Forensic Medicine Notes

CHAPTER I
GENERAL CONSIDERATIONS
Legal Medicine - the application of medicine to legal cases
Forensic Medicine - concerns with the application of medical science to elucidate legal problems
Medical Jurisprudence - denotes knowledge of law in relation to the practice of medicine
Medical Jurist - A physician who specializes or is involved primarily with medicolegal duties
Imhotep - earliest medicolegal expert
Antistius - first police surgeon
Paulus Zacchias - father of forensic medicine
Types of Medical Evidence - TAPED
1. Autoptic/Real
Indecency and Impropriety
Repulsive objects and those offensive to the senses
2. Testimonial
Ordinary witness
Expert witness
3. Experimental
4. Documentary
5. Physical
Dying Declaration - exception to hearsay rule
Methods of Preserving Evidence - PSDMPS
1. Photography - most practical, useful and reliable means of preserving evidence
2. Sketching
3. Description
4. Manikin method
5. Preservation in the Mind of the Witness
6. Special methods
CHAPTER II
DECEPTION DETECTION
Methods of Deception Detection
A. Devices which record the psycho-physiological response
1. Lie detector - physiological changes that occur in association with lying. Phases:
a. Pre-test
Purpose of the interview
b. Actual interrogation and recording through the instrument
Irrelevant questions
Relevant questions
Control questions
c. Post test
d. Supplementary
Peak-of-tension - test given if not yet informed of the details of the offense
Guilt complex - test applied when response to relevant are similar in consistency examiner cannot
determine if subject is telling the truth
Silent Answer - asked to answer silently
2. Use of Word Association Test 3. Use of Psychological Stress Evaluator (PSE) - detects, measures and graphically displays the voice
modulations that we cannot hear.

B. Use of Drugs that Inhibit the Inhibitor

1. Administration of Truth serum - hyoscine hydrobromate
2. Narcoanalysis or Narcosynthesis - psychiatric sodium amytal or sodium penthotal
3. Intoxication with alcohol - in vino veritas - in wine there is truth
C. Hypnosis - alteration of consciousness and concentration in which the subject manifests a
heightened of suggestibility while awareness is maintained.
D. Observation - signs and symptoms - SCEDFSPINS
Sweating
Color change
Excessive activity of the Adams apple
Dryness of mouth
Fidgeting
Swearing to the truthfulness of his assertion
Peculiar feeling inside
Inability to look at the investigator straight in the eye
Not that I remember expression
Spotless past record
E. Scientific Interrogation - 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
Suspect -person whose guilt is considered on reasonable ground to be practical possibility
Witness - person requested to give information concerning the incident
Techniques in Interrogation: BLEMS
1. Bluff on split-pair - all suspects are interrogated separately and the results of individual statements
are not known to one another.
2. Lengthy time-consuming narration
3. Emotional appeal - sympathetic and friendly to subject
4. Mutt and Jeff - 2 investigators who acts Mutt (arrogant and restless) and Jeff (sympathetic, kind and
friendly)
5. Stern approach - utilizes harsh language and immediate response is demanded.
F. Confession - 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.
1. Extra-judicial - made outside of court
Voluntary and Involuntary
2. Judicial - confession of an accused in court
Tokyo Declaration - guidelines to be observed by physicians concerning torture and other cruel,
inhuman and degrading treatment or punishment in relation to detention and imprisonment.
CHAPTER III
MEDICOLEGAL ASPECTS OF IDENTIFICATION
Identification - determination of the individuality of a person or thing.
Importance of Identification of a Person:
1. ID of offender and victim must be established
2. ID of missing or presumed dead persons to facilitate settlement of transmission of rights
3. ID resolves anxiety of next-of-kin
4. ID in transactions
Law of Multiplicity of Evidence in Identification - the greater number of points of similarities and
dissimilarities of two persons compared, the greater is the probability for the conclusion to be correct.
Methods of Identification

1. By comparison - post-mortem records to compare with ante-mortem records

Latent fingerprints
Dental findings
2. By exclusion - if 2 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.
Ordinary methods of Identification
1. May easily be changed GCFGBC
a. Growth of hair, beard or mustache
b. Clothing
c. Frequent place of visit
d. Grade of profession
e. Body ornamentations
2. May not be easily changed MSGMHCCFLD
a. mental memory
b. speech
c. gait
d. mannerism
e. hands and feet
f. complexion
g. changes in the eyes
h. facies
i. left or right-handedness
i. degree of nutrition
Applicable to Living and Dead WORSTSMIDBTBS
1. Weight
2. Occupational Marks
3. Race
4. Stature
Tips of the middle fingers of both hands with the arms extended laterally approximately equals the
height
2x the length of 1 arm +12 inches from the clavicle and 1.5 inches from the sternum = approximate
height
2x the length of the vertex of the skull to the pubic symphysis is the height
Length of forearm from tip of olecranon process to the tip of the middle finger is 5/19 of the height.
8x the length of the head = approximate height
4. Tattoo marks
5. Scars
6. Moles
7. Injuries leaving permanent results - amputation, improper union of bones
9. Deformities
10. Birth marks
11. Tribal marks
12. Blood examination
13. Sexual organ
Anthropometry (Bertillon System) - Alphonse Bertillon devised a scheme utilizing anthropometrical
measurement of the human body as the basis of identification.
Portrait Parle (spoken picture) a verbal, accurate and picturesque description of the person identified.
Scientific Methods of Identification
Aspects of Identification Requiring Scientific Knowledge

A. Fingerprinting - most valuable method of identification because there are no 2 identical fingerprints
and fingerprints are not changeable.
Dactylography - art and study of recording fingerprints
Dactyloscopy - art of identification by comparison of fingerprints
Poroscopy - study of the pores found on the papillary or friction ridges of the skin
B. Dental Identification
Adult has 32 teeth and each tooth has 5 surfaces
Enamel of the teeth is the hardest substance of the human body
The greater the degree of tissue destruction, the greater the importance of dental characteristics
C. Handwriting
Bibliotics - science of handwriting analysis, it is the study of documents and writing materials to
determine its genuineness or authorship
Bibliotist - handwriting expert/qualified question document examiner
Graphology - the study of handwriting for the purpose of determining the writers personality,
character and aptitude.
Movements in Writing - finger, hand, arm and whole arm
D. Identification of Skeleton
Whether the remains are of human origin or not
Whether the remains belong to a single person or not
Height, sex, race, age
Length of interment or length of time from date of death
Presence or absence of ante-mortem or post-mortem bone injuries
Congenital deformities and acquired injuries on the hard tissues causing permanent deformities
Determination of the sex of the skeleton
The following bones must be studied - pelvis, skull, femur, humerus and sternum
E. Determination of Sex - Importance:
As an aid in identification
Determine whether an individual can exercise certain obligations vested by law to one sex only
Marriage or the union of man or woman
Rights granted by law are different to different sexes
Certain crimes wherein a specific sex can only be the offender or victim
Tests to Determine the Sex:
1. Social 3. Gonadal
2. Genital 4. Chromosomal
Problems in Sex determination
Gonadal agenesis - sex organs never developed
True hermaphrodism - bisexuality both gonads present
Evidence of Sex:
Transvestism - form of sexual deviation characterized by an overwhelming desire to assume the attire
and be accepted as a member of the opposite sex.
1. Presumptive
Female Male
a. hips broader than shoulders a. vice versa
b. small build b. larger build
c. breasts developed c. not developed
d. not prominent Adams apple d. prominent
e. striae present e. absent
f. pubic hair straight stops at mons veneris f. thick, curved extending up to umbilicus
g. hair absent on face, abdomen and chest g. present (beard and moustache)

h. skull is lighter, smaller/thin bones, smooth h. skull is longer, heavier and thick bones
i. trunk abdominal larger i. smaller
j. thighs conical j. cylindrical
2. Highly probable evidence
Possession of vagina, uterus in female and penis in male
Developed and large breasts in female
Muscular development and distribution of fat in the body
3. Conclusive evidence
Presence of ovary in female and testis in male
F. Determination of Age
Growth of pubic hair, beard and moustache
Changes of the breast in female
Development of the voice
Changes in colour of the hair
Grade or year in school or college
Menstruation in women
Degree of mental development
Manner of dressing, self-beautification and social life
Atheromatous changes of blood vessels, opacity of the lens and cornea
Wrinkleness of the skin usually appears after 40
G. Identification of Blood and Blood Stains
H. Identification of Hair and Fibers
CHAPTER IV
MEDICOLEGAL ASPECTS OF DEATH
Importance of Death Determination
Civil personality of natural person extinguished by death
Property of person transmitted to heirs at time of death
Death of partner one of the causes of dissolution of partnership agreement
Criminal liability of person extinguished by death
Death - termination of life, the complete cessation of all the vital functions without possibility of
resuscitation, an irreversible loss of the properties of living matter.
1. Brain death - deep irreversible coma, absence of electrical brain activity and complete cessation of
all the vital functions without possibility of resuscitation
Characteristics
Unreceptivity and unresponsiveness
No movements or breathing
No reflexes
Flat electro-encephalogram
2. Cardio-respiratory death - there is a continuous and persistent cessation of heart action and
respiration
Kinds of Death
1. Somatic or Clinical Death - state of body which there is complete, persistent and continuous
cessation of the vital functions of the brain, heart, and lungs which maintain life and health
2. Molecular or Cellular Death - after cessation of vital functions of body there is still animal life
among individual cells, after 3-6 hours later, there is death of cells.
3. Apparent death or state of suspended animation - not really death but a transient loss of
consciousness or temporary cessation of the vital functions of the body on account of disease, external
stimulus or other forms of influence.

Signs of Death
1. Cessation of Heart Action and Circulation
a. examination of the heart
b. examination of the peripheral circulation
Magnus test - a ligature is applied around the base of the finger (bloodless zone)
2. Cessation of respiration
3. Cooling of the body (algor mortis) - progressive fall of body temperature is one of the most
prominent signs of death
Factors influencing the rate of cooling of the body:
conditions connected with the body
conditions connected with the surroundings.
4. Insensibility of the body and loss of power to move
5. Changes in the skin - pale and waxy
6. Changes in and about the eye - tache noir de la sclerotique
Changes in the Body following death:
1. Changes in muscle
a. primary flaccidity
b. post mortem rigidity
c. secondary flaccidity or commencement of putrefaction
Conditions Stimulating Rigor Mortis
heat stiffening
cold stiffening
cadaveric spasm or instantaneous rigor - occurs at the moment of death due to extreme nervous
tension and injury to the nervous system
Distinction between Rigor Mortis and Cadaveric Spasm
RM CS
Appears 3-6 hrs Appears immediately after death
All muscles of body Only certain muscle or group
Natural phenomenon May or may not appear
Utilized by medical jurist to approximate time of death To determine the nature of crime
2. Changes in Blood
a. coagulation of blood
b. post-mortem or cadaveric lividity/postmortem hypostasis
importance of cadaveric lividity:
one sign of death
may determine whether the position of the body has been changed
color of lividity may indicate the cause of death
may determine how long the person has been dead
gives an idea as to the time of death
3. Autolytic or autodigestive changes after death
4. Putrefaction of the body - the breaking down of the complex proteins into simpler components
associated with the evolution of foul smelling gases and accompanied by the change of color of the
body.
Duration of Death ROPES
1. presence of Rigor mortis
2. Onset of decomposition
3. presence of Postmortem lividity
4. Entomology of the cadaver
5. Stage of digestion of food in the stomach

CHAPTER V
MEDICOLEGAL INVESTIGATION OF DEATH
Inquest Officer - an official of the state charged with the duty of inquiring the manner and cause of
death of a person.
Stages of Medicolegal Investigation
1. Crime scene investigation - investigation of the place of commission includes setting of crime and
adjoining places of entry and exit of both offender and victim.
Methods of conducting search SDSWZ
strip, double strip or grid, spiral, wheel and zone
2. Autopsy - comprehensive study of a dead body performed by a trained physician, employing
recognized dissection procedure and techniques, body is opened and internal examination is conducted
postmortem exam is only external exam of the dead body without incision although blood and other
fluids may be collected.
Kinds of Autopsy
1. Hospital or non-official autopsy - with consent from relatives fro the purposes of:
providing correlation of clinical diagnosis to symptoms
determining the cause of death
determining the effectiveness of therapy
studying the natural course of disease process
educating students and physicians
2. Medicolegal or official autopsy for purposes of:
determining the cause, manner (mode) and time of death
recovering, identifying and preserving evidentiary material
providing interpretation and correlation of facts and circumstances related to death
provide a factual objective medical report
separating death due to external cause for protection of the innocent
Manners of Death that should be autopsied VASUGIO
1. death by Violence
2. Accidental death
3. Suicide
4. death Unattended by a physician
5. death In hospitals or clinic (DOA-dead on arrival)
6. death Occuring in an unnatural manner
Negative Autopsy - if after all efforts, including gross and microscopic, fail to reveal a case of death
and does not yield any definite cause of death
Negligent Autopsy