Professional Documents
Culture Documents
Legal Medicine by Pedro Solis PDF
Legal Medicine by Pedro Solis PDF
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 Euro-
pean 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 eluci-
date legal problems. On the other hand, .medical jurisprudence
(j'uris-law, prudentia-knowledge) denotes knowledge"of lawT in rela-
tion to the practice of medicine. It concerns with the study of the
rights, duties and obligations of a medical practitioner with parti-
cular 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 ad-
mission 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
1
2 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 medico-
legal duties is known as medical jurist, (meoical examiner, medico-
legal 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 with-
out 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 3
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
J
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.)
i
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 diag-
nosing, 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.
4 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.
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
12 LEGAL MEDICINE
^'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 deter-
mining 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
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 ques-
tion 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 lie-
detector 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 accom-
panied 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 border-
line 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 emo-
tional 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 incom-
petent 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 ques-
tions 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 sub-
ject 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 com-
pelled to be subjected to the test without his consent.
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 com-
bination 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.
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, time-
consuming 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 in-
cludes, 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 inter-
course with the complaining witness at the time and place men-
tioned 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 some-
one 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:
L
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 ad-
missible in evidence against him.
(2) Involuntary extra-judicial confession: lA ^ C A W * * A M -
V
?
' Confessions obtained through force, threat, intimi-
dation, 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.
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 phy-
sical 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 de-
tention 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 regula-
tion, or (2) by inflicting such punishment in a cruel and humil-
iating 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 treat-
ment 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 respon-
sible.
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 nourish-
ment, 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 con-
sequences 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 circum-
stance 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
/ 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 pro-
cedure is demanded.
2 JPhose which are based on scientific knowledge — Identification is
<
(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.
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.
Triangular face
Tattoo marks
so l e g a l 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 dif-
ference 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.
A Fingerprint
58 LEGAL MEDICINE
d. Twin loop — There are at least two loops opening at the dif-
ferent sides.
e. Accidentals — There are no rules that can be made in this pat-
tern. 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 finger-
print is available for proper means of identification.
Can fingerprints be effaced?
John Dillinger, a notorious gangster and a police character at-
tempted 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 in-
destructible.
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 con-
ducted 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 dentist-
ry 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
Dental Chart
2. Age
9 yrs 12 permanent teeth (8 incisors and 4 molars).
11 yrs 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 know-
ledge 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.
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 commer-
cial 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, Phy-
sical Evidence and the Police Laboratory by Paul L. Kirk,
p. 446).
MEDICO-LEGAL ASPECTS OF IDENTIFICATION 69
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 pro-
cess 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.
82 LEGAL MEDICINE
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
T
x 100
Width of the orbit
Above 89 — Megasemes — Mongolian
84 — 89 — Mesosemes — Semato-Caucasian
Below 84 — Microsemes — Malayan
, , T Breadth of the base , n n
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
0 f T A
2. Pelvis:
Pelvic Index = Anteroposterior diamete^ x 1 Q Q
Transverse diameter
Below 85 — Platypellic — Semato — Caucasian
86 — 95 — Dolicopellic — Malayan
Above 95 — Mesopellic — Negroes
MEDICO-LEGAL ASPECTS OF IDENTIFICATION 83
Length of femur
18-20 yean The head of the femur should have joined diaphy-
sis; the epiphysis of long bones of the hand and
foot should have united to the diaphyses; the basi-
occiput 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
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 obli-
gations vested by law to one sex only:
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 im-
pediments 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 twenty-
one 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, hair-
style, 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 in-
volve exploration of the abdomen and in some cases a histolo-
gical 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).
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 un-
conscious; and —^
3. When the woman is under/twelve years of agej even though
neither of the circumstanceTm^ntioned in the two preced-
ing 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 mini-
mum 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
{2) When a child was born out of lawful wedlock and the
mother claimed someone to be the father but he vehe-
mently 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 he-
morrhage.
^Determination of the direction of^ escape of the victim or the
assailant:
The shape of the blood or blood stains will give the investi-
gator 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
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. Men-
strual blood will show abundance of vaginal epithelial cells and Doe-
derlein'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.
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 agglu-
tinins.
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 O A, B, AB
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
104 LEGAL MEDICINE
Bx AB A, B, AB O
ABx AB A, B, AB O
Inheritance of M—N type
Parents Possible Children
MxM M
MxMN M, MN
MxN MN
MN x MN M, N, MN
MN x N MN, N
NxN N
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 influ-
ences, 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 wo-
man'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.
MEDICO-LEGAL ASPECTS OF IDENTIFICATION
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 im-
bricated 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:
Cortex
Looks like a thick muff. Looks lixe a fairly thin
hollow cylinder.
Pigments in the form of fine Pigments in the form of
grains. irregular grains larger
than that of human's.
Cuticle
Thin scales not protruding, co- Thick scales protruding,
vering one another to about do not cover one ano-
4/5. ther to the same degree
as the human's.
f A. KINDS OF DEATH ^ j j ^
)MATIC DEATH OR CLINICAL DEATH:
This is the state of the body in which there is ^complete, per-
sistent 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 pre-
sence 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 ani-
mation 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).
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. Applica-
tion of pressure with the finger tip will produce fitting impres-
sion 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 mis-
taken 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 under-
neath 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 what-
ever intensity of light stimulus. However, absence of corneal
reflex may also be found in a living person the following condi-
tions:
(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 :
lt
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.
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
(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 perma-
nent 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 mur-
derer 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 inges-
tion 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 1
Decomposition in water with bloating of the whole body, blackening of the face and
attitude of the extremities at the time of recovery.
Decomposition - Soft tissues of the chest and head have disappeared while
those of the abdomen and extremities are mummified.
c. Arms.
d. Abdomen.
e. Legs.
Death in the sea with post-mortem erosion of the face due to the activities
of the fishes and other aquatic animals.
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 put-
refaction.
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, decompo-
sition 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 dece-
dent'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, contra-
riwise, 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 ab-
sence or insufficiency of pepsin and other digestive fer-
ments 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 Fol-
lowing 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 decom-
position. 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
154 LEGAL MEDICINE
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 dis-
appeared 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 circum-
stances 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 pre-
sumed 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 dif-
ferent, 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
156
MEDICO-LEGAL INVESTIGATION OF DEATH 157
2. AUTOPSIES:
An autopsy is a comprehensive study of a dead body, per-
formed 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 exami-
nation, the body is opened and an internal examination is con-
ducted.
(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) deter-
mining the cause of death; (2) providing correlation of clinical
diagnosis and clinical symptoms; (3) determining the effective-
ness of therapy; (4) studying the natural course of disease pro-
cess; 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
PROCEDURE OF AUTOPSY
Guidelines in the Performance of Autopsies:
1. Be it an official (medico-legal) or non-official autopsy, the patho-
logist 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 suf-
ficient reason for the premature termination of the autopsy. The
existence of a certain disease or injury does not exclude the pos-
sibility 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 pro-
ductive of information that bears the identity and other physical
trauma received. Frequently a pathologist's reluctance to per-
form 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 ce-
metery 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 five-
minute interval. There was authorization to perform an autop-
sy on one of them but the nurse interchanged the tags. The
deceased wherein there was no authorization given was autop-
sied. 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 un-
fortunately 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 de-
ceased. 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 toxico-
logical 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 vio-
lence 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 author-
ization 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 symp-
toms 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 ad-
visable that no unauthorized person should be present.
170 LEGAL MEDICINE
Cardio-Vascular System:
Aorta Sclerosis, atheroma, syphilis, aneu-
rysm.
Veins 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, condi-
tion 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 attach-
ment and the tentorium cerebelli. Examine the brain for patholo-
gical 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.
ADRENALS:
Weight 4.8 — 7.3 gms.
Measurement 40 x 20 x 2 mms.
WEIGHT OF THYMUS: Both
Newborn 13.26 gms.
I - 55 years
j 22.08 gms.
6 - l10 O years
j 26.18 gms.
5 3years
I I - 115 37.52 gms.
16 - 2020 years
j 25.52 gms.
21 - 25253years 24.73 gms.
26 - 35353years 19.8 gms.
36 - 45453years 16.27 gms.
46 - 55553years 12.85 gms.
56 - 65653years 6.08 gms.
6 6 - 775
5 3years 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 deter-
mination 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 pul-
monary 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.
180 LEGAL MEDICINE
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
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 can-
not 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 with-
out 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 devel-
oped 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 paraly-
sis 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 sud-
den 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.
190 LEGAL MEDICINE
(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 impru-
dence, 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 impru-
dence.
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 impru-
dence.
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 homi-
cidal 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).
(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
LEGAL MEDICINE
^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 pro-
hibited 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 punish-
ment 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 pro-
tection.
203
204 LEGAL MEDICINE
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 peni-
tentiary 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 exe-
cuted 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 electro-
cution as well as during the proceedings prior to the execution.
If the person under sentence so desire, he shall be anesthe-
sized 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 in-
flicted 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 per-
sons 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
206 LEGAL MEDICINE
2. Death by Hanging:
The convict is made to stand in an elevated collapsible flat-
form 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 con-
vict, 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.
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.
3. SUICIDE:
Suicide or self-destruction is usually the unfortunate conse-
quence 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 opposi-
tion 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 impli-
cations 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 deter-
mining 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.
Death b y itarvation
214 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 pro-
longed 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, ma-
rooned 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.
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 absorp-
tion 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 dis-
agreeable 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
216 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.
C O N C E P T O F POSSESSION:
The right of custody over a dead body means possession. Posses-
sion 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
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 pre-
vented from interfering with that right (Cited by Meridith).
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 forty-
eight 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 author-
ities that the body may be buried more than 48 hours
after death;
DISPOSAL OF THE DEAD BODY 221
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.
226 LEGAL MEDICINE
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. Cre-
mation 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 trans-
form the whole body into ashes.
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 SCIEN-
TIFIC PURPOSES, U N D E R C E R T A I N C O N D I T I O N S
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 OR-
G 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 PUR-
POSES, 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 scien-
tific 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 author-
ization 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
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:
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 produc-
tion 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
240
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.
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 in-
crease 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.
242 LEGAL MEDICINE
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, hema-
toma, 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
Incised ( d e f e n s e ) w o u n d
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 245
"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.
( 3 ) Assaulting ( A r t . 263); or
( 4 ) Administering injurious substances (Art. 264) without the in-
tent to kill.
It may be committed through a simple negligence or impru-
dence.
The main purpose of dividing the provision into four paragraphs
is to graduate the penalties depending upon the nature and cha-
racter 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 pre-
adolescent age and that on account of the physical injuries in-
flicted there is an arrest of mental development.
Impotency is the inability to grant to the partner sexual gratifi-
cation.
Blindness must be total or involvement of both eyes. If only
one eye became blind, then the physical injury will fall in para-
graph 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 con-
sequences 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
P R E S I D E N T I A L D E C R E E N O . 169
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:
(SGD) F E R D I N A N D E. MARCOS
President
Republic of the Philippines
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).
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 hemor-
rhage 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
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 con-
tusion 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
/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 vio-
lence or some existing pathology.
(a) Close or Simple Fracture — Fracture wherein there is no
break in continuity of the overlying skin or where the ex-
ternal air has no point of access to the site of injury.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 259
/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.
/ 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
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 pro-
duce 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 rough-
ness of the object and the amount of pressure in the course of
the sliding. The course will be indicated by a clean commence-
ment and tags on the end.
c. Impact or Imprint Abrasion (Patterned Abrasion, Stamping
Abrasion, "Abrasion A La Signature"):
Those whose pattern and location provides objective evidence
to show cause, nature of the wounding 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 parchment-
like consistency.
. ~ , ,, ^ —. . .
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.
Hacked wound. The injury is quite severe, edges may or may not
be contused depending on the nature of the edge of the instru-
ment used.
Characteristics of Incised Wound:
a. Edges are clean- both 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 he-
morrhage 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).
M u l t i p l e Incised w o u n d s ( H o m i c i d a l ) .
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 move-
ment. 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.
M u l t i p l e stab w o u n d s
S t a b w o u n d w i t h intestinal herniation.
Characteristics:
a. The opening on the skin is very small and may become un-
noticeable 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
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.
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
Line of cleavage
Langer's line
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
B o d y surface
278 LEGAL MEDICINE
Kinds of Shock:
a. Primary Shock:
This is caused by immediate nerve impulse set up at the in-
jured 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.
284 LEGAL MEDICINE
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 trau-
matic 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 micro-
organisms 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
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.
288
MEDICO-LEGAL INVESTIGATION OF WOUNDS
EfcrThe edges gape owing to the . The edges do not gape, but are
reaction of the skin and closely approximated to each
muscle fibers. 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
292 LEGAL MEDICINE
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
examining individually the wounds and note which of them are in-
volved 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.
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.
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 local-
ized 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 lace-
ration 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
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
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 sub-
stance, 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.
304 LEGAL MEDICINE
b. Subdural Hemorrhage:
Unlike extradural hemorrhage, subdural bleeding is essential-
ly 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 me-
ningeal vessels. It usually comes from the small blood vessels
which cross the subdural space to the subarachnoidal area.
Extensive s u b d u r a l h e m o r r h a g e
c. Subarachnoidal Hemorrhage:
Subarachnoidal hemorrhage may be due to trauma or to
spontaneous rupture of blood vessels. Its causes may be sum-
marized 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 com-
monly 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
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 under-
lying 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-
308 LEGAL MEDICINE
(GradwohVs Legal Medicine by F.E. Camps ed., 2nd ed., pp. 317-
319).
PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY 309
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-conjunc-
tival. Hemorrhage is frequently observed in a fist blow. Fracture
312 LEGAL MEDICINE
of the base of the anterior cranial fossa may also produce con-
tusion of the eyelids, and this may be distinguished from con-
tusion 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. Hemor-
rhage 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. For-
cible blow in the anterior portion of the neck may cause un-
consciousness or even death due to reflexed inhibitory action on
the vagus nerve.
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).
318 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 ab-
dominal 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 acci-
dents 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 pro-
tected at its upper portion by the ribs and also by the air-con-
taining 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-
320 LEGAL MEDICINE
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 sym-
physis 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. Symp-
toms 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, hemor-
rhage, 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
5. EXTREMITIES:
Physical injuries on both upper and lower extremities are usual-
ly 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
322
DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION 323
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
328 LEGAL MEDICINE
/ 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
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 gun-
powder.
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
w
332
GUNSHOT WOUNDS 333
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.
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.
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 (per-
cussion 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 com-
pletely 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 consti-
tuents of primer are lead, antimony and barium.
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%).
338 LEGAL MEDICINE
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 acci-
dental 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:
344 LEGAL MEDICINE
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
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 high-
pressured 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.
Bullet Efficiency:
The cartridge powder charge can be burned in approximately
0.00001 second. The conversion rate by combustion of the gun-
powder 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 ex-
plosion 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
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 pis-
tols 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.
The sudden release of the expanded gas from the muzzle follow-
ing the bullet is known as a muzzle blast.
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 epider-
mal 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 in-
creases, 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
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
/
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
354 LEGAL MEDICINE
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 con-
sideration:
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
Gunshot wound of entrance with contusion collar, powder burns and tattooing.
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.
2. Internal Examination:
a. Actual Dissection and Tracing the Course of the Wound at
Autopsy:
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
3. Embalming:
Embalming trocar may be introduced on the gunshot wound it-
self 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 "make-
u p " may modify the actual appearance of the wound.
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 re-
covery 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.
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 369
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
Grade of Choke:
A shotgun is choked when the muzzle end of the barrel is a dia-
meter 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.
376 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 gun-
powder 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.
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
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 in-
creases. 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.
The test is simply applied but does not enjoy substantial uti-
lization 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.
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 deter-
mined 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 inves-
tigator 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
5. Ballistics Examination:
Ballistics is the study of physical forces reacting on projectiles
or missiles.
Forensic ballistics is conventionally known as firearm identi-
fication. It deals with the examination of fired bullets and cart-
ridge cases in a particular gun to the exclusion of all others.
Ballistic c o m p a r i s o n m i c r o s c o p e
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.
386 LEGAL MEDICINE
GUNSHOT WOUNDS 387
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 tun-
nelled bullet tract. In most cases, injury of the brain causes
sudden loss of consciousness and incapable of voluntary move-
ment.
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 ap-
preciable. 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 instan-
taneous 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 gastro-
intestinal 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, ster-
num 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 emphy-
sematous. 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 muscu-
lature of the latter which produces temporary closure of the
wound. Bullet may lodge in the musculature of the ventricle and
392 LEGALMEDICINE
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 ver-
tebral 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.
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 com-
plications.
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, throm-
bosis, hemorrhage, deformity are not unusual after-effects.
Chapter XIV
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 for-
mation and gangrene of the exposed part of the body.
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.
396 LEGAL MEDICINE
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 gan-
grene, 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.
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 ab-
dominal pain.
THERMAL INJURIES OR DEATHS 397
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 sub-
normal.
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.
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 .
398 LEGAL MEDICINE
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.
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
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 carbon-
ization 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 demar-
cation 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
endings. Healing may leave a scar which contains all the ele-
ments 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 in-
flammatory changes may develop in the surrounding tissues.
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.
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 sub-
jected 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.
408 LEGAL MEDICINE
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 of the adrenal glands with hemorrhagic
infarcts.
( 8 ) Lungs are shrunken, mucous membrane of the bronchi
are congested and sub-serous hemorrhages present.
( 9 ) Intestinal mucous membrane are congested especially
the Brunner's glands of the duodenum.
(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.
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.
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 che-
micals to the underlying tissue.
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 com-
monly 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 redden-
ing 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 per-
sistent dermatitis. There is uncomfortable irritation of the skin
and may later develop into a blister.
Chapter XV
3. Mechanical effect:
The expansion of the air on account of the superheated atmos-
phere may bring about mechanical injury. It may result to lacera-
tion 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 super-
heated 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
A victim of lightning
2. Delayed Effects:
a. Insomnia and defective memory.
b. Irritability and inability to concentrate.
c. Paralysis or an increasing weakness of the limbs with pro-
gressive 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.
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.
Post-mortem Findinge:
There is nothing specific, or may show no lesion at all.
420 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 appli-
cation of hot water in bottles and blankets. Cerebral edema may
be treated by lumbar puncture. Stimulant may be given to im-
prove 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
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):
421
422 LEGAL MEDICINE
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 con-
tents 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 altitude the oxygen content of the atmos-
phere becomes lesser and lesser. Hypoxia will be felt between
8,000 to 15,000 feet level. Aircraft flying beyond 34,000 feet
above sea level must be provided with oxygen to maintain the
human demand.
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).
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.
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, al-
though the oxygen is delivered to the tissues, it cannot be utilized
properly. Cyanide and alcohol are common agents responsible for
histotoxic anoxic death.
Classifications of Asphyxia:
1. Hanging.
2. Strangulations:
a. Strangulation by ligature.
b. Manual strangulation or throttling.
428 LEGAL MEDICINE
A. ASPHYXIA BY HANGING
Mechanism of Death:
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.
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 bed-
dings, 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 com-
pared 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.
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 res-
Diration mav successfully revive the victim.
Treatment:
1. Induce the Natural Acts of Respiration:
a. Ligature must be loosened and the mouth must be wiped to
DEATH BY ASPHYXIA 433
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 dif-
ferentiate this from ligature marks.
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 differ-
entiated from accidental strangulation by- the umbilical cord during
child birth. In accidental strangulation during child birth, the um-
bilical 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.
Treatment:
1. Removal of the ligature.
438 LEGAL MEDICINE
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 pete-
chial 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.
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 oc-
casionally 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
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
C. ASPHYXIA BY SUFFOCATION
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 smother-
ing 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
442 LEGAL MEDICINE
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).
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 anse-
rina," 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 re-
mained 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
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 differ-
ence although death was not due to drowning.
448 LEGAL MEDICINE
drowning took place, presence of wearing apparel, age, sex and body
built. The body when recovered, floats usually with flexed extre-
mities. 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 decom-
position.
Determinations Whether Drowning is Suicidal, Homicidal or
Accidental:
1. Suicidal Drowning:
a. Heavy articles or weight may be found in the pocket of cloth-
ings.
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 de-
struction 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.
e. Presence of physical injuries which could not have been self-
' inflicted, like gunshot wound at the back, severe injuries in the
head, etc..
J f. Testimony of witnesses.
I 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)
F. A S P H Y X I A BY B R E A T H I N G IRRESPIRABLE GASES
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.
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.
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:
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 vol-
canoes.
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 sup-
pression 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, in-
convenience, weakening of resistance of defense and physical damages
on the victims.
456 LEGAL MEDICINE
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 com-
pound known as carboxyhemoglobin and reduces the oxygen-
carrying capacity of the blood.
Chapter XVIII
459
460 LEGAL MEDICINE
When the car is running with a high velocity before the im-
pact, the front portion of the car may be shortened or "accor-
dioned" 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.
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,
464 LEGAL MEDICINE
scars at the wrist or stab wounds in the chest and abdomen. Prior
psychiatric evaluation may reveal pathological findings and suicidal
tendency.
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 oc-
curred, 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.
MOTORCYCLE CRASH:
Reasons Why there is a High Percentage of Motorcycle Crash:
1. A motorcycle can attain a high speed compared with other or-
dinary 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 con-
trol of the bike. It may hit a fixed object, the tire may skid, or
the cyclist may be drunk.
A. BOXING
A
Rotational
Acceleration
B
Linear
Acceleration
C
Injury to Carotid
472 LEGAL MEDICINE
Post-Mortem Findings:
( 1 ) In case of death after the injury due to intracranial hemor-
rhage:
(a) Generalized edema of the brain.
( b ) Presence of intracranial hemorrhage usually subdural.
(c) Compression of the brain on account of massive hemor-
rhage.
( 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
B. WRESTLING
1. Common Injuries Suffered by Combatants:
a. Injury to the cervical spine (fracture and/or dislocation) especial-
ly 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
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 self-
reliance;
(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 develop-
ment 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
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.
MEDICO-LEGAL ASPECTS
OF
SEX CRIMES
VIRGINITY A N D DEFLORATION
A. VIRGINITY
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, dis-
tinction 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. In-
asmuch 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.
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 ver-
tically.
(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
Thin hymen
B. DEFLORATION
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 instru-
mentation 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.
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 com-
plications, 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 lacera-
tion 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 un-
eventfully, 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 un-
common 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 dispro-
portion between the injury and the amount of hemor-
rhage. Blood transfusion may be required when the
VIRGINITY AND DEFLORATION 495
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.
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 con-
traction 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.
^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 punish-
able 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
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.
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.
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).
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 ac-
quitted (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
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.
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 map-
like contour with silvery appearance of the surface. It is hard-
ened with shiny borders.
510 LEGAL MEDICINE
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).
3. Microscopic Examinations:
a. A dried spermatic fluid stain on the slide is stained with hema-
toxylin 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 undoubted-
ly 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 dilu-
tions.
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.
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 Medi-
cal Jurisprudence by K. Simpson, 12th ed.. Vol 2, p. 32).
the upper recesses of the vagina for more than two weeks" (Coy\
p. 246).
A. SEDUCTION
B. •E S E D U C T I O N :
Art, 338, Revised Penal Code — Simple seduction — The seduc-
tion 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.
CTS OF LASCIVIOUSNESS
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
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 com-
mitted by the same persons and under the same circumstances
as those provided in article 337 (qualified seduction) and 338
(simple seduction).
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.
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.
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.
522 LEGAL MEDICINE
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.
PROSTITUTION
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 super-
vision of a "madam" or "mama-san" (Criminology by R.G.
Caldwell, 2nd ed., p. 125).
Effects of Prostitution:
1. Arrest and imprisonment.
2. Venereal infection.
3. Social ostracism.
4. Poor personal hygiene.
5. Excessive use of alcohol.
6. Irregular habit of eating and sleeping.
7. Demoralization and physical deterioration.
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.
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
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, includ-
ing 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 re-
moved 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.
U N N A T U R A L SEXUAL OFFENSES
AND SEXUAL ABNORMALITIES
SEXUAL ABNORMALITIES:
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
As to Visual Stimulus:
1. Voyeurism — A form of sexual perversion characterized by a com-
pulsion 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 in-
timacies.
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 com-
bination 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".
Sexual Reversal:
1. Transvestism ("Sexo-esthetic inversion", "Psychical hemaphro-
ditism" 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 trans-
vestite 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 amen-
able 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 com-
pulsion to have the opposite sex that they hate their genitalia as
a persistent evidence that they are not what they want to be, and
538 LEGAL MEDICINE
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 du-
ration, although several methods are employed, none of the methods
are perfectly reliable.
539
540 LEGAL MEDICINE
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.
5 calendar months — 3 fingers below the umbilicus.
6 calendar months — At the level of the umbilicus.
7 calendar months — 3 fingers above the umbilicus.
8 calendar months — 6 fingers above the umbilicus.
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.
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 ex-
treme 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.
544 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 ab-
domen.
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.
2. Reagents:
a. Pregnancy Slide Test antiserum (human H C G antiserum from
rabbit)
b. Pregnancy Slide Test antigen ( H C G latex suspension, che-
mically 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 (homoge-
neous) 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.
3. Corpus Luteum:
Corpus luteum may be well-developed and attains a certain
size, however, it may gradually retrogress, but it is usually well-
developed 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 fertili-
zation. There is no synchrony between coitus and fertilization.
3. Count forty weeks or ten lunar months from the date of the first
day of the last menstruation.
4. Determination of the level of the fundus of the uterus, (supra,
p. 542)
5. MacDonald Method:
Measure the distance from the symphysis pubis up to the fundus
of the uterus in centimeters divided by 3.5 gives the age in month
of gestation.
6. Date of the quickening. It is customary to count ahead 24 weeks
in multigravidas and 22 weeks in primagravidas from the date of
the quickening. This has been found not to be reliable.
Super fecundation:
This is the fertilization made by separate intercourses of two
ova which have escaped at the same act of ovulation.
Superfoetation:
This is the fertilization of two ova which have escaped at dif-
ferent acts of ovulation. This is possible before the time the decidua
vera has united with the decidua reflexa; that is, before the end of
the third month of pregnancy.
During the later months of pregnancy, the following are the addi-
tional proofs of death of the fetus:
3. Cessation of the fetal movement after they have been felt.
4. Absence of fetal heart sounds after a repeated and prolonged
examination.
5. Positive signs of fetal death as shown by the palpation of softened
macerated fetal head, with bones freely movable on each other
and the scalp hanging over a loose sac.
6. The breasts cease to enlarge and become soft and flabby.
DELIVERY
Methods of Delivery:
1. Natural Route:
Expulsion of the products of conception through the normal
passage; that is, through the vaginal canal.
a. Spontaneous:
When the products of conception passed out of the vagina
without the aid of physician, midwife, instrumentation or
surgical intervention.
b. Surgical Intervention:
When delivery is effected with the aid of surgery, e.g., Sym-
physiotomy.
c. Instrumentation:
The second stage of labor is modified by the use of instru-
ments. Example: Forceps application.
2. Surgical Route:
The expulsion of the products of conception is not through
normal openings of the female generative tract but through some
artificial openings brought about by surgery,
a. Abdominal Caesarian Section:
The child is delivered by opening the abdominal wall and the
anterior wall of the uterus.
552
DELIVERY 553
A. SIGNS OF RECENT D E L I V E R Y :
1. Languid look, with pulse and temperature slightly increased:
This usually disappears normally in two or three days after
delivery. However, these symptoms may be present in other
conditions or sickness, hence cannot be conclusive.
2. Peculiar odor:
The characteristic odor of the lochial discharge is present
up to the tenth day of confinement. The odor is fishy but
sometimes the said odor is present on women who are men-
struating normally.
3. Changes in the breast:
There is a sensation of tightness of the breasts and milk
may be expressed. The presence of colostrum corpuscles in
the milk suggests that parturition has just taken place.
4. Flaccidity of the abdominal wall:
The laxity of the abdominal wall is due to the distention
when the uterus is gravid to accommodate the growing pro-
duct of conception en utero. However, a previous ascites or
cystic condition of the ovary or other internal pathology
causing enlargement of the abdomen will also give rise to
laxity of the abdominal wall.
5. Linea Albicantes present in the abdominal wall:
At first it is reddish in color and is called linea rubra. It
is brought about by the breaking of the capillaries when the
abdomen is distended. Later, a scar-like tissue develops from
the area and is called "Linea albicantes." This is also called
striae of pregnancy.
6. Presence of Linea Nigra:
During the course and development of the gravid uterus,
there develops on the abdominal wall from the region of the
symphysis pubis to the umbilicus or even above it a dark
pigmentation of the skin. This pigmentation which is usually
in the form of a straight line in the median line persists up to
delivery. The origin of linea nigra is most probably hormonal.
554 LEGAL MEDICINE
B . SIGNS O F R E M O T E D E L I V E R Y I N T H E L I V I N G :
1. Changes in the breast:
POST-MORTEM F I N D I N G S I N A W O M A N W H O D I E D R E C E N T L Y
AFTER D E L I V E R Y :
1- Findings in the uterus:
a. Laceration or contusion of the cervix.
b. Uterus is enlarged and flabby.
c. The inner surface of the uterus is bloody and rugged-looking.
d. Dark color sloughy and gangrenous sinuses are evident at the
endometrial lining at the site of the former placenta.
e. There is relative hypertrophy and increase in thickness of the
uterine wall.
556 LEGAL MEDICINE
ABORTION
The Revised Penal Code does not define abortion, but merely
mentions circumstances which makes abortion criminal and punish-
able. Authorities differ as to the length of intra-uterine existence
which may be considered abortion. Some define abortion as the
expulsion of the contents of a gravid uterus anytime before full term
while others consider it as the forcible expulsion of the product of
conception anytime before the age of viability.
Viability is the point at which the fetus is "potentially able to live
outside the mother's w o m b " , albeit with respiratory aid. And, later,
as when it is capable of meaningful life outside the mother's womb
(The Rights of Doctors, Nurses and Allied Health Professionals by
Annas and Glantz, p. 202).
In the legal viewpoint, abortion is the willful killing of the fetus in
(
the uterus, or violent expulsion of the fetus from the maternal womb
and which results to the death of the fetus. According to Viada, as
long as the fetus dies as a result of violence used or of the drug ad-
ministered, the crime of abortion exists, even if the fetus is full term.
Whichever be the definition of abortion, the following are the
principal elements of the crime:
1. That the expulsion of the product of conception is induced.
2. That the fetus dies either as an effect of the violence used, drug
administered or the fetus was expelled before the term of its
viability.
Causes of Abortion:
1. Death of the fetus — Congenital abnormality, poisoning by
minerals like lead, disease of the decidua, chorion, placenta,
amnion, etc.
2. Abnormality of the uterus.
3. Emotional condition — Fright, grief and anger.
4. Abortificient drugs — Ergot, purgatives,
5. Trauma — Direct or indirect.
6. Hormonal deficiency.
7. Acute specific fever and high temperature.
Kinds o f Abortion: — •
^Spontaneous or Natural Abortion:
Abortion which occurs without any form of inducement or
intervention.
^Induced Abortion:
Abortion which will not take place had it not been for some
form of inducement or intervention. Induced abortion may be:
X- Therapeutic Abortion:
Abortion purposely done to preserve the life of the mother.
Preservation of the health of the mother may also be a ground
to induce therapeutic abortion. The phrase "to preserve the life
of the woman" does not only mean to preserve the life of the
woman from death.
b\ Criminal Abortion:
Abortion done without any therapeutic indication but with
criminal intent is punishable by law.
Post-mortem Abortion:
This is the expulsion of the product of conception after death of
the pregnant woman brought about by the post-mortem contraction
of the uterine muscles. It is possible during the early stage of preg-
• nancy when the fetus is small. During the later stage, the contrac-
tion of the uterus may cause its rupture and expel its contents of
pregnancy into the abdominal cavity.
(2) Ecbolics:
Ecbolics are substances which when taken cause death or
expulsion of the product of conception by stimulation of
the uterine muscles.
The Most Common Ecbolics are:
(a) Ergot
( b ) Quinine
(c) Pituitary Extract
(d) Lead and Mercury
Complications of Abortion:
1. Immediate Untoward Effects:
a. Shock:
The shock may be due to the laceration of the uterus or the
adjacent organ, like the bladder, rectum, intestine or blood
vessels. The injury may be due to the introduction of instru-
ments or the application of hot fluid or corrosive substances.
No definite autopsy findings may be seen, except the pre-
sence of the gravid uterus, remnants of the fetus and placenta,
and the laceration or perforation. Secondary shock may
develop later and may be due to hemorrhage, infection or
corrosions.
b. Hemorrhage and Anemia:
Occasionally, big pelvic vessels are injured or failure of the
uterine wall to contract is observed in abortion. The rupture
of the blood vessels may be due to the injury of the uterine
and vaginal wall of injudicious instrumentation. Adherent
placental tissue, infection, presence of foreign bodies and atony
of the uterus may cause hemorrhage for failure of the uterine
muscles to contract.
c. Embolism:
(1) Air Embolism:
The air may enter the lacerated vessels of the vagina and
uterine wall and carried by the blood to the inferior vena
cava, heart and block the pulmonary circulation. In cases
wherein the foramen ovale is potent, the air may escape
pulmonary circulation and block the cerebral circulation.
e. Poisoning:
Abortifacent irritants which may be locally applied may be
absorbed into the circulation and produce systemic effects.
Lysol, corrosive sublimate, iodine solution are frequently used
for vaginal douche and may cause systemic poisoning.
f. Vagal inhibition:
Sudden dilatation of the cervix due to the introduction of
some objects may cause sudden collapse due to reflex inhi-
bition of the vagus nerve.
g. Perforation of the bladder or any of the neighboring organs:
In the insertion of the uterine sound to determine the
position of the uterus or in the process of curretting, the
bladder or the other surrounding organs may be perforated
' and which may eventually result to death due to hemorrhage
or shock.
ABORTION 567
THERAPEUTIC ABORTION:
Therapeutic abortion is an abortion which the law allows under
some specific justifications.
BIRTH
Legal Importance of the Study of Birth:
1. Birth determines personality:
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 intra-uterine life of less than seven
months, it is not deemed born if it dies within twenty-four hours
after its complete delivery from the maternal w o m b .
2. Appearance of a child is a ground for the revocation of donation:
Art. 760, Civil Code:
Every donation inter vivos, made by a person having no children
or descendants, legitimate or legitimated by subsequent marriage,
or illegitimate, may be revoked or reduced as provided in the next
article, by the happening of any of these events.
575
576 LEGAL MEDICINE
A. STILL-BIRTH:
When the child has not breathed or has not shown any sign
of life after being completely born.
Causes of Still-birth:
1. Immaturity.
2. Congenital diseases or malformation.
3. General debilitating diseases:
a. Acute specific infection.
b. Toxemia.
c. Kidney disease.
d. Acute liver disease.
e. Septicemia.
B. L I V E - B I R T H .
In live-birth the child after birth exhibited clear signs of vitality
and viability is not necessary. In law, the presumption is every new-
born child found dead was born dead. The burden of proof lies on
those who declare otherwise. To have a child acquire personality
distinct as that of the mother, there must be proof of life after
complete separation from the mother's womb.
BIRTH 577
Proofs of Live-Birth:
1. Presence of Heart Action and Circulation:
The presence of heart sound when the new-born is examined
by means of a stethoscope is a sign of life. Sometimes the pulse
is imperceptible by palpation especially when the child suffered
much during labor.
2. Movement of the Child and Crying:
The first instinct of the child after birth is restlessness and
crying. Children born after severe and prolonged second stage
of labor, may be too weak to move or cry. After a while, they
begin to move and later cry upon application of bodily stimulus.
3. Presence of Respiration:
Proofs that respiration has taken place:
a. There is arching of the chest.
b. Fall of the level of the diaphragm:
Before birth, the diaphragm reaches the level of the 4th
or 5th rib, but if respiration has taken place, it reaches
to the level of the 6th or 7th ribs. This test is not con-
clusive but merely corroborative.
c. Expansion of the lungs:
Appearance of the lungs if respiration has taken place:
(1) The lungs fill the thoracic cavity and overlapping the
heart and thymus gland.
(2) The lungs are voluminous, with rounded edges and pink-
mottled color.
(3) The surface is covered with mosaic of expanded air
vesicles, giving a marble appearance.
(4) On pressure, they crepitate, and on section they exude
froth.
8. Nails project from the fingers but the toe-nails reach only to
the end.
9. One or both testes are in the scrotum, or labia have close the
vulva.
10. Lower end of femur may show center of ossification about 0.6
cm. in diameter.
(Gradwohl's Legal Medicine by Camps, 3rd ed., p. 416).
Chapter XXVI
/ I N F A N T I C I D E (Neonaticide)
InpaHticide is the killing of a child less than three days old.
Art. 255, 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.
Jf the crime penalized in this article be committed by the mother
of the child for the purpose of concealing her dishonor, she shall
suffer the penalty of prision correccional in its medium and maxi-
mum 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. '
If the~killing was done by the parents, grandparents or other
direct ascendants, or either of them, the penalty to be imposed is
the same as that of__parricide. However, if the killing was done by
any other person, the penalty is the same as that of murder.
Lenient penalty is to be imposed when the killing was done by
the mother or by the maternal grandparents, or either of them for
the purpose of concealing her dishonor.
Problems:
lylnfancy is the period in the life of a child from birth up to one
year.. Thereafter, it is called _childhood. This distinction is made
on account of physiologic changes undergone by the child during
infancy and childhood. Why is the crime of infanticide applied
only to the killing of less than a three-day-old infant rather than
within the first year of the life of the child?
2. During the process of delivery when the head and neck of the
child are already out of the birth canal and the child has breathed
spontaneously through the lungs, the child was deliberately put to
death before expulsion of the other parts of the body. What crime
was committed by the offender? The child was not yet capable
of independent existence inasmuch as placental circulation was
still maintained. Ideally it is foeticide, but it is not a crime in the
Philippines. Can it be considered infanticide?
3. A child was born less than 7 months of uterogestation. Under
ordinary condition, considering prematurity and underdevelop-
583
584 LEGAL MEDICINE
ment, there is more chance for the child to die, but with modern
neonatal management the child had all the chances to live.
A few hours after birth the child was deliberately killed. Is
the killing a case of infanticide? According to Art. 41, Civil
Code . . If the foetus had an intra-uterine life of less than
seven months, it is not deemed born if it dies within twenty-
four hours after its complete delivery from the maternal womb",
and birth determines personality. Can the crime of infanticide
be committed on someone who is not yet a person as con-
templated by law?
Criminological Characteristics:
1. It is most often committed by the mother.
2. The criminal act is almost always committed in the home.
3. The crime scene shows no manifest disturbance, no witnesses and
no noise or outcry.
4LThe trauma applied is so minimal that when applied to an adult
it will not even produce lethal effect.
5. A newly born child found dead was born dead. The burden of
proof that a living child has been killed is placed on the prosecu-
tion.
b. Suffocation:
The face of the child may be pressed into some soft tissues
like a bed-sheet or a pillow.
c. Strangulation:
This is commonly made by placing a tight cord or rope
around the neck. Manual strangulation is also common.
d. Drowning:
The child may be disposed of in a sewerage disposal in a
creek, or in a deeper body of water with weight attached to
the body to prevent floating.
e. Poisoning:
Denatured alcohol, tincture of iodine, or any other drugs
which form a part of the household-remedies may be administered
to the child. A thorough examination of the gastro-intestinal
tract for irritation and an examination of the organs and its
contents by a toxicologic are necessary to determine the kind
of poison and the quantity taken.
586 LEGAL MEDICINE
f. Burning:
This form of killing an infant is not common. This may be
resorted to with the simultaneous burning of the dwelling place
to conceal offense.
g. Deliberate exposure to heat or cold:
The child may be exposed to direct sunshine or may be
placed in a basin of cold water until death.
Kinds of Children:
A. Legitimate Children:
1. Legitimate children (proper).
2. Legitimated children.
3. Adopted children.
B. Illegitimate Children:
1. Natural Children:
a. Natural children (proper).
b. Natural children by presumption.
c. Natural children by legal fiction.
2. Spurious Children:
a. Adulterous children.
b. Incestuous children.
c. Manceres children.
d. Sacrilegious children.
588 LEGAL MEDICINE
A. LEGITIMATE CHILDREN
anger declare that the child is not that of the husband although
it is not true.
b. The husband may connive with the wife and let her declare the
child as illegitimate and thus decrease his right over the proper-
ties of the husband.
c. Between legitimacy and illegitimacy, the law is in favor of
legitimacy. A child must not be punished by the wrongful
acts of his parents.
Presumption of illegitimacy based on ethnic reasons:
Art. 257, Civil Code:
Should the wife commit adultery at or about the time of the
conception of the child, but there was no physical impossibility
of access between her and her husband as set forth in article 255,
the child is prima facie presumed to be illegitimate if it appears
highly improbable, for ethnic reasons, that the child is that of the
husband. For the purposes of this article, the wife's adultery need
not be proved in a criminal case.
Example:
A and B, both white-Americans were legally married. During
the period of conception for the child C, the wife had an illicit
relation with X, a negro. The child born has dark skin, wiry and
curly hair and with thick lips. There is no ancestor in A and B
who is negro. The child C is prima facie presumed illegitimate.
A widow who shall marry within three hundred and one days
from the date of the death of her husband, or before having
delivered if she shall have been pregnant at the time of his death,
shall be punished by arresto mayor and fine not exceeding 500
pesos.
The same penalties shall be imposed upon any woman whose
marriage shall have been annulled or dissolved, if she shall marry
before her delivery or before the expiration of the period of
three hundred and one days after the legal separation.
PATERNITY AND FILIATION 593
Example of N o . ( 2 ) :
A widow married 80 days after the death of the first husband.
A child is born 200 days after the celebration of the second
marriage. The child born is prima facie presumed to be le-
gitimate child of the second husband because the child was
born after 180 days following the celebration of the second
marriage.
Flaw of the presumption:
A widow married 50 days after the death of the first husband.
A child was born 200 days following the celebration of the second
marriage. Following the provision of the presumption, the child
594 LEGAL MEDICINE
2. Legitimated Children:
Legitimation is defined as a remedy or process by which a child
born out of lawful wedlock and are therefore considered ille-
gitimate are by fiction of law considered legitimate by subsequent
valid marriage of the parents.
3. Adopted Children:
Adoption is defined as the act or proceeding by which relations
of paternity and filiation are recognized as legally existing between
persons not so related by nature. The purpose of adoption is to
establish a relationship of paternity and filiation and to afford
persons who have no child of their own consolation of having one
by legal fiction. The child wherein paternity and filiation is es-
tablished is an adopted child and with all the legal rights as a
legitimate child in relation to the adopting parents.
Persons who may be adopted:
a. The natural child, by the natural father or mother;
b. Other illegitimate children, by the father or mother;
c. A step-child, by the step-father or step-mother (Art. 338,
Civil Code); and
d. A n y person, even if of age, provided the adopter is sixteen
years older (Art. 337, Civil Code).
b. The guardian, with respect to the ward, before the final ap-
proval of his accounts;
c. A married person, without the consent of the other spouse;
d. Non-resident aliens,
e. Resident aliens with whose government the Republic of the
Philippines has broken diplomatic relations, and
f. Any person who has been convicted of a crime involving moral
turpitude, when the penalty imposed was six months' im-
prisonment or more (Art. 335, Civil Code).
PATERNITY AND FILIATION 597
B. ILLEGITIMATE CHILDREN
Illegitimate children are those who were born out _of lawful
wedlock or after a competent time after its dissolution.
1. Natural Children:
a. Natural Children (Proper):
Natural children are those born outside wedlock of parents
who, at the time of the conception of the former, were not
disqualified by any impediment to marry each other (Art. 269,
Civil Code).
b. Natural Children by Legal Fiction:
Natural children by legal fiction are those children born of
void marriages or those born of voidable marriages after the
decree of annulment.
Example:
A was married with B, his o w n step-daughter. The mar-
riage is void. A child was born thereafter. The child is
natural by legal fiction.
c. Natural Children by Presumption:
Natural children by presumption are those natural children
acknowledged by the father or the mother separately if the
acknowledging parent was legally competent to contract mar-
riage at the time of conception (Borres and Barza v. Mun. of
Panay, 42 Phil. 643).
Example:
A, a married woman who is living separately from his
husband, had an illicit relation with B. The child born has
been recognized by B to be his own. The child is considered
to be natural by presumption.
2. Spurious Children:
Illegitimate children who are not natural are considered spurious.
Spurious children may be:
a. Adulterous Children:
These are children conceived in an act of adultery or con-
cubinage.
b. Sacrilegious Children:
These are children born of parents who have been ordained
in sacris. In civil law, there is no such kind of illegitimate
children because a priest or a nun can marry. There is no
impediment in law for them to marry. It is only the regula-
598 LEGAL MEDICINE
c. Incestuous Children:
These are children born by parents who are legally incapable
of contracting valid marriage because of their blood relationship
as marriage between brothers and sisters, father and daughter,
etc..
d. Manceres:
These are children conceived by prostitutes. It is very
difficult to determine the father because of the nature of the
business.
A. Medical Evidences:
Is Parental Likeness:
Heredity transmits traits and characteristics from parents to
the offsprings. There must be some gross manifestation of the
children which may be in common with the father.
The following points may be considered by the examining
physician to determine physically whether paternity and
filiation exists between persons in question:
a. General feature p. Gait, speech, and movement
b. Manner of gesture fr Color and texture of the hair
c. Personal peculiarities gc Color of the eyes
di Personal deformities K. General built and size
The fact that the blood type of the child is a possible pro-
duct of the parents, does not conclusively show that the child
is born by such parents. But, if the blood type of the child is
not the possible blood type when the blood of the parents are
cross-matched, it shows definitely that the child is not that of
the husband. A positive result is not conclusive, but a negative
result is conclusive.
B. Non-medical Evidences:
1. Record of birth in the Civil Registrar, or by an authentic
document or a final judgment (Art. 265, Civil Code).
2. Continuous possession of the status of a legitimate child (Art.
266, Civil Code).
3. Any other evidences allowed by the Rules of Court and special
laws (Art. 267, Civil Code).
Chapter XXVffl
PATERNITY A N D FILIATION ON
NON-CONVENTIONAL METHODS OF PROCREATION
A. ARTIFICIAL INSEMINATION
Artificial insemination is a medical procedure by which the
semen is introduced into the vagina by means other than copulation
for the purpose of procreation. Some physicians consider the term
"therapeutic insemination" as a more suitable term for the pro-
cedure (Sagall).
601
602 LEGAL MEDICINE
Consent on A . L D . :
In A . I . D . the consent and release for any future claim must be
obtained by the physician from all parties in writing.
The consent of the wife is necessary to avoid being held liable for
an assault.
The consent of the husband is necessary to avoid the wife being
charged with adultery, or to ward the question of legitimacy of the
child, issues of divorce, separation or inheritance.
The consent and release of the donor should be obtained for the
unrestricted use of the semen supplied and he should also certify
in writing that he will make no effort to ascertain the identity of
the couple involved. If the donor is married, the consent of the
wife must also be obtained to the giving of semen because her marital
interest may be affected by the donation.
decree arguing that because the child has resulted from A . I . D . , the
husband is not the father of the child and therefore he is not entitled
to visitation right. The court, however, predicted on the assump-
tion that the procedure had been performed with the consent of the
husband, rules that "the child has been potentially adopted or semi-
adopted by the defendant and with the particular reference to
visitation, he is entitled to the same right as those to which a natural
parent under the circumstances would be entitled (Strand v. Strand
78N.Y.S. 2d 390(1918).
In an action for a divorce, the Wife alleged that her husband had
no visitation right since the child had been conceived from a donor
sperm. The court upheld an axiomatic legal principle: "When a
child is born within marriage by whatever legal method, there is
legal presumption that both marriage partners are its parents (Ohlson
v. OhlsonNo. 54, S. 138, 875 (Super. Ct. Cook Country, Sept. 1955).
Child born by artificial insemination is illegitimate:
The trial judge granted the divorce but denied the husband of
visitation rights and the custody of an A . I . D . child declaring that
"Heterologous artificial insemination", with or without the consent
of the husband, is contrary to public policy and good morals, and
constitutes adultery on the part of the mother. A child so conceived
is not a child born in wedlock and therefore illegitimate. As such,
the mother and the father have no rights or interests of the said
child (Dornbus v. Dornbus, No. 51, S. 13 875 (Super Ct. Cook
Country, No. 1954, appeal dismissed 12 III. App. 2d 473 (1956).
A child conceived by A . I . D . is illegitimate, but the husband at
the time of birth was obliged to give support. The trial judge ruled
that because the husband had consented to the artificial insemi-
nation procedure there arose "an implied contract to support the
child although the court considered the child illegitimate (Gursky
v. Gursky, 242 NnYlS. 2d 406, 39 Misc. 2d 1083 Sup. Ct. 1936).
Child born by artificial insemination is entitled for support:
The husband consented in writing for artificial insemination of
the wife. A male child was conceived and born. The spouse later
had a divorce and the wife was given custody of the child. The
wife later became ill and disabled so she applied for a state support
of the child. The District Attorney brought a criminal action against
the husband to force him to provide for the child's support. The
court ruled that "reasonable man who, because of his inability to
procreate, actively participates and consents to his wife's artificial
insemination, knows that such behavior carries with it legal res-
ponsibilities of fatherhood and criminal responsibility of non-
support (People v. Sorenson, 66 Cal. Rptr. 7, 437 P. 2d 499 (1968).
606 LEGAL MEDICINE
B. IN VITRO FERTILIZATION
A. AS TO REQUISITES OF A V A L I D M A R R I A G E :
Art. 52, Civil Code:
Marriage is not a mere contract but an inviolable social institu-
tion. Its nature, consequences and incidents are governed by law
and not subject to stipulation, except that the marriage settle-
ments may to a certain extent fix the property relations during
the marriage.
613
614 LEGAL MEDICINE
Art. 62, Civil Code:
Males above twenty but under twenty-five years of age, or
females above eighteen but under twenty-three years of age, shall
be obliged to ask their parents or guardian for advice upon the
intended marriage. If they do not obtain such advice, or if it be
unfavorable, the marriage shall not take place till after three
months following the completion of the publication of the appli-
cation for marriage license. A sworn statement by the contracting
parties to the effect that such advice has been sought, together
with the written advice given, if any, shall accompany the appli-
cation for marriage license. Should the parents or guardian
refuse to give any advice, this fact shall be stated in the sworn
declaration.
A physician may be required to determine the ages of the con-
tracting parties whenever the question of the validity of marriage
is at issue. Such determination of the age may be made by the
analysis of the peculiarities connected with the age, e.g., growth
of the pubic hair, presence of the third molar, development of
the breast, height, character, and educational attainment of the
person.
Art. 81, Civil Code:
Marriages between the following are incestuous and void from
their performance, whether the relationship between the parties
be legitimate or illegitimate.
(1) Between ascendants and descendants of any degree;
( 2 ) Between brothers and sisters, whether of the full or half
blood;
( 3 ) Between collateral relatives by blood within the fourth
civil degree.
Art. 82, Civil Code:
The following marriages shall also be void from the beginning:
(1) Between stepfathers and stepdaughters, and stepmothers
and stepsons,-
( 2 ) Between the adopting father or mother and the adopted,
between the latter and the surviving spouse of the former,
and between the former and the surviving spouse of the
latter;
( 3 ) Between the legitimate children of the adopter and the
adopted.
B. AS TO M A R I T A L RELATION:
Art. 109, Civil Code:
The husband and wife are obliged to live together, observe mutual
MARITAL UNION AND DISSOLUTION 615
6. Economic conditions:
a. Unemployment of the husband.
b. Wife sole or co-wage earner.
c. Support or dependents.
d. Desire to complete education or professional training.
Contraceptive Methods:
1. Contraceptive Methods in General
Condom Contraceptive jelly alone
Coitus interruptus Coitus interruptus and
Douche douche
Suppository Condom and pessary
Safe period Condom and douche
Nothing Condom and jelly
Gold-stem wishbone pessary External coitus
Vaginal diaphragm (rubber) Lactation
French pessary (cervical Suppository and douche
type) Abstinence
Lanteen pessary
2. Male Method of Contraception:
Condoms with jelly, suppository or douche.
Coitus interruptus with douche.
MARITAL UNION AND DISSOLUTION 617
C. A S T O A N N U L M E N T O F M A R R I A G E :
Art. 85, Civil Code:
A marriage may be annulled for any of the following causes,
existing at the time of the marriage:
(1) That the party in whose behalf it is sought to have the mar-
riage annulled was between the ages of sixteen and twenty
years, if male, or between the ages of fourteen and eighteen
years, if female, and the marriage was solemnized without
the consent of the parent, guardian or person having author-
ity over the party, unless after attaining the ages of twenty
or eighteen years, as the case may be, such party freely
cohabited with the other and both lived together as husband
and wife;
618 LEGAL MEDICINE
(2)
(3) That either party was of unsound mind, unless such party,
after coming to reason, freely cohabited with the other
as husband or wife;
(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;
(5)
(6) That either party was, at the time of marriage, physically
incapable of entering into the married state, and such
incapacity continues, and appears to be incurable.
D. AS TO LEGAL SEPARATION:
Our law recognizes only relative divorce but not absolute divorce.
Art. 97, Civil Code:
A petition for legal separation may be filed:
( 1 ) For adultery on the part of the wife and for concubinage
on the part of the husband as defined in the Penal Code; or
(2) An attempt by one spouse against the life of the other.
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
MARITAL UNION AND DISSOLUTION 619
I. IMPOTENCY
620
IMPOTENCY AND STERILITY 621
Causes of Impotency:
A. General or Functional, Not Connected Directly with the Sexual
Organs:
Any of the following factors lead to, cause, or produce per-
manent or temporary impotency.
1. Age:
Inasmuch as the female is the passive agent in the sexual
intercourse, there is no limit for her age, except when she is
below the age of sixteen. As long as there is erection in the
male, he is considered to be potent.
2. Illness:
Diseases attended by general debility may temporarily re-
move the sexual power on the part of the male. Diseases of
the brain and of the spinal cord may yield to permanent loss
of potency. Mumps occasionally leads to the atrophy of the
sex organs.
622 LEGAL MEDICINE
3. Emotion:
Some females manifest vaginismus due to actual pain on
contact or to the fear of pain on sexual intercourse. This con-
dition is usually common among virgins. This is produced by
the violent contraction of the constrictor muscles of the vaginal
orifice and may also be brought about by the contraction of
the adductor muscles of the thighs. Anesthesia may cure the
condition and pregnancy may produce a permanent cure. In
the male, emotion may lead or produce temporary impotency.
4. Hormonal dysfunction may also lead to temporary or permanent
impotency.
B. Local or Organic, in Direct Connection with the Sexual Organs:
1. Congenital Defects:
a. In Males:
(1) Nondevelopment of the penis.
(2) Maldevelopment of the penis.
(3) Penis adherent to the scrotum.
(4) Duplex organ.
b. In Females:
(1) Absence of vagina.
( 2 ) Vagina ill-developed, e.g., may be too small.
( 3 ) Vagina occluded by intrauterine disease.
2. Disease or Accident:
a. In the Males:
(1) Penis:
( a ) Acute diseases of the penis, as gonorrhea.
( b ) Chronic diseases as epithelioma.
( c ) Complete amputation of the penis.
( 2 ) Testis:
(a) Removal of the testis.
( b ) Sexual abuse.
b. In the Females:
( 1 ) Vaginal ulceration.
( 2 ) Diseases of the vulvae.
( 3 ) Obstruction of the vaginal canal due to tumor, cyst or
fibroid.
II. STERILITY
Sterility is the loss of power of procreation and is absolutely
independent of whether or not impotence is present. A man or a
woman may be sterile and yet not impotent, and impotent yet not
sterile.
IMPOTENCY AND STERILITY 623
Causes of Sterility:
A. General or Functional, Unconnected Directly with the Sexual
Organs:
Before puberty there is no spermatozoa in the seminal fluid,
hence sterile, but as age increases, fertility also increases.
B. Local Causes of Sterility:
1. Congenital Conditions:
a. In the Male:
( 1 ) Absence or nondevelopment of testicle.
( 2 ) Absence or nondevelopment of penis.
(3) Maldevelopment of the testicle.
( 4 ) Misplacement of the testicle.
( 5 ) Malformation of the penis, as in epispadias or hypospadias.
b. In the Female:
(1) Absence or maldevelopment of the ovary.
(2) Absence or maldevelopment of the uterus.
(3) Absence of the vagina.
2. Acquired Conditions:
a. In the Male:
(1) Complete amputation of the penis.
(2) Excision of the testicle.
(3) Diseases of the testicle.
(4) Atrophy of the testicle.
b. In the Female:
(1) Excision of the ovaries.
(2) Diseases of the ovary.
(3) Occlusion of the vagina from diseases.
(4) Diseases of the vagina.
(5) Occlusion of the Fallopian Tubes.
Methods of Sterilization:
A. On the part of the male:
1. The source of sperm production can be eliminated by removing
both testicle (Orchiectomy).
2. The tubular passage (vas deferens) through which the sperm are
transported from the testicle to the urethra where they com-
bined with the seminal fluid elaborated by the prostrate gland
to form the ejaculant, can be divided and the cut ends tied
(vasectomy); thus newly produced sperm cannot join the
ejaculant and the ability of the male to fertilize the female
is lost.
624 LEGAL MEDICINE
MEDICO-LEGAL ASPECT
OF
DISTURBANCE OF MENTALITY
I. INSANITY
625
626 LEGAL MEDICINE
(1)
( 2 ) If the testator was insane, or otherwise mentally in-
capable of making a will, at the time of its execution.
g. An insane cannot give consent to a contract:
Art. 1327, Civil Code — The following cannot give consent to
a contract:
( 1 ) Unemancipated minors:
( 2 ) Insane or demented persons, and deaf-mutes who do not
know how to write.
h. The guardian or the insane himself, if there is no parent or
guardian shall be held liable for damages due to his insanity:
Art. 2180, Par. 3, Civil Code — Guardians are liable for
damages caused by the minors or incapacitated persons who
are under their authority and live in their company.
Art. 2182, Civil Code — If the minor or insane person causing
the damage has no parents or guardian, the minor or insane
person shall be answerable with his own property in an action
against him where a guardian ad litem shall be appointed.
A guardian ad litem is a guardian appointed by the court to
prosecute or defend a suit on behalf of a party incapacitated
because of minority or insanity.
2. In the Revised Penal Code:
a. Insanity exempts a person from criminal liability:
Art. 12, Revised Penal Code — Circumstance which exempt
from criminal liability — The following are exempt from cri-
minal liability:
( 1 ) An imbecile or an insane person, unless the latter has
acted during lucid interval.
b. A person who becomes insane after final sentence:
Art. 79, Revised Penal Code — Suspension of the execution
and service of the penalties in case of insanity — When a
convict shall become insane or an imbecile after final sentence
has been pronounced, the execution of said sentence shall be
suspended only with regard to the personal penalty, the pro-
visions of the second paragraph of circumstances number 1 of
article 12 being observed in the corresponding cases.
If at any time the convict shall recover his reason, his sen-
tence shall be executed, unless the penalty shall have prescribed
in accordance with the provision of this Code.
The respective provisions of this section shall also be ob-
served if the insanity or imbecility occurs while the convict is
serving his sentence.
628 LEGAL MEDICINE
( 3 ) Fear of Place:
Churches — Ecclasiophobia Crowds — Ochlophobia
Empty room — Kenophobia Sea — Thalassophobia
Enclosed room — Home surroundings —
Claustrophobia Ecophobia
School — Scholionophobia _ River — Potamophobia
DISTURBANCE OF MENTALITY 633
2. Physical Examination.
3. Instrumentations:
X-ray, electroencephalogram, scanning and other modern
apparatus.
4. Mental Examination:
Psychologic Testing
Psychiatric Evaluation
The wife of the accused and her cousin testified that the ac-
cused was continuously out of his mind for many years. The
assistant district health officer who examined the accused testified
that he was suffering from violent mania and that condition could
be present at the time he killed the deceased. There was no
motive for the accused to kill the deceased. The court considered
the accused insane (People v. Bascos, 44 Phil. 204).
The accused was suffering from malignant malaria when she
attacked, wounded and killed her husband. It has been shown
that malaria affected the nervous system and caused complications
like acute melancholia and insanity at times. The accused was
considered not criminally liable (People v. Lucena, 69 Phil. 350).
2. As a Mitigating Circumstance:
Art. 13, Revised Penal Code — Mitigating circumstances — The
following are mitigating circumstances:
8. 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.
9. Such illness of the offender as would diminish the exercise
of the will-power of the offender without however de-
priving him of consciousness of his acts.
10. A n d , finally, any other circumstance of a similar nature
and analogous to those above mentioned.
The fact that the accused is suffering from a mild behavioral
disorder as a consequence of an illness she had in early life is
regarded as mitigating circumstance under Art. 13, Par. 8 or in
Par. 9 of the Revised Penal Code (People v. Amit. 82 Phil. 820).
One who was suffering from acute neurosis which made him
ill-tempered and easily angered was entitled to the mitigating
circumstance because illness diminished his exercise of will power
(People u. Carpenter C.A. G.R. 4168 Apr. 22, 1940).
(c) If the accused knew the nature and quality of the act,
then it must be proven that he did not know that what
he was doing was wrong. "Wrong", insofar as McNagh-
ten's Rule is concerned, means contrary to law. The
knowledge that the act was in violation of criminal
law has been held to be sufficient to justify holding
the accused reponsible.
The accused's delusion that the killing in question
has been directed by God was not sufficient to excuse
DISTURBANCE OF MENTALITY 639
Classical Classification:
1 Idiot - Usually congenital and due to defective development of
the mental faculties. An idiot is wanting in memory, will power
and emotion. He cannot express himself by language, is quiet,
642 LEGAL MEDICINE
/. Q. Classification
Above 140 "Near" genius or genius
1 2 0 - 140 Very superior intelligence
1 1 0 - 120 Superior intelligence
90 - 110 Normal or average intelligence
80 - 90 Dullness, rarely classified as feeble-minded
7 0 - 80 Borderline deficiency, sometimes classified
as dullness, often as feeble-minded
Below 70 Definitely feeble-minded
2. Upon motion of one of the parties, the court may issue an order
to submit a person to a physical and mental examination.
1. Judicial Methods:
a. Rule 101, Rules of Court:
Proceedings for hospitalization of insane persons:
Section 1. Venue. Petition for commitment — A petition for
the commitment of a person to a hospital or other place for the
insane may be filed with the Court of First Instance (Regional
Trial Court) of the province where the person alleged to be
insane is found. The petition shall be filed by the Director of
Health in all cases where, in his opinion, such commitment is
for the public welfare, or for the welfare of said person who, in
his judgement, is insane, and such person or the one having
charge of him is opposed to his being taken to a hospital or
other place for the insane.
Section 2. Order for hearing — If the petition filed is suf-
ficient in form and substance, the court, by an order reciting
the purpose of the petition, shall fix a date for the hearing
thereof, and copy of such order shall be served on the person
alleged to be insane, and to the one having charge of him, or
on such of his relatives residing in the province or city as the
judge may deem proper. The court shall furthermore order the
sheriff to produce the alleged insane person, if possible, on the
date of the hearing.
2. Extrajudicial Methods:
a. Voluntary:
The insane person himself or with the assistance of the
relatives or guardian during the lucid intervals or during such
time that he is still normal may request his confinement in a
hospital or asylum. This is common among persons who are
afflicted with the disease and are aware of the advantage of
hospitalization.
b. Involuntary:
The immediate relatives, the peace officer or other per-
sons who are concerned with the welfare of the society may
force the insane to be confined in a hospital. Such coersive
confinement may be in accordance with the valid exercise of
police power of the state or by virtue of ordinance.
Police power is the power inherent in a government to enact
laws within constitutional limitations, to promote order, safety,
health, morals, and the general welfare of society.
Sec. 2238, Revised Administrative Code — General power of
council to enact ordinances and make regulations: —"The
municipal council shall enact such ordinance and make such
DISTURBANCE OF MENTALITY 649
Causes of Malingering:
1. To Avoid Military or Naval Training:
A person may feign disease or injury because he is required by
law to undergo military or naval training. Under the National
Defense Act (Commonwealth Act N o . 1) all male citizens of the
Philippines who have reached 20 years of age must undergo
military training under penalty of law for failure to do so. All
male college students enrolled must have at least two years of
military training as a requisite for graduation. For some reason
or cause, a person may malinger disease or injury so that he will
not be subjected to such a requirement.
2. To Avoid Court Summons:
A person may have received a summon from a court requiring
him to appear on a specified date, time and place but refuses to
appear because he is a defendant in the case wherein he wants to
delay the proceeding, or he is afraid to be subjected to the ordeal
of direct and cross examination. He may simulate that he is
suffering from a disease or injury which incapacitate him to attend
the trial.
3. As a Defense to a Criminal Prosecution:
Impotency may be utilized by the defendant in the prosecution
of the crime of rape. An accused while on trial may allege that it
is not possible for him to commit the crime of rape because he is
impotent.
4. To Increase Civil Liability:
A plaintiff in a civil action for the recovery of damages and for
the injury sustained may exaggerate the physical disability so that
he may receive bigger award from the court.
5. To Promulgate Sympathy:
A beggar may exaggerate incapacity or simulate disease or injury
so that the public may be more sympathetic towards him and give
him more alms.
650 LEGAL MEDICINE
Types of Malingering:
1. "Feigned or Fictitious" Malingering:
Malingering is built up out of pure imagination and does not have
the slight basis of fact. The disease or injury which a person
allegedly is suffering from does not exist at all.
Example: A person may simulate that he is totally blind while
in fact both eyes are normal.
2. "Factitious" Malingering:
This is a form of malingering whereby something really exists as
a fact but is converted to a more serious disability or injury, or
to an exaggeration of the real complaint. Here the person is really
suffering from an injury or disease but he may exaggerate or
amplify the seriousness of the complaint or nature of the injury or
disease.
Example: A person might have received a small superficial
scratch but complained of severe and unbearable pain
and incapacity to move.
placing of the injured portion under plaster cast and the patient
may refuse because it may put him to some inconvenience.
A person may complain of some disturbance in the gastrointes-
tinal tract but when prescribed magnesium sulfate, he refused to
take it.
Whenever a physician is requested to examine a patient to
determine whether he is malingering or not, he must utilize all
of his senses, have a keen observation and apply methods of
detection appropriate for the occasion.
1. Somnambulism:
This is an abnormal mental condition whereby a person is
performing an act while in the state of natural sleep. A somnam-
bulist might be concentrated in a particular train of idea or ob-
sessed by certain thoughts which baffled his mind that he tried to
execute it while in the state of sleep. He may commit the crime
of murder, infanticide, or parricide while under the influence of
the fit. A somnambulist has no recollection of the events occur-
ring during the fit and in several courts of different countries
somnambulists are exempted from criminal liability.
In a case cited by Modi, Marggie Alexander was charged of
having killed her child with a razor while in the state of sleep.
The jury gave a verdict of guilt but insane because the somnambulist
did not know what she was doing nor was capable of appreciating
the nature and quality of the act.
In the Philippines, in the case of People v. Gimena (55 Phil-
604) the defendant attacked his wife with a bolo. The defense
DISTURBANCE OF MENTALITY 653
2. Semisomnolence or Somnolencia:
A person is in a semisomnolence state when he is half asleep or in
a condition between sleep and waking. A person may be suddenly
aroused and may unconsciously commit a criminal act, like
murder, infanticide or parricide, or some other crimes, while his
mind is at the state of confusion.
Criminal acts committed in this state do not show manifestations
to justify insanity. There is no jurisprudence in the Philippines
deciding squarely whether it will exempt a person from criminal
liability.
3. Hypnotism or Mesmerism:
A person is made unconscious by the suggestive influence of the
hypnotist. He may commit a criminal act while under the influence
of hypnotism which he may not be capable of doing while under
a normal state.
A person cannot be hypnotized against his will, and if a person
volunteers to be hypnotized he must anticipate all the conse-
quences of his acts while under the hypnotic spell.
Hypnotism as a defense to a criminal act is not accepted with
favor in the court. A person cannot take advantage of his own
misconduct.
However, under the Civil Code (Art. 1328) contracts agreed to
during hypnotic spells are voidable. The Civil Code seems to
acknowledge the absence of the normal state of mind of a person
under the influence of hypnotism.
4. Delirium:
Delirium is a state of confusion of the mind. It is characterized
by incoherent speech, hallucination, illusions, delusions, restless-
ness, and apparently purposeless motions. A person may, when
under the state of delirium, commit a crime.
It may be advanced that a person committing a felonious act
while in a delirious state may be exempted from criminal liability
although there is no jurisprudence in the issue yet.
Chapter XXXII
DRUG DEPENDENCE
654
DRUG DEPENDENCE 655
D A N G E R O U S D R U G ACT
rates the drugs which are included in the category of prohibited and
those considered regulated drugs for the purpose of graduating
penalties. Violation of different acts relative to prohibited drugs has
higher penalties as compared with the same acts committed in vio-
lation of the regulated drugs. The classification is not based on their
pharmacologic effects but on societal reaction in the control on
specific acts of specific drugs. If society has a strong adverse attitude
against any drug, then it will be included in the enumeration of
prohibited drugs. The following drugs or group of drugs are con-
sidered dangerous and are governed, by the Dangerous Drug Act.
1. Prohibited Drugs:
a. Opium and its active components and derivatives, such as heroin
and morphine;
b. Coca leaf and its derivatives, principally cocaine;
c. Alpha and beta cocaine, hallucinogenic drugs, such as mescaline,
lysergic acid diethylamide ( L S D ) and other substances pro-
ducing similar effects;
d. Indian hemp and its derivatives;
e. All preparations made from any of the foregoing; and
f. Other drugs, whether natural or synthetic, with the physio-
logical effects of a narcotic drug (Sec. 2.2, N o . 1, R . A . 6425).
2. Regulated Drugs:
a. Self-inducing sedatives, such as secobarbital, phenobarbital,
pentobarbital, barbital, amobarbital and any other drug which
contains salt or a derivative of a salt of barbituric acid;
b. A n y salt, isomer or salt of an isomer, of amphetamine, such as
benzedrine, or any drug which produces a physiological action
similar to amphetamine; and
c. Hypnotic drugs, such as methaqualone or any other compound
producing similar physiological effects (Sec. 2. No. (2), R. A.
6425).
Any drug or group of drugs included in the classification may
cause a user to be drug dependent. Drug dependence means a state
of psychic or physical dependence, or both, on a dangerous drug,
arising in a person following administration or use of that drug on
a periodic or continuous basis (Sec. 2(g), R . A . 6425). Drug depend-
ence may either be a condition of drug addiction or drug habituation.
1. Drug addiction is a state of periodic or chronic intoxication pro-
duced by the repeated consumption of a drug, whether synthetic
or natural, and found to be detrimental to the individual and to
the society ( W H O ) .
DRUG DEPENDENCE 657
1. Prohibited Drugs
Section Prohibited Act Penalty
3 Importation of prohibited 14 yrs. & 1 day to life
drugs. imprisonment and a
fine of 14,000 to
30,000 pesos.
4 Sale, administration, deli- 12 yrs. & 1 day to
very, distribution and trans- 20 years imprisonment
portation of prohibited and a fine of 12,000
drugs. to 20,000 pesos.
If the victim died, life
imprisonment to death
& a fine of 20,000 to
30,000 pesos.
pesos.
2. Regulated Drugs
HYPNOTIC DRUGS
Stage of Stupor:
a. The person suddenly becomes quiet.
b. There may be headache, giddiness, lethargic condition and
uncontrollable desire to sleep.
c. When asleep, he can be aroused by external stimuli.
d. Pupils are contracted, face and lips are cyanosed.
e. There is itching sensation all over the skin.
f. Pulse and respiration are still normal.
Stage of Narcosis:
a. The patient passed into a deep coma.
b. He cannot be aroused by external stimuli.
c. Muscles are relaxed and reflexes are lost.
d. Skin secretion is completely suspended although the skin feels
cold and clammy.
e. The face is pale, the lips are livid and there may be a drop of
the lower jaw.
f. The pupils are contracted to almost a pinpoint and they're
insensible to light.
g. Conjunctivae are injected.
h. The pulse is slow, small and compressible.
i. Respiration is slow, labored and stertorous.
If dosage is lethal and no prompt and proper treatment is given,
the following symptoms of the toxicity may be observed:
j. Lividity of the face increases and pulse becomes slower, irreg-
ular and imperceptible,
k. Respiration becomes slower, feeble and later Cheyne-Stokes
and the patient may die of asphyxia.
1. The heart may beat for a while but later stop,
m. Convulsion may occur with the pupils dilated immediately
after death.
4. Consequences of Continuous Use of the Drug:
a. Development of tolerance to the drug. The drug is taken in
large quantity without producing any effect or without fatal
consequence.
b. Physical and moral deterioration.
c. Untruthfulness, dishonesty and mental deterioration.
d. When under the influence of the drug, he is calm and com-
posed, but becomes restless and irritable when deprived of
the drug.
e. May develop constipation and intercurrent infection, like
tuberculosis.
f. Those who try to inject themselves develop scars and abscesses
in the skin.
662 LEGAL MEDICINE
7. Withdrawal Syndrome:
If an addict is suddenly deprived of opiate, the following symp-
toms may be observed:
Objective Signs:
a. 8 to 16 hours after withdrawal — nervousness, restlessness and
anxiety.
b. 14 hours later — frequent yawning, sweating, running of nose
and lacrimination.
c. 24 hours later — symptoms increase, pupils are dilated, goose-
flesh develops and shivering attack.
d. 36 hours — severe twisting of muscles, painful cramps of legs
and abdomen, vomiting and diarrhea.
e. 3 — 4 days — blood sugar rises; patient becomes sleepy on the
3rd day.
Subjective Symptoms:
a. Pain.
b. Hallucination.
c. General body weakness.
d. Suicidal impulse.
e. Depression.
f. Criminal propensities.
g. Colic.
8. Elimination of Opium:
a. Through the stomach and intestine irrespective of whether the
drug is administered by mouth or by injection.
b. A great portion of the drug is oxidized in the liver.
c. A small portion is eliminated through the urine.
9. Post-mortem Findings in Opium Poisoning:
Nothing characteristic but signs of asphyxia are most pro-
minent:
a. Face and fingernails are livid.
b. Froth comes out of both nostrils and mouth.
c. Dark fluid blood is found in the heart and big blood vessels.
d. Trachea is congested and filled with froth.
e. Lungs are engorged, edematous and exudes frothy fluid.
f. Stomach may contain brownish lump of opium mixed with
brownish viscid fluid, if opium was ingested.
g. Odor of opium may be present in the stomach content.
h. There is brain congestion.
664 LEGAL MEDICINE
SEDATIVES
BARBITURATES:
Barbituric acid or malonyl carbamide was the product of the
synthesis of malonic acid and urea allegedly on St. Barbara day.
Small dose has sedative effects while bigger dose may induce sound
sleep.
Long-acting preparations:
Combination:
a. Secobarbital — amobarbital (Tuinal) — "tooies", "christmas
trees", "rainbow".
Barbiturates in general — "goofballs", "footpills".
2. Use of Barbiturates:
Medicinal:
a. Prescribed in the treatment of high blood pressure, insomnia
and epilepsy.
b. Used in the diagnosis and treatment of mental illness.
c. Given to relax patient before and during surgery.
Non-medicinal:
a. To escape personal problems — usually insecurity, failure or
frustration.
b. A substitute for heroin when the supply of their preferred
drugs runs short to intensify the effect of heroin.
c. To quiet oneself down (Amphetamine abusers).
d. Some patients have increased their prescribed dosage to the
state of dependence.
DRUG DEPENDENCE 665
METHAQUALONE:
Methaqualone is a sedative drug in a smaller dose and a hypnotic
in a bigger dose. The effect is similar to barbiturates and action is
within 30 minutes after administration; the effect is for 6 to 10
hours. It has no analgesic effect but can potentiate the analgesic
effect of other drugs like codeine. The hypnotic dose is 150 —
500 mg. and the fatal dose is probably 5 grams.
The symptoms of poisoning are nausea, gastric irritation, vomiting
muscle twitching, hypertonia, cardiac arrhythmia, tachycardia and
respiratory depression.
666 LEGAL MEDICINE
H A L L U C I N O G E N S OR PSYCHOMIMETIC D R U G S
1. Classification:
a. Natural
Source Active principle
Amanita muscaria — Mushroom Unknown
Banisteria caapi — vine Harmine
Cannabis sativa — Hemp Cannabinols
Catnip — plant Unknown
Datura — plant Scopolamine
Epena — tree bark Unknown
Iboga — plant root Ibogaine
Kaba — Piper M. plant Unknown
Nutmeg — tree seeds Myristicine
DRUG DEPENDENCE 667
b. Synthetic
Name Chemical Name
DET Diethytrytamine pipidylbenzilate
DITRAN Pipidylbenzilate
DMT Dimethyl tryptamine
DPT N ( 1 ) N dipropyltryptamine
LBJ N ( C H 3 ) 3 piperidylbenzilate H C L
LSD D Lysergic Acid Diamide
MDA 3, 4 Methylenedioxyamphetamine
MMDA 5 methoxymethlenedioxyamphetamine
PCP Phencyclidine
PCPA p-chlorophenylalanine
STP-DOM 2, 5 dimethoxy 4 methylamphetamine
TMA 3, 4, 5, trimethoxyamphetamine
MARIJUANA.
Marijuana is a Mexican term meaning "pleasurable feeling".
Marijuana is a mixed preparation of the flowering tops, leaves, seeds
and stem of the hemp plant, Cannabis sativa. The plant may grow
from 3 to 10 feet high, but may grow as tall as 16 feet. The highest
quality of marijuana is derived from choice hemp grown in hot, and
humid places and from the mixture containing mostly of resin
covered tops and upper leaves. The flowering tops of both male
and female plants produce a sticky resin which contains Tetrahydro-
cannabinol or T H C , the major pharmacological active ingredient.
The potency of the mixture depends on the resin content and this
is determined mainly by the plant strain and also by the factors
involved in cultivation, harvesting and preparation of the crop.
There are many species of cannabis and other plants reported to
contain T H C . On a study, it's been reported that 117 of 350 plants
of cannabis contains 0% of T H C . Another study showed that the
THC content ranges from 0.04% to 6.1%.
Questions:
1. Does our local marijuana plant contain THC?
2. If so, how much does it averagely contain?
3. What will be the effect on the toxic contents if grown in high
mountain or in the lowland?
668 LEGAL MEDICINE
Effects of Marijuana:
1. Subjective Effects (after a number of inhalation):
a. A feeling of lightness of the extremities, followed by "rushes"
of warmth and well-being that eventually lead to a sense of
relaxation and mild euphoria.
b. A distortion of sense of time, distance, vision and hearing.
( 1 ) A minute seems like an hour.
( 2 ) Eyes tend to focus on one object to the exclusion of others.
( 3 ) Certain sounds become striking in character and music
takes on a new dimension.
c. Whetted appetite. Food and drink taste especially good.
d. A tendency to be confused about the past, present and future.
e. Impaired short-term memory. There is a deterioration in the
capacity to carry out task requiring multiple mental steps to
reach specific goals.
f. Tendency to be easily distracted.
g. The suggestibility and release of inhibition.
h. Increased sense of sociability and hilarity.
These effects are at peak, shortly after smoking and fade
away after a few hours, leaving a desire to sleep.
2. Objective Effects:
a. Moderate increase in resting pulse rate.
b. Reddening of the eyes due to dilatation of the conjunctival
blood vessels.
c. Difficulty of speech and of remembering the logical trend of
what was being said.
d. Neurological and EEG examinations show slight increase in
cortical functions.
670 LEGAL MEDICINE
L Y S E R G I C A C I D D I E T H Y L A M I D E ( L S D - 2 5 ; D ) — Lysergic acid
diethylamide tartrate.)
The drug was first synthesized by Dr. Albert Hoffman and Dr.
Arthur Stell while working in a Swiss pharmaceutical firm. LSD is
synthesized from the alkaloids or ergot (Claviceps purpurea), a
fungus that parasitizes rye and other grains in Europe and America
and diethylamide portion of ergotamine ergonevine, the active
oxytocic and vasoconstrictor drugs. The synthesis was found to
have strange and potent central effects.
3. Untoward Effects:
a. Acute panic reaction ("Bad trip", "freak-out") as a frequent
complication may lead to suicide attempts.
b. L S D removes the usual intrinsic restraints causing uncontrol-
lable violence or aggression.
c. It causes chromosomal breaks and/or chromosomal rearrange-
ments which may persist as long as 15 months. This may cause
malformation of the children to be born.
Thalidomide is another allied drug which produces a broadly
defined syndrome of limb, cranial nerve, heart, eye, ear and
reproductive system defects of varying degree of severity. The
fetus is susceptible to thalidomide only for 14 days; that is
between the 36th to the 50th day following the last menstrual
period.
STIMULANTS
AMPHETAMINES:
Amphetamine was first synthesized in 1927 as a substitute for
epinephrine which was isolated from the adrenal gland and from
ephedrine obtained from the Chinese herb ephedra vulgaris.
Withdrawal Symptoms:
Initially there is a sensation of chilliness, uneasiness and yawning.
This symptom will be followed by rhinorrhea, lacrimation and
mydriasis. Respiration will become labored and short with a feeling
of anorexia. Later the person will fall asleep and if awakened the
symptoms will become pronounced with tachycardia, fever and
hypertension. Pain and cramp of the legs and abdomen will be
observed. Perspiration, vomiting, diarrhea and tremor will be ob-
served.
Psychological dependence develops among chronic abusers only
and may lead to social, economic and emotional deterioration.
Excretion:
50% of amphetamine is destroyed in the liver by dissemination and
the rest in the kidneys at a slower rate. The drug use to appear in
the urine 3 hours after administration.
The presence of amphetamine is detected in body fluid by (1) gas
chromatography with hydrogen flame detector or by ( 2 ) thin layer
chromatography.
COCAINE:
Cocaine is an alkaloid from the leaves of the coca shrub cul-
tivated extensively in Bolivia and Peru. It is also grown in Java,
Taiwan and Sri Lanka. The leaves are harvested from the plant not
less than 10 months old. The matured leaves are plucked, dried and
packed in bales.
Cocaine may be taken by injection, by chewing or by sniffing of
crystals through the nostrils. The coca leaf is chewed by many
DRUG DEPENDENCE 677
Indians of the Andes for its stimulating effects and also for depres-
sing appetite. Repeated sniffing of cocaine crystals into the nasal
passage may cause gradual erosion and perforation of the nasal
membrane.
Cocaine stimulates the sympathetic system causing increased
pulse rate, dilatation of the pupils and perspiration. It is a eupho-
riant and speedily relieves fatigue. Cocaine is said to cause sexual
excitement and the drug therefore is popular among the undersexed
or sexual perverts.
Tolerance to the drug is slow and dependence tends to be psycho-
logical rather than physical.
If cocaine is taken for a period of time, especially in excessive
dosage, it may cause pallor, poor appetite, salivation, loss of weight,
and damage to the nasal membrane and cartilage in sniffers. Cuta-
neous scars of old injection sites may be evident and habitual cocaine
eaters develop black teeth and tongue.
Magnan's Symptom or the feeling as if grains of sand are lying under
the skin or small insects (cocaine bugs) are creeping on the skin is
the most characteristic symptom.
It has been reported that cocaine leads to erotic tension in women.
Death may be due to epilepsy or respiratory failure.
The drug when withdrawn from the user may cause withdrawal
symptoms in the form of insomnia, reactive depression, and paranoid
attitudes which may lead to paranoid psychosis.
Users of cocaine recently combine it with heroin called "mixing
the gravy" to counteract lethargy and social isolation effect of
heroin.
Medically the use of cocaine has markedly declined and its major
use is only as anesthesia of the nose and throat. On account of the
disadvantages observed in the use, the synthetic procaine becomes
the wildly used substitute under the trade name of novocain.
Prostitutes inject a solution of cocaine into the vagina. This
gives the individual a sense of local constriction and exhilarating
systemic feeling. In men cocaine is applied locally to the glans
penis to increase the duration of the sexual act. It may cause sexual
perversion especially in homosexuality or in libidinous outrages.
In fatal dose, death is due to cardiac or respiratory failure.
Cocaine "body packer" Syndrorpe refers to the ingestion of
multiple small packages of cocaine for the purpose of transporting
the contraband. The drug is placed in a durable, non-digestible
container, taken by mouth to be recovered at the place of desti-
nation in the fecal discharge. Aside from human beings, the pack-
678 LEGAL MEDICINE
ages are fed to camels or ducks. In the case of ducks they are slaugh-
tered to retrieve the drug. Rupture of the container while in the
alimentary tract with consequent cocaine poisoning has been reported
in literature.
DRUG DEATH:
Drug related death may be classified into three categories:
1. Primary drug fatalities — those which death is due to the toxic
or adverse effect of the chemical agent, with or without the con-
tributory influence of pre-existing, unrelated natural disease.
2. Secondary drug fatalities — those arising from medical compli-
cations of drug abuse, such as viral hepatitis and bacterial endo-
carditis.
3. Drug-associated fatalities — those caused by homicidal, accidental
and suicidal violence stemming directly or indirectly from acti-
vities related to the obtaining and use of illicit drugs.
The qualitative and quantitative determination of the dangerous
drug in the human body or the pathologic changes in organs cannot
be utilized as the basis of the cause of death. There are other
factors to be considered which may be responsible for the death:
1. The decedent may be usually susceptible to the deleterious effect
of the drug;
2. The combination of the drugs taken can interact in an additive
fashion;
3. Some pre-existing natural disease may have contributed to the
death;
4. The rapid absorption of large quantity of the drug can kill prior to
complete absorption of all the substance from the gastro-intestinal
tract;
5. Normal metabolic degradation of the chemical can reduce its
blood concentration during the prolonged survival interval in
which respiratory complications and hypoxic encephalopathy
maintain coma and act as the immediate cause of death.
(Modern Legal Medicine, Psychiatry and Forensic Science by
Curran, et. at., p. 1129).
d. LSD:
Van Urk test (1% p-dimethylaminobenzaldehyde and 10%
concentrated hydrochloric acid in ethyl alcohol). This reagent
turns blue-purple in the presence of L S D . However, owing to
the extremely small quantities of L S D in illicit preparations,
this test is difficult to conduct under field conditions.
e. Cocaine:
Cobalt Thiocynate test — (2% cobalt thiocyanate in water).
This reagent produces a blue flaky precipitate in the presence
of cocaine. The test is not reliable as many other drugs and
diluents respond in the same manner.
4. Chromatography:
a. Thin layer chromatography.
b. Gas chromatography.
In both methods the drug is separated from the diluent while
providing for its identification.
5. Spectrometry:
Selective absorption of light by drugs in the UV (Ultra-violet)
and IR (Infra-red) regions of the electromagnetic spectrum. UV
spectrum is not conclusive for the positive identification of drug
because other drugs may very well produce an indistinguishable
spectrum, but may be useful to establish the probable identity
of the drug.
IR spectrophotometry can specifically identify substances, but
the substance to be identified must be in pure form. A com-
bination of preliminary screening by UV followed by verification
through infra-red spectrophotometry is the most ideal approach to
drug identification.
DELIRIANTS
PRESCRIPTION OF D A N G E R O U S D R U G S
Prescription Forms:
For the purpose of this Act, all prescriptions issued by physicians,
dentists, veterinarians or practitioners shall be made out on forms
exclusively issued by and obtained from the Board. Such forms shall
be made of a special kind of paper and shall be distributed in such
quantities and contain such information and other data as the Board
may, by rules and regulations, require. Such forms shall not be issued
684 LEGAL MEDICINE
2. Where the need for prescribing the dangerous drugs has arisen as
a result of a serious accident necessitating the administration of
the drugs at the scene or in the vicinity of the accident and the
required prescription forms are not readily available.
3. Where the need for the dangerous drug is urgent and its ready
availability may, in the opinion of the prescribing physician,
spell the difference between life and death of the patient, and
for unavoidable and justifiable reasons the prescribed prescrip-
tion form is not within access (Board Regulation N o . 4, Series
of 1973).
ALCOHOLISM
Ethyl alcohol ( C H O H , Ethanol, grain alcohol) i> a colorless
2 5
687
688 LEGAL MEDICINE
shall contain not less than 2% and not more than 10% by
volume of alcohol.
c. Stout — A malt liquor brewed in such a manner as to possess
the aroma, taste and character commonly attributed to stout
and, to a marked degree, the flavor of hops.
d. Porter — Malt liquor brewed in the manner used in brewing of
stout but having in comparison with stout a less marked flavor
of hops.
An alcoholic beverage shall possess the characteristic attributed
to the type of drink that is stated in the definition and standard of
identification. The preparation must be free from any ingredient
injurious to health, free from sediment of any kind, and shall be
manufactured in premises built and maintained under hygienic
condition.
Other Effects:
1. Dilatation of the blood vessels of the cutaneous surface.
2. Increase in the pulse rate.
3. Weaker cardiac systole which tend to cause cardiac dilatation.
4. Locally, it has direct irritation effect on the mucous membrane
of the stomach and intestine.
5. Slight depression of the liver functions as indicated by the de-
crease in hepatic oxygen consumption and decrease in glycogen
storage.
6. Fall of the blood pressure.
Degree of Intoxication:
1. Slight Inebriation — There is flushing of the face, with exaggerated
mood, but a person is able to control his behavior. He shows no
signs of mental impairment, incoordination of movement and
difficulty of speech.
2. Moderate Inebriation — Person is talkative, argumentative and
over-confident. There is slight impairment of mental faculties,
difficulty of articulation, and loss of coordination to finer move-
ments. The face is flushed with eyeballs congested. He is reckless
and shows motor incoordination. He may be certified as being
"under the influence of alcohol".
3. Drunk — The mind is confused, behavior is irregular and move-
ment is uncontrolled. The speech is thick and incoordinated.
Behavior is uncontrollable.
4. Very Drunk, "Dead drunk" — The mind is confused and dis-
oriented. There is difficulty in speech and marked motor incoor-
dination and often walking is impossible.
5. Coma — The subject is stuporous or comatose. Sometimes it is
difficult to differentiate this condition with others having coma.
Pathological Drunkenness:
A condition wherein a small amount of alcohol intake may be
sufficient to make a person drunk on account of an existing patho-
logical condition of the body. Brain concussion, sun-stroke, epilepsy
and other conditions may predispose a person to the effects of
alcohol.
Punch Drunkenness:
This is not a condition of drunkenness. It may be observed
among professional boxers who may have developed a peculiar
physical and mental condition on account of repeated trauma on the
head. The individual begins to have lack of concentration. He may
change the subject-matter of a conversation abruptly and may ask
the same question for several times. He has a bad memory of recent
events. He is not too sociable, garrulous and boastful but rather timid
and shy. His articulation may be glazed and slurring. Romberg's sign
may be positive and locomotion may be ataxic and unsteady. In-
voluntary movement of a boxic nature may be present. He simulates
continuously a person who is drunk.
1. Analysis of Blood:
Analysis of the blood is probably the most widely accepted
way to determine the concentration of alcohol in the body.
It is a direct method of estimation although the subject may
refuse blood extraction for such analysis.
Alcohol should not be used to sterilize the skin before with-
drawal for it might possibly give a false high reading. The blood
sample must be drawn by a physician, nurse or other competent
technician under sterile condition. On account of the great
number to be tested, especially those traffic violators, it makes
the blood analysis quite impractical.
2. Analysis of the Breath:
The concentration of alcohol in the blood can be determined
indirectly by making a quantitative determination of alcohol in
the respired air. The basis of the analysis is that there is a constant
ratio between the concentration of alcohol in the blood stream
and in the alveolar air.
Definition of Poison:
A poison is anything other than physical agencies which is capable
of destroying life, either by chemical action on the tissues of the
living body, or by physiological action by absorption into the living
system.
Legally, a poison is a substance which, if applied or administered
internally, has been applied or administered with the intention to kill
or to do harm.
The intent in the administration is the essential element in law.
The quantity does not affect culpability, nor is the law concerned
with the quantity in which the substance acts.
(From: A Synopsis of Forensic Medicine & Toxicology by E. W.
Caryl Thomas, 2nd ed., p. 142).
712
MEDICO-LEGAL ASPECT OF POISONING 713
c. Intramuscularly:
Absorption is faster than in the hypodermic method.
d. Endodermically:
The poison may be rubbed into and absorbed through the
skin.
f. By the Lungs:
Poison through this route may be made of a substance which
can be transformed to gaseous state.
716 LEGAL MEDICINE
2. Idiosyncrasy:
Some persons possess sensitivity to certain foods or drugs. The
most common drugs are potassium iodide, arsenical preparations,
aspirin and the sulfas. As to foods, the most common are fish,
shrimps, eggs and oysters.
3. Age:
There are substances which are considered poison for babies but
wholesome for adults, while the opposite is true for other sub-
stances.
There are substances which children can take more than the
proportionate dose in adults, like mercury and belladonna. In case
of some other drugs, children may be so sensitive that they cannot
take the proportionate dose for their age, like opium preparations.
4. Habit:
The body may acquire tolerance to some drugs. Habit diminishes
the effect of certain poisons. Tobacco, alcohol, opium, barbi-
turates, arsenic are good examples of this.
5. Dose:
The effect of drugs and poisons in the body is usually propor-
tional to the dose taken.
Example: Alcohol, when taken in small dose, stimulates body
reflexes and tone, while large amount depressed the
whole body.
Fatal Dose:
This is the smallest dose known to cause death: not the
smallest amount which will certainly cause death.
Clark's Rule:
Divide the weight of the child in pounds by the average weight
of the adult (150 lbs.) and take the fraction of the adult dose.
Example: The weight of the child is 50 lbs. then 50/150 equals
1/3. So the child can take 1/3 of the adult dose.
Young's Rule:
Divide the age of the child by the age of the child plus 12, and
the resulting fraction is the portion of the adult dose which
may be used.
Example: If the child is 6 years old, then 6/6+12 equals 6/18 or
1/3 of the adult dose.
MEDICO-LEGAL ASPECT OF POISONING 717
Cowling's Rule:
Divide the age of the child on his next birthday by twenty-four
and the fraction of the adult dose is to be used.
Example: If the child is 8 years old, then 8/24 equals 1/3 of
the adult dose.
b. Administration of Emetics:
(1) Zinc Sulfate — 30 grs.
( 2 ) Ipecacuanha — 20-30 grs. in two six drachms of wine.
(3) Mustard and Water — One tablespoon in one tumbler of
water.
( 4 ) Salt and Water.
(6) Apomorphine — 1/10 gr. hypodermically.
c. Physical Reaction:
This is the formation of a non-soluble compound thereby
preventing absorption.
Examples: (1) Tannic acid precipitates Strychnine.
( 2 ) Egg albumen precipitates mercuric chloride.
When the exact nature of the poison is unknown, a mixture
composing of the following substances may be used:
Powdered charcoal 2 parts
Magnesia 1 part
Tannic acid 1 part
The following formula is advanced by Murrel to be used in cases
of poisoning of any kind, although it may be incomplete:
Saturated solution of sulphate of iron 100 parts
Calcined magnesia 88 parts
Animal Charcoal 40 parts
Water 100 parts
The above formula is indicated in case of arsenic, zinc salts,
digitalis, acids of ordinary types, mercury salts, morphine and
strychnine poisoning; but this is of no use for alkalies, phos-
phorus, tin salts, or hydrocyanic acid poisonings.
3. Application of Physiological Antidotes:
a. Strychnine may be used to stimulate respiration.
b. Depression of the heart by aconite may be counter-acted by
digitalis.
c. Blood vessels may be constricted by ergot, suprarenal extracts,
digitalis and dilated by amyl nitrate and sodium nitrite.
d. Morphine, bromides or barbiturates may be given for poisoning
by stimulants.
4. Keep the patient alive by general measures, while his organs of
elimination are getting rid of the poison. Treat any urgent and
dangerous symptoms.
Symptomatic Treatments:
Pain may be relieved by the injection of morphine.
Absorption from the stomach may be hindered by adrenalin and
the use of demulcent like oil, starch, egg-albumen and water.
MEDICO-LEGAL ASPECT OF POISONING 721
3. Chemical Analysis:
This portion of criminal investigation is beyond the scope of a
physician's duty. The expert analyst or a toxicologist is much
more in the position to perform the work.
The expert chemist, analyst or toxicologist must be able to
answer the following questions:
a. When, where and from whom did you receive the article which
you have analyzed?
b. In what state were they received?
c. When did you analyze it, and where?
d. Did you analyze it alone, or were you assisted?
e. What test did you employ?
CLASSIFICATION OF POISONS
4. Animal Irritants:
a. Cantharides
5. Food Irritants
C. Narcotics:
1. Somniferous Group:
a. Opium c. Synthetic Hypnotics
b. Chloral
2. Deliriant:
a. Belladonna c. Stamonium
b. Hyoscyamus d. Cocaine
D. Depressants:
1. Neural Depressant: Paralysis of the spinal cord.
a. Aconite
b. Conium
2. Cerebral Depressants: Inhibiting the brain functions.
a. Hydrogen Cyanide c. Laurel Water
b. Oil of Bitter Almond
3. Cardiac Depressants:
a. Digitalis c. Camphor
b. Strophanthus
E. Poisons which are Exito-Motor in Action:
1. Strychnine
2. Brucine
3. Thebaine
F. Poisonous and Irrespirable Gases:
1. Poisonous Gases:
a. Carbon Dioxide d. Arseniureted Hydrogen
b. Carbon Monoxide e. Carbon Disulfide
c. Hydrogen Sulfide
2. Irrespirable Gases:
a. Chlorine c. Hydrogen Cyanide
b. Benzene
G. Contact Poisons:
1. Vegetable Irritants
2. Animal Irritants
3. Chemical Irritants
H. Vulnerants:
1. Nails 3. Dust
2. Broken Glasses
MEDICO-LEGAL ASPECT OF POISONING 727
Symptoms:
a. Vomiting and diarrhea.
b. Abdominal pain.
c. Prostration.
d. Collapse with cold sweating.
e. Rigor with pain at the back and limbs.
f. Headaches and dizziness.
Post-mortem Examination:
a. Congestion of mucous membrane of the stomach and intestine.
b. Petechial hemorrhages of the visceral organs.
c. Cloudy swelling of the kidneys.
d. Congestion of the liver and spleen.
e. Isolation of the specific organism.
Bacteriology:
The members of the salmonella group which may cause food
poisoning are:
a. B. Enteritidis e. B. Suipestifer
b. B. Paratyphosus A f. B. Psittacosis
c. B. Paratyphosus B g. B. Abortus equi
d. B. Aertryke
Botulism:
This is a specific infection in which symptoms arises from the
ingestion of a very potent exotoxin of anerobic Clostridium botu-
linum. Poisoning is usually due to ingestion of food stored and
prepared in unsatisfactory conditions and eaten without cooking.
poisons an entry stating the date of each sale and the name and
address of the purchaser, the name and quantity of the poison
sold, and the purpose for which it was claimed to be purchased,
before delivering it to the purchaser. He shall not deliver any such
poison to any person without satisfying himself that such person is
aware of its poisonous character, and that the poison is to be used
for a legitimate purpose, and he shall affix to every box, bottle, or
other package containing any dangerous or poisonous drug, a label of
red paper upon which shall be printed in large black letters the word
"poison" and a vignette representing a skull and bones, before deli-
vering it to any person. Books kept for the purpose of recording
the sale of poisons shall be open at all times to the inspection of the
Board of Pharmaceutical Examiners, and of health officers or officers
of the law, and every such book shall be preserved for at least five
years after the last entry in it has been made.
POST-MORTEM F I N D I N G S IN SOME
CHEMICAL POISONING
A. Sulfuric Acid:
1. External Appearance:
a. Putrefaction is frequently delayed.
b. There are cutaneous stains in areas where the corrosive liquid
has been spilled. The stains are frequently found in the angles
of the mouth and running in a linear fashion from the pos-
terior part of the lips to the chin.
c. The outer layers of the skin are destroyed and the derma is
parchmentized, while the deepest layer is reddish-brown in
color.
d. The lips may be blackened.
e. The tongue and mucous membrane of the mouth may be
softened, corroded and white in color.
2. Internal Appearance:
a. Internal findings are usually confined to the changes due to
the local action of sulfuric acid.
b. Cardio-Vascular System:
( 1 ) The aorta may be found with the outer wall blackened
and corroded.
( 2 ) The blood in the vessels may be coagulated and hard-
ened. This produces black arborescent cast in the smaller
vessels and in their branches and larger cylindrical casts
in the vessels of greater caliber.
c. Respiratory System:
( 1 ) The epiglottis may be blackened and shrunkened.
( 2 ) The mucous membrane of the larynx and trachea may be
swollen and congested.
( 3 ) Death may be due to asphyxia when acid has been
inspired.
( 4 ) The diaphragm may be perforated after the escape of the
acid into the peritoneal cavity.
(5) The surface of the lungs and pleura is then tough, leathery
and stained brown.
d. Digestive System:
( 1 ) Mucous membrane of the pharynx is gray and may be
softened. Patches of brownish color are scattered in the
pharynx due to the effusion of dark-colored blood.
MEDICO-LEGAL ASPECT OF POISONING 733
B. Hydrochloric Acid:
1. External Appearance:
a. External staining is absent.
b. The angle of the mouth may be whitish, opaque and may be
inflamed.
2. Internal Appearance:
a. Blood is darkened but not as a rule coagulated by the action
of acids.
b. Edema of the glottis.
c. Larynx and trachea are congested and the mucous membrane
is converted into whitish-gray opaque layer which can be
rubbed off.
d. There may be congestion and edema of the lungs.
e. Mucous membrane of the mouth and pharynx is opaque and
grayish-white.
f. Esophagus is dilated with the mucous membrane reddened
and inflamed.
g. The liver is pale and fatty.
C. Nitric Acid:
The lesions produced by nitric acid are similar to hydrochloric
acid except that the cutaneous stains are distinctly yellow.
2. Internal Appearance:
The only changes are those due to the local action of the
alkali.
a. Pharynx is lined by softened and hyperemic mucous mem-
brane.
b. Edema may be considerable especially at the opening of the
larynx.
c. Esophagus is corroded in its upper part.
d. Peritoneal surface is pale and blood vessels are filled with
dark fluid blood.
e. Stomach contents are viscid, turbid fluid.
f. The mucous membrane of the stomach at the region of the
cardiac end is brownish-red in color, uneven and hardened.
g. The wall of the stomach is edematous and with a soapy feel.
h. The entire length of the intestine is congested.
i. Larynx and trachea are inflamed and congested.
j . Bronchial tree is congested and contains viscid mucous.
b. Respiratory System:
( 1 ) There may be ulceration of the nasal septum.
(2) Bronchitis may be present.
c. Digestive System:
( 1 ) Tongue may be coated.
( 2 ) Mucous membrane of the stomach is inflamed with
ulcerative patches. The whole surface is covered with
tenacious mucous with blood or blood streaks.
( 3 ) Mucous membrane of the duodenum and upper part of
the jejenum, ascending colon and rectum are inflamed.
( 4 ) Peyer's patches are swollen and minute ulcerative areas
are common.
d. The liver is enlarged and shows advanced fatty changes.
e. The kidneys are enlarged. On section, the cortex is swollen
and pale.
b. Renal System:
Both kidneys are enlarged. Section shows that the cortex
is pale, yellowish, and swollen. The capsule strips easily
and leaves a smooth pale surface. Hemorrhagic spots may be
seen in the cortex and on the outer surface.
If the victim survived for a time, he will later succumb to
renal insufficiency. The pale cortex is streaked with yellow
due to fatty changes in the section, owing to the deposit
of calcium carbonate and phosphate.
c. When poisoning is due to mercurials administered by in-
jection or absorbed through the skin or mucous membrane,
the changes in the stomach are slight although intense con-
gestion may be found.
d. Renal System:
Kidneys resemble that of arteriosclerosis. They are smaller
than their normal size. The surface is granular, the granules
MEDICO-LEGAL ASPECT OF POISONING 739
C R I M I N A L O R PENAL L A W DEFINED:
Criminal or Penal L a w is defined as that branch or division of law
which defines crimes, treats of their nature and provides for their punish-
ment.
The Philippine criminal law is embodied in the R E V I S E D P E N A L
CODE and in the penal provision of other statutes.
The Revised Penal Code took effect on January 1, 1932. ( A r t . 1) It
consists principally of three parts, namely:
( a ) Principles affecting criminal liability (Arts. 1-20)
( b ) Provisions on penalties including criminal and civil liability (Arts.
21-113)
( e ) Felonies defined under different title ( A r t . 114-367).
743
744 LEGAL MEDICINE
5. Should commit any of the crimes against national security and law
of nations, defined in Title One of Book Two of this Code. (Art. 2).
Exceptions to the Rule that the Penal Laws are Strictly Territorial:
I. Provisions of treaties and Laws of -preferential application:
The Philippines accepted the principles of international law as a
part of the law of the land. The generally accepted principles of
International Law must prevail over the existing municipal laws in
case of conflict between the two laws.
1. Provision of Treaty:
The Philippine-United States Base Agreement:
a. The Philippine consents that the United States shall have the
right to exercise jurisdiction over the following offenses:
(1) Any offense committed by any person within any base ex-
cept:
(a) Where the offender and the offended parties are citizens
of the Philippines, and
(b) The offense is against the security of the Philippines.
(2) Any offense committed outside the bases by any member
of the armed forces of the United States in which the of-
fended party is also a member of the armed forces of the
United States.
(3) Any offense committed outside the base by member of the
armed forces of the United States against the security of
the United States.
b. The Philippines shall have the right to exercise jurisdiction over
all other offenses committed outside the bases by any member
of the armed forces of the United States.
2. Operation of International Law (Exterritoriality):
The right of exterritoriality is the right to be exempted from
local jurisdiction granted to citizen or subjects of another state
by operation of International Law.
Exterritoriality embraced the following immunities and privileges
of diplomats and members of the suite:
a. Exemption from criminal and civil jurisdiction.
b. Immunity of domicile and diplomatic premises from local juris-
diction (franchise de l'hotel).
The diplomatic envoy and his residence is considered to be an
extension of the territory and person of the country wherein he is
a citizen of.
I I . Statutory Exceptions:
Article 2 of the Revised Penal Code mentioned specific instances
wherein the provision may also be applied.
1. Should commit an offense while on a Philippine ship or airship.
This is based on the theory that the vessel or airship of local
registry is an extension of the territory of the Philippines.
APPENDIX 745
CRIMINAL INTENT:
As a general |rule, intent is necessary in a felony, for an act does not
make a person a criminal unless he possesses a criminal mind.
CRIMINAL LIABILITY:
Criminal liability shall be incurred:
1. By any person committing a felony (delito) although the wrongful
act done be different from that which he intended.
2. By any person performing an act which would be an offense against
persons or property, were it not for the inherent impossibility of its
accomplishment or on account of the employment of inadequate or ineffectual
means. ( A r t . 4).
This includes the impossible crimes. Although the wrongful act
was made with evil intent, it does not produce the desired injury
on account of either of the following:
1* Inherent impossibility of accomplishing it.
2. Employment of inadequate or ineffectual means.
There is inherent impossibility of accomplishing the felony, when
the very nature of the act, it is impossible to consummate it.
Example:—Stabbing a person with intent to kill who has been long
long dead.
Employment of inadequate or ineffectual means implies that the
offended performs an act which is not capable of producing the de-
sired effect.
APPENDIX 747
A felony is consummated when all the elements necessary for its execu-
tion and accomplishment are present; and it is frustrated when the offender
performs all the acts of execution which would produce a felony as a
consequence but which, nevertheless, do not produce it by reason of causes
independent of the will of the perpetrator.
There is an attempt when the offender commences the commission
of a felony directly by overacts, and does not perform all the acts of
execution which should produce the felony by reason of some causes or
accident other than his own spontaneous desistance. (Art. 6).
1. Attempted crime:
In attempted felony, the offender never goes beyond the sub-
jective phase of the crime. The following are the requisites:
a. The offender commences directly or by overt acts the execu-
tion of the crime.
b. The external acts must have direct connection with the crime.
Overt act means the act which followed by another act will
commit the felony.
c. The offender fails to perform all the acts of execution by
reason or cause other than his spontaneous desistance.
In attempted felony, the offender fails to perform all the acts
of execution of the crime due to external interventions or causes.
If the offender desisted later because of fear or remorse, there
would be no attempted felony and such act is not punishable by law.
The reason of the law for exempting him from any criminal liability
is to reward him for having been at the verge of a crime, heed
to the call of his conscience and return to the path of righteousness.
(Guevarra)
Example: The offender with intent to kill tried to aim his gun
against another person, but fortunately the gun was grabbed
by another.
2. Frustrated Crime:
There is frustrated felony when the offender has performed all
the acts of execution which will produce the felony, but it did not
produce the crime because of some causes independent of the will
of the offender. The subjective phase of the crime is complete
but fails to realize the objective phase for reason independent of
the will of the offender.
The subjective phase of the crime begins from the moment the
offender thought of committing the felony or from the commence-
ment of the overt acts to the last act of the offender to produce
the desired effect. The objective phase starts beyond the last act
of the offender up to the time the desired effect has been produced.
Requisites:
a. The offender has done all the acts of execution which would
produce the felony.
b. The desired effect was not produced by reason or causes
independent of the will of the offender.
APPENDIX 749
21. That the wrong done in the commission of the crime be deliberately
augmented by causing other wrong not necessary for its commission
(Art. 14, Revised Penal Code).
V. Alternative Circumstances:
Alternative circumstances are those which must be taken into con-
sideration as aggravating or mitigating according to the nature and
effects of the crime and the other conditions attending its commission.
They are the relationship, intoxication and the degree of instruction and
education of the offender.
The alternative circumstance of relationship shall be taken into con-
sideration when the offended party is the spouse, ascendant, descendant,
legitimate, natural, or adopted brother or sister, or relative by affinity
in the same degrees of the offender.
The intoxication of the offender shall be taken into consideration as
a mitigating circumstance when the offender has committed a felony
in the state of intoxication, if the same is not habitual or subsequent
to the plan to commit said felony; but when the intoxication is habitual
or intentional it shall be considered as an aggravating circumstance.
(Art. 15).
PENALTIES:
No felony shall be punishable by any penalty not prescribed by law
prior to its commission (Art. 21). Penal laws shall have a retroactive
effect in so far as they favor the person guilty of a felony, who is not
a habitual criminal, as this term is defined in rule 5 of article 62 of this
code, although at the time of the publication of such laws of final sentence
has been pronounced and the convict is serving the same. (Art. 22). For
purposes of this article, a person shall be deemed to be habitual delinquent,
if within a period of ten years from the date of his release or last con-
viction of the crimes of serious or less serious physical injuries, robo, hurto,
estafa, or falsification, he is found guilty of any of said crimes a third
time or offender. (Rule 5, Art. 62).
5. To do justice:
The criminals are punished by the State as a n act o f retributive
justice, a vindication of absolute right a n d moral l a w violated by
the criminal.
Classification of Penalties:
I . Principal Penalties:
1. Capital punishment:
death
2. Afflictive penalties:
Reclusion perpetua
Reclusion temporal
Perpetual or temporary absolute disqualification
Perpetual or temporary special disqualification
Prision mayor
3. Correctional penalties:
Prision correccional
Arresto mayor
Suspension
Destierro
4. Light penalties:
Arresto menor
Public censure
5. Penalties common to the three preceding classes:
Fine, and
Bond to keep the peace.
II. Accessory Penalties:
1. Perpetual or temporary absolute disqualification
2. Perpetual or temporary special disqualification
3. Suspension from public office, the right to vote and to be voted
for, the profession or calling.
4. Civil interdiction
5. Indemnification
6. Forfeiture or confiscation of instruments and proceeds of the of-
fense
7. Payment of costs. (Art. 25)
Duration of Penalties:
1. Reclusion perpetua:
Any person sentenced to any of the perpetual penalties shall be
pardoned after undergoing the penalty for thirty years, unless such
person by reason of his conduct or some other serious cause shall
be considered by the Chief Executive as unworthy of pardon.
(Art. 27)
2. Reclusion temporal:
The penalty of reclusion temporal shall be from twelve years
and one day to twenty years. (Art. 27)
756 LEGAL MEDICINE
4. Civil Interdiction:
Civil interdiction shall deprive the offender during; the time of
his sentence of {he rights of parental authority, or guardianship,
either as to the person or property of any ward, of marital au-
thority, of the right to manage his property and of the right to
dispose of such property by any act or any conveyance inter vivos.
( A r t 34)
5. Bond to keep the peace:
It shall be the duty of any person sentenced to give bond to
keep the peace, to present two sufficient sureties who shall under-
take that such person will not commit the offense sought to be
prevented, and that in case such offense be committed they will
pay the amount determined by the court in its judgment, or other-
wise to deposit such amount in the office of the clerk of the court,
to guarantee said undertaking.
The court shall determine, according to its discretion, the period
of duration of the bond.
Should the person sentenced fail to give the bond as required
he shall be detained for a period which shall in no case exceed
six months, if he shall have been prosecuted for a grave or less grave
felony, and shall not exceed thirty days for a light felony. (Art. 35)
6. Destierro:
Any person sentenced to destierro shall not be permitted to enter
the place or places designated in the sentence, nor within the radius
therein specified, which shall not be more than 250 and less than
25 kilometers from the place designated. (Art 87)
EFFECT OF PARDON:
A pardon shall not work the restoration of the right to hold public
office, or the right of suffrage, unless such rights be expressly restored
by the terms of the pardon.
A pardon shall in no case exempt the culprit from the payment of
the civil indemnity imposed upon him by the sentence. (Art. 36)
I . Total Extinction:
1. By the death of the convict, as to the personal penalties; and as to
pecuniary penalties, liability therefore is extinguished only when
death of the offender occurs before final judgment.
2- By service of the sentence.
3. By amnesty, which completely extinguishes the penalty and all its
effects.
4. By absolute pardon.
6. By prescription of the crime.
6. By prescription of the offense.
7. By the marriage of the offended woman, as provided in article 344
of this Code. (Art. 89)
I I . Partial Extinction:
1. By conditional pardon.
2. By commutation of the sentence.
3. For good conduct' allowances which the culprit may earn while he is
serving his sentence. (Art. 94)
4. Special time allowance for loyalty (Art. 98)
5. Preventive imprisonment.
REFERENCES
Adelson, Lester, THE PATHOLOGY OF HOMICIDE , 1974, Charles C. Thomas
Publisher, Springfield, Illinois, USA.
Anderson, W. A. D., SYNOPSIS OF PATHOLOGY, 9th ed., 1967, The C.V. Mosby
Co., St. Louis.
Beall, Walter C, WRONGFUL DEATH AND SURVIVORSHIP, 1958, The W.H. An-
derson Co., Cincinatti.
Bhattacharyya, Rai Saheb Nagendar Kumar, COX'S MEDICO-LEGAL COURT COM-
PANION, 4th Rev. ed., 1950, Eastern Law House Ltd., Calcutta.
Biglieri, Edward G., PHYSICIAN'S HANDBOOK, 18th ed., 1976, Lange Medical
Publishing Maruzes Co., Ltd.
Black, Henry Campbell, BLACK'S LAW DICTONARY, 4th ed, 1951,West Pub-
lishing Co, St. Paul, Minnesota.
Boas, Ernst P., CARDIAC INJURY RESULTING FROM EFFORT OR TRAUMA:
CLINICAL AND LEGAL ASPECTS, 1955, Edwards Brothers, Inc., Ann
Arbor, Michigan.
Bowden, Keith Macrae, MOLLISON'S FORENSIC MEDICINE, LECTURES, 5th
ed., 1949, W. Ramsay (Surgical) Property Ltd., Melbourne.
Brend, William A., A HANDBOOK OF MEDICAL JURISPRUDENCE & TOXI-
COLOGY, 8th Rev. ed., 1941, Charles Griffin & Co., Ltd. London.
Brown, Kent Louis, MEDICAL PROBLEMS AND THE LAW, 1971, Charles C.
Thomas. Publisher, Springfield, Illinois, USA.
Bryan, James E., PUBLIC RELATIONS IN MEDICAL PRACTICE, 1954, The
Williams and Wilkins Co., Baltimore.
Surges, S. H. &Hlton, J.E., eds., THE NEW POLICE SURGEON, 1978, Hutchinson
Benham Ltd., London.
Camps, Francis E. & Purchase, W.B., PRACTICAL FORENSIC MEDICINE, 1957,
The McMillan Co., New York.
Camps, Francis E., ed., GRADWOHL'S LEGAL MEDICINE, 3rd ed., 1976, John
Wright & Sons Ltd., Bristol.
Carpio, Frank S., VARIATIONS IN SEXUAL BEHAVIOR, 1955, John Calder
(Publisher) Ltd., London.
Chadha, P. Vijay, HANDBOOK OF FORENSIC MEDICINE & TOXICOLOGY
(MEDICAL JURISPRUDENCE), 4th ed., 1981, Jaypee Brothers, India.
Cherasken, E., L L Langley & Ruth Slerper, DYNAMIC ANATOMY & PHYSIO-
LOGY, 2nd ed., 1963, McGraw-Hill Book Co., Inc.
Child, Charles Gardner, STERILITY & CONCEPTION, Vol. I, 1931, D. Appleton
& Co., New York & London.
Cotran, Ramzi S. & Stanley L Robbins, PATHOLOGIC BASIS OF DISEASE, 2nd
ed., 1979, W.B. Saunders Co., Philadelphia, London & Toronto.
759
760 LEGAL MEDICINE
Curran, William J., LAW & MEDICINE TEXT & SOURCE MATERIAL ONM-L
PROBLEMS, 1960, Little, Brown & Co., Boston & Toronto.
Curran, William J. & A. Louis McGarry, MODERN LEGAL MEDICINE, PSYCHI-
ATRY & FORENSIC SCIENCE, 1980, F.A. Davis Co., Philadelphia.
Davidson, Henry A., FORENSIC PSYCHIATRY, 2nd ed., 1965, The Ronald Press
Co., New York.
Davidson, Maurice, MEDICAL ETHICS, 1957, Lloyd-Luke (Medical Books) Ltd.,
London.
Davies, M. R. R., THE LAW OF BURIAL, CREMATION AND EXHUMATION,
1956, Shaw & Sons Ltd., London.
De River, J. Paul, THE SEXUAL CRIMINAL, 2nd ed., 1956, Charles C. Thomas.
Publisher, Illinois & Bannerstone House, USA.
Dewar, Thomas, A TEXTBOOK OF FORENSIC PHARMACY, 4th ed., 1957,
Edward Arnold (Publisher) Ltd.,
Di Maio, Vincent J. M., ed., CLINICS IN LABORATORY MEDICINE, Vol. 3,
No. 2, 1983, W.B. Saunders Co., Philadelphia.
Dix, Dorothy Knight & Alan H Todd, MEDICAL EVIDENCE IN PERSONAL IN-
JUR Y CASES, 1961, H.K. Lewis & Co., Ltd., London.
Dornette, William H.L, ed., CLINICAL ANESTHESIA, 1972, F.A. Davis Co.,
Philadelphia.
Dreisbach, Robert H., HANDBOOK OF POISONING, 10th ed., 1980, Lange Medi-
cal Publishing, Los Altos, California.
Eckert, William G., C.G.Tedeshi & Luke Tedeshi, FORENSIC MEDICINE - A
STUDY IN TRAUMA & ENVIRONMENTAL HAZARDS, Vol. I - Mechanical
Trauma, 1977, W.B. Saunders Co., Philadelphia, London & Toronto.
Eckert, William G., C.G. Tedeshi & Luke Tedeshi, FORENSIC MEDICINE - A
STUDY IN TRAUMA & ENVIRONMENTAL HAZARDS, Vol. II - Physical
Trauma, 1977, W.B. Saunders Co., Philadelphia, London & Toronto.
Eckert, William G., C.G. Tedeshi & Luke Tedeshi, FORENSIC MEDICINE - A
STUDY IN TRAUMA & ENVIRONMENTAL HAZARDS, Vol. ffl - Environ-
mental Hazards, 1977, W. B. Saunders Co., Philadelphia, London & Toronto.
Eckert. William G., ed., INTRODUCTION TO FORENSIC SCIENCES, 1980, The
C.V. Mosby Co., St., Louis.
Farber, Sidney, THE POSTMORTEM EXAMINATION, 1937, Charles C. Thomas.
Publisher, Springfield, Illinois.
Fatteh, Abdullah, HANDBOOK OF FORENSIC PATHOLOGY, 1973, J.B. Lip-
pincott Co., Philadelphia & New York.
Fatteh, Abdullah, MEDICOLEGAL INVESTIGATION OF GUNSHOT WOUNDS,
1976, J.B. Lippincott Co., Philadelphia & New York.
Feegel, John R., LEGAL ASPECTS OF LABORATORY MEDICINE, 1973, Little
Brown & Co., Boston.
Fiddes, Frederick 5mith & Sydney Smith, FORENSIC MEDICINE, 10th ed., 1955,
J. & A. Churchill Ltd., London.
Fisher, Russell S. <*. Charles S. Petty, eds., FORENSIC PATHOLOGY, 1977, Natl
Inst, of _aw Enforcement & Criminal Justice Law Enforcement Assistance
Administration, US Dept. of Justice.
REFERENCES 761
Fisher, Russell S. & Werner V. Sj>itz, eds., MEDICOLEGAL INVESTIGATION OF
DEATH, 1973, Charles C. Thomas. Publisher, Springfield, Illinois.
Fisher, Russell S., ed., FORENSIC DENTISTRY, Publ. No. 990, The Bannerstone
Div. of American Lectures in Forensic Pathology.
Flores, Casiano 0., ed., CRIMINAL LAW (PROCEEDINGS OF THE INST'. OF
CRIMINAL LAW- 1980), 1981, UP Law Center, Q.C.
Fox, Robert M., THE MEDICOLEGAL REPORT THEORY & PRACTICE. 1969,
Little, Brown & Co., (Inc.), Boston.
Francisco, Vicente J., EVIDENCE, Rev. Ed., 1955, East Publishing, Manila.
Garriott, James C. & W. T. Lovery, FORENSIC TOXICOLOGY CONTROLLED
SUBSTANCES AND DANGEROUS DRUGS, 1979, Plenum Press, New York
& London.
Gee, D. J., LECTURE NOTES ON FORENSIC MEDICINE, 3rd ed., 1979, Black-
well Scientific Publications, London.
Gee, D. J., THE ESSENTIALS OF FORENSIC MEDICINE, 3rd ed., 1973, Perga-
mon Press Ltd., Oxford & New York.
Gelber, Louis J., MEDICO-LEGAL TEXT ON TRAUMATIC INJURIES, 1938,
Soney & Sage Co.
Glaister, John, RECENT ADVANCES IN FORENSIC MEDICINE, 2nd ed., 1939,
J.&A.. Churchill Ltd., London.
Glaister, John, MEDICAL JURISPRUDENCE & TOXICOLOGY, 8th ed., 1947,
The Williams & Wilkins Co., Baltimore.
Glaister, John & Edgar Rentoul, MEDICINE JURISPRUDENCE & TOXICOLOGY,
12th ed., 1966, E. & S. Livingstone Ltd., Edinburgh, London.
Gonzales, Thomas, Milton Helperer, Charles J. Umberger & Morgan Vance, LEGAL
MEDICINE PATHOLOGY & TOXICOLOGY, 2nd ed., 1954, Appleton-Cen-
tury-Crofts Inc., New York.
Gordon, Everett J., A PRACTICAL MEDICO-LEGAL GUIDE FOR THE PHYSI-
CIAN, 1973, Charles C. Thomas. Publisher, Illinois.
Gordon, I. & H. A. Shapiro, FORENSIC MEDICINE A GUIDE TO PRINCIPLES,
1975, Churchill Livingstone, Edinburgh, London.
Gordon, I., R. Turner & T. W. Price, MEDICAL JURISPRUDENCE, 3rd ed., 1953,
E . & S. Livingstone Ltd, Edinburgh, London.
Gradwohl, R. B. H., ed., LEGAL MEDICINE, 1954, The C.V Mosby Co., St. Louis.
Gresham, G. Austin, A COLOUR ATLAS OF FORENSIC PATHOLOGY, 1975,
Wolfe Medical Publishing Ltd.
Greval, S.P.S., LYON'S MEDICAL JURISPRUDENCE FOR INDIA, 10th ed., 1953,
Thaeker, Spink & Co., (1933) Ltd., Calcutta.
Grewal, Rajinder S., MEDICAL JURISPRUDENCE AND TOXICOLOGY, 1973,
Scientific Book Agency, Calcutta.
Grould, JuUus & William C. Kolb, eds., A DICTIONARY OF SOCIAL SCIENCES,
1964, Tavistock Publishing Ltd., London.
Head, Murdock & David S. Sharpe, PROBLEMS IN FORENSIC MEDICINE, 1966,
The Sigma Press Publishers, Washington, DC.
762 L E G A L MEDICINE
Heffron, Floyd N., THE OFFICER IN THE COURTROOM, 1955, Charles C. Tho-
mas. Publisher, Illinois.
Helfand, Max & 0. Marburg, INJURIES OF THE NER VOUS SYSTEM INCLUDING
POISONING, 1939, Veritas Press, New York.
Herzog, Alfred W., MEDICAL JURISPRUDENCE, 1931, The Bobbs-Merrill Co.
Publishers, Indianapolis.
Hirsch, Charles S., R. C. Morris & A. R. Moritz, HANDBOOK OF LEGAL MEDI-
CINE, 5th ed., 1979, The C..V. Mosby Co., St. Louis.
Inbau, Fred E. & John Reid, LIE DETECTION AND CRIMINAL INTERROGA-
TION, 3rd ed., 1953, The Williams and Wilkins Co., Baltimore.
Inbau, Fred E. & John Reid, CRIMINAL INTERROGATION AND CONFESSIONS,
1962, The Williams and Wilkins Co., Baltimore.
Jnbau, Fred E. SL Jon R. Waltz, MEDICAL JURISPRUDENCE, 1971, the MacMillan
Co., N . Y . & Collier-MacMillan Ltd., London.
James, A. Everette Jr., ed., LEGAL MEDICINE WITH SPECIAL REFERENCE TO
DIAGNOSTIC IMAGING, 1980, Urban and Schwarzenberg, Baltimore & Mu-
nich.
Kamath, M.A., MEDICAL JURISPRUDENCE, 5th ed., 1948, The Madras Law Jour-
nal Office, Madras.
Kerr, Douglas J. A., FORENSIC MEDICINE, 6th ed., 1957, Adam & Charles Black,
London.
Kessler, William F. & P. B. Weston, THE DETECTION OF MURDER, 1953, Green-
berg: Publisher & Ambassador Books Ltd., Canada.
Kirk, Paul L , CRIME INVESTIGATION PHYSICAL EVIDENCE & THE POLICE
LABORATORY, 1953, Interscience Publishing Co., New York.
Krogman, Wilton Marion, THE HUMAN SKELETON IN FORENSIC MEDICINE,
Charles C. Thomas. Publisher, Illinois.
Lambert, D.P., THE MEDICO-LEGAL POST-MORTEM IN INDIA, 1941, J. & A.
Churchill Ltd., London.
Levinson, Samuel A., ed, SYMPOSIUM ON MEDICOLEGAL PROBLEMS, 1948,
J.B. Lippincott Co., Philadelphia, London & Montreal.
Levinson, Samuel A., ed., SYMPOSIUM ON MEDICOLEGAL PROBLEMS, Series
2, 1949, J. B. Lippincott Co., Philadelphia, London & Montreal.
Iiebenson, Harold A., THE DOCTOR IN PERSONAL INJUR Y CASES, 1956, The
Year Book Publishers, Inc. Chicago,
little John, Harvey, FORENSIC MEDICINE, 1925, J. & A. Churchill Ltd. London.
Luntz, Lester L. & P. Luntz, HANDBOOK FOR DENTAL IDENTIFICATION,
1973, J.B. Lippincott Co., Philadelphia & Toronto.
Magath, Thomas B., ed., THE MEDICO LEGAL NECROPSY, 1934, The Williams
& Wilkins Co., Baltimore.
Mallik, C C . A HANDBOOK OF MEDICAL JURISPRUDENCE & TOXICOLOGY,
1969, Academic Publisher, Calcutta.
Manning, George C. Jr., ed., DISABILITY AND THE LA W, 1962, The Williams &
Wilkins Co., Baltimore.
Mant, A. Keith, FORENSIC MEDICINE OBSERVATION & INTERPRETATION,
REFERENCES 763
1960, The Yearbook Publishers, Inc. Chicago & Lloyd-Luke (Medical Books)
Ltd.
Mant, A. Keith, MODERN TRENDS IN FORENSIC MEDICINE-3, 1973, Butter-
worth & Co., (Publisher) Ltd., London.
Mason, J. K., ed., THE PATHOLOGY OF VIOLENT INJURY, 1978, Edward
Arnold (Publishers) Ltd.
Merkeley, Donald Karl, THE INVESTIGATION OF DEATH, 1957, Charles C. Tho-
mas. Publisher, Illinois.
Modi, Jaising P., A TEXTBOOK OF MEDICAL JURISPRUDENCE & TOXICO-
LOGY, 10th ed., 1949, N.M. Tripathi Ltd., Booksellers. Publishers, Bombay.
Modi, J.P., ed., A TEXTBOOK OF MEDICAL JURISPRUDENCE & TOXICO-
LOGY, 12th ed., 1957, N.M. Tripathi Ltd., Booksellers: Publishers, Bombay.
Moritz, Alan R. & R. Crawford Morris, HANDBOOK OF LEGAL MEDICINE, 3rd
ed., 1970, The C.V. Mosby Co., St. Louis.
Nickolls, L. C, THE SCIENTIFIC INVESTIGATION OF CRIME, 1956, Butter-
worth & Co. (Publisher) Ltd., London.
Noguchi, Thomas T., CORONER, 1983, Pocket Books, New York.
Nunan, William, LECTURES IN MEDICAL JURISPRUDENCE, 1925, D.B. Tara-
parevala Sons & Co., Bombay.
O'Connel, John J., & Harry Soderman. MODERN CRIMINAL INVESTIGATION,
4th ed., 1952, Funk & Wagnalls Co.. New York.
O'Hara, Charles E., FUNDAMENTALS OF CRIMINAL INVESTIGATION, 1956,
Charles C. Thomas. Publisher, Illinois.
Parikh, C.K., A SIMPLIFIED TEXT BOOK OF MEDICAL JURISPRUDENCE AND
TOXICOLOGY, 1970, Medical Publications, Bombay.
Petty, Charles S., ed., FORENSIC PATHOLOGY, 1977, Nat'l. Inst, of Law Enforce-
ment & Criminal Justice Law Enforcement Asst. Adm. US Dept. of Justice.
Polesky, Herbert F., PATERNITY TESTING, 1975, Educ. Products Div. American
Society of Clinical Pathologist, Chicago.
Polsky, Samuel, THE MEDICO LEGAL READER, S. Docket, Vol. V I , 1956, Ocean
Publication, New York.
Poison, C.J., ed., THE DISPOSAL OF THE DEAD, 1953, English Universities Press
Ltd., London.
Poison, C.J., THE ESSENTIALS OF FORENSIC MEDICINE, 1955, English Univer-
sities Press Ltd., London.
Poison, C.J., THE ESSENTIALS OF FORENSIC MEDICINE, 3rd ed., 1973, Perga-
mon Press, Oxford, London, N . Y . & Paris.
Purchase, W.B. & H.W. WoUaston, JER VIS ON THE OFFICE & DUTIES OF CORO-
NERS WITH FORMS AND PRECEDENTS, 9th ed., 1957, Sweet & Maxwell
Ltd., London.
Ray, Rames Chandra, OUTLINES OF MEDICAL JURISPRUDENCE WITH SPE-
CIAL TREATMENT OF TOXICOLOGY & INSANITY, 5th ed., 1914, K.C.
Niyogi Nababibhakar Press, Calcutta.
Rental, Edgar & Hamilton Smith, eds., GLAISTER SMEDICAL JURISPRUDENCE
& TOXICOLOGY, 13th ed., 1973, Churchill Livingstone, London.
L E G A L MEDICINE
764
o r in CALCULATION OF INDUSTRIAL DISABILITIES OF THE EXTRE-
MTTIES Ss2^rfcfc Thomas. Publisher, Springfield, Illinois.
Roueche, Berton, ANNALS OF MEDICAL DETECTION, 1954, Victor Gollancz
Ltd., London.
Rust, P. J., LAW A PRACTICE OF HURT & HOMICIDE, 3rd ed., 1958, Law Book
S t r a U E B 7 r C / / / l r j R 1 E M 0 D E R N W 0 R L D
ttd ; Londo n ' ' ™ ™ - 1958, Michael Joseph,
& 0tt WCnde1
^T,^ °SECTION, ' CRtME
1955, Elsevier Publishing Co.,
- 0 P S I S F
^ T n d ^ S ? ? ™ ° FORENSIC MEDICINE & TOXICOLOGY,
& S M U d B r i s t o 1 & S i m p k i n M a r s h a U ( 1 9 4 1 )
Ltd. London ^ ° -
REFERENCES 765
P R I N I E U BY
CHAPTER Page
INTRODUCTION
I. GENERAL CONSIDERATION 1
IDENTIFICATION
HI. MEDICO-LEGAL ASPECTS OF IDENTIFICATION 41
Identification of Persons 42
Anthropometry 52
Portrait Parle S3
Extrinsic Factors in Identification 54
Light Factor in Identification 55
'Fingerprinting 56
Dental Identification 61
Handwriting 65
Identification of Skeleton 75
Determination of Sex 86
Determination of Age 90
Identification of Blood and Blood Stains 95
Identification of Hair and Fibers 105
v
TABLE OF CONTENTS
111
Types of Death 112
Kinds of Death 116
Signs of Death 117
^Changes in the Body following Death 126
Changes in the Muscles 126
Changes in the Blood 130
Autolytic or Autodigestive 136
Putrefaction 136
Special Modification to Putrefaction 148
Duration of Death 151
Presumption of Death 154
Presumption of Survivorship 155
V. INVESTIGATION OF DEATH 156
Inquest Officer 156
Crime Scene Investigation 160
Autopsies 163
VI. CAUSES OF DEATH 182
Immediate or Primary Cause of Death 182
Proximate or Secondary Cause of Death 182
Mechanism of Death 182
Manner of Death 183
Instantaneous Physiologic Death 184
Medico-legal Classification of Death 185
Penal Classification of Death 191
Pathological Classification of Death 198
VII. SPECIAL DEATHS 203
Judicial Death 203
Euthanasia 207
Death by Starvation 213
VID. DISPOSAL OF DEAD BODIES 218
Methods of Disposal of Dead Body 220
Embalming 220
Burial or Inhumation 220
Disposal into the Sea 227
Cremation 228
Use of Dead Body for Scientific Purposes 228
Donation of Parts of the Human Body 230
Exhumation 233
TABLE OF CONTENTS
PHYSICAL INJURIES
LX^MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
Physical Injuries brought about by Physical Violence 240
^Classification of Wounds 242
. Legal Classification of Physical Injuries 246
< Mutilation 246
Serious Physical Injuries 248
Administering Injurious Substances or Beverages 2S0
Less Serious Physical Injuries 251
Slight Physical Injuries or Maltreatment 253
^Medical Classification of Wounds 254
Factors Affecting the Severity of Wounds 278
Fatality of Wound 282
Complication of Wound 283
Healing of Wounds 285
x. INVESTIGATION OF WOUNDS
Outline of Investigation of Physical Injuries 288
Determination Whether the Wounds were Inflicted
During Life or After Death 290
Length of Survival of the Victim 293
Possible Instruments Used by Assailant 294
Which Injuries Sustained Caused Death 294
Which of the Wounds was Inflicted First 295
Effect of Medical and Surgical Intervention 295
Volition Power of the Victim 296
Relative Position of the Victim & Assailant 297
Extrinsic Evidences in Wounds 297
XI. PHYSICAL INJURIES IN DIFFERENT PARTS
OF THE BODY
Head and Neck Injuries 299
Injuries in the Chest 314
Abdominal Injuries 317
Pelvic Injuries 320
Extremities 321
DEA TH OR PHYSICAL INJURIES
XII. DEATH OR PHYSICAL INJURIES CAUSED
BY EXPLOSION
Mechanical Explosion 322
Electrical Explosion 322
Chemical Explosion 322
Identification of the Site of Explosion
and Collection of Evidences 326
viii TABLE OF CONTENTS
Atomic Bomb Explosion 327
Other Sources of Radiation 330
XIII. GUNSHOT AND SHRAPNELS 332
Classification of Small Firearms 334
Cartridges or Ammunition 336
"'Firearm 343
Other Parts of Firearm 343
Mechanism of Firearm Action 346
Things Coming Out of the Gun Muzzle after the Fire 347
Bullet Kinetic Energy 347
Bullet Efficiency 348
Bullet Coefficient 348
Flame 349
Heated, Compressed and Expanded Gas 349
Factors Responsible for the Injurious Effects of Missile 351
/Gunshot Wound of Entrance 353
^Exit (Outshoot) Wound 361
Effects of Clothings in Gunshot 367
Special Consideration on Bullets 368
/Gunshot Wound - Suicidal, Homicidal or Accidental 369
Determination How Long a Firearm Has Been Fired 372
Determining Whether the Firearm is an Automatic
Pistol or a Revolver 373
Shotgun Wounds 374
" Determination of the Presence of Gunpowder and
Primer Components 378
Firearm Identification 382
Gunshot Wounds in Different Parts of the Body 389
XTV. THERMAL INJURIES OR DEATHS 394
Death or Injury from Cold 394
Local Effect 394
Systemic Effect 395
Death or Injury from Heat 396
General or Systemic Effect 396
Local Effects of Heat 398
XV. DEATH OR PHYSICAL INJURIES BY LIGHTNING
AND ELECTRICITY 414
rhor Physical Injury by lightning 414
Elements of lightning that Produce Injury 414
Points to be Considered in Making Diagnosis 415
th or Physical Injury from Electricity 417
Factors which Influence the Effect of
Electrical Shock 417
Mechanism of Death 418
TABLE OF CONTENTS ix
XVI. DEATH OR PHYSICAL INJURIES DUE TO CHANGE
OF ATMOSPHERIC PRESSURE (BAROTRAUMA) 421
Effect of Increase of Atmospheric Pressure 421
Effect of Decrease of Atmospheric Pressure 421
Aircraft Injuries and Fatalities 423
Helicopter Injury 424
XVII. DEATH BY ASPHYXIA 426
^Pypes of Asphyxial Death 426
Asphyxia by Hanging 428
Asphyxia by Strangulation 436
Asphyxia by Suffocation 441
Asphyxia by Submersion or Drowning 442
Asphyxia by Breathing Irrespirable Gases 451
War Gases 455
XVIII. DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE
CRASH OR ACCIDENT 459
Automotive Crash 459
Pedestrian-Vehicle Collision 464
Motorcycle Crash 468
XIX. DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC
SPORTS 469
Some Aspects of Sports Development 469
Boxing 470
Wrestling 476
XX. CHILD ABUSE OR NEGLECTED CHILD 478
Duties of Parents 478
Rights of Parents 479
Classification of Child Abuser 480
Social Reaction to Child Abuse and Neglect 481
Other Battered Victims 484
XXI.
Rape 500
Examination for Seminal Fluid and Spermatozoa 509
Other Crimes Against Chastity 515
.Seduction 515
A6ts of Lasciviousness 518
X TABLE OF CONTENTS
Adduction 520
Adultery and Concubinage 521
Prostitution 523
Abuse Against Chastity 527
Unnatural Sexual Offenses and Sexual Abnormalities 528
MARITAL RELATION
XXLX. MARITAL UNION AND DISSOLUTION 613
Requisites of a Valid Marriage 613
Marital Relation 614
Annulment of Marriage 617
Legal Separation 618
XXX. IMPOTENCY AND STERILITY 620
Impotency 620
Legal Classification 620
Causes of Impotency 621
Sterility 622
Causes of Sterility 622
Methods of Sterilization 623
DISTURBANCE OF MENTALITY
XXXI. INSANITY AND MENTAL DEFICIENCY 625
Legal Importance 625
Some Manifestations of Mental Disorders 629
Insanity and Criminal Responsibility 635
Mental Deficiency 641
Classical Classification 641
Methods of Estimating Mental Capacity 643
Ways of Hospitalizing an Insane Person 647
Malingering 649
Causes of Malingering 649
Types of Malingerer 650
Ways of Determining Malingering 651
Other Conditions Manifestating or Simulating
Disturbance of Mentality 652
xii TABLE OF CONTENTS
TOXICOLOGY
XXXTV. POISONING 712
Definition 712
Site of Action of Poisons 713
Signs and Symptoms That May Lead One to Suspect
Poisoning 717
Differential Diagnosis of Poisoning 718
Treatment of Patient Suffering from Acute Poisoning 719
Medical Evidences 721
Classification of Poisons 725
Food Poisoning 729
Laws on Poisons and Other Poisonous Substances
in the Philippines 730
Post-mortem Findings in Some Chemical Poisoning 732
TABLE OF CONTENTS xiii
APPENDIX - Basic Principles of Philippine Criminal Law 743
REFERENCES 759
INDEX 767