liberty of the offended woman (People
v. Bernardo, 38 O.G. 3479).
The victim and the accused must immediately be examined by
the physician to have a strong medical evidence of rape, but the
lack of medical examination of the victim is not an indispensible
element in the prosecution of the crime of rape. Whether or not it
will prosper will depend upon the evidences offered. As long as
the evidences convince the court, a conviction of the crime of rape
is proper (People v. Suarez, C.A. 40 O.G. 28).
When the defendant has sexual intercourse twice in succession
with the complainant, no evidence having been presented that
SEX CRIMES
SOS
there was any resistance on her part or that the defendant had
used force, violence and intimidation, the defendant was acquitted
(U.S. v. DeDios, 8 Phil. 279).
The defendant attempted to commit the crime of rape in an
open field on a woman whom he has courted for 2 years and in
the presence of other persons. The offended party allowed the
defendant to visit her after the attack. The defendant was acquitted (U.S. v. Estacio, 18 Phil. 432).
A complaint in the prosecution of rape is not valid unless it is a
complaint of the offended party. The complaint signed and sworn
to by the chief of police is not valid in the prosecution for rape
(People v. Manaba, 58 Phil. 665). An information not signed by
the offended party is insufficient to confer jurisdiction on the
court to hear and determine a charge of attempted rape (People
v. Trinidad, 59 Phil. 163). The filing of the complaint by the
father of the offended party who is a girl only fourteen years of
age which alleges the commission of the offense is a sufficient
compliance of the Revised Penal Code to confer jurisdiction for
trial of the offense charged (People v. Imas, 65 Phil. 419).
i
Instances When Rape is Punishable by Death:
1. When by reason or on the occasion of the rape, the victim becomes insane;
2. When the rape is attempted or frustrated and a homicide is committed by reason or on the occasion thereof; and
3. When by reason or on the occasion of the rape, a homicide is
committed.
Death of a woman from peritonitis as a result of having been
infected with a venereal disease by a man having sexual intercourse
with her against her will, will constitute the complex crime with
homicide (People v. Acosta, 60 Phil. 158).
Medical Evidences in Rape:
1. Evidences from the victim:
Before actual examination is made on the subject, it is necessary
to have a written consent from the subject herself or from her
guardian if the victim is not of age. If the woman is confined in a
correctional institution the consent may be given by the head of
the institution.
A short history of the alleged rape must be taken and it is
advisable to reduce it in writing. The history must include all the
circumstances leading to the abuse, the age of the victim at the
time of the alleged commission of the offense and also the men-
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LEGAL MEDICINE
strual history. It may be used as a guide to the examining physician
as to the different points that must be emphasized in the course
of the examination. Aside from the history, the following points
must also be recorded by the physician.
a. Date, time and place of alleged commission of rape:
This is necessary in order to determine how long a time has
elapsed after alleged commission of the offense before the
victim filed the necessary complaint or subjected herself to the
medical examination. If several days have gone by before the
filing of the complaint, let her explain the cause of the delay.
The place where the alleged offense was committed is necessary to determine which court can acquire jurisdiction over the
case.
b. Date, time and place of the examination:
The date of the examination is material to the determination
of the possible findings of the physician on the victim. A long
interval of time between tha date of commission and the
examination will remove the possibility of finding the effects of
a recent sexual intercourse.
c. Condition of the clothings:
If force is applied in the commission of the offense, there
will be tearing, staining with blood and semen, and soiling of the
clothings. The clothings must be preserved after they have been
thoroughly dried for further laboratory examination.
d. The physician must observe the gait, the facial expression and
the bodily and mental attitude of the subject. If the victim
suffered from genital injuries she may walk with legs apart
and slowly, with the face manifesting signs that she is suffering
from pain.
e. Physical and mental development of the victim:
The height, strength and degree of muscular development of
the woman must be noted to determine whether she has the
capacity to resist any unlawful aggression. If the victim is a
child, examination of the physical condition is usually not
necessary because it is apparent to the age. In most cases,
children are "bribed" or lured by attractive articles such as
candies by the offender.
The examiner must observe the mental state of the victim.
She may be in the state of mental shock, under the influence of
depressant drugs, alcohol or sex stimulants. The offender might
have taken advantage of her insanity or mental deficiency.
SEX CRIMES
507
The victim may appear exhausted, despondent on account of the public humiliation she will suffer, or may be
hostile to the investigator. Care and more psychologic approach
is necessary in order to get her full cooperation and consent.
f. Examination of the body for signs of violence:
If actual force was applied in the commission of the crime,
there must be signs of physical violence on the body of the
victim.
Her whole body must be subjected to inspection.
Physical injuries must be described and the exact location must
be determined. Areas of tenderness or swelling must not be
overlooked and if necessary X-ray pictures must be taken to
determine bone lesions.
Determination of the probable age of the physical injuries
found is material. Does it correspond to the alleged date of
commission? .
g. Examination of the genitalia, including the breast:
The breasts must be examined for the presence of finger
marks or application of pressure. They might have been roughly handled or the nipples bitten.
The vulva may show swelling, tenderness, contusion, abrasion,
laceration or may be smeared with blood, semen and other
foreign bodies.
The hymen may show fresh laceration, swelling or bruising.
There may be healed lacerations or signs of physical virginity.
In the pubic hair, the following medical evidence may be
gathered:
( 1 ) Pubic hair of the offender.
(2) Semen and spermatozoa.
( 3 ) Blood stains.
( 4 ) Body louse.
Abrasion which is normally found in the posterior commissure is usually brought about by friction or a violent attempt of
insertion.
The vaginal canal may show obliteration of the
rugosities or even purulent discharge.
2. Examination of the alleged offender:
a. Physical development, mental condition and strength:
The relative physical development and strength of the victim
and the offender must be compared to determine whether the
offender can overpower the resistance offered by the victim.
b. Evidence of physical injuries:
The whole body must be examined. The victim, in the
course of the struggle, may inflict bodily harm to the offender.
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LEGAL MEDICINE
Fingernail marks on the neck, arms and chest may be found.
The frenum of the penis may be abraded or lacerated on account
of the violent insertion on a relatively small vulvar or vaginal
opening.
c. Condition of the sex organ:
Aside from the examination of the frenum, washing from the
surface of the penis may reveal blood, seminal stain, vaginal
epithelium and doderleins bacillus. The urethral meatus may be
moist on account of the recent discharge.
d. Evidence from the pubic hair:
The pubic hair may be matted together due to blood stains
or from seminal fluid discharge. Examine carefully for the
presence of body louse.
e. Potency of the offender:
The offender may put up a defense that he is impotent and
that it could have been hardly possible that he had committed
the crime. It may be necessary to subject the offender to a
strong sex stimulus sufficiently under normal condition to
produce erection.
f. Evidence of genital infection — If the offender is suffering from
venereal disease which is transmitted to the victim during the
criminal act, the crime committed is rape with physical injuries
because infection in law is a physical injury.
3. Evidences from the companion of the victim:
a. A history of the incident must be taken from the companion
of the victim. Try to see whether they are consistent with the
narration of facts by the victim.
b. If the companion helped the victim when force was applied by
the offender, the companion must be subjected to a physical
and medical examination for physical injuries.
c. Examination of the clothings may be necessary for signs of
struggle.
d. Investigation must be made to determine whether the companion might have participated as an accomplice to the crime.
e. The mental condition, physical power, age and emotional
state must be taken into consideration to determine the capacity to resist unlawful aggression from the offender.
f. Examination must be made as to the presence of alcohol or
other depressants which may diminish the companion's capacity
to defend the victim from the offender.
SEX CRIMES
509
Investigation of the Crime Scene:
1. Disturbances in the place of commission may infer or affirm the
statement of the victim that she did offer resistance.
2. Strands of hair, blood, seminal and other stains may be recovered
to prove consummation and struggle.
3. Pieces of personal belongings of the offender and /or victim may be
recovered to prove identity and physical struggle.
4. Investigation of witnesses who may possibly be material to the
prosecution of the case may be conducted.
EXAMINATION FOR SEMINAL FLUID
AND SPERMATOZOA
The semen is the viscid, albuminous fluid with faint grayishyellow color, having the characteristic fishy odor, and containing
spermatozoa, epithelial cells, lecithin bodies and other substances.
Spermatozoon is a living organism, normally present in the seminal
fluid consisting of a head, neck and tail. It is from 50 to 55 microns
in length. The head is ovoid and flattened when viewed in front and
pearshape when viewed on the profile. The head is about 5 microns
in length while the neck is very short. The tail is the longest part of
the spermatozoon and consists of a long slender filament with tapering
end. The ciliary movement of the tail is responsible for the forward
movement of the spermatozoon.
There are 2.5 to 5.0 cubic centimeters of semen per ejaculation.
The semen contains 60 million spermatozoa per cubic centimeter,
80% of which are motile after 45 minutes. After 3 hours not more
than 20% become abnormal in forms.
The following specimens may be examined for seminal fluid and
spermatozoa:
1. Wearing apparel of the victim and of the alleged accused.
2. Vaginal smear from the victim.
3. Stains on the body of the victim and of the accused.
4. Stains found at the site of the commission of the offense.
PROCEDURE:
1. Gross Examinations:
a. Inspection by means of the naked eye or with the use of the
hand lens:
The stain is grayish-white to faint yellow in color. In fabrics,
the area occupied is slightly depressed. It usually has a maplike contour with silvery appearance of the surface. It is hardened with shiny borders.
LEGAL MEDICINE
510
b. Inspection by means of Ultraviolet light:
This method is resorted to in order to make visible, small
seminal stains or patches. Determine the side of the clothings
where the stains are located. Under ultraviolet radiation, the
seminal discharge shows bluish fluorescence.
2. Micro-Chemical Examinations:
Moisten a portion of the stained fabric with very diluted hydrochloric acid solution (one drop in 50 cc. of water) and let the
soaking stay for 1/2 to 5 hours depending upon the age of the
stain. Allow the liquid portion to dry on the slide. Perform any
of the following:
a. Florence Test:
Place a cover slip over the dried stain on the slide glass.
Allow a drop of Florence solution to run under the slip.
Place the preparation under the microscope and if semen is
present, a group of crystals appears similar in color and in shape
as the hemin, but larger in size. The crystals are dark brown,
in clusters, rosettes, crossing over the microscopic field.
Composition of the Florence Solution:
Potassium iodide
Iodine
Distilled water
1.65 gms.
2.54 gms.
30.00 cc.
Value of the Test:
This test is produced by the action of iodine on choline, a
natural base found in many cells. It is not a specific test for
spermatic fluid. The test is not a proof of seminal fluid but
only of the presence of some vegetable or animal substance.
A positive result is merely a presumptive evidence of seminal
fluid; a negative result means, in all probability, it is not that of
the seminal fluid.
b. Berberio's Test:
To the spermatic stain on the slide glass, a saturated solution (alcoholic or aqueous) of picric acid is added.
The preparation is placed under the microscope and needleshape crystals with yellow color is produced.
Some allege that this test is specific for spermatic fluid.
The reaction probably depends-on the presence of spermatic
secretion.
c. Puramen Reaction:
This is based on the presence of spermine in the prostatic
fluid. A small part of the stain is extracted with a few drops
SEX CRIMES
511
of saline and put into a micro tube and to the extract is added a
few drops of Puramen's reagent (5% solution of 2.4 dinitro
l-naphthol-7-sulfonic acid, flavianic acid). The tube is then
placed in a refrigerator for a few hours. In a positive reaction, a
yellow precipitate of spermine flavianate can be seen at the
bottom of the tube.
When examined microscopically, the
precipitate is found to consist of small cross-like crystals of a
characteristic shape. Puramen reaction is found to be very
reliable and rather characteristic of seminal fluid
(Modern
Criminal Investigation by Soderman, p. 250).
d. Acid Phosphatase test:
The semen produces a very high acid phosphatase activity as
compared with other body fluids (saliva, perspiration, urine,
etc.) and common vegetable and fruit juice stains. The method
of estimating the activity of a stain on clothings or other
materials is to extract with distilled water and perform the acid
phosphatase determination on the filtered extract.
The following solutions are necessary in the performance of
the test:
(1) Citrate buffer solution — pH 4.9 to 5.2:
Citric acid monohydrate 18.9 g. dissolve in 500 ml. distilled
water.
Sodium hydroxide 1 N 180 ml.
Hydrochloric acid 0.1 100 ml.
The pH adjusted sodium hydroxide and hydrochloric
acid to 4.9 to 5.2. A liter is prepared and stored in a
refrigerator. The solution is stable for six months.
(2) A suitable substrate:
A saturated solution of sodium alpha-naphthanil phosphate.
(3) A diazonium salt (Naphthanil Diazo Blue B)
Reaction: If acid phosphatase is present, the substrate is
hydrolized to produce alpha-naphthol, which is coupled with
a diazonium salt to produce a highly colored dye. In the
absence of the enzyme, the reaction does not appear.
Procedure:
There are three glass slides placed side by side on top of a
white paper.
Slide one (1) is the negative control with filter paper.
Slide two ( 2 ) is the positive control with filtered paper
impregnated with seminal stain.
Slide three (3) is with the suspected material.
LEGAL MEDICINE
512
To each is added a drop of buffer solution followed by a
drop of the substrate solution and finally a drop of the
diazonium salt in solution.
Result — The negative control 1 will remain yellow;
Slide two with known seminal stain will turn deep purple
immediately;
Slide three will also become deep purple if semen is present
but will have no change in color if semen is absent.
The test is conclusive of the presence of semen.
3. Microscopic
Examinations:
a. A dried spermatic fluid stain on the slide is stained with hematoxylin or methylene blue and counter-stained with eosin.
Examined under the microscope, under high power and under
oil immersion, spermatozoa and bacterial infection can be
seen. The presence of a complete spermatozoon will undoubtedly infer the presence of seminal fluid, although semen may be
present without spermatozoa, such as in cases of aspermia
(semen without spermatozoa) or oligospermia (semen with few
spermatozoa).
b. Dr. Hankin's Method:
The fabric with seminal stain is boiled with tannin solution
before dissolving in a solution of potassium cyanide so as to
render the spermatozoa capable of removal. The fabric is then
placed on a slide, teased with carbol-fuchsin. This is examined
with a medium power lens.
c. GangulCs Method:
The same procedure as that of Dr. Hankin but the staining
is with erythrocin and malachite green. This is claimed to be
the best way to stain spermatozoa in India.
4. Biological
Examinations:
a. Precipitin Test (Biological test of Farnum):
This is a test to determine whether the semen is of human
origin or not. A rabbit is immunized with human semen for
four to six weeks. After a time the blood is drawn and the
blood serum is taken and its potency made at different dilutions.
This is used for the test of unknown semen in the same way
as blood precipitin is done.
The presence of a white ring at the point of contact between
unknown semen extract and the anti-human semen serum shows
that the unknown is of human origin.
SEX CRIMES
513
b. Seminal Grouping:
Specific agglutinable substances A and B are present in the
semen, like that of the blood. Seminal grouping is similar to
that of the blood. The test is of value for elimination. A
positive result does not definitely imply that the person is the
owner of the semen in question. A negative result will totally
exclude the alleged accuse as the possible owner of the semen.
The mere presence of speunatozoa on the stain shows the
presence of spermatic fluid, but the absence of spermatozoa does
not prove that the stain is not seminal. The semen may be present
without spermatozoa.
The presence of one complete, unbroken spermatozoon is sufficient to make the conclusion that the stain or fluid is seminal.
It is quite necessary also to examine for infectious disease in
connection with the laboratory examination for semen and
spermatozoa.
How long after sexual intercourse can spermatozoa be found in the
vaginal canal?
Authorities differ in their opinions in this respect:
1. ". . . but, there is every reason to believe that the life of the
effective sperm in the maternal passage is very short, probably
less than thirty hours" (Taylor's Principles and Practice of Medical Jurisprudence by K. Simpson, 12th ed.. Vol 2, p. 32).
2. "There has been a great number of observations this latter point,
and the evidence points to a comparatively short life of the sperm
in the female tract and the period appears shorter with the number
of observations. It is a present belief that the life of the sperm in
the vagina is a matter of hours and its total life in the female tract
is a matter of two or three days at most" (Forensic Medicine by
S. Smith, 10th ed., p. 311).
3. ". . . that spermatozoa may survive less than two hours in the
vagina, but tfiey live as long as forty-three hours both in the cervix
and uterus where the secretion are more favorable" (Medical
Jurisprudence & Toxicology by J. Glaister, 12th ed., p. 325).
4. "Spermatozoa may remain motile in the vagina up to 17 days"
(A Synopsis of Forensic Medicine & Toxicology by C. Thomas,
2nd ed., p. 97).
5. "Fertilization of the ovum does not necessarily occur immediately
after coitus, as it is known that spermatozoa can remain alive in
514
LEGAL MEDICINE
the upper recesses of the vagina for more than two weeks" (Coy\
p. 246).
6. "Some observers have reported finding spermatozoa in the vagina
after seven hours while others have reported finding them as long
as 48 hours after intercourse" (Homicide Investigation by L.
Snyder, 1st ed., p. 327).
Can a woman be raped while she is on her natural sleep?
Occasionally, it may happen, but highly improbable. To a normal
virgin it is hard to conceive that such act could ever be committed
without her knowledge, inasmuch as she has never experienced it.
But, such act may be possible to a woman who has had several
sexual intercourses and to those who have given birth.
Can a woman commit the crime of rape on a man?
In the definition of the crime of rape, it is "committed by having
carnal knowledge of a woman." The law specifically states that it
can only be committed on a woirian and not on a man (inclusio
unius et exclusion alterios). She committed acts of lasciviousness.
Can rape cause death?
Although it may not be usual, the introduction of a matured male
sex organ into the vagina of a young girl may produce local injury
sufficient to produce death. The death may be due to hemorrhage
brought about by the laceration of the vaginal canal, shock, subsequent infection such as gangrene or peritonitis.
Laceration of the vagina with accompanying hemorrhage can also
occur even in adult women if the man's sex organ is exceptionally
big, especially when the sexual act was done roughly.
Can the husband commits the crime of rape on his wife?
The husband cannot be guilty of rape committed on his wife.
Marriage is a license of the husband to have sexual intercourse with
his wife. The purpose of marriage is procreation and there can be
no procreation if there is no sexual intercourse.
However, if there is a decree of legal separation by the court, the
husband may be guilty of rape on his wife. Legal separation does
not dissolve the matrimonial tie between the husband and wife, but
merely separation in bed.
The husband may be guilty also of rape on his wife if he is a
principal by cooperation or by inducement for the act committed
by another man.
SEX CRIMES
SIS
OTHER CRIMES A G A I N S T CHASTITY
A. SEDUCTION
Seduction is the act of a man enticing women to have unlawful
intercourse with him by means of persuasion, solicitation, promises,
bribes, or other means without employment of force (Van de Velde
v. Colle, 8 N.J. Misc. 782, 152 A. 615, 646).
Not all countries recognize seduction as a criminal act but only a
ground for civil liability.
There are two kinds of seduction punishable under the Revised
Penal Code:
1. Qualified seduction
2. Simple seduction
*•
Art. 337, Revised Penal Code — Qualified seduction — The
seduction of a virgin over twelve years and under eighteen years
of age, committed by any person in public authority, priests,
house-servant, domestic, guardian, teacher, or any person who, in
any capacity, shall be entrusted with the education or custody of
the woman seduced, shall be punished by prision correccional in
its minimum and medium periods.
The penalty next higher in degree shall be imposed upon any
person who shall seduce his sister or descendant, whether or not
she be a virgin or over eighteen years of age.
Under the provisons of this Chapter, seduction is committed
when the offender has carnal knowledge of any of the persons
and under the circumstances described herein.
/Types of Qualified Seduction:
1. Ordinary Qualified Seduction:
Seduction of a virgin over twelve years and under eighteen
years of age, committed by any person in public authority,
priest, house-servant, domestic, guardian, teacher or any person
who in any capacity, shall be entrusted with the education or
custody of the woman seduced.
2. Incestuous Qualified Seduction:
This includes seduction wherein there is blood relationship
between the seducer and the seduced. Father seducing daughter or other descendants, or brother seducing sister.
In this type of seduction, the woman seduced need not be a
virgin or may be more than eighteen years of age. T h e penalty
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LEGAL MEDICINE
imposed is one degree higher than that of ordinary qualified
seduction.
The reason for the reduction of the requirements and the
imposition of a higher penalty is that the father or ascendant
and the brother are obliged to lead the descendant or sister to
the path of rectitude and morality, but instead virtually persuaded her to become immoral or be a party to the condemnable act.
Elements of ordinary qualified seduction:
a. The offended party must be a virgin;
b. The offended party must be over twelve but under eighteen
years of age;
c. There must be sexual intercourse between the offender and
the offended party; and
d. The sexual act was done through abuse of authority or
confidence.
( 1 ) Those who acted with abuse of authority:
(a) Person in public authority
( b ) Guardian
( c ) Teacher
( d ) Person who in any capacity is entrusted with the
education or custody of the woman seduced.
( 2 ) Those who seduced through abuse of confidence:
( a ) Priest
( b ) House-servant
( c ) Domestics
Elements of incestuous qualified seduction:
a. Sexual act between the offender and offended party; and
b. Blood relation between the offender and offended party.
(1) Brother who seduces his sister, or
(2) Ascendant who seduces his descendant.
A public school teacher who is in charge of education
had sexual intercourse with a student, is guilty of qualified
seduction (People v. Cariaso, 50 Phil. 884). The accused
need not be the teacher of the woman seduced. Suffice
it is if the accused is a teacher in the same school who has
moral influence over the student (Santos u. People, 40
O.G. supp. 6, 23).
The offended party went to the catholic church to
confess. The accused priest embraced and kissed her and
in spite of her resistance she was brought to the store-
SEX CRIMES
517
room of the convent where he was able to have sexual
intercourse with her. The acts of the priest were proven
in the trial court to constitute the crime of qualified
seduction (U.S. v. Santiago, 41 Phil. 1 793).
Sexual intercourse with the cousin of the wife who is
living in the house and a virgin, under 18 but over 12 is
guilty of qualified seduction because he took advantage
of his authority and there is abuse of confidence (People
v. Lauchengco, C.A. 45 O.G. 3845).
B.
•E S E D U C T I O N :
Art, 338, Revised Penal Code — Simple seduction — The seduction of a woman who is single or a widow of good reputation, over
twelve but under eighteen years of age, committed by means of
deceit, shall be punished by arresto mayor.
Elements of the Crime:
1. The offended party is over twelve but less than eighteen years
of age;
2. The offended party must be single or a widow of good reputation;
3. There must be sexual intercourse done by the offender with
her; and
4. The sexual act was committed by means of deceit.
The statute making simple seduction a crime is not to punish
illicit intercourse, but to punish the seducer who by means of his
promise of marriage, destroyed the chastity of an unmarried
female of previous chaste character, and who thus draws her aside
from the path of virtue and rectitude, and then fails or refuses
to fulfill his promise, a character so despicable in the eye of every
decent honorable man (People v. Iman, 62 Phil. 92).
Deceit is a fraudulent and cheating misrepresentation, artifice,
or device, used by one or more persons to deceive and trick
another, who is ignorant of the true facts, to the prejudice and
damage of the party imposed upon (French v. Vining, 102 Mass.
132, 3 Am Rep. 440). Deceit may be:
a. Suggestion, as a fact, of that which is not true, by one who
does not believe it to be true;
b. The assertion, as a fact, of that which is not true, by one who
has no reasonable ground for believing it to be true;
c. The suppression of a fact, by one who is bound to disclose
it, or who gives information of other facts which are likely
to mislead for want of communication of that fact; or
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LEGAL MEDICINE
d. A promise made without any intention of fulfillment.
, The most common form of deceit is the promise of marriage,
but if the seducer is known to the victim to be married, even if
the previous promise of marriage cause her to accede to the sexual
act, the crime of simple seduction is not committed.
Virginity is not an element of simple seduction. It is sufficient
that the victim is a single or a widow of good reputation.
Medical Evidences in the Crime of Seduction:
Medico-legal investigation of a victim of seduction is practically
the same as in the case of rape insofar as proof of sexual intercourse is concerned. However, medical proofs on account of the
application of force, and conditions that will cause the victim to
be deprived of her reason or otherwise unconscious are no longer
relevant.
Sometimes, the issue of the age of the victim becomes a problem
and its determination through medical proofs may be necessary.
The woman may claim to be less than 18 years old although she
is more than that at the time of the alleged commission of the
offense.
If the alleged criminal act developed into pregnancy and birth
of the child, the question of paternity may be necessary.
CTS OF LASCIVIOUSNESS
Acts of lasciviousness are acts which tend to excite lust; conduct which is wanton, lewd, voluptuous or lewd emotion (Black's
Law Dictionary).
Acts Considered Lascivious:
1. Embracing, kissing and holding the woman's breast (People v.
Collado, 60 Phil. 610).
2. Placing of the man's private organ over a girl's genital organ
(People v. Domondon, C.A. 364 O.G. 1977).
There are two articles in the Revised Penal Code penalizing
acts of lasciviousness, namely:
3. Art. 336, Revised Penal Code — Acts of lasciviousness.
4. Art. 339, Revised Penal Code — Acts of lasciviousness with the
consent of the offended party.
A. ACTS OF LASCIVIOUSNESS:
Art. 336, Revised Penal Code — Acts of lasciviousness — Any
person who shall commit any act of lasciviousness upon other
persons of either sex, under any of the circumstances mentioned
SEX CRIMES
519
in the preceding article (rape), shall be punished by prision correccional.
Elements of the Crime:
1. The offender commits any act of lasciviousness;
2. The lascivious act is done under any of the following circumstances
a. By using force or intimidation.
b. By depriving her of her reasons or otherwise unconscious.
c. When the woman is under 12 years of age.
3. The offended party must be a person of either sex.
The victim owed the defendant one peso. The defendant
sent policemen to her house and arrested her. The victim was
brought to the house of the accused and after beating her with
a stick, the defendant compelled her to take off her clothes
and dance before the defendant and many other persons. Such
acts constitute the crime of acts of lasciviousness
(U.S. v.
Bailoses, 2 Phil. 49).
Acts of lasciviousness had been committed by the defendant
who held the offended party by the waist, touched her breast,
hugged her with the intention of kissing her, and touched her
private part against her will (People v. Famularcano, C.A. 43
O.G. 1721).
The accused went to the house of the woman and found
her to be alone. The accused gained admission to the house
under the pretext of asking for a drink of water, and while
inside the house, he embraced her against her will. The defendant threatened to kill her if she refused to submit to his
desire. The acts constitute the crime of acts of lasciviousness
(People v. Collado, 60 Phil. 610).
B . A C T S O F L A S C I V I O U S N E S S W I T H T H E C O N S E N T O F THE
OFFENDED PARTY:
Art. 339, Revised Penal Code — Acts of lasciviousness with the
consent of the offended party — The penalty of arresto mayor
shall be imposed to punish any other acts of lasciviousness committed by the same persons and under the same circumstances
as those provided in article 337 (qualified seduction) and 338
(simple seduction).
Elements of the Crime:
1. The offender commits acts of lasciviousness;
2. The offended woman must be over 12 but under 18 years of
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LEGAL MEDICINE
age, except when the Victim is the sister or descendant of the
offender;
3. The offender commits the act by abuse of authority, confidence, relationship or deceit;
4. The victim must be a woman, virgin, single, or widow of good
reputation, except when she is the sister or descendant of the
offender where virginity is not required.
A man who embraced and kissed his girlfriend (lover) is not
guilty of the crime of acts of lasciviousness with the consent of
the offended party because consent was not obtained through
abuse of confidence, authority, relationship, or by means of
deceit.
Medical Evidences in the Crime of Acts of Lasciviousness:
Like in the crimes of rape and seduction, medico-legal investigation is involved in proving the lascivious act itself and the
other elements to constitute the crime. Physical injuries may be
suffered by the victim on the part of the body where the lascivious act was committed by insertion of his finger into the private
part of the victim or through the application of bodily force with
the consequent production of physical injuries.
Abduction is the carrying away of a woman by an abductor
with lewd design.
Lewd design is the intent of the abductor to have sexual intercourse with the woman abducted. This can be inferred from the
acts of the offender.
There are two types of abduction punishable under the Revised
Penal code:
1. Forcible abduction ( A r t . 342)
2. Consented abduction ( A r t . 343)
A. Forcible Abduction:
Art. 342, Revised Penal Code — Forcible abduction — The
abduction of any woman against her will and with lewd designs
shall be punished by reclusion temporal.
The same penalty shall be imposed in every case, if the female
abducted is under twelve years of age.
Elements of the Crime:
1. The victim abducted is a woman;
2. The abduction is against her will; and
SEX CRIMES
521
3. The abduction is with lewd design.
The civil status, reputation and age of the woman abducted are
not the ingredients of the crime, however, in case the woman is
under 12 years of age, the crime committed is still forcible abduction even if the woman consented.
If there are several abductors, it is sufficient that one of them
had lewd design.
Inference of lewd design may be deduced when the offender
kissed and embraced the offended party, took the victim farther
to an uninhabited place to perform lascivious acts on her.
In forcible abduction, the act of the offender is violative of the
personal liberty of the woman abducted, her honor and reputation, and of public order (U.S. v. de Vivar, 29 Phil. 458).
B. Consented Abduction:
Art. 343, Revised Penal, Code — Consented abduction — The
abduction of a virgin over twelve and under eighteen years of age,
carried out with her consent and with lewd designs, shall be
punished by the penalty of prision correccional in its minimum
and medium periods.
^Elements of the Crime:
1. The offended party must be a virgin;
2. The offended party must be over 12 but under 18 years old;
3. The carrying away of the offended party is with her consent;
and
4. The taking away must be with lewd design.
Rationale of the Provision:
The purpose of the law is not to punish the wrong done to the
girl, because she consents thereto, but to prescribe punishment for
the disgrace to her family and the alarm caused therein by the
disappearance of the one who is, by her age and sex, susceptible
to cajolery and deceit (U.S. v. Reyes, 20 Phil 510).
^ a . ADULTERY AND CONCUBINAGE
A. Adultery:
Art. 333, Revised Penal Code — Who are guilty of adultery —
Adultery is committed by any married woman who shall have
sexual intercourse with a man not her husband and by the man
who has carnal knowledge of her, knowing her to be married, even
if the marriage be subsequently declared void.
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522
Adultery 6hall be punished by prision correccional in its
medium and maximum periods.
If the person guilty of adultery committed this offense while
being abandoned without justification by the offended spouse,
the penalty next lower in degree than that provided in the next
preceding paragraph shall be imposed.
Elements of the Crime:
1. The woman is married;
2. She has had sexual intercourse with a man not her husband; and
3. The man with whom she had sexual intercourse knows her to
be married even if the marriage has subsequently been declared
void.
Reason for the Provision:
Adultery is made a crime to avoid introduction of foreign blood
in the family. Adultery may cause introduction of spurious heirs
into the family wherein the right of the real heirs may be impaired
(U.S. v. Mata, 18 Phil. 490).
Blood examination of the children born by such adulterous act
may be material in the presecution of the crime.
If the married woman and the paramour were caught "in flagrante delicto", medical examination of the woman may be necessary to determine the presence of semen and spermatozoa in the
vaginal canal. Biological seminal grouping may be done to prove
the identity of the semen found.
B. Concubinage:
Art. 334, Revised Penal Code — Concubinage — A n y husband
who shall keep a mistress in the conjugal dwelling, or, shall have
sexual intercourse, under scandalous circumstances, with a woman
who is not his wife, or shall cohabit with her in any other place,
shall be punished by prision correccional in its minimum and
medium periods.
The concubine shall suffer the penalty of destierro.
Ways of Committing the Crime:
1. Keeping a mistress in the conjugal dwelling; or
2. Having sexual intercourse, under scandalous circumstances,
with a woman who is not his wife; or
3. Cohabiting with her in any other place.
A married man committing concubinage violates the marital
vow.
SEX CRIMES
523
PROSTITUTION
Prostitutes are women who, for money or profit, habitually
indulge in sexual intercourse or lascivious conduct (Art. 202,
N o . 5, Revised Penal Code).
Requirements to be satisfied before a woman may be considered a prostitute:
1. She habitually indulges in sexual intercourse or lascivious acts.
A single isolated sexual intercourse or lascivious act for
money profit will not make a woman a prostitute. There
must be habituality or repeated acts. This makes prosecution
for the crime difficult. Medical evidence on this matter is purely presumptive.
A woman may still be considered a prostitute although she
does not indulge in the habitual sexual intercourse because
habitual indulgence in lascivious acts also makes her a prostitute.
2. When the habitual sexual intercourse or lascivious act is done
for money or profit.
Habitual sexual intercourses with several men but not for
money or profit will not make a woman a prostitute.
The penalty imposed on a woman who has been proven to
be a prostitute is arresto menor or a fine not exceeding 200
pesos, and in case of recidivism, by arresto mayor in its medium
period to prision correccional in its minimum period, or a fine
ranging from 200 to 2,000 pesos, or both, in the discretion of
the court (Art. 202, last par., Revised Penal Code).
Reasons why some women become prostitutes:
1. Physiological and psychological traits — Prostitutes are seldom
nymphomaniac, although nymphomaniacs may become prostitutes. Some of them are found to be emotionally unstable,
psychopathic, neurotic, suggestible, or addicted to the use of
tobacco, alcohol and narcotic drugs. They may be lonely and
may lack association with the intimate family circle.
2. Economic factors — They are financially hard up and indulge
in the business for fear of starvation. Their earnings are meager
and cannot maintain a decent life or cope with the domestic
needs.
3. Home and neighborhood — A great number of them comes
from broken homes, over-crowded homes with members of
both sexes sleeping in the same room, or having a male border
or roomer. In some instances the mother is a prostitute, and
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the father is a pimp and their daughters are allowed to roam
in the streets and being initiated in sexual intercourse.
4. Influence of contraceptives — The availability of contraceptives
and prophylactic treatment for infection make it possible to
indulge in sexual relationship without fear of pregnancy and
infection.
(Criminology by Taft and England, p. 266).
Medico-legal Aspects of Prostitution:
1. Prostitution is one of the venues in spreading venereal and other
diseases.
2. Evidences may be gathered to prove sexual or lascivious acts.
Types of Prostitutes:
1. Call Girl — Receives telephone calls from the selected group of
customers and makes arrangements to meet them at a designated
place.
2. Hustler:
a. Bar or tavern "pick-up" — Frequent places where liquor is
sold, sometimes with the knowledge of the management,
b. Street walker — She finds her customers in various places and
makes the contact herself, but she may walk with taxicab
drivers.
3. Door Knocker — A newcomer in the field of prostitution. She
frequents small hotels and furnished rooms or roams in the
hall room of these places.
4. Factory Girl — She works in regular house of prostitution. She
accepts all comers and has nothing to do with the selection
and solicitation of customers. She is under the direct supervision of a "madam" or "mama-san" (Criminology by R.G.
Caldwell, 2nd ed., p. 125).
Personnel Associated with Prostitution:
1. "Madam" or "Mama-san" — She is the general manager of the
prostitution den.
She handles cash, meets customers and
transacts all business for the house.
2. Procurer — The person is charged with the duty of getting
girls to work as prostitutes.
3. Transporter — The man or woman who takes prostitutes from
town to another.
4. Pimp or "Bugao" — one who gets customers. He may be a
taxicab driver, bartender, or a girl's own husband. He earn's
by percentage basis.
SEX CRIMES
525
Types of Prostitution Houses:
1. Disorder House - Employs only 4 to 8 girls in the business
This type is gradually disappearing as it is an easy target of
organized program against prostitution.
2. Furnished Room House — This is operated by experienced
madams. The house has 2 to 3 girls and also rooms for rent
to legitimate roomers in order to maintain the appearance of
respectability.
3. Call House — It is merely a place where a telephone is maintained by a madam. The customer calls, and the madam sends
the girl out to meet him.
Other Reasons for Indulging in Prostitution:
1.
2.
3.
4.
Poor social background with personality handicaps.
Previous sexual experience in or out of wedlock.
Contact with a person in or in the fringe of prostitution.
Desire for money or forced by loneliness, desertion or broken
promises.
Effects of Prostitution:
1.
2.
3.
4.
5.
6.
7.
Arrest and imprisonment.
Venereal infection.
Social ostracism.
Poor personal hygiene.
Excessive use of alcohol.
Irregular habit of eating and sleeping.
Demoralization and physical deterioration.
Medical Evidence in Prostitution:
Genital examination required is the same as in any other sexual
offense.
Can rape be committed on a prostitute?
Yes, virginity or chastity of character is not a necessary element
of the crime of rape. However, medical proof of sexual intercourse is not a legal proof of the commission of rape.
The fact that the offended person has been a person of unchaste character constitutes no defense to the charge of rape,
provided that it is proven that the illicit relations complained of
were committed with violence or force. The defendant in a
criminal action for rape is guilty of the crime if force or violence
was used, regardless of the good or bad character of the offended
party (People v. Blance, 45 Phil. 113).
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LEGAL MEDICINE
V u l v a o f prostitute w i t h l e u c o d e r m a
Methods of Control:
1. Legalized but regulated:
a. Segregation of prostitute in a restrictive area.
b. License given to the house of prostitution.
c. Periodic examination ol the prostitutes.
Defects of the Method:
a. Segregation does not segregate.
b. Many prostitutes fail to register, either through negligence
or desire to avoid the stigma which registration creates.
c. The medical inspection does not protect.
d. Regulations create a false sense of security (overconfidence).
e. Regulations promote prostitution, foster immorality, corrupt
officials and increase crime.
2. Strict prohibition:
a. Strict enforcement of legislation against prostitution and all
activities connected with it.
b. Education of the public regarding sex, prostitution and
venereal disease.
c. Adoption of medical measures and establishment of medical
facilities for the diagnosis and treatment of venereal disease.
d. Rehabilitation of prostitutes.
SEX CRIMES
527
e. Adoption of codes of self-regulation and organization of
community cooperation.
Other persons involved in the business of prostitution are
punished by the following provisions of the Revised Penal Code:
A. Corruption of Minors:
Art. 340, Revised Penal Code:
A n y person who shall promote or facilitate the prostitution or
corruption of persons under age to satisfy the lust of another, shall
be punished by prision correccional in its minimum and medium
periods, and if the culprit be a public officer or employee, including those in government owned or controlled corporations, he
shall also suffer the penalty of temporary absolute disqualification
(as amended by B.P. 92).
Habitually or with abuse of authority or confidence was removed from the original provision as an element in promoting or
facilitating the prostitution or corruption of persons under age to
satisfy the lust of another. A single act without abuse of authority
or confidence is now a crime. A mere proposal to promote or
facilitate the prostitution or corruption of a person under age is
already a consummation of the crime.
The term under age presumably means below the age of 18,
inasmuch as 18, insofar as sexual offenses are concerned, is the
age of legal consent.
B. White Slave Trade:
Art. 341, Revised Penal Code:
The penalty of prision correccional in its medium and maximum periods 6hall be imposed upon any person who, in any
manner, or under any pretext, shall engage in the business or shall
profit by prostitution or shall enlist the services of women for the
purpose of prostitution.
Ways of Committing the Crime:
a. Engaging in the business of prostitution.
b. Profiting by prostitution.
c. Enlisting the services of women for the purpose of prostitution.
Any one of the above mentioned act is sufficient to constitute
offense which need not be habitual.
Abuse Against Chastity
Art. 245, Revised Penal Code:
The penalties of prision correccional in its medium and maxi-
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LEGAL MEDICINE
mum periods and temporary special disqualification shall be
imposed:
1. Upon any public officer who shall solicit or make immoral or
indecent advances to a woman interested in matters pending
before such officer for decision, or with respect to which he is
requested to submit a report to, or consult with, a superior
officer;
2. Any warden or other public officer directly charged with the
care and custody of prisoner or persons under arrest who shall
solicit or make immoral or indecent advances to a woman under
his custody.
If a person solicited by the wife, daughter, sister or relative
within the same degree by affinity of any person in the custody
of such warden or officer, the penalties shall be prision correccional in its minimum and medium periods and temporary
special disqualification.
Ways of Committing Abuse Against Chastity:
1. By soliciting or making immoral or indecent advances to a
woman interested in matters pending before the offending
officer for decision or with respect to which he is required to
submit a report to, or consult with a superior officer.
2. By soliciting or making immoral or indecent advances to a
woman under the offender's custody.
3. By soliciting or making immoral or indecent advances to the
wife, daughter or relatives with the same degree by affinity of
any person in custody of the offending warden or officer.
Solicit means to propose earnestly and persistently something
immoral or indecent. Mere proposal is sufficient. It is not necessary that the woman solicited yields to the solicitation of the
offender.
But proof of solicitation may no longer be necessary when
there is sexual intercourse. A warden of a woman prisoner entered
the cell and had illicit relation with her. On appeal the appellant
argued there was no proof of solicitation. Absence of sufficient
solicitation is not necessary when the act solicited was consumated
(U.S. v. Morales, 29 Phil. 572).
U N N A T U R A L SEXUAL OFFENSES
AND SEXUAL ABNORMALITIES
Unnatural sexual offenses are not only a deviation to the normal
course of nature but also uncommonly observed manifestations of
sexual perversion.
Most of those persons suffering from the con-
SEXUAL ABNORMALITIES
529
ditions do not exhibit criminal intent but manifesting mental aberrations which may be a subject-matter for the psychiatrist to treat.
Environment, degree of education, degree of morality, habits, etc.
are some of the factors responsible for such sexual maladjustments.
There is no specific provision of our Revised Penal Code on any of
the unnatural sexual offenses, although certain provisions of the code
may be made applicable.
Municipal ordinances of cities and towns may penalize unnatural
sexual offenses in consonance with the power to promulgate rules
and regulations necessary for the promotion of public safety, moral
and welfare.
Provisions of the Penal Code which may be Applicable to Unnatural
Sexual Offenses:
1. Grave Scandal:
Art. 200, Revised Penal Code:
The penalties of arresto mayor and public censure shall be
imposed upon any person who shall offend against decency or
good customs by any highly scandalous conduct not expressly
falling within any other article of the code.
Requisites of the Crime:
a. The offender performs act or acts;
b. Such act or acts is/are highly scandalous and offending against
decency and good customs;
c. It is also necessary that the act or acts be committed in a public
place or within the view or knowledge of the public (U.S. v.
Samaniego, 16 Phil. 663).
2. Immoral doctrines, obscene publications and exhibitions:
Art. 201, Revised Penal Code:
That penalty of prision correccional in its minimum period or a
fine ranging from 200 to 2,000 pesos, or both, shall be imposed
upon:
a. Those who shall publicly expound or proclaim doctrines openly
contrary to public morals;
b. The authors of obscene literature, published with their knowledge in any form, and the editors publishing such literature;
c. Those who in theaters, fairs, cinematographs or any other place
open to public view, shall exhibit indecent or immoral plays,
scenes, acts or shows; and
d. Those who shall sell, give away or exhibit prints, engravings,
sculptures or literature which are offensive to morals.
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LEGAL MEDICINE
3. Vagrants and Prostitutes:
Art. 202, Revised Penal Code:
The following are vagrants:
1
2. Prostitutes.
For the purposes of this article, women who, for money or
profit, habitually indulge in sexual intercourse or lascivious
conduct, are deemed to be prostitutes.
Any person found guilty of any of the offenses covered by this
article shall be punished by arresto mayor or a fine not exceeding
200 pesos, and in case of recidivism, by arresto mayor in its
medium period to prision correccional in its minimum period or a
fine ranging from 200 to 2,000 pesos, or both, in the discretion of
the court.
4. Unjust vexation or any other coercion:
Art. 287, 2nd paragraph, Revised Penal Code:
Any other coercions or unjust vexations shall be punished by
arresto menor or a fine ranging from 5 to 200 pesos, or both.
Unjust vexation includes any human conduct, although not
productive of some physical or material harm would, however,
unjustly annoy of vex an innocent person (Guevarra).
SEXUAL ABNORMALITIES:
As to the Choice of Sexual Partner:
1. Heterosexual — Sexual desire towards the opposite sex. This is
a normal sexual behavior, socially and medically acceptable.
2. Homosexual — (Michaelangelo, Shakespeare, Oscar Wilde, Waltz
Whiteman), — Sexual desire towards the same sex.
a. Kinds of Homosexuals:
(1) Overt — Persons who are conscious of their homosexual
cravings, and who make no attempts to disguise their
intention. They make advances towards members of their
own sex.
( 2 ) Latent — Persons who may or may not be aware of the
tendency in that direction but are inclined to repress the
urge to give way to their homosexual yearning.
Tribadism (Lesbianism) — A special name for female
homosexuals wherein a woman has the desire to have
sexual intercourse with another woman. The "masculine
SEXUAL ABNORMALITIES
531
woman may be the active subject during the sexual act.
Most lesbians have antipathy towards men.
3. Infanto8exual — Sexual desire towards an immature person.
a. Pedophilia — A form of sexual perversion wherein a person has
the compulsive desire to have sexual intercourse with a child of
either sex. Children of various ages participate in sexual activities,
like fellatio, cunnilingus, fondling with sex organs, or anal
sexual intercourse.
Usually committed by a homosexual,
between a man and a boy the latter being a passive partner.
A Pedophile may be:
a. Homosexual pedophile — may attempt either oral or anal
intercourse with his victim.
b. Heterosexual pedophile — may attempt either oral, vaginal,
anal, intracrural intercourse as well as cunnilingus, but attempts
at vaginal penetration are most common.
Offenders entice their victim through promise of money,
candy, etc.
Reasons Why Physicians Fail to Detect Child Sexual Abuse:
a.
b.
c.
d.
The lack of "hard" physical evidence of abuse;
A belief that sexual abuse does not exist;
A fear of antagonizing parents; and
Ignorance of how to obtain a detailed sexual history from the
child.
Theories Why Adults become Interested in Children:
a. Emotional congruence — Children are sexually attractive to
adult for a number of reasons:
(1) Children are nondominant;
(2) Adults have low self-esteem, immaturity, socialization to
male dominance or narcissism; and
(3) Unconscious impulse, compulsively to repeat child-adult
sex contact to master, and his or her own early experience
of child-adult sexual abuse.
b. Conditioning Modeling — Behavioral modeling begins with early
childhood experience, positive or negative, and is conditioned
by hormonal abnormalities, child pornography and the misattribution of arousal as being only from children.
c. Blockage — Alternative sexual gratification may become blocked
due to poor social skills with adults of the opposite sex, anxiety
about sex, unresolved oedipal conflicts, unavailability of or
LEGAL MEDICINE
532
conflict with a committed partner, as well as repressive socialsexual norms.
d. Disinhibition — Sexual controls may become disinhibited due
to senility, dementia, mental retardation, psychosis, drug or
alcohol, impulse disorders, situational stress, failure of incest
avoidance, a general cultural acceptance.
(JAMA, Vol. 254, No. 16, Oct. 25, 1985).
4. Bestosexual — Sexual desire towards animals.
a. Bestiality (Zoophilia) — Sexual gratification is attained by
having sexual intercourse with animals.
5. Autosexual (Self gratification or masturbation) — It is a form of
"self-abuse" or "solitary vice" carried without the cooperation
of another person.
Relation of Masturbation to Health and Sex Crime:
a. It serves as a sedative for a variety of neurotic disposition.
Many persons who suppress the urge to masturbate and give up
the habit often develop an anxiety neurosis.
b. It serves as an adequate form of sexual gratification.
c. It prevents the development of homosexuality.
d. It prevents the development of suicidal tendency on account of
the absence of sexual gratification.
e. It protects certain persons from committing sex crimes.
Types of Masturbation:
a. Conscious Type — The person deliberately resorts to some
mechanical means of producing sexual excitement with or without orgasm:
Ways of Masturbation:
(1) In male:
(a) By manual manipulation to the point of emission.
( b ) Ejaculation produced by rubbing his sex organ against
some part of the female body without the use of the
hand (frottage).
( 2 ) In female:
(a) Manual manipulation of the clitoris.
( b ) Introduction of the penis-substitute.
Medical evidences cannot go beyond to prove the emission of
semen, and unless caught "in flagrante delicto," it is not likely
that a person could be brought to trial. It may be a criminal act
if done in public places or within the knowledge and view of the
public. Psychiatric evaluation of the offender may be necessary.
SEXUAL ABNORMALITIES
533
b. Unconscious type — The release of sexual tension may come
about via the mechanism of nocturnal stimulation with or
without emission, which may also be considered as "masturbation equivalent". The explanation is that the conscious
urge to masturbate is repressed during the waking state and
expressed during the sleep when we are less apt to censor our
thoughts and desires.
7. Gerontophilia — Sexual desire with elder person.
8. Necrophilia — A sexual perversion characterized by erotic desire
or actual sexual intercourse with a corpse.
9. Incest — Sexual relations between persons who, by reason of
blood relationship cannot legally marry.
As to Instinctual Strength of Sexual Urge:
1. Over Sex:
a. Satyriasis — Excessive sexual desire of men to intercourse.
b. Nymphomania — Strong sexual feeling of women. They are
commonly called "hot" or "fighter".
Both satyriasis and
nymphomania are general expression of compulsive neurosis.
2. Under-sex (Sexual frigidity):
a. Sexual anesthesia — Absence of sexual desire or arousal during
sexual act in women.
b. Dyspareunia — Painful sexual act in women.
o. Vaginisimus — Painful spasm of the vagina during sexual act.
d. Old age — Weakening of sexual feeling in the elderly. There
may be the desire but there is difficulty of accomplishment. It
may be accompanied by aberrant behavior, like exhibitionism,
incest, or homosexuality.
As to Mode of Sexual Expression or Way of Sexual Satisfaction:
1. Oralism — The use of the mouth as a way of sexual gratification.
a. Fellatio (Irrumation) — The female agent receives the penis of
a man into her mouth and by friction with the lips and tongue
coupled with the act of sucking initiates orgasm.
b. Cunnilingus — Sexual gratification is attained by licking or
sucking the external female genitalia.
c. Anilism (anilingus) — A form of sexual perversion wherein a
person derives excitement by licking the anus of another person
of either sex.
2. Sado-masochism (Algolagnia) — Pain or cruel act as a factor for
gratification.
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LEGAL MEDICINE
Flagellation — A sexual deviation associated specifically with
the act of whipping or being whipped.
a. Sadism (Active Algolagnia) — A form of sexual perversion in
which the infliction of pain on another is necessary or sometimes the sole factor in sexual enjoyment.
(1) Cannibalism — Sexual gratification attained by biting
without flesh eating but with presumed unconcious wish
to consume.
(2) Love bites — These are superficial punctate contusions seen
most frequently at the side of the neck, overlying or anterior
to the sternomostoid muscle, breast and other parts of the
body. The bitten tissue must be loose and the mark is
caused by forcible sucking applied to tissue seized by the
mouth. Usually during the act the teeth are guarded by the
lips. Because of the sucking, contusion develops.
The infliction of such injury although amorous may be
a part of the sadistic attitude of the offender.
It is called necrosadism or lust murder if the victim dies.
The deviate has a strong homicidal urge, quite often suffering from organic brain disease or may be schizophrenic,
epileptic or psychopath.
b. Masochism (Passive algolagnia) — The pain and humiliation
from the opposite sex is the primary factor for sexual gratification.
3. Fetishism — A form of sexual perversion wherein the real or
fantasied presence of an object or bodily part is necessary for
sexual stimulation and/or gratification.
Kinds of Fetishes:
a. Anatomic — Where particular portions of the anatomy, such as
the breasts, or buttocks are the target of interest for sexual
stimulation.
b. Clothing — The deviate may have interest centered on shoes,
handkerchief, undergarments, either on a sexual partner or
stolen from a neighborhood washline.
c. Necrophilic — The deviate has the desire to be near a dead body
and may or may not violate the dead person for sexual gratification.
d. Odor (Ospresiophilia) — Fetish whose stimulus is pleasant odor
or foul odor for sexual stimulation or gratification.
(1) Urolagnia — A sexual deviation in which sexual excitement
is associated with the sight of women urinating. In some
instances, there is a desire to drink the urine.
SEXUAL ABNORMALITIES
535
( 2 ) Coprolognia — A form of sexual deviation wherein sexual
gratification is attained by seeing women defecate.
(3) Mysophilia — Sexual response to filth or excretion.
e. Pygmalionism — A sexual deviation whereby a person has
sexual desire for statues.
f. Mannikinism — Sexual desire with mannikins.
g. Narcissism — A person has extreme admiration and love of one's
self. Sexual gratification is attained by looking at the mirror
and appreciating his or her own self.
h. Negative fetish — The marked dislike for things, like eyeglasses,
beard, hair cut, as the sole stimulus for gratification.
i. Saboteur fetish — A deviate does damage while he gets satisfaction, like cutting clothes or hair.
j. Incendiarism — Deviate derives sexual pleasure from setting fire.
(Did Nero belong to this category? ).
k. Vampirism — Deviate attains sexual stimulation or gratification
at the sight of blood.
As to the Part of the Body:
1. Sodomy — Sexual act through the anus of another human being.
2. Uranism — Sexual gratification attained by fingering, fondling
with the breast, licking parts of the body, etc.
3. Frottage — A form of sexual gratification characterized by the
compulsive desire of a person to rub his sex organ against some
parts of the body of another. They generally achieve their erotic
gratification by rubbing or pressing their organs against the buttocks of women in crowded subways, buses, theaters, or streetcars. The frotteur often pretends that the rubbing is accidental.
4. Partialism — A form of sexual deviation wherein a person has
special affinity to certain parts of the female body. Sexual libido
may develop in the breast, buttock, foot, legs, etc. of women.
Usually, sexual intercourse is merely secondary to satisfy the
sexual desire.
A person may prefer rubbing his penis against the woman's
breast or may prefer his partner to lie prone and kiss the buttocks
or perform cunnilingus.
Frottage differs from partialism in the sense that in the former
there must be rubbing at certain parts of the body to arouse
sexual stimulation, while in the latter the act may not only be
rubbing but actual intercourse.
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LEGAL MEDICINE
As to Visual Stimulus:
1. Voyeurism — A form of sexual perversion characterized by a compulsion to peep to see persons undress or perform other personal
activities.
The offender is sometimes called "Peeping Tom".
Usually after peeping, he masturbate in excess.
2. Mixoscopia (Scoptophilia) — A perversion wherein sexual pleasure
is attained by watching couple undress or during their sex intimacies.
As to Number:
Normal sexual relation is only between a man and a woman, but
deviation in sexual behavior may attain gratification when more than
two persons are participating.
1. Troilism (Menage a trois') — A form of sexual perversion in which
three persons are participating in the sexual orgies. The combination may consist of two men and a woman or two women and
a man. The usual activity may be fellatio, kissing the buttock,
sucking the breast, a "suixante-neuf" (sixty-nine) arrangement,
or coitus combined with other sexual practices. Sexual gratification
is attained in the "eternal triangle".
A husband may request his wife to invite another woman
and spend their night in a room. In their nude condition, the
husband may perform cunnilingus to the woman and at the same
time performing coitus with his wife. The invited woman may
remain doing nothing other than kissing the buttock of the husband.
2. Pluralism — A form of sexual deviation in which a group of
person participate in the sexual orgies. T w o or more couples
may perform sexual act in a room and they may even agree to
exchange partners for "variety sake" during the "sexual festival".
Other Sexual Deviates:
1. Coprolalia — A form of sexual deviation characterized by the need
to use obscene language to obtain sexual gratification. Sometimes
they go beyond uttering profane words by making some writings
and sketches on the walls of toilets.
2. Don Juanism — The term applied by psychiatrists to describe a
form of sexual deviation characterized by promiscuity and making
seduction of many women as a part of his. career. The pervert
cannot find anyone to be a permanent companion.
3. Indecent exposure (Exhibitionism) — This is the willful exposure
in public places of one's genital organ in the presence of other
persons, usually of the opposite sex. Usually, the exhibitionist is
naked. It is the act of men whose sexual satisfaction is attained
SEXUAL ABNORMALITIES
537
principally by exhibition with or without performance of masturbatory act. Women may expose themselves naked in public
as in "bubble and fan" dances and the "strip tease" acts in night
clubs.
In civilized society, exhibitionism committed in public places
is harmful to the sense of decency and good morals, hence it is
punishable.
One evening two detectives and a reporter with a camera
entered one of the burlesque shows and they found the theater
dark with a dim light in the stage where a woman was seen
swaying her hip to and fro and sometimes raising her feet
one after another. She had on an "abbreviated" nylon panty
and patches on her breasts to interrupt her stark nakedness.
There were about 100 people inside the theater and while the
girl (accused) was dancing the people shouted in Tagalog
"Sigue, muna, sigue, nakakalibog".
The dancer was later apprehended and charged for immoral
exhibition. H E L D : She was found guilty, because the act
deprived or corrupted those minds which were susceptible to
immoral influence.
The object of the law is to protect the
public. The reaction of the public during the show showed
the act to be immoral (People v. Aparici, G.R. 13375).
Sexual Reversal:
1. Transvestism ("Sexo-esthetic inversion", "Psychical hemaphroditism" or "Metamorphosis sexualis paranoica") — A form of
deviation wherein a male individual derives pleasure from wearing
the female apparel. This condition is found sometimes in females
who desire to dress themselves in male attire. The transvestite has
a psychic identification with the opposite sex. A female transvestite may imagine that she possesses a penis. It is quite difficult
to detect a female transvestite, since it is quite common for
women to wear slacks or dress in masculine tailored ways.
Transvestites are, as a rule harmless insofar as they have no
desire to assault anyone.
Like exhibitionists they are merely
interested in attracting attention. Transvestitism is a symptomatic
expression of some deep underlying sexual maladjustment amenable to psychotherapy.
2. Transexualism — There is a dominant desire in some persons to
identify themselves with the opposite sex as completely as possible
and to discard forever their anatomical sex. So strong is the compulsion to have the opposite sex that they hate their genitalia as
a persistent evidence that they are not what they want to be, and
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LEGAL MEDICINE
sometimes attempt to castrate themselves or mutilate their external genitalia. They may go to the extreme of taking for a long
period of time sex hormones to develop secondary sex characteristics of the opposite sex. They may go to the extent of subjecting themselves to surgery to change their anatomical sex.
3. Intersexuality — A genetic defect wherein an individual show
intermingling, in varying degrees, of the characteristics of both
sexes including physical form, reproductive organs, and sexual
behavior.
Classification of Intersexuality:
a. Gonadal agenesis — The sex organs (testes or ovaries) have never
developed. This condition can be determined very early in
fetal life.
b. Gonadal dysgenesis — The external sexual structures are present
but at puberty the testes or the ovaries fail to develop.
( 1 ) Klenefetter's syndrome — A male type of dysgenesis in
which although the anatomical structure is entirely male,
the nuclear sexing is female (Chromatin positive), characterized by the presence of small testes with fibrosis and
hyalinization of the seminiferous tubules. It is associated
with X X Y chromosomes.
( 2 ) Turner's syndrome — Structurally and phenotypically
female but the ovaries are small. There is sterility with the
absence of the second X chromosomes.
c. True hermaphroditism — A state of bisexuality, having both
ovaries and testicles. The nuclear sex is usually female. The
character may be neutral or whichever is dominant.
d. Pseudohermaphrodite — Sex organ is anatomically of one sex
but the sex characters is that of the opposite sex.
( 1 ) Male pseudohermaphrodite — Gonads are testicles but the
character is effeminate.
( 2 ) Female pseudohermaphrodite
with masculine character.
— Gonads are ovaries but
Chapter XXII
PREGNANCY
Pregnancy is the state of a woman who has within her body the
growing product of conception or a fecundated germ. It commences
from the time the egg cell is fertilized and terminates at the time
such product of conception is expelled or delivered. The average
duration of pregnancy is 270 to 280 days from the first day of the
last menstruation. There is no perfect way of determining its duration, although several methods are employed, none of the methods
are perfectly reliable.
Legal Importance of the Study of Pregnancy:
1. Pregnancy is a ground for the suspension of the execution of the
death sentence in a woman:
Art. 83, Revised Penal Code:
Suspension of the execution of the death sentence:
The death sentence shall not be inflicted upon a woman within
the three years next following the date of the sentence or while
she is pregnant, nor upon any person over seventy years of age.
In this last case, the death sentence shall be commuted to the
penalty of reclusion perpetua with the accessory penalties in
article 40.
2. A conceived child is capable of receiving donation:
Art. 742, Civil Code:
Donations made to conceived and unborn children may be
accepted by those persons who would legally represent them if
they were already born.
3. A conceived child may exercise civil rights:
Art. 40, Civil Code:
Birth determines personality; but the conceived child shall be
considered born for all purposes that are favorable to it, provided
it be born later with the conditions specified in the following
article.
Art. 41, Civil Code:
For civil purposes, the foetus is considered born if it is alive at
the time it is completely delivered from the mother's womb.
However, if the foetus had an intrauterine life of less than seven
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540
months, it is not deemed born if it dies within twenty-four hours
after its complete delivery from the maternal womb.
4. Concealment of the woman that she is pregnant at the time of
marriage is a ground for the annulment of marriage:
Art. 85, Civil Code:
A marriage may be annulled for any of the following causes,
existing at the time of the marriage:
( 4 ) That the consent of either party was obtained by fraud,
unless such party afterwards, with full knowledge of the
facts constituting the fraud, freely cohabited with the other
as her husband or his wife, as the case may be.
Art. 86, Civil Code:
Any of the following circumstances shall constitute fraud
referred to in number 4 of the preceding article:
(3) Concealment by the wife of the fact that at the time of
the marriage, she was pregnant by a man other than her
husband.
No other misrepresentation or deceit as to character, rank,
fortune or chastity shall constitute such fraud as will give grounds
for action for the annulment of marriage.
Art. 87, Civil Code:
The action for annulment of marriage must be commenced
by the parties and within the periods as follows:
( 4 ) For causes mentioned in number 4, by the injured party
within four years after the discovery of the fraud.
Instances W h y Some Women Claim Pregnancy Even if None Exists:
1. Pregnancy is a ground for the suspension of the death sentence
in a woman:
If a woman claims that she is pregnant at the time of execution,
she may file for a motion or petition in court for the suspension of
the execution of the death sentence, and if found to be pregnant,
the execution will be deferred until she has delivered.
2. A lawful plea in mitigation when charged with theft:
A woman may be accused of the crime of theft. She may
raise the plea in mitigation of kleptomania brought about by her
temporary insanity due to conceptfon.
3. A ground for widow's larger claim:
A widow may claim larger damages as a result of the recent
death of her husband on account of the negligence of another.
PREGNANCY
541
4. Claim for the posthumous child:
A widow may ask or petition the court for the share of the
posthumous child in the estate of the deceased husband.
5. F o r black-mailing purpose:
A woman may claim that she is pregnant for the purpose of
black-mailing a man or for the purpose of inducing a man to marry
her.
Instances W h y Some Women Deny the Existence of Pregnancy:
1. When there is no ground for them to become pregnant:
Women who are unmarried, or divorced, or who are living
separately from their husbands for a time may be accused by
someone that they are pregnant. To defend their moral and
social reputation, they deny the existence of pregnancy.
2. Defense when accused of infanticide or abortion:
The absence of previous pregnancy may be used as a defense
when a woman is accused of infanticide or abortion. Infanticide
cannot be committed unless there has been previous pregnancy.
3. Marriage inducement:
A woman may deny the existence of pregnancy by another
man, to induce the man to marry her.
MEDICAL EVIDENCES OF PREGNANCY:
Signs and symptoms of pregnancy may be divided into presumptive or probable and positive or certain:
A. Presumptive or Probable Signs and Symptoms:
1. Cessation of Menstruation:
A married woman who missed her menstruation is presumed
to be pregnant, however, cessation of menstruation may be
due to some other causes other than pregnancy. Emotional
disturbance, anemia, systemic infection, disturbance in the
function of the ovary, may bring about amenorrhea. It is also
worthy of mention that a woman is capable of menstruating
even though she is pregnant. This is possible during the first
three months of pregnancy, but no longer possible during the
later period on account of the fusion of the decidua vera to
the decidua capsularis. A nursing mother may not menstruate
during the period she is nursing the child.
2. Morning Sickness:
This is the pernicious vomiting of a pregnant woman more
manifest in the morning. Although this is a frequent phenomena in the early stage of pregnancy, other conditions may
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LEGAL MEDICINE
also give rise to the same symptoms. The hypertonicity of the
stomach, peptic ulcer, gastric hyperacidity may simulate
morning sickness of pregnancy.
3. Changes in the Breast:
There is increase in size and sensation of tightness of both
breasts. The pinkish-brown color of the areolae are changed
into dark-brown or black. The tubercles of Montgomery are
developed and the tissues are erectile. Colostrum is found on
the third month. Secretion of milk may occur in a non-pregnant woman, as in tumor of the ovary.
4. Progressive Enlargement of the Abdomen:
At the end of the third month, the fundus of the uterus is
at the level of the brim of the pubic bone. At later periods,
there is gradual increase in size of the uterus capable of perception by palpation on the abdominal wall. The enlargement of
the abdomen may be due to tumor of the uterus or ovarian
cyst, or other abdominal pathology.
The relation between the age of the fetus and the level of
the fundus of the uterus is as follows:
3 calendar months (complete) — 3 fingers above the pubic bone.
4 calendar months
"
— Between the symphysis and
umbilicus.
— 3 fingers below the umbilicus.
5 calendar months
— At the level of the umbilicus.
6 calendar months
— 3 fingers above the umbilicus.
7 calendar months
— 6 fingers above the umbilicus.
8 calendar months
9 calendar months
— More than 8 fingers above the
umbilicus.
Note: In some women the 9th month has the same level as the
8th month because sometimes the head of the fetus
approximates the pelvic cavity so that fundus does not
go so high.
5. Changes in color of the vagina and softening of the cervix:
There are different signs to show change in color of the
vaginal wall and softening of the cervix.
a. Jacquemin-Chadwick's Sign:
There is a pale violet discoloration of the anterior wall of
the vagina below the urethral meatus. The color changes to
bluish as pregnancy advances and in some cases it becomes
later very dark or black in color.
b. Hegar's Sign:
Bi-manual examination of the gravid uterus shows extreme softening of the cervix.
c. MacDonald's Sign:
On account of the softening of the isthmus, the fundus of
the uterus is anteflex, so by bi-manual examination, there is
an easy approximation of the fundus and the cervix.
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LEGAL MEDICINE
d. GoodelVs Sign:
When the cervix of the uterus feels as hard as the tip of
the nose, pregnancy does not exist, but when it is as soft as
the lips, the uterus is gravid.
6. Funic Souffle or Umbilical Souffle:
Funic souffle, sometimes called umbilical souffle, is the
whistling sound synchronous with the fetal heart beat and is
only of subordinate value owing to the possibility of other
sounds being mistaken for it.
7. Ballottement:
This is the feeling perceptible to the fingers on giving
sudden impulse to the child through the neck of the uterus.
The child floating in liquor amnii is driven by the impulse
against the other side of the uterus, and it is this blow against
the womb that is perceptible to the hand placed on the abdomen.
8. Braxton-Hick's Sign:
This is the rhythmical contraction and relaxation of the
uterus, perceptible to the hand when resting on the abdomen.
The interval of contraction is usually five to twenty minutes
and lasting from two to five minutes. Fibroid uterus may
also give this sign.
9. Bladder Irritability :
Irritability of the bladder is a common occurrence among
pregnant women. This is noticeable at the second month of
pregnancy, manifested as frequent urination. However, it has
of no diagnostic value because even a non-pregnant woman
may manifest the same symptom.
10. Capricious Appetite:
Women during the early stage of pregnancy or even thereafter may have specially capricious appetite. The desire for a
particular class or kind of food is shown by a conceiving
woman. Not all women do manifest this sign and its presence will not conclusively show the presence of pregnancy.
11. Abnormality in Pigmentation:
The pregnant woman usually manifest pigmentations in
some parts of the body especially in the abdomen and perineum. It may not be very prominent among colored people.
Pigmentation may be present in some diseases, like Addison's
disease.
PREGNANCY
545
12. Easy Fatigability:
A pregnant woman easily gets tired on slight effort. This
may be due to the weight of the gravid uterus and insufficiency of nutrient and oxygen supply to the tissues of the
body due to the deviation of a portion to the growing fetus.
Easy fatigability is present also in cardiac and pulmonary
diseases, debilitating affection and old age.
B. Positive Signs and Symptoms of Pregnancy:
The finding of any of the following signs or symptoms of
pregnancy will show conclusively its existence:
1. Hearing of the Fetal Heart Sounds (Mayor's Sign):
The heart beat of the fetus is compared to the ticking of a
watch under the pillow. The rate is 120 to 140 beats per
minute. The location is at the anterior abdominal wall and is
dependent upon the presentation and position of the fetus.
Fat and amniotic fluid may interfere with the intensity of the
sound,
2. Outlining of the Fetal Parts:
By palpation, we can determine the head, neck, arm, back
and buttocks. If these parts could be outlined, the pregnancy
is sure, however, it may be confused with irregular ovarian
cyst.
3. Movement of the Fetus (Quickening):
The movement of the fetus may be felt by the woman and
may be visible to other observers. This is an indisputable
evidence of life, and is observed at the fifth month of pregnancy.
4. X-ray Examination:
Fetal skull and vertebra are visible with x-ray examination.
This is positive at the fifth month of pregnancy. X-ray is also
valuable to determine the presence of plural pregnancy, malformation and death of the fetus. However, this must not be
used injudiciously for diagnostic purpose only on account of its
bad effect on the fetus.
Laboratory Test for Pregnancy:
A.Pregnancy Slide Test:
1. Principle — An agglutination-inhibition reaction is used to
demonstrate the hormone human chorionic gonadotropin
( H C G ) which is excreted into the urine during pregnancy.
H C G which is chemically bound to latex particles is agglutinated
by HCG antibodies in the presence of free HCG, this reaction
is inhibited because the antibodies are neutralized.
LEGAL MEDICINE
546
2. Reagents:
a. Pregnancy Slide Test antiserum (human H C G antiserum from
rabbit)
b. Pregnancy Slide Test antigen ( H C G latex suspension, chemically bound)
3. Procedure:
Place 1 drop of urine, then 1 drop of Pregnancy Slide Test
antiserum 1 in one of the circles on the test slide and mix
thoroughly with a disposable stirring rod.
A d d 1 drop of Pregnancy Slide Test antigen 2 (shake well).
Mix well with the stirring rod, distributing the mixture over the
whole area of the circle.
Carefully agitate the slide with a circular motion to ensure
that the fluid revolves slowly within the circle.
Read the result after two minutes.
4. Interpretation of result — If there is no agglutination (homogeneous) the urine tested came from a pregnant woman. If there
is agglutination (granular), the urine came from a non-pregnant
woman.
5. Sensitivity — H C G concentration of 1.5-2.4 IU/ml urine and
over are detectable with "Pregnancy Slide Test". A positive
reaction is often possible within 5 days of the missed menstrual
period.
Usually the pregnancy will be diagnosed 12 days
after the missed menstrual period.
6. Remarks — Fresh urine preferably morning urine is suitable
for use.
It is advisable to have controlled urine from known positive
or negative subjects.
If the result is doubtful, it is advisable to repeat the test a
few days later.
B. Gravindex HCG Slide Test — The principle involved and procedure
is practically the same as the Pregnancy Slide Test. Gravindex is
merely a trade name.
Characteristics of the fetus in various periods throughout pregnancy
(Calendar Months):
End of first month
—Length — 1.0 cm.; Diameter — 2.0 cm.;
Eyes, ears and mesodermic segments are distinguishable; Limb buds are present.
End of second month—Length — 3.0 cm.; Diameter — 6.5 cm.;
Weight — 15.5 gm.
End of third month —Length — 8.0 cm.; Weight — 85.0 gm.;
PREGNANCY
547
Chorion laeve has lost most of its villi, neck
is develop, oral and nasal cavities are separated by the development of the paint*
Sexual organs have appeared, fingers and
toes are present, and nails can just be detected. Ossification has begun in most of the
bones.
End of fourth month — Length — 13 cm.; Weight — 204 gm.; Sex
can be distinguished; Skull partly ossified,
with wide sutures and fontanelles.
End of fifth month
—Length — 22.5 cm.; Weight — 450 gm.;
Hair and lanugo have appeared; Skin begins
to be covered with vernix caseosa.
End of sixth month
— Length — 30 cm.; Weight — 900-1,100 gm.;
Skin is still wrinkled, but subcutaneous fat
is beginning to form; Eyebrows appear;
End of seventh month— Length — 37.5 cm.; Weight — 1 Vt kg.;
Eyelids open; Testicle is beginning to descend unto the scrotum; nails do not reach
the tip of fingers; Lanugo disappearing from
the face; Child is viable (28 weeks).
End of eight month — Length — 42 cm.; Weight — 2 to 2 A kg.;
Skin is only slightly wrinkled, and flesh
colored; Lanugo beginning to be shed;
Left testicle is generally in scrotum.
l
At term
l
— Length — 50 cm.; Weight — 3 to Z A kg.;
Nails beyond or at the level of the finger
tips; Hair of the scalp is 5 cm. long; Lanugo
is only seen on the shoulder.
(Obstetrics and Gynecology by Aleck Bourne, 10th ed., p. 21-22).
Signs of Pregnancy in the Dead:
In addition to the objective signs already mentioned, the following additional findings are present if the pregnant woman dies:
1. Presence of Ovum or Fetus:
Examination of the uterine content will reveal the product of
conception together with the placenta, amniotic fluid, and membrane.
2. Findings on the Uterus Itself:
There is thickening, increase in size and capacity of the uterus.
The mark of placental attachment may be seen.
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LEGAL MEDICINE
3. Corpus Luteum:
Corpus luteum may be well-developed and attains a certain
size, however, it may gradually retrogress, but it is usually welldeveloped at the time of delivery. The changes in the corpus
luteum may also be found in fibroid tumor or other pathological
condition and even in cases of congestion.
Duration of Pregnancy:
The average duration of pregnancy is 270 to 280 days from the
onset of the last menstruation. There is no means of determining it
with certainty. The evidence derived from pregnancy following a
single coitus is trustworthy, but inasmuch as some authorities
consider more than two weeks as the life span of the spermatozoa
in the vaginal canal, it is hard to ascertain the exact date of fertilization. There is no synchrony between coitus and fertilization.
Abnormally Prolonged Gestation:
Cases in which pregnancy extends to 300 days can now be regarded
as well established. Many examples of longer duration have been recorded, but most of them are doubtful. Eden quotes sex cases which
have been accepted as authentic in which the calculated period of gestation lay between 311 and 336 days, the weights of the infant ranging
from 12-3/4 to 13-1/4 pounds. In all cases where the gestation much
over 300 days is alleged, confirmatory evidence should be expected
in the exceptional weight and size of the child (A Handbook of
Medical Jurisprudence and Toxicology by W. Brend, 8th Rev. ed.,
p. 113).
Minimum Period of Gestation Compatible with Viability of the Child:
Most authors hold that a child born at one hundred and eighty
days of gestation may live. A child may be born alive before this
period, but it is not viable or capable of living. A fetus of three
or four months development may exhibit signs of life, movements
of the limbs, etc., but cannot continue to live, owing to the want of
development of the breathing muscles and breathing center. Most
6 months old infants die immediately or within a few days of birth;
occasionally one has been reared (Cox's Medico-Legal Court Companion by Bhattacharyya, 4th Revised ed., p. 248).
Methods of Estimating the Date of Expected Delivery:
1. From the date of the first day of the last menstruation, add seven
da