CHAPTER 1

LEGAL MEDICINE
Legal Medicine
- Is that branch of medicine that applies, medical and surgical concepts, scientific
knowledge and skills to medico legal issues, in order to assist the trier of facts in
the proper dispensation of justice.
Medical Jurisprudence
- is the study of the Medical Law and its applicable Jurisprudence that governs,
regulates and defines the practice of medicine.
In the Philippines, Legal Medicine is the appropriate name for Forensic Medicine.
Modern Legal medicine has a broad range of applications, it is used in civil
cases such as paternity and filiation, annulment of marriage, DNA testing , etc.
In all cases the medical examiner must conduct an investigation of the crime
scene and also an autopsy.
TECHNIQUES OF LEGAL MEDICINE:
- Legal Medicine uses sophisticated laboratory techniques to detect the presence
LEGAL MEDICINE of substances in the victim, in the suspected criminal, or at the
crime scene.
- Forensic examination of substances found at a crime scene can often establish
the presence of the suspect at the crime scene.
LEGAL MEDICINE AND THE LEGAL SYSTEM
- Courts routinely call upon physicians to give expert testimony in a trial, especially
concerning the findings of an autopsy and the results of laboratory tests.
- As an expert witness he is allowed to express an opinion about the validity of the
evidence in a case and may quote the statements of other experts in support of an
opinion.
- Ordinary testimony is restricted to statements concerning what the witness
actually saw or heard.
- The evidence to be presented by the legal medicine expert must signify a
relation between the facts called the Factum Probandum or proposition to be
established and the factum Probans which is the material evidencing the
proposition.
- The Physician must present RELEVANT, MATERIAL AND COMPETENT
EVIDENCE.
HISTORY OF LEGAL MEDICINE:
- Paulus Zacchias ( 1584 1659 ) is the Father of Forensic Medicine. He was
the first to describe the importance and application of medicine to the proper
administration of justice.
- In the Phil. , the father of Legal Medicine can be rightfully bestowed to Dr. Pedro

P. Solis. His book on Legal Medicine copyrighted in 1987, contains the most
extensive treatise and teachings in Philippine Legal Medicine.

APPLICATION OF LEGAL MEDICINE TO LAW:

Legal Medicine is Applied to Law
1. Civil law
- the determination and termination of civil personality
- the limitation or restriction of a natural persons capacity to act
- marriage and legal separation
- paternity and filiation
- testamentary capacity of a person making a will
- the right to hereditary succession

2. Criminal Law
- Felonies and circumstances which affect criminal liability
- Civil liability ex delictu
- Crimes relative to opium and prohibited drugs
- Crimes against persons
- Crimes against chastity
- Crimes against civil status of persons
- Quasi offenses
3. Remedial Law
- Physical and Mental Examination of a person
- Hospitalization of insane persons
- Rules of Evidence

4. Special Laws
- Dangerous Drug Act
- Youth and Child Welfare Code
- Sanitation Code
- Insurance law
- Labor Code
- Employees Compensation Law
5. CORPUS DELICTI
- Is the body or substance of the crime and is defined as the fact that a crime
actually has been committed. In all criminal prosecutions, the burden is on the
prosecution to prove the corpus delicti.
QUANTUM OF PROOF

1. In Civil Cases the quantum of proof necessary to prove a civil complaint is a

PREPONDERANCE OF EVIDENCE. The party filing or bringing a civil complaint
has the burden of proof and must establish the truth and righteousness of his
allegations by a preponderance of the evidence admitted by a competent court.
2. In Criminal Cases
the quantum is proof beyond reasonable doubt.
- In a criminal case the accused is entitled to an acquittal, unless his guilt is shown
beyond reasonable doubt
- Presumption of INNOCENCE is a conclusion drawn by the constitution and the
law in favor of the accused , while REASONABLE DOUBT, is a condition of mind
produced by proof resulting from evidence in the case.
3. To establish matters of defense
- The doctrine of reasonable doubt applies only to incriminative facts.

4. To establish self defense

- One who sets up SELF DEFENSE must rely on the strength of his own
evidence and not on the weakness of that of the prosecution.
5. To establish Alibi
- It must be proved by positive, dear and satisfactory evidence. Oral Evidence
of alibi is so easily manufactured and usually unreliable that it can rarely be given
credence.
6. In Administrative Complaints
- In cases filed before administrative or quasi judicial bodies, a fact maybe
deemed established if it supported by substantial evidence which means that
amount of relevant evidence which a reasonable mind might accept as adequate
to justify a conclusion.
CHAPTER 2
MEDICAL AND HOSPITAL JURISPRUDENCE
Medical Jurisprudence:
- Is the study of the Medical Law and its applicable Jurisprudence, that governs,
regulates, and defines the practice of medicine.
- It includes the rights, duties, obligations and liabilities of both physician and
patient to each other in a physician patient professional contract.
The Following Acts Constitute the Practice of Medicine:
1. To physically examine and diagnose a patient.
2. To physically examine and treat a patient

3. To physically examine and perform surgery in a patient

4. To physically examine and prescribe any remedy to a patient.
Any person who practice any of the above acts enumerated, without any valid
certificate of registration as a physician, is practicing illegal medicine.
The Nature of the Physician Patient Professional Relationship is
1. Consensual:
- based on mutual consent of both patient and physician.
- Contracts that are consensual in nature, are perfected upon mere meetings of
the minds
2. Fiduciary:
- founded in trust, faith, and confidence reposed by one person in the integrity
and fidelity of another.

DUTIES AND OBLIGATIONS OF THE PHYSICIAN TOWARDS HIS PATIENTS:

1. He must possess that knowledge and skill possessed by an average physician.

2. He must use such knowledge and skill with ordinary care and due diligence.
3. He is obliged to exercise his best judgment
in good faith.
4. He has the duty to keep the secrets and confidentialities of his patients.
The Terms and Conditions not included in the Physician Patient Professional
Relationship Contract ( refer to book )

The only promise or guaranty that the law requires is that, the physician will treat
the patient in accordance with the standards of medical care.
PATIENTS RIGHTS RESPECTED BY PHYSICIANS:
1. The right to appropriate medical care and humane treatment.
2. The right to his religious belief.
3. The right to refuse treatment.
4. The right to Informed Consent.
5. The right to choose his physician.
6. The right to medical records.
7. The right to privacy and confidentiality.
8. The right to a second or third opinion.

9. The right to leave.

10. The right to information.
11. The right to self determination.
12. The right to refuse participation in medical research
13. The right to express grievance
14. The right to be informed of his rights and obligations.
Obligations of the Patients to their Physicians ( Refer to Book )
SOCIATAL RIGHTS OF THE PATIENTS FROM THE GOVERNEMNT ( Refer to
Book )
RIGHTS INHERENT IN THE PRACTICE OF MEDICINE:
1. The right to choose his patients
2. The right to limit the practice of his profession
3. The right to determine appropriate treatment procedures in the discretion and
judgment of the physician.
4. The right to avail of hospital privileges after being qualified.
5. The right to receive just and fair compensation from his patients.
Liabilities of a Physician Which May Arise from His Negligent or Wrongful Acts or
Omissions:
1. Administrative Liability
- A complaint under oath can be filed before the Professional Regulation
Commission Board of Medicine, for reprimand, of the license to practice medicine.
2. Criminal Liability
- When an act or omission constitutes a crime, the physician can be imprisoned
or fined or both, as any other profession.
3. Civil Liability
- The aggrieved party can be awarded monetary damages for any wrongful or
negligent act or omission, when the professional is found guilty.
CASES ( Refer to Book )
Ex. Negligent or Wrongful Act
Medical malpractice is a particular form of negligence which consists in the failure
of a physician or surgeon to apply to his practice of medicine that degree of care
and skill which is ordinarily employed by the profession generally, under similar
conditions, and in like surrounding circumstances
There are Four Elements involved in medical negligent cases:
1. Duty

2. Breach
3. Injury
4. Proximate Causation It has been recognized that expert testimony is usually
necessary to support the conclusion as to causation.
Ex. Whether A Hospital may be Held Liable for the Negligence of Physicians
Consultants allowed to Practice in its Premises.

CHAPTER 3
DEATH
Legal Presumption of Death:
- If absent without explanation from his or her usual or last place of residence for a
long continuous period.
- Circumstantial proof of death
Ex. a passenger on an airplane that crashed is considered to have died even if no
remains can be recovered.
Rules of Evidence in Rule 131, section 5 paragraph X, paragraph JJ, and
paragraph KK.
In common law the presumption of death does not arise until the expiration of
seven years of continuous absence.

DEATH IS THE COMPLETE CESSATION OF ALL THE VITAL FUNCTIONS OF

THE BODY WITHOUT POSSIBILITY OF RESUSCITATION. THE
ASCERTAINMENT OF DEATH IS A MEDICAL AND NOT A LEGAL PROBLEM.
Death maybe
A. Brain Death occurs when there is a deeply irreversible coma, and absence of
electrical brain activity.
B. Cardio Respiratory Death occurs when there is continuous and persistent
cessation of heart action and respiration.
4 Kinds of Death:
1. Clinical or Somatic Death
2. Brain Death
3. Biological Death
4. Cellular Death

Clinical or Somatic Death

- This particular kind of death occurs when in the judgment of the physician with
the use of his clinical eye the bodys vital signs of life cease to exist continuously
and permanently.
- The clinical death is verifiable only by a physician after he observes that the
patient no longer has a heart beat no pulse rate, no spontaneous breathing and
movement, with the pupils of the eye widely dilated and not reactive to light and
accommodation.
- When a clinically dead person is brought to the morgue the generalized
contraction of the muscles or Rigor Mortis of the body within 3 to 6 hours, may
simulate a return to life, because of the motion or movement of the body.

BRAIN DEATH
- This kind of death follows clinical death almost immediately unless
resuscitative procedures are started promptly, because the human brain under
normal conditions cannot survive loss of oxygen for more than 6 to 10 minutes.
- Brain Death may occur in the
Stage 1 Cerebral Cortex- the highest center of the brain that is most sensitive to
changes in the supply of oxygen and blood to the brain. When the cerebral cortex
dies, the patient is in cortical death.
Stage 2 - Cerebellum It deals with the function of equilibrium. It follows the death
of the cerebral cortex.

Stage 3 Brainstem and Vital centers These centers controlling respiration,

heart rate and blood pressure, ultimately die. When it does, the patient is, Brain
Stem Dead.
- If the brain stem is damaged, then the vital centers in the medulla maybe
destroyed, causing the respiratory center to fail.
- The occurrence of brain stem death is equivalent to Legal Death, so that Doctors
can now issue a Death Certificate, even though the heart is still beating, and make
arrangements to harvest donor organs and tissues at this stage.
- Further, in the presence of brain stem death, artificial respirators only achieve
the maintenance of an oxygenated circulation through a corpse or cadaver.

CRITERIA FOR DIAGNOSING BRAIN STEM DEATH. ( refer to textbook )

Persistent Vegetative State ( PVS )
- This condition exists, when irreversible destruction of the Cortex of the brain
occurs without damage to the vital centers, and there are permanent eyes open
state of unconsciousness, but cardio respiratory functions continue, sometimes

without respiratory assistance, but most often with respiratory support.

- They do not however match the clinical criteria of Brain Death, in as much as
they have elicitable reflexes, spontaneous respirations and reactions to external
stimuli.
HARVARD CRITERIA OF WHOLE BRAIN DEATH:
1. Unreceptivity and Unresponsitivity
2. No spontaneous movements or breathing
3. No reflexes
4. Flat EEG of Confirmatory value
WHOLE BRAIN DEAD
- When the brain ceased all functions, even though the heart continues to beat. As
a rule doctors can legally declare whole brain death twelve hours after they have
corrected all treatable medical problems, but the brain still doesnt respond even
to induced pain , they eyes do not react to light and the person doesnt breath
without a respirator.
BIOLOGICAL DEATH
- All the components of the brain are dead
- There is also permanent extinction of bodily life.
- It is cardiorespiratory and brain death altogether with permanent cessation of all
the anatomic and physiological functions of the body organs.

CELLULAR DEATH:
- The death of the different parts of the body occurs at different times and stages.
- This is the reason why such organs as the corneas and the kidneys can be
removed immediately after biological death and transplanted successfully.
SIGNS OF DEATH:
1. Cessation of heart action and circulation
2. Cessation of respiration
3. Cooling of the body ( Algor Mortis )
- The temperature of 15 20 degrees Fahrenheit is considered as a certain sign
of death.
4. Loss of motor power
5. Loss of sensory power
6. Changes in the skin
7. Changes in and about the eye
- There is loss of corneal reflex

CHANGES IN THE BODY FOLLOWING DEATH

1. Changes in the Muscle

a. Stage of primary flaccidity

b. Cadaveric rigidity or rigor mortis
- muscular contraction which develops 3 6 hours after death and may last for 24
36 hours.
- may also be utilized to approximate the length of time the body has been dead
from 3 to 36 hours
c. Stage of secondary flaccidity or commencement of putrefaction
Cadaveric Spasm- is the immediate or instantaneous spasm or rigidity of the
skeletal muscles occurring at the moment of death due to exhaustion, etc.

Medico legal Importance of Cadaveric Spasm

( Refer to Book )
2. Changes in the Blood
a. Coagulation of the blood
b. Postmortem lividity or Livor Mortis
3. Autolytic or Auto Digestive Changes After Death
4. Putrefaction of the Body
PUTREFACTIVE CHANGES OCCURING AFTER DEATH ( Refer to Book )
Kinds of Putrefaction:
1. Mummification
2. Saponification This is also called Adipocere Formation.
3. Maceration

Factors to Consider in Approximating the Duration of Death in a Cadaver

1. Entomology The presence of maggots in the cadaver indicates duration of
death for more than 24 hours
2. Presence of live Fleas in clothing in death by drowning, a flea can survive for
about 24 hours submerged in water. After 24 hours submersion in water the fleas
die.
3. Blood vessel clots blood clotting occurs in 6 -8 hours after death.
4. Post Mortem lividity develops in 3 to 6 hours after death.
5. Rigor Mortis- begins to develop in 3 to 6 hours after death and may last for 24 to
36 hours after death.

6. Onset of decomposition Decomposition takes place within 24 48 hours after

death.
7. Food in the stomach
8. Skeletal soft tissues soft tissues may disappear from 1.5 years to 2 years
after burial.
Position of the Body at the time of Death
1. Post Mortem lividity
2. Cadaveric spasm Death due to violence or inflicted physical injuries, usually
manifest the position of the body at the time of death.
Ex. In suicide by gunshot wound, the gun maybe tightly grasped in the hand of the
deceased
In drowning, the victim maybe holding objects that come in contact with his
hands to cling to life.

MEDICOLEGAL IMPORTANCE OF RIGOR MORTIS AND CADAVERIC SPASM:

Rigor mortis is utilized to approximate the time of death. Generalized muscular
contractions occur from 3 to 6 hours until 36 hours.
Cadaveric spasm occurs immediately after death and is useful to ascertain the
circumstances of death.
Medico Legal Investigation of Death
- Deaths which are not obviously due to natural causes, but are criminal,
suspicious, accidental, suicidal, murderous, homicidal, sudden or unexpected, or
unexplained, need medico legal investigation.

The Death Certificate

- The death certificate is a legal document necessary for burial of the dead, as it
certifies the occurrence of death. It is a document from the Office of the Civil
Registrar General, listing the particulars of an individuals death.
- It contains the Immediate Cause or Primary cause of death, the antecedent
causes and underlying cause of death
Immediate Cause or Primary Cause of Death
Ex. Suffocation due to drowning

Asphyxia

Cardio Respiratory Arrest

Antecedent Cause of Death are events or conditions that substantially contribute
to the immediate cause of death
Ex. Acute peritonitis, Acute Hypovolemic shock, Acute Septic Shock,
Underlying Cause of Death is the basic cause or bottom line cause of death. It is
the diagnosis of the patients or victims illness or sickness that resulted to his
death
Ex. Acute Appendicitis, Hepatocarcinoma, Pelvic Fracture, Stab or Gunshot
Wound to the chest.
Non Natural Causes of Death
Ex. Murder, Homecide, Suicide, Accident
Death Warrant is a warrant from the proper executive authority appointing the
time and place for the execution of the sentence of death upon a convict judicially
condemned to suffer death.
Manner of Death
- Is the explanation as to how the cause of death arose, and maybe either Natural
Death or Violent Death

Lazarus Syndrome
- Is also called Lazarus Phenomenon is the spontaneous return of circulation after
failed attempts at resuscitation.
Implications of Lazarus Syndrome
- raise ethical and legal issues for doctors, who must determine when medical
death has occurred, when resuscitation efforts should end, and post mortem
procedures such as autopsies and organ harvesting may take place.
Lazarus Sign
- Lazarus sign or Lazarus reflex is a reflex movement in brain dead patients,
which causes them to briefly raise their arms and drop them crossed on their
chests.
- The phenomenon has been observed to occur several minutes after the removal
of medical ventilators used to pump air in and out of brain dead patients to keep
their bodies alive.
NEAR DEATH EXPERIENCE
- Refers to a broad range of personal experiences associated with impending
death, encompassing multiple possible sensations including detachment from the
body; feelings of levitation etc.

EUTHANASIA
- Meaning good death ( well or good )
- Refers to the practice of ending life in a painless manner.
- Deliberate intervention undertaken with the express intention of ending life, to
relieve intractable suffering
Classification of Euthanasia:
1. Voluntary euthanasia is euthanasia conducted with consent
2. Involuntary euthanasia
is euthanasia conducted without consent.
-is conducted where an individual makes a decision for another person incapable
of doing so.
- also known as physician assisted death, physician assisted suicide or mercy
killing.
3. Passive euthanasia entails withholding of common treatments
4. Active euthanasia entails the use of lethal substances or forces to end life and
is the most controversial means.

CHAPTER 4
REGIONAL TRAUMA
Trauma
is the leading cause of death in the first four decades of life and the 3rd leading
cause of death in all age groups today.
-Penetrating trauma particularly handguns is becoming common in nearly all
areas of the country.
Trimodal Distribution of Death from Trauma:
1. Seconds to minutes of injury due to the injury to the brain, high spinal cord,
heart, aorta and other large vessels. These patients can rarely be salvaged.
2. Minutes to Few hours from injury ( The Golden Hour )
- It is in this period that Advanced Trauma Life Support9 ( ATLS ) techniques are
important.
3. Several days to weeks of Injury these are due to sepsis or organ failure.
SPECIFIC INJURIES
1. Head
a. Types of Head Injuries:
a.1 Hematoma

a.2 Contusions
a.3 Skull fractures
a.4 Hemorrhage
2. Spine and Spinal Cord Injuries
The most common causes of severe spinal trauma are motor vehicular
accidents, falls, diving accidents, and gunshot wounds.
3. Chest
a. Life Threatening Injuries
Pnumothorax
Hemothorax
Flail chest as in multiple rib fractures Cardiac tamponade due to penetrating
injuries

b. Potentially Lethal Injuries

b.1. Pulmonary Contussion with or without flail chest
b.2. Thoracic Aortic Tear or Rupture the most common cause of sudden death
after a vehicular accident or fall ( major decelaration injury )

c. Serious Chest Injuries

4. Abdomen
Types of Injuries:
a. Penetrating
- Gunshot wounds of the abdomen carry 95% probability of significant visceral
injury
- A bullet when it hits the abdomen will penetrate the abdominal wall, enter the
abdominal cavity and most likely injure more than one organ.
- The incidence of abdominal injury is strikingly higher in gunshot wounds than in
stab wounds.
- The major cause of death is hemorrhage and this occurs within the first 24 hours
- In stab wounds of the abdomen , only 2/3 penetrate the peritoneal cavity; of
these only cause significant visceral injury that requires surgical repair.
b. Blunt
- The spleen and liver are the most commonly injured organs due to blunt trauma.
- Their frequent incidence also explains why the mortality rate following blunt
trauma is higher than that of penetrating injury.
5. Fractures and Dislocations
The word fracture comes from the Latin word fractura which means a break in
the continuity of the bone. It is also a combination of a break in the bone and soft
tissue injury
A. Open Fractures - 90% of open fractures are caused by vehicular accident.
B. Hip fractures are very common in elderly people and are usually caused by
minor falls. It is the most common cause of traumatic death after the age of 75.

6. Urologic
- Hematuria following trauma
- Blunt kidney injury is usually due to motor vehicular accidents which account for
70 90 % of kidney trauma.
- Penile injury:
The erect penis is usually 6 8 inches long and 1 -2 inches in diameter.
- Avulsion of the prepuce this may follow accidents where the foreskin called
prepuce is detached or lacerated by a blunt force.
- Fracture of the penis this is the traumatic rupture of the corpora cavernosa
penis resulting from a forceful trauma to the flaccid organ.
- Amputated penis the penis of an avid womanizer is sometimes intentionally cut
or amputated by a jealous derange wife or lover.
7. Arterial trauma
8. Burns
CLASSIFICATION OF WOUNDS
1. AS TO LEGAL CLASSIFICATION
Chapter 1
DESTRUCTION OF LIFE
a. Article 246. Parricide
b. Article 247. Death or Physical Injuries Inflicted Under Exceptional
Circumstances
c. Article 248. 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 Perpetua, to
death if committed with any of the following attendant circumstances;
1. With treachery
2. In consideration of a price , reward or promise
3. By means of inundation etc.
4. On occasion of any of the calamities etc.
5. With evident premeditation
6. With cruelty etc
Article 249 HOMICIDE
Article 251. Death Caused in a Tumultous Affray
Article 252. Physical Injuries Inflicted In a Tumultuous Affray
Article 253. Giving Assistance to Suicide
Article 254. Discharge of Firearms
Article 255. Infanticide
Article 256. Intentional Abortion
Article 257. Unintentional Abortion who shall caused an abortion by violence but
not intentional.
Article 258. Abortion Practiced by the Woman Herself or By Her Parents
Article 259. Abortion Practiced by a Physician or Midwife and Dispensing of

Abortives
Article 260. Responsibility of Participants in a Duel
Article 261. Challenging to a Duel
CHAPTER 2
PHYSICAL INJURIES
a. Article 262. Mutilation Any person who shall intentionally mutilate another by
depriving him, either totally or partially , of some essential organ of reproduction.
b. Article 263. Serious Physical Injuries Any person who shall wound, beat, or
assault another, shall be guilty of the crime of serious physical injuries
c. Article 264. Administering Injurious Substances or Beverages
d. Article 265. Less Serious Physical Injuries Any person who shall inflict upon
another physical injuries which shall incapacitate the offended party for labor for
10 days or more, or shall require medical attendance for the same period
e. Article 266. Slight Physical Injuries and Maltreatment.
- 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.
Chapter 3, RAPE When and How rape is committed
1. By a man who shall have carnal knowledge of a woman under any of the
circumstances
a. Through force, threat, or intimidation
b. When the offended party is deprived of reason or otherwise unconscious
c. By means of fraudulent machinations or grave abuse of authority
d. When the offended party is under twelve ( 12 ) years of age or is demented,
even though none of the circumstances mentioned above is present.
2. By any person who, under any of the circumstances mentioned in paragraph 1
hereof, shall commit an act of sexual assault by inserting his penis into another
persons mouth or anal orifice or any instrument or object into the genital or anal
orifice of another person.
Classification of Wounds
2. AS TO THE DEPTH OF THE WOUND
a. Superficial When the wound involves only the layer of the skin
b. Deep When the wound involves the structures beyond the layers of the skin.

b.1 Penetrating the wound enters the body but does not come out. Punctured,
stab and gunshot wounds usually belong to this type of wound.
b.2 Perforating there is a communication between the outside, inner and the
outer side. There is both a point of entry and exit.

Classification of Wounds
3. AS TO MORTALITY
a. Deadly Wound- Death results immediately, after the infliction of the wound.
Deadly wounds though mortal, maybe prevented with prompt medical treatment.
b. Non Deadly Wounds Does not result to death immediately, after the wound is
inflicted. A non deadly wound may cause death later, due to complications i.e.
tetanus, septicemia

Classification of Wounds:
4. AS TO THE WOUNDING INSTRUMENTS USED:
a. Sharp Instruments Ex. incised wound, punctured wound, stab wound dagger
or kitchen knife
b. Blunt Instruments A block of wood or iron produces contusion, hematoma,
abrasions, lacerated wound when used to strike, attack, wound, beat or assault
another
Classification of Wounds:
5. AS TO THE CONSEQUENTIAL INJURY AFTER THE APPLOCATION OF
FORCE
a. Coup Injury b. Coup Centre Coup Injury
c. Contre Coup Injury
d. Locus Minoris resistancia
e. Extensive injury

Classification of Wounds:
6. AS TO THE INTEGRITY OF THE SKIN
A. CLOSED WOUNDS Presents no break in the integrity or continuity of the skin.
There maybe only outward manifestations of injury internally.
Ex. of closed wounds:
1. petechiae a circumscribe extravasation of blood in the subcutaneous tissue.
2. contusion effusion of blood into the tissues underneath the skin as a result of
a blunt force. Ex. black eye
3. Hematoma
4. Blunt injury
5. Musculoskeletal injuries
Ex. Sprain, Dislocation, Fracture, Strain
Cerebral Concussion there is a brief loss of consciousness and sometimes
memory after a head injury that doesnt cause obvious physical damage.

Cerebral Contusion they are bruises to the brain, usually caused by a direct,
strong blow to the head. They are more serious than concussions.
B. OPEN WOUNDS
- There is a break in the continuity of the skin
Examples:
1. Abrasion
2. Bruise
3. Incised wound
4. Stab wound
5. Punctured wound
6. Perforating wound
7. Lacerated wound
8. Bites
9. Gunshot wounds
B. OPEN WOUNDS there is a break in the continuity of the skin
B.1. Abrasion Scratch, friction mark
B.2. Bruise cause by a blunt injury to the tissues which damage blood vessels
beneath the surface, allowing blood to extravasate or leak into the surrounding
tissues.
B.3. Incised wound
B.4. Stab wound
B.5. Punctured wound
B.6. Perforating wound
B.7. Lacerated wound result of an injury from a blunt instrument. In cerebral
laceration, the brain tissue is torn often with an accompanying visible head
wounds and skull fractures.
B.8. Bites they maybe abraded, bruised or rarely lacerated. They are usually
seen in sexual assaults and in child abuse and also by animal bites
B.9. Gunshot wounds

TEST FOR THE PRESENCE OF POWDER RESIDUES:

1. Paraffin test or Dermal Nitrate test present on the skin of the hand dorsum or
site of the wound of entrance. This test is not conclusive because fertilizers,
cosmetics, cigarettes, urine and other nitrogenous compounds with nitrates will
give a positive reaction. A negative test is also not conclusive . The test usually
gives a positive result even after a lapse of 3 days or even if the hands are
subjected to ordinary washing
2. Use of Scanning Electron Microscope with a linked X ray analyzer. This

method appears to be more specific but seldom used because the instrument is
expensive.
SPECIAL TYPES OF WOUNDS
1. Assailants wounds these wounds are sustained by the assailant from the
victim, while the former is in the process of attacking, wounding, assaulting,
beating or killing his victim.
2. Defense wounds in the process of defending himself from the attacks, assault,
wounding, beating or violence of the assailant, the victim sustains defensive
wounds usually in the upper extremities.
3. Victims wounds these are wounds sustained by the victim, from the assailant,
the former not having the chance or opportunity to defend himself. The victims
wounds maybe located in any part of the body.
4. Self Inflicted wounds these are wounds self inflicted by the person on
himself. The wounds are usually found on the accessible parts of the body, usually
with no intention to kill himself. Unless the victim is insane, self inflicted wounds
are for a fraudulent or self serving purpose.
5. Homicidal wounds these are the serious wounds sustained by the victim
resulting to his death, from the criminal assailant. Usually the wounds are situated
in the areas of the neck, chest, the abdomen and the skull.
6. Accidental wounds these wounds are sustained by the victim, without any
fault or intention whatsoever on the part of the accused to inflict the wounds on the
victim. The wounds are usually located on any part of the victims body.
7. Suicidal wounds these are wounds self inflicted by the victim on himself, and
usually seen on the temple, the roof of the mouth, and other fatal body areas,
accessible to the hand of the victim.

CHAPTER 5
COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002
REPUBLIC ACT 9165
A DANGEROUS DRUG is a drug whose use is attended by risk and therefore is
unsafe, perilous and hazardous to people and society.
A DRUG is any substance , vegetable, mineral or animal in origin, used in the
composition or preparation of medicines or any substance used as medicines.

The Dangerous Drug Act of 1972, include the following Dangerous Drugs as
follows:
A. PROHIBITED DRUGS
1. Opium and its active components and derivatives such as heroin and morphine.

2. Coca leaf and its derivatives, principally cocaine.

3. Hallucinogenic drugs such as mescaline, lysergic acid diethylamide ( LSD ) and
other substances producing similar effects.
4. Other drugs whether natural or synthetic with the physiological effects of a
narcotic drug.
B. REGULATED DRUGS
1. Self inducing sedatives such as secobarbital, phenobarbital, pentobarbital,
barbital and any drug which contains salt or derivative of a salt of barbituric acid.
2. Any salt of amphetamine such as Benzedrine or any drug which produces a
physiological action similar to amphetamine.
3. Hypnotic drugs, such as methaqualone producing similar physiologic effects.
IMPORTANT TERMS in the DANGEROUS DRUG ACT OF 2002
1. Drug Syndicate
2. Illegal Trafficking
3. Chemical Diversion
4. Planting Evidence
5. Drug Dependence
Two Classes of Drug Dependence:
a. Drug Addiction is a state of periodic or chronic intoxication produced by the
repeated consumption of a drug, whether synthetic or natural and found to be
detrimental to the individual and to the society.
Characteristics of Drug Addiction:
A. An overpowering desire or need to continue taking the drug or to obtained it by
any means.
- a tendency to increase the dose.
-a psychological and physical dependence on the effects of the drug.
- a detrimental effect to the society and to the individual
B. Drug Habituation is the desire to have a continuous use of the drug but with
the capacity to refrain physically from using it.
Characteristics of Drug Habituation:
- The desire to use the drug is not compulsive but merely psychical.

- There is little or no tendency to increase the dose

- The detrimental effect if any, is primarily on the individual.
6. Protector
7. Pusher
8. Controlled Delivery
9. Den, Dive or Resort
10. PDEA The Philippine Drug Enforcement Agency, which is the implementing
arm of the Dangerous Drugs Board.
UNLAWFUL ACTS AND PENALTIES IN THE DANGEROUS DRUGS ACT OF
2002 ( R.A. 9165:
1. Importation of Dangerous Drugs and or Controlled Precusors and Essential
Chemicals.
2. Sale, Trading, Administration, Dispensation, Delivery, Distribution and
Transportation of Dangerous Drugs and or Controlled Precursors and essential
Chemicals.
3. Maintenance of a Den, Dive or Resort
4. Employees and Visitors of a Den, Dive or Resort
5. Manufacture of Dangerous Drugs and or Controlled Precursors and Essential
Chemicals
6. Illegal Chemical Diversion of Controlled Precursor and Essential Chemicals
7.Manufacture or Delivery of Equipment , Instrument, Apparatus and Other
paraphernalia for Dangerous Drugs and or Controlled Precursors and Essential
Chemicals
8. Possession of Dangerous Drugs
9. Possession of Equipment, Instrument , Apparatus and Other Paraphernalia for
Dangerous drugs.
10. Possession of Dangerous D During Parties, Social Gatherings or Meetings
11. Possession of Equipment, Instrument, Apparatus and Other Paraphernalia for
Dangerous Drugs During Parties, Social Gatherings or Meetings
12. Use of Dangerous drugs

13. Cultivation or Culture of Plants

Sources thereof

Classified as Dangerous Drugs or are

14. Failure to Maintain and Keep the Original Records of transactions on

Dangerous drugs and or Controlled Precursors and Essential chemicals
15. Unnecessary Prescription of Dangerous Drugs
16. Unlawful Prescription of Dangerous drugs
THE CUSTODY AND DISPOSITION OF CONFISCATED, SEIZED AND OR
SURRENDERED DANGEROUS DRUGS, PLANT SOURCES OF DANGEROUS
DRUGS, CONTROLLES PRECURSORS AND ESSENTIAL CHEMICALS,
INSTRUMENTS AND PARAPHERNALIA AND OR LABORATORY EQUIPMENT
The PDEA shall take charge and have custody of all dangerous drugs, plant
sources of dangerous drugs, controlled precursors and essential chemicals, as
well as Instruments paraphernalia and laboratory equipment so confiscated,
seized and or surrendered, for proper disposition in the following manner ( Refer
to Book ).
IMPORTANT PROVISIONS OF R.A. 9165 OR THE COMPREHENSIVE
DANGEROUS DRUGS ACT OF 2002
Section 22. Grant of Compensation, Reward and Award
Section 23. Plea Bargaining Provision
Section 36. Applicants for Drivers License
Section 38.
Offenders

Laboratory Examination or test on Apprehended / Arrested

Section 39. Accreditation of Drug Testing Centers and Physicians

Section 40. A physician, dentist, veterinarian or practitioner authorized to
prescribe any dangerous drug shall issue the prescription therefore in one original
and 2 duplicate copies.
Section 54. Voluntary Submission of a Drug Dependent to Confinement,
Treatment and Rehabilitation
Section 55 Exemption from Criminal Liability
Under the Voluntary Submission Program
Section 56. Temporary Release from the Center; After Care and Follow up
Treatment Under the Voluntary Submission Program

Section 58. Filing of Charges Against a Drug Dependent who is not rehabilitated
Under the Voluntary Submission Program.
Section 61. Compulsory Confinement of a drug dependent who refuses to apply
under the Voluntary Submission Program
Section 62. Compulsory Submission of a Drug Dependent Charged with an
Offense, to Treatment and Rehabilitation
Section 70. Probation or Community Service for a First Time Minor Offender In
Lieu of Imprisonment
Section 73. Liability of a Parent, Spouse or Guardian Who refuses to Cooperate
with the Board or any Concerned Agency
Section 77. The Dangerous Drugs Board
Section 82. Creation of the Philippine Drug Enforcement Agency ( PDEA )
Section 85. The PDEA Academy
Section 90. Jurisdiction
Section 91. Responsibility and Liability of Law Enforcement Agencies and Other
Government Officials and Employees in Testifying as Prosecution Witnesses in
Dangerous Drug Cases
Section 92. Delay and Bungling in the Prosecution of Drug Cases
PHARMACOLOGIC CLASIFICATION OF DANGEROUS DRUGS
1.Hypnotics
2. Sedatives and Tranquilizers
3. Hallucinogens and Psychomimetics
4. Stimulants
5. Depressants
6. Deliriants and Intoxicants
A.Hypnotics:
Opiates and Their Derivatives Opium is obtained from the milky exudates of the
unripe seed capsules of the poppy plant, Papaver Sornoiferum.
Derivatives of opium commonly used are morphine, heroin, and codeine.
Its synthetic preparation are Demerol and Methadone.

Narcotics that have a legitimate medical used as powerful pain relievers are called
Opioids, and include codeine, oxycodone, meperidine, morphine and
hydromorphone.
Heroin which is prohibited is a very strong pain reliever and narcotic
Signs and Symptoms of Opium Administration:
1. Stage of Excitement
2. Stage of Stupor
3. Stage of Narcosis
B. SEDATIVES:
Barbiturates: - are the products of malonic acid and urea, synthesized on St.
Barbara day.
- Used to treat anxiety and to induce sleep can cause both psychologic and
physical dependence.
C. HALLUCINOGENS OR PSYCHOMIMETIC DRUGS:
Marijuana ( Cannabis Sativa ) is a Mexican term for pleasurable feeling.
Marijuana is not addictive. Physical dependence and dose tolerance do not
develop with its use. Psychic dependence may occur.
Subjective effects of Marijuana:
- There is a feeling of lightness of the extremities followed by rushes of warmth
and well being that eventually lead to a sense of relaxation, mild euphoria and a
dreamy state where ideas are disconnected.
Objective Effects of Marijuana:
- Moderate increase in resting pulse rate, reddening of the eyes due to dilatation
of the conjunctival blood vessels. Difficulty of speech and of remembering of the
logical trend of what was being said.
Lysergic Acid Dsethylamide ( LSD )
- These drugs are false hallucinogens.
- It produces impaired judgement so that a user might think that he can fly, and
may even jump out a window to prove it, resulting in severe injury or death.
D.STIMULANTS:
Amphetamines methamphetamines ( Shabu, speed );
methylenedioxymethamphetamine ( MDMA, ecstasy or Adam )
- Acts on the cerebral cortex causing alertness, excessive self confidence and
feeling of well being. Physical performance may to some degree temporarily
improve.
Untoward Effects:
- They increase the blood pressure and heart rate. Fatal heart attacks have
occurred even in healthy, young athletes. The blood pressure maybe so high that

a blood vessel in the brain ruptures causing a stroke.

Coccaine is an alkaloid from the leaves of the coca shrub cultivated in Bolivia
and Peru.
- It produces effects similar to amphetamines, but is a much more powerful
stimulant.
- Is used to excite the undersexed.
- Is a euphoriant and readily relieves fatigue
Untoward Effects:
- Same as amphetamine
E. DEPRESSANTS:
- Angel dust
- Depresses the brain and abusers usually become confused and disoriented
shortly after taking the drug.
- Can be combative and because they dont feel the pain they may continue
fighting even when hit hard.

CHAPTER 6
SEXUAL DYSFUNCTIONS AND SEXUAL CRIMES
SEXUALITY IS A NORMAL BIOLOGICAL URGE AND AN IMPORTANT PART
OF THE HUMAN EXPERIENCE.
4 Stages of a Sexual Response:
1. Desire
2. Arousal
3. Orgasm
4. Resolution
SEXUAL DYSFUNCTIONS ( Classification )
A. As to choice of sexual partners
1. Homosexual
2. Infanto sexual
3. Besto sexual
4. Auto sexual
5. Gerontophilia
6. Necrophilia

7. Incest
B. As to instinctual strength of the sexual urge:
1. Over sex
2. Under sex or sexual frigidity
a. Sexual anesthesia
b. Dyspareunia
c. Vaginismus
d. Old age
C. As to the mode of sexual expression
1. Oralism
a. Fellatio
b. Cunnilingus
c. Analism

2. Sado masochism
a. Sadism
b. Masochism
3. Fetishism
a. Anatomic
b. Clothing

c. Necrophilic
d. Odor ( ospresiophilia )

Kinds of Ospresiophilia
1. Urolagnia
2. Coprolagnia
3. Mysophilia
a. Narcissism
b. Saboteur Fetish
c. Vampirism

D. As to the part of the body

1. Sodomy
2. Uranism
3. Frottage
4. Partialism
E. As to visual stimulus
1. Voyeurism
2. Scoptophilia

F. As to number

1. Troilism
2. Pluralism

G. Other sexual deviates.

1. Don Juanism
2. Indecent exposure
3. Coprolalia
H. Disorders of sexual function:
1. Premature ejaculation
2. Retarded ejaculation
3. Low sexual desire disorder
4. Sexual aversion disorder
5. Sexual arousal disorder in women
6. Inhibited orgasm
7. Dyspareunia
8. Vaginismus
I. Sexual reversal
1. Transvertism
2. Transexualism
3. Intersexuality
SEXUAL CRIMES:
Chaste An unmarried woman who has had no carnal knowledge with men or
that she never voluntarily had unlawful sexual intercourse. These also denotes
purity of mind and innocence of heart.
Virgin A woman who has had no carnal knowledge
have not been altered by carnal connection.

of man. Her genital organs

Kinds of virginity
1. Moral virginity the state of not knowing the nature of sexual life and not having
experience sexual relation.
2. Physical virginity A condition whereby a woman is conscious of the nature of
sexual life but has not experienced sexual intercourse.
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 allows sexual intercourse, but only inter femora or even
inter labia, but not to the extent of rupturing the hymen.
4. Virgo intacta A truly virgin woman. There is no structural change in her organ,
notwithstanding the fact of a previous sexual intercourse.
DEFLORATION This is the laceration or rupture of the hymen, as a result of

sexual intercourse. All other lacerations which are not due to coitus are not
considered defloration.
SEMEN AND SPERMATOZOA:

ERECTILE DYSFUNCTION ( Impotence )

- The diagnosis of Erectile Dysfunction is important especially in complaints of
rape. It must be proven convincingly that the accused is permanently impotent, so
that the crime of rape cannot be proved beyond reasonable doubt.
- Impotence usually results from vascular impairment, neurologic disorders, drugs,
abnormalities of the penis or psychological problems that interfere with sexual
arousal.
- These includes injury, diabetes mellitus, stroke and drugs like all
antihypertensive and psychotics, antidepressants and some sedatives.
- Alcohol can also cause impotence and also low levels of testosterone

SEX CRIMES IN THE REVISED PENAL CODE:

A. Rape
B. Carnal Knowledge
- is the act of a man in having sexual bodily connection with a woman. There is
carnal knowledge if there is the slightest penetration in the sexual organ of the
female by the sexual organ of the male.
C. Seduction
- is the art 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
D. Acts of Lasciviousness
E. Acts of Lasciviousness with Consent of the Offended Party

F. Abduction
1. Forcible Abduction
2. Consensual Abduction
G. Adultery
H. Concubinage
I. Bigamy
J. Marriage Contracted Against the Provisions of Law
K. Premature Marriage
L. Performance of Illegal Marriage Ceremony

M. Prostitution
N. Corruption of Minors
O. White Slave Trade
P. Abuse Against Chastity

PROVISIONS OF THE REVISED PENAL CODE APPLICABLE TO

UNNATURAL SEXUAL OFFENSES
1. Grave Scandal ( Art. 200 )
2. Immoral Doctrines, Obscene Publications and Exhibitions ( Art. 201 )
3. Vagrants and Prostitutes ( Art. 202 )
4. Grave Threats ( Art. 282 )
5. Light Threats ( Art. 283 )
6. Other Light Threats ( Art. 285 )
7. Grave Coercions
8. Unjust Vexation or Any Other Coercion ( Art. 287 )

CHAPTER 7
MENTAL HEALTH DISORDERS
Mental Health Disorders include disturbances in thinking, emotion, and behavior.
There is a complex interaction between the physical, psychologic, social, cultural
and hereditary influences.
Factors that Contribute to the Development of Mental Disorders:
1. Heredity the most frequent factor that contributes to insanity and a good
history will reveal the ascendants afflicted with the same.
2. Incestous Marriage The mental illness is accentuated when they are blood
relatives.
3. Impaired Vitality Stress, tension, worry, grief may predispose to insanity

4. Poor Moral Training and Breeding Corrupt moral upbringing in the family due
to immorality of the parents
5. Psychic Factors Factors like love, hate, rage, anger, passion disappointments
6. Physical Factors
a. Non toxic factors exhaustion resulting from severe physical and mental
strain and traumatic injuries to the head.
b. Toxic factors drug addiction, infections of the brain
KINDS OF MENTAL HEALTH DISORDERS:
1. Psychosomatic disorders physical disorders caused by psychologic factors.
2. Somatiform disorders encompasses several psychiatric disorders in which
people report physical symptoms but deny having psychiatric problems.
3. Generalized Anxiety Disorders
4. Panic Attacks and Panic Disorder

i. Obsessive Compulsive
j. Passive Aggressive
k. Dissociative

5. Phobic Disorders
a. Agoraphobia
b. Specific phobias
c. Social phobia
6. Obsessive Compulsive Disorder
7. Post Traumatic Stress Disorder
8. Depression and Mania
9. Bipolar Disorder
10. Suicidal Behavior
11. Eating Disorders
a. Anorexia nervosa
b. Bulimia nervosa
c. Binge eating disorder
12. Personality Disorders
a. Paranoid
b. Schizoid
c. Histrionic
d. Narcissistic
e. Antisocial
f. Borderline
g. Avoidant
h. Dependent

13. Schizophrenia a serious mental disorder characterized by loss of contact

with reality ( psychosis ) , hallucinations, delusions ( false beliefs ) , abnormal

thinking, disrupted work and social functioning

Types of Schizophrenia:
a. Paranoid
b. Hebephrenic
c. Catatonic

14. Delusional Disorder

15. Psychological Incapacity a waste basket diagnosis because it is so broad a
term, that it covers all possible Mental Disorders.

SOME MANIFESTATIONS OF MENTAL DISORDERS:

1. Disorders of Cognition ( Knowing )
a. Illusion
b. Hallucination
2. Disorders of Memory
a. Dementia
3. Disorders in the Content of Thought
A. Delusion
a. Delusion of grandeur
b. Delusion of persecution
c. Delusion of reference
d. Delusion of Self Accusation
e. Delusion of infidelity
f. Nihilistic delusion
g. Delusion of poverty
h. Delusion of control
i. Delusion of depression
B. Obsession

4. Disorders in the trend of thought

Types:
a. Mania
b. Melancholia
5. Disorders of Emotions or Feelings a disorder in the state of mind, fervor, or
sensibility, not in accord with reality.
6. Disorders of volition or conation ( doing )
Kinds of Conation:
A. Impulsion or Impulse ( Compulsion ) a sudden and irresistible force
compelling a person to the conscious performance of some action without motive

or forethought.
Types of Compulsion:
a. Pyromania
b. Kleptomania
c. Dipsomania
d. Homicidal impulse
e. Sex impulse
f. Suicidal impulse
DISTINCTIONS BETWEEN TRUE AND FALSE INSANITY:
1. True insanity develops insidiously usually with the existence of some
predisposition to an exciting cause if careful history is taken, while false insanity
develops suddenly with no existing predisposition.
2. In true insanity, there is a peculiar facial expression, which is absent in false
insanity
3. In true insanity, there is a continuous and persistent manifestation of insanity,
which is only present in false insanity when the pretender is under observation,
and absent when not under observation.
4. In true insanity, there is a clinical entity of a specific mental disorder, which is
absent in false insanity.
5. In true insanity, the patient can endure a violent or stressful activity without
fatigue, which is not present in false insanity
6. In true insanity, the patient does not observe personal hygiene, in false insanity,
the pretender observes hygiene
Insanity or Mental Illness is an exempting or mitigating circumstance to Criminal
Liability as provided in the following:
1. As an exempting Circumstance
Article 12 of the Revised Penal Code provides, When the imbecile or an
insane person has committed an act which the law defines as felony, the court
shall order his confinement in one of the hospitals or asylums established for
persons thus afflicted and he shall not be permitted to leave without first obtaining
the permission of the same court.
2. As a mitigating Circumstance
Article 13, of the Revised Penal Code provides, the following are mitigationg
circumstances:
a. That the offender is deaf and dumb, blind or otherwise suffering from physical
defect which thus restricts his means of action, defense or communication with his
fellow beings

The American Law Institute formulated the following Rules on Criminal

Responsibility and states that;
1. A person is not responsible for his criminal conduct if at the time of such
conduct as a result of mental illness or defect, he lacks essential capacity to
appreciate the criminality of his conduct or to conform his conduct to the
requirement of the law.
2. The term mental disease or defect does not include an abnormality
manifested only by repeated criminal or otherwise anti social conduct
Fundamental Principles of Insanity and Criminal Responsibility:
1. A sane man is assumed to be wholly responsible for the consequence of his
crime.
2. A person who commits a criminal act is presumed to be sane.
3. Crime is always considered as an affair of the mind as well as the body and to
make an act or omission a crime, there must be a criminal act ( actus reus ) and
an criminal mind ( mens rea ) . Actur facit reum, nisi mens sit rea.

Mental Deficiency or mental retardation, is sub average intellectual ability

present from birth or early infancy. Intelligence is both determined by heredity and
environment. In most cases of mental deficiency, the cause is unknown.
Classification of mental deficiency:
1. Idiot The idiots intelligence never exceeds that of a normal child over 2 years
old. The IQ is between 0 20. This is usually congenital.
2. Imbecile the imbeciles intelligence is compared to a normal child from 2 7
years old and the IQ is 20 40.
3. Feeble Minded his mentality is similar to that of a normal child between 7 12
years old and an IQ of 40 70.

The Legal Importance of determining the persons state of mind are the following
In Criminal law, insanity exempts a person from criminal liability
In Civil law, Insanity is a restriction of the capacity of a natural person to act as
provided in Article 38 of the Civil Code.
Insanity modifies or limits the capacity of a natural person to act as providedin
Article 39, also of the Civil Code.
Insanity at the time of marriage of any or both parties is a ground for the
annulment of marriage.