LEGAL MEDICINE :

GENERAL CONSIDERATION

Legal Medicine – is a branch of medicine which deals with the application of

medical knowledge to the purposes of law and in the
administration of justice.

Legal medicine – Application of medicine to legal cases.

Forensic medicine – Application of medical science to elucidate legal problems.

Medical jurisprudence – Knowledge of law in relation to the practice of medicine.

SCOPE: Application of medical and paramedical sciences as

demanded by law and administration of justice.

NATURE OF THE STUDY OF LEGAL MED:

- The ability to acquire facts, arrange them and draw a conclusion from facts in
the administration of justice.

Medical jurist, Medical examiner, Medicolegal officer, Medicolegal expert

- A physician who specializes primarily with medico-legal duties.
- Imhotep – 2980 B.C. earliest medico-legal expert.

DIFFERENCE : ORDINARY PHYSICIAN MEDICO-LEGAL OFFICER

a) Injury/Disease
point of view - Treatment Cause
b) Examine a Diagnose Testify / justice
patient
c) Minor injuries Ignored Records all / qualify crime

PRINCIPLE OF STARE DECISIS:

- When the court has once laid an interpretation of law as applied to certain facts, it will adhere
to and apply to all future cases where the facts are substantially the same.

BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS:

1. “Ignorantia legis nominem excusat “ – prevent use as defense in violation

2. Law shall have no retro-active effect.
3. Rights may be waived, unless the waiver is contrary to law, public order,
public policy, morals or good customs, or prejudiced to a third person with a
right recognized by law.

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4. Customs which are contrary to law, public order or public policy shall not be
countenanced.
5. Laws are repealed by subsequent ones, and their violation or non-observance
shall not be excused by dis-use, custom or practice to the contrary.

Persons authorized to perform autopsies:

1. Health Officers
2. Medical officer of law enforcement agencies.
3. Members of the medical staff of accredited hospitals.

Autopsies shall be performed in the following cases.

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

MEDICAL EVIDENCE
- is the means sanctioned by the rules of court of ascertaining in a
judicial proceeding the truth respecting a matter of fact.

Types of evidence:
1. Autoptic or Real evidence – made known to the senses
2. Testimonial evidence – oral under oath
3. Experimental evidence
4. Documentary evidence

Methods of preserving evidence:

1. Photo, videotape,photocopy 4.Manikin method – miniature model of the scene or body
2. Sketching 5.In the mind of the witness
3.Description 6. Special methods: embalming

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CHAPTER IV
MEDICO-LEGAL ASPECTS OF DEATH

Importance of Death determination:

1, The civil personality of a natural person is extinguished by death.
2. The property of a person is transmitted to his heirs at the time of death.
3. The death of a partner is one of the causes of dissolution of partnership agreement.
4. The death of either the principal or agent is a mode of extinguishment of agency.
5. The criminal liability is extinguished by death.
6. The civil case fro claims which does not survive is dismissed upon death of the defendant.

DEATH
= Death is the termination of life
= complete cessation of all the vital functions without possibility of resuscitation
= in irreversible loss of the properties of living matter
= compared:
Dying = continuing process
Death = is an event that takes place at a precise time
= ascertainment of death is clinical not a legal problem

TYPES OF DEATH
1. BRAIN DEATH
2. CARDIO-RESPIRATORY DEATH
3. BOTH BRAIN AND CARDIO-RESPIRATORY

1. Brain death
=occurs when there is a deep irreversible coma,
=absence of electrical brain activity
=complete cessation of all vital functions without possibility of resuscitation

Irreversible coma
Characteristics: -
Unreceptivity and unresponsibility
= there is a total unawareness to externally applied stimuli and inner need and
complete unresponsiveness (definition of irreversible coma)
No movement or breathing
= no spontaneous muscular movements or spontaneous breathing
(observed within a period of at least one hour)
No reflexes
= absences of elicitable reflexes
= pupil will be fixed and dilated
= will not respond to a direct source of bright light
= blinking are absent
Flat Electro-encephalogram (EEG)

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 = of great confirmatory value

Criteria for the determination of death (Philadelphia Protocol)

= use of criteria of brain death may only be applied to those persons who are potential
organ donors
a. Lack of responsiveness to internal and external environment
b. Absence of spontaneous breathing movement for 3 minutes in the absence of
hypocarbia
c. No muscular movement with generalized flaccidity and no evidence of postural
activity or shivering
d. Reflexes and responses
i. Pupils fixed and dilated; non-reactive to strong stimuli
ii. Conrneal reflexes absent
iii. Supra-orbital and other pressure response absent
iv. Absence of snouting or sucking response
v. No reflex response to upper and lower airway stimulation
vi. No ocular response to ice water stimulation of the inner ear
vii. No deep tendon reflexes
viii. No superficial reflexes
ix. No plantar reflexes
e. Falling arterial pressure w/o support by drugs
f. Flat EEG (electro-encephalogram)

2. Cardio-Respiratory death
= death occurs when there is a continuous and persistent cessation of heart action and
respiration
= a condition in which the physician and family members pronounces a person to be
dead based on common sense or intuition

3. Both brain and cardio-respiratory bases in an alternative and ecletic way

= considered medically and legally dead, if in the opinion of a physician there is:
- absence of spontaneous respiratory and cardiac function
- absence of spontaneous brain function

Kinds of death:
1. Somatic or clinical death – persistence of vital functions
2. Molecular or cellular death – 3 to six hours after cessation of life
3. Apparent death or State of suspended animation –
transient loss of consciousness in hysteria, uremia, electric shock

Signs of death:
1. CESSATION OF HEART ACTION AND CIRCULATION., Usually the auricle contract after somatic
death for a longer period than the ventricle, last to stop so called ULTIMEN MARIENS.

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 Methods of detecting the cessation of heart action and circulation:
a) Examination of the heart- pulse, aucultation, flouro, ECG
b) Examination of peripheral circulation
= Magnus test – application of ligature around the base of the finger
- bloodless area at site of application
- dead man – no change
= Opening of small artery- spurting
= Icards test – injection of flourescein SQ
- greenish yellow discoloration in the whole skin
- dead man only in the area of injection
= Pressure on fingernails
= Diaphanous test – fingers are spread wide through a strong light- Red
= Application of heat on the skin - blister
= Palpation of Radial pulse
= Dropping of melted wax

2. CESSATION OF RESPIRATION – more than 3 ½ minutes

Methods of detecting cessation of respiration:
a) Observance of movement of chest and abdomen
b) With the aid of stet.
c) Examination with a mirror
d) Examination with a feather or cotton fibers
e) Examination with a glass of water
f) Winslow’s test – no movement in the image formed by reflecting artificial light on the
water in a saucer and placed in the chest if respiration is taking place.

3. COOLING OF THE BODY ( ALGOR MORTIS)

- After death the metabolic process inside the body ceases.
- The progressive fall of the body temp. is one of the most prominent signs.
- First two hours after death the cooling is rapid.
- Fall of temp. of 15 to 20 degrees Fahrenheit is considered as a
certain sign of death.

POST-MORTEM CALORICITY – is the rise of temp. of the body after death due to rapid
and early putrefactive changes. Usually in the first 2 hours.
= seen in cholera, liver abscess, tetanus, RF,Strynine poisoning, Peritonitis

A. Conditions connected with the body:

Factors delaying the rate of cooling of the body:
1. Acute pyrexial disease
2. Sudden death in good health
3. Obesity of person
4. Death from asphyxia
5. Death of the middle age

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 Factors accelerating cooling:
1. Leaness of the body
2. Extreme age
3. Long-standing illness
4. Chronic pyrexial disease with wasting

B. Conditions that are connected with the surroundings

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

Factors accelerating cooling:

1. Unclothed body
2. Conditions allowing the access of air
3. Large room permitting the dissipation of heat
4. Cooling more rapid in water than in air

Methods of estimating how long a person has been dead from the cooling of the body:
1. If body temp. is normal at the time of death:
= the average rate of fall of the temp. during the first 2 ½ hours is ½ of the
difference of the body temperature and that of the air.
= the body attains the temp. of the surrounding air from 12 to 15 hours after
death in tropical countries.

2. Chemical Method ( Schourup’s formula for the determination of the time of death of
any cadaver whose CSF is examined for the concentrations of L.A., NPN, A.A.
= L.A> 15 mg to 200 mg/100cc rapid in 1st 5 hours.
= NPN inc. from 15 to 40 mg/100 cc in 1st 15 hours
= A.A. inc. from 1 mg to 12 mg% 1st 15 hours.

4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE

= may be seen in the living with- apoplexy, epilepsy , trance, catalepsy, hysteria

5. CHANGES IN THE SKIN – opacity, flattening, loss of elasticity

6. CHANGES IN AND ABOUT THE EYE

a) Loss of corneal reflex – seen I n live pts: G.A., uremia, narcotic poisoning
b) Clouding of cornea
c) Flaccidity of the eyeball
d) Pupil in the position of rest.
e) TACHE NOIR DE LA SCLEROTIQUE – spot found in the sclera after

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 death.
7. ACTION OF HEAT ON THE SKIN
= Heat applied while alive – produced blister with serum and redness around
the area.

= Following combinations of signs show death has occurred:

a) Loss of animal heat to a point not compatible with life
b) Absence of response of muscle stimulus
c) Onset of rigor mortis.

CHANGES IN THE BODY FOLLOWING DEATH

1. CHANGES IN THE MUSCLE – complete relaxation of the whole

muscular system.
Three Stages After Death:
a) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY)
= muscle relax, may contract, dilated pupil, sphincters are relaxed
= presence of molecular life
= warm place: 1 hour and 51 minutes
= chemical reaction of muscle is alkaline

b) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY ,

DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS)
= whole body is rigid due to contraction of the muscles
= starts at muscle of neck, lower jaw
= Reaction is acidic due to inc. of lactic acid
= develops 3 to 6 hours after death in temperate, earlier in warm
= last from 2 to 3 days in temperate, warm: 24-48H cold weather
18-36H summer
c) Stage of Secondary flaccidity or Commencement of putrefaction
( DECAY OF MUSCLES)
= muscle are flaccid, not respond to stimuli, reaction is alkaline
= due to dissolution of muscle proteins

FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS

(1) Internal Factors
a) State of the muscles
= healthy – appears late
= Onset is hastened in:
a.1 hunted animal
a.2 prolonged convulsion/lingering illness
a.3 death from- TY, Cholera, Phthisis, typhus
b) Age
= early onset – aged and newborn

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 = delayed – good health, good muscular development
c) Integrity of nerves
= section of the nerve will delay onset, paralyzed muscle

(2) External factors

a) Temperature
= Hastened by high temperature
= > 75 degrees will produce heat stiffening
b) Moisture
= rapidly but with short duration in moist air

Conditions simulating RIGOR MORTIS:

1. Heat stiffening - > 75 degrees coagulates muscle proteins resulting to rigidity.
= “ Pugilistic attitude” flexed upper and lower limb
= hands clenched, flexor stronger than extensors, burned to death

2. Cold stiffening
= due to solidification of fats when exposed to cold temp.

3. Cadaveric spasm or Instantaneous Rigor

= instantaneous rigidity due to extreme nervous tension, exhaustion,
injury to the nervous system.
= weapon in hand, weeds

RIGOR MORTIS CADAVERIC SPASM

1. Time of appearance 3-6H after death Immediately after death
2. Muscles involved All muscles Certain group
3. Occurrence Natural phenomena May or may not appear
4. Medico-legal signif. Approximates time of death Determine nature of death

RIGOR MORTIS MUSCLE CONTRACTION

1. Contracted muscle Losses transparency More or less transparent
2. Elasticity Loss elasticity Very elastic
3. Litmus reaction Acidic Neutral or sl. alkaline
4. Contraction Absolute flaccidity Possess inherent
Contraction

2. CHANGES IN THE BLOOD

a) Coagulation of blood
= blood may remains fluid inside the blood vessels 6-8H after death.

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 ANTE-MORTEM CLOT POST-MORTEM CLOT
1. Consistency Firm Soft
2. Surface of blood vessels Raw after clots are removed Smooth, health after
3. Clots Homogenous Can be stripped
can’t be stripped off in layers

b) Post-mortem Lividity or Cadaveric Lividity , or Post-mortem Suggilation

or Post-mortem Hypostasis or Livor Mortis
= Stoppage of heart action and loss of tone of b.v. accumulates in
dependent areas except in bony areas.
= capillaries coalesce > purplish in color called Post-mortem lividity.
= Hasten by death due to cholera, uremia, Typhus fever
= appears 3 – 6 H after death and fully developed 12 H after death.

Physical characteristics of Post-mortem Cadaveric Lividity

1. Occurs in the most dependent areas.
2. Involves the superficial layer of the skin
3. Does not appear elevated from the rest of the skin.
4. Color is uniform.
5. No injury of the skin

Kinds of Post-mortem Cadaveric Lividity

1. Hypostatic lividity
2. Diffusion lividity

Importance of Cadaveric lividity:

1. One of the signs of death.
2. Determines the position of the body has been changed after it’s appearance in the body.
3. Color of lividity may indicate the cause of death.
a) asphyxia – lividity is dark
b) CO poisoning – pink
c) Hemorrhage – less marked
d) Hydrocyanic acid – bright red
e) Phosphorus – dark brown
f) Potassium chlorate – coffee brown
4. Determines how long the person has been dead
5. Gives us an idea as to the time of death.

Points to be considered which may infer the position of the body at the time of death:
1. Posture of the body when found.
2. Post-mortem hypostasis or lividity
3. Cadaveric spasm

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 CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS

1. Small bruises – Below epidermis in true skin In the epidermis or cutis

larger ones - below this

2. Cuticle Abraded by the same violence Unabraded

that produce the bruise.

3. Bruise Appears at the seat or surrounding Always dependent

may or may not be dependent

4. Elevated, inflammatory condition Not elevated, blood in b.v.

CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS

5. Incision shows blood outside the b.v. Blood inside the vessels
= most certain test of difference
6. Color variegated Uniform color

Internal hypostasis in Visceral organs:

1. Lungs
2. Loops of intestine
3. Brain

POST-MORTEM LIVIDITY OF ORGANS SIMPLE CONGESTION

1. Post-mortem
staining in organs Irregular, most dependent parts Uniform, all organs
2. Mucous membrane Dull,lusterless Not in congestion
3. Inflammatory exudate Not seen Not seen

Other changes in the blood

1. Hydrogen ion concentration – acid pH CO2, L.A., After 24H alkaline ammonia.
2. Breakdown of liver glycogen leads to accumulation of dextrose in the IVC and
the right side of the heart.
3. Rise in NPN and Free A.A.
4. Chemical:
= chloride in the plasma/RBC decrease due to extravascular diffusion, in
72 H only ½ of its content.
= Mg – increases due to diffusion from without.
= K – increases due to diffusion from the vascular endothelium.
3. AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH
- After death, proteolytic, glycolytic and lipolytic ferments of the glandular
tissues continue to act which lead to the autodigestion of organs.

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4. PUTREFACTION OF THEBODY
- Is the breaking down of complex proteins into simpler components associated
with the evolution of foul smelling gasses and accompanied by the change of
color of the body.

Tissue changes in putrefaction:

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

MARBOLIZATION – prominence of the superficial veins with reddish

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

2. Evolution of gasses in the tissues

CO2, ammonia, H2, Suphurated hydrogen, methane.= offensive odor

Effects of pressure of gasses of putrefaction:

a) displacement of the blood – bleeding in open wounds
b) bloating of the body
c) fluid coming out from nostrils, mouth
d) extrusion of the fetus in a gravid uterus
e) floating of the body

3. Liquefaction of the soft tissues

Putrefy rapidly : Eyeball, lining of trachea, larynx , brain, stomach,
intestine, liver, spleen
Putrefy late : Highly muscular organs and tissues, Esophagus,
diaphragm, heart, lungs, kidneys, U.B., uterus, P.G.

Factors modifying the RATE of putrefaction:

1. INTERNAL FACTORS
a) age : healthy adults, NB not yet fed, later than infants
b) condition of body : full grown/obese – rapid , Stillborn- late
c) cause of death : infection - rapid

2. EXTERNAL FACTORS
a) Free air
a.1 air : free air hastens decomposition
a.2 moderate moisture - accelerates

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 a.3 loaded with septic bacteria – early aerobes, later anaerobic
- Clostridium welchii= decomposition
b) Earth
b.1 dry absorbent soil - retards
b.2 moist fertile soil - accelerates

c) Running water- more rapid than still water

d) Clothings – early it hastens but delays in the later stage.
- tight clothings - delay

Factors influencing the changes in the body after burial:

1. state of the body before death – thin slower, mummify
2. time elapsed between death and burial and environment of the body
3. effect of coffin – later
4. clothings and other coverings on the body when buried – pressure, insects
5. depth at which the body was buried - greater the later
6. condition and type of soil
7. inclusion of something in the grave which will hasten decomposition-food
8. access of air to the body after burial
9. mass grave – rapid
10. trauma to the body – violent death - slow

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS

1-3 DAYS AFTER DEATH - greenish discoloration over iliac fossa, soft eyeballs
3-5 DAYS - frothy blood from mouth, nostrils
8-10 DAYS - abdominal distention, nails firm
14-20 DAYS - blisters all over the body, maggots
2-5 MONTHS - skull exposed, orbits empty

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

BEEN SUBMERGED IN WATER

FIRST 4 OR 5 DAYS Cold water little change, in rigor mortis
FROM 5 – 7 DAYS Skin on hands, feet is bleached, face faded white
1 – 2 WEEKS Face swollen and red, skin of hands and feet wrinkled
4 WEEKS Skin wrinkled, nail intact

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6 – 8 WEEKS Abdomen distended, skin of hands/ feet come off with nails

Factors influencing the floating of the body in water:

1. age – fully developed, well nourished - rapid
2. sex – females floats sooner
3. conditions of the body – obese float quicker
4. season of the year – moist hot air – putrefaction – floats due to gas
5. water- shallow and stagnant water of creeks, higher specific gravity
- sea water floats sooner than fresh water, higher specific gravity
6. external influence – heavy-wearing apparel - slower
Only teeth, bones and hair remain for an indefinite time.
Flat bones disintegrates faster than round bones.

SPECIAL MODIFICATION OF PUTREFACTION

1. Mummification
= is the dehydration of the whole body which results in the shivering
and preservation of the body.
= usually occurs when buries in a hot, dry with free access of hot air

2. Saponification or Adipocere fromation

= a condition where the fatty tissues of the body are transformed to soft
brownish-white substance known as ADIPOCERE at SQ level.

3. Maceration
= softening of the tissues when in fluid medium in the absence of putrefactive
mircro-org, seen in death in utero
– reddish or greenish color, skin peeling off and arms flaccid and frail.
HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH
1. Presence of rigor mortis : 2-3 hours after death
12 H fully developed
18-36 H disappears concomitant with putrefaction
2. Presnce of Post-mortem lividity
3-6 H after death
appears as small petechia-like red spots
3. Onset of decomposition
24-48 H after death
manifested watery. foul smelling froth, mouth, nostrils
4. Stage of decomposition
5. Entomology of the cadaver – 24 H before eggs are hatched, maggots
6. Stage of digestion - 3-4 H gastric empty
6-8 distal ileum, cecum
7. Presence of live flies in the clothing in the drowning victim – less than 24H
8. State of clothings - pajama , night
9. Changes in CSF

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10. Blood clots inside the b.v. in 6 –8 H after death.
11. Soft tissues of the body may disappear 1 to 2 years after burial.

Post-mortem conditions simulating disease, poisoning or injury:

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

PRESUMPTION OF DEATH
Disputable presumption - not heard in 7 years
Presumption of death
Absence of 7 years except succession 10 years
Vessel for 4 years
Armed forces 4 years
In danger of death 4 years

PRESUMPTION OF SURVIVORSHIP
1. under 15 y.o. – older survives
2. above 60 y.o.- younger
3. under 15, above 60 - former
4. over 15 and under 60 y.o. – male, older
5. under 15, or over 60 y.o. and the other in between - latter

CHAPTER V
MEDICO-LEGAL INVESTIGATION OF DEATH

Inquest Officer – is an official of the state charged with the duty of inquiring into
certain matters.
- in medico-legal examination: manner and cause of death

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The following officials of the government are authorized to make death investigations:
1. Provincial and City Prosecutors
2. Judges of the RTC, MTC
3. Director of NBI
4. SolGen

Stages of MEDICO-LEGAL INVESTIGATION:

1.Crime Scene Investigation – investigation of place of commission of the crime
2.Autopsy - investigation of the body of the victim

1. Crime Scene Investigation

- place where the essential ingredients of the crime took place.
- Person composed the Search Team:
a) Physician MLI trained
b) Photographer
c) Assistant, evidence collector, note taker

2. Autopsy
- comprehensive study of a dead body, in addition to the external examination . Post-
mortem examination- external exam without incision being made.

Purpose of autopsy:
1. Determine cause of death
2. Correlate clinical diagnosis and symptoms
3. Determine effectiveness of treatment
4. Study the natural course of the disease
5. Educate students and physicians

MEDICO-LEGAL OR OFFICIAL AUTOPSY:

1. Determine cause, manner, time of death
2. Recovering, identifying, preserving evidentiary material
3. Provide interpretation and correlation of facts related to death
4. Provide factual, objective medical report
5. Separating death due to disease from external causes.

Dead body belongs to the state for cases that requires medico-legal autopsy.

PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY

1. Requirement Consent of next of kin Law that gives the consent
2. Confirmation Clinical findings of research Correlate tissue changes to
criminal act
3. Emphasis Notation at all abnormal findings Effect of wrongful act

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4. Conclusion Summation of all abnormal findings Specific to the purpose
5. Minor Need not be mentioned Included If useful

The following manner of death should be autopsied:

1. Death by violence
2. Accidental deaths
3. Suicides
4. Sudden death of persons who are in good health
5. Death unattended by physician
6. D.O.A. with no clinical diagnosis
7. Death occurring in an unnatural manner

Mistakes in autopsy:
1. Error or omission in the collection of evidence for identification
2. Errors or omission in the collection of evidence required fro establishing the time of
death
3. Errors or omission in the collection of evidence required fro the medico-legal
examination.
4. Errors or omission result in the production of undesirable artifacts or in the destruction
of valid evidence.
Negative autopsies
- if after all efforts including gross and microscopic studies and toxicological analysis fail to
reveal a cause of death.

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

CHAPTER VI
CAUSES OF DEATH

Primary purpose of a medico-legal autopsy:

Determination of the cause of death.
Death is the direct and the proximate consequence of the criminal or negligent act.

Defense wounds on the victim: Qualify the crime to homicide.

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 Series of cuts in the borders of the wound: Multiple trust- intent to kill.

Cause of death: is the injury or disease or both which initiates the physiological disturbance
resulting to a fatal termination.

1. Immediate or Primary cause of death – when injury or disease kills quickly the victim and
no opportunity for complications to develop.
Ex: extensive brain injury
2. Proximate cause or Secondary cause - the injury or disease was survived for a longer
period

Mechanism of death: is the physiologic derangement or biochemical disturbance incompatible

with life which is initiated by the cause of death.
Ex: Hemorrhagic shock, pulmonary depression, cardiac arrest,
tamponade metabolic problem.

Manner of death: is the explanation as to how the cause of death arose.

1. Natural death – fatality is cause solely by disease. Ex: pneumonia, cancer
2.Violent or unnatural death – due to injury

Medico-legal masquerade- violent deaths may be accompanied by minimal or no external

evidence of injury or natural death where signs of violence may be present.

Degree of Certainty to the cause of death:

1. Structural abnormalities established beyond doubt the cause of death. Ex. SW
with H.
2. Degree of probability amounting to the cause of death. Ex: Electrical shock
3. History establishes cause of death and confirmed by anatomic or chemical
findings.
4. When neither history, laboratory and anatomic findings, taken individually or in
combination is sufficient to determine the cause of death but merely speculate
as to the cause of death. Ex. Crib death among infants.

Steps in the Intellectual Process in the determination of the cause of death:

1. Recognition of the structural organic changes or chemical abnormalities

responsible for the cessation of vital functions.
2. Understanding and exposition of the mechanism by which the anatomic and
other deviations from normal caused the death.

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Instantaneous physiologic death or Death from inhibition, death from primary shock,
Syncope with instantaneous exitus.
- This is sudden death which is cause within seconds or minute or two after a minor
trauma or peripheral stimulation of relatively simple nature.
- The peripheral stimulation initiates the cardio-vascular inhibitory reflex.
Ex: Vagocardiac slowing or stoppage of the heart.
Blow to the larynx, solar plexus, scrotum, pressure to the carotid sinus.

Diseases with no specific findings of a disease:

1. Sudden infant death syndrome (SIDS) or crib death
2. Sudden unexplained nocturnal death (SUND)

DOA – means actually dead or dying, provided the physician had not been given ample
opportunity to arrive at a working diagnosis as to the cause of death.

Undetermined - if the physician cannot determine the cause of death.

MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH

a. Natural death – cause by natural disease condition in the body.
b. Violent death
1. Accidental death
2. Negligent death
3. Infanticidal death
4. Parricidal death
5. Murder
6. Homicidal death
If signs of violence are associated with the natural cause of death:

* Did the person die of a natural cause and were the physical injuries inflicted immediately
after death?
- violence applied in a dead person : Impossible crime.

* Was the victim suffering from a natural disease and the violence only accelerate the death?
= Offender responsible of the death of the victim.
= Criminal liability shall be incurred by any person committing a felony
although the wrongful act done be different from which he intended.
(Art.4 no.1 RPC)
* Did the victim die of a natural cause independent of the violence inflicted?
- accused will not be responsible for the death but merely for the physical
injuries he had inflicted. Ex. Slapping a person with heart problem, only
slight physical injury.

- to make the offender liable for the death of the victim, it must be proven that
the death is the natural consequence of the physical injuries inflicted.

18
The following are deaths due to natural causes:
1. Affection of the Central Nervous System (CNS)
a. Cerebral apoplexy – sudden loss of consciousness followed by paralysis or
death due to Hemorrhage from thrombosis or
embolism in the cerebral vessels.
b. Abscess of the brain
c. Meningitis of the fulminant type

2. Affection of the circulatory system

a. Occlusion of the coronary vessels :
=most common cause of Sudden death due to natural causes.
b. Fatty or myocardial degeneration of the heart.
c. Rupture of the aneurysm of the aorta
d. Valvular heart disease
e. Rupture of the heart
3. Affections of the Respiratory system
a. Acute edema of the larynx
b. Tumor of the larynx
c. Diptheria
d. Edema of the lungs
e. Pulmonary embolism
f. Lobar pneumonia
g. Pulmonary hemorrhage
4. Affections of the Gastro Intestinal Tract GIT
a. Ruptured Peptic ulcer
b. Acute intestinal obstruction
5. Affections of the Genito Urinary Tract
a. Acute strangulated hernia
b. Ruptured tubal pregnancy
c. Ovarian cyst with twisted pedicle
6. Affection of the glands
a. Status thymico-lymphaticus
b. Acute hemorrhagic pancreatitis
7. Sudden death in young children
a. Bronchitis
b. Congestions of the lungs
c. Acute broncho-pneumonia
d. Acute gastroenteritis
e. Convulsion
f. Spasm of the larynx

B. Violent death
- are due to injuries inflicted in the body by some forms of outside force.

19
 The physical injury must be the proximate cause of death.
= That the victim at the time the physical injuries were inflicted was
in normal health.
= That the death may be expected from the physical injuries inflicted.
= That the death ensued within a reasonable time.

CLASSIFICATION OF TRAUMA OR INJURIES

1. Physical injury – trauma sustained through the use of physical force.
2. Thermal injury – injury by heat or cold
3. Electrical injury – electrical energy.
4. Atmospheric injury – due to change of atmospheric pressure.
5. Chemical injury – chemicals
6. Radiation injury – radiation
7. Infection – microbic invasion

PENAL CLASSIFICATION OF VIOLENT DEATHS

1. Accidental deaths – due to misadventure or accident.
Art. 12 no. 4 RPC
Any person who while performing a lawful act with due care, causes an
injury by mere accident without fault or intention of causing it.
Ex. Patient died of ATS injection after proper skin test.
2. Negligent death – felonies may be committed when the wrongful act is due to reckless
imprudence, negligence, lack of skill or foresight.
Ex. Surgeon left a pack – Homicide through reckless imprudence
3. Suicidal death , destruction of one’s self
- not punished, unfortunate being.
- Art 253 RPC Giving assistance to suicide. Punishable because he has no
right to destroy or assist in the destruction of life of another.
4. Parricidal deaths
Art. 246 father, mother, child, (leg/illeg) ascendant, descendant, spouse (leg.)
5. Infanticidal deaths – Art. 255 killing of a child less than 3 days
6. Murder Art. 248
- treachery, consideration, means of inundation, occasion of calamities,
- evident pre-meditation, cruelty
7. Homicidal deaths Art 249

DEATHS UNDER SPECIAL CIRCUMSTANCES

1. Death caused in a tumultuous affray Art 251.
2. Deaths or physical injuries inflicted under exceptional
circumstances. Art 247

2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH

a. Death due to syncope – fatal and sudden cessation of the action of the heart.

20
 b. Death from asphyxia – a condition in which the supply of oxygen to the blood or to the
tissues or to both has been reduced below normal working level.
Stage of increasing dyspnea 1 min
Stage of Expiratory convulsion
Stage of exhaustion 3 min
c. Death from coma

SPECIAL DEATHS
1. Judicial deaths – Art. III Sec.1 Par. 19 Phil. Const. “cruel and unusual punishment
shall not be inflicted. ; electrocution, hanging, musketry, gas chamber.
2. Euthanasia or mercy killing
3. Suicide
Automatism - due to drug may be considered as accidental rather than
suicidal.

Evidences that will infer death is suicidal:

1. History of depression, mental disease.
2. Previous attempt
3. Injuries are located in areas accessible to hand.
4. Effects of the act of self-destruction may be found in the victim;, empty bottle
5. Presence of suicidal note.
6. Secluded, not in public view.
7. Evidences which rule out H,M, P

4. Death from starvation :

Cause may be due to suicidal, homicidal or accidental.
The human body without food losses 1/24th of its weight daily.
And 40% loss>death
Factors that influence the length of survival: age, condition of the body, sex,
environment.

CHAPTER IX
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

Physical injury : is the effect of some of stimulus on the body.

Stab wound the effect is immediate but a
blunt object is delayed production on the contusion.

21
Causes of Physical Injuries
1. Physical violence
2. Heat or cold
3. Electrical energy
4. Chemical energy
5. Radiation by radioactive substances
6. Change of atmospheric pressure
7. Infection

1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

= The effect of the application of physical injury on person is the
production of wound.
= A disruption of the anatomic integrity of the tissues of the body.
= However, not all physical violence will result in the production of wound.

Physics of wound production:

MV2
a. Kinetic energy = __________
2

`Velocity component is the important factor:

M16 rifle with a velocity of 3200 ft/ sec causes damage more
than a heavier .38 caliber.
b. Time
= The shorter the period of time needed for the transfer of energy,
the greater the likelihood of producing damage.
= If a person is hit on the body and the body moves towards the
direction of the force applied, the injury is less as when the body
is stationary.
= The longer the time of contact between the object or instrument
causing the injury, the greater will be the dissipation of energy.
c. Area of transfer
= The larger the area of contact between the force applied on the
body, the lesser the damage to the body.
= By applying an equal force, the damage caused by stabbing is
greater compared to a blunt instrument.

d. Other factors
= The less elastic and plastic the tissue > the greater that a
laceration will result.
= Elasticity :
Ability of the tissue to return to its normal sizes and shape after
being deformed by a pressure.

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 = A force transmitted through a tissue containing fluid will force the
fluid away from the area of contact in all directions equally,
frequently causing the tissue to lacerate.
VITAL REACTION
= It is the sum total of all reactions of tissue or organ to trauma, either
observed micro or macroscopically.
a. RUBOR – redness or congestion of the area due to an increase of blood
supply as a part of the reparative mechanism.
b. CALOR – Sensation of heat or increase in temperature.
c. DOLOR - pain due to involvement of the sensory nerve.
d. LOSS OF FUNCTION- due to trauma, the tissue may not function.

The presence of vital reaction differentiates an ante-mortem from a post-mortem injury.

EXCEPT: vital reactions not seen even if injury inflicted during life:
1. During agonal state of a living person were cells don’t react to the
trauma.
2. Sudden death as in sudden coronary occlusion.

CLASSIFICATION OF WOUNDS:
1. AS TO SEVERITY
a. Mortal wound – caused immediately after infliction that is capable of
death.
Parts of body that are mortal – heart, vessels, CNS, lungs, other organs.

b. Non-mortal wound - Not capable of producing death after infliction.

2. AS TO KIND OF INSTRUMENT USED
a. Blunt instrument – contusion, hematoma, lacerated wound.
b. Sharp instrument
= Sharp-edge instrument> incised wound
= Sharp pointed > punctured wound
= Sharp edge and sharp-pointed > stab
c. Wounds brought about by tearing force – lacerated wound
d. By change in atmospheric pressure – barotraumas.
e. Wounds brought about by heat or cold – frostbite, scald, burns.
f. Wounds brought about by chemical explosion – GSW, shrapnel wound
g. Wounds brought about by infection.

3. AS TO THE MANNER OF INFLICTION

a) HIT – means of bolo, blunt instrument, axe.
b) TRUST or STAB – bayonet dagger
c) GUN POWDER EXPLOSION – Projectile or shrapnel wound.
d) SLIDING or RUBBING or ABRASION
4. AS REGARDS TO THE DEPTH OF THE WOUND

23
 a) Superficial – wound involves only the layers of the skin.
b) Deep – inner structures beyond the layers of the skin.

PENETRATING WOUND - Wounding agent did not come out or

Piercing a solid organ.

PERFORATING WOUND – Wounding agent produces communication

between the inner and outer portion of the hollow organs.

OR piercing or traversing completely a particular part of the

body causing communication between the points of entry and
exit of the instrument or substance producing it.

5. AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE AND THE LOCATION
OF INJURY
a. Coup Injury – Physical injury which is located at the site of the
application of force.
b. Contre-coup injury – opposite the site of the application of force.
c. Coup contre-coup injury – site and also opposite of application of force.
d. Locus minoris resistencia – Physical injury not located at the site nor
opposite the site of the application of force but in some areas
offering the least resistance to the force applied.
Example: Blow in fore head > contusion on the region of the eyeball.
e.Extensive injury – Physical injury involving a greater area of the body
beyond the site of the application of force.
Example : Fall or MVA

6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED

Injuries in various parts of the body

7. SPECIAL TYPES OF WOUNDS

a) DEFENSE WOUNDS – Instinctive reaction of self-preservation. >
hands/fractures
b)PATTERNED WOUND – Wound in the nature and shape of the
instrument. > Wheels,abrasions from rope.
c)SELF-INFLICTED WOUNDS - Wound produced on oneself but no
intention to end his life.

Motive of producing self-inflicted wounds:

1. To create or deliberately magnify an existing injury or disease for pension or
workman’s compensation.
2. To escape certain obligations or punishment.
3. To create a new identity.
4. Gain attention or sympathy.

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 5. Psychotic behaviour.

Some ways of self-mutilation:

1. Head banging or bumping
2. Exposure of body to heat radiation from open fires, radiators
3. Penetrating nail to chest wall
4. Castration by amputation of the penis
5. Trichotillomania- pulling of body hair

LEGAL CLASSIFICATION OF PHYSICAL INJURIES

1. MUTILATION
= Art. 262 RPC Kinds of mutilation:
a. Intentionally depriving a person, totally or partially of some of
the essential organs for reproduction.
b. Intentionally depriving a person of any part or parts of the human body
other than the organs for reproduction.
Mutilation to be punishable it must be intentional or not physical injury.

MAYHEM – is the unlawful and violent deprival of another of the use of a

part of the body so as to render him less able in fighting, either
to defend himself or to annoy his adversary.

Vasectomy/Tubal ligation are not mutilation and a legitimate method of contraception

despite the fact that it is done intentionally and deprives a person of his power of reproduction.

SERIOUS PHYSICAL INJURIES Art. 263 RPC

Any person who shall wound, beat or assault another Art. 263 and
administering injurious substance, without intent to kill Art. 264.

The main purpose of dividing the provision into four paragraphs

a) Is to graduate the penalties depending upon the nature and character of
the wound inflicted
b) Their consequences on the person of the victim.

1. Prison mayor – because of the physical injuries inflicted, the injured person
becomes insane, imbecile, impotent or blind.
2. Prision correctional in its medium and maximum periods
- loss of speech, hear or smell
- loss of eye, hand, foot, arm, leg
= loss of the use or incapacitated for the habitual work he used to do.
3. Prision correctional in its minimum and medium periods.
- person injured shall be deformed.
- lost any other part of the body, incapacitated for more than 90 days.
4. Arresto mayor in its maximum period to prision correctional

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 - If the physical injuries shall have cause the illness or incapacity for
labor for more than 30 days.

Is the offense shall be committed against any of the persons enumerated in

Art. 246 Or with attendance of any of the circumstances mentioned in Art. 248

= The case covered by subdivision number 1 of this art. Will be punished by

reclusion temporal in its medium and maximum periods.
= Subdivision number 2 by Prision correctional in its maximum period to
prision mayor in its minimum period.
= Subdivision number 3 by prision correctional in its medium and maximum
= Subdivision number 4 prision correctional in its minimum and medium periods.

The provisions of the preceding paragraph shall not be applicable to a parent

who shall inflict physical injuries upon his child by excessive chastisement.
RA 7610.

It may be committed through a simple negligence or imprudence.

ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC

Elements:
1. The offender inflicted upon another any serious physical injury,
2. There is knowledge that the substance or beverage administered is injurious Or took
advantage of the victims weakness of credulity.
3. There is no intent to kill in the part of the offender.
If intentional so> frustrated murder. Treachery is inherent in Art. 264 RPC

LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC

Any person who shall inflict upon another physical injuries not described in the preceding
articles,
= But which shall incapacitate the offended party for labor 10 days or more
= Or shall require medical attendance for the same period
Both of which is 10 days but not more than 30 days and
there must be proof to it..

The crime of less serious physical injuries may be qualified and a fine of a higher penalty is
imposed when:
1. There is a manifest intent to insult or offend the injured person.
2. There are circumstances adding ignominy to the offense.
3. The victims is the offender’s parents, ascendants, guardian, curators,
teachers.
4. The victim is a person of rank or person of authority, provided the crime is not direct
assault.

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P.D. 169 Obligation imposed on Physicians treating persons suffering serious and less serious
physical injuries required to report to law enforcement agencies.

SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC

1. Arresto menor- when the offender has inflicted physical injuries which shall incapacitate
the offended party for labor form 1 to 9 days or shall
require medical attendance of the same period
2. Aresto menor or fine not exceeding P200 and censure when the offender has cause
physical injuries which do not prevent the offended party
from engaging in his habitual work nor require medical attendance.
3. Arresto menor in its minimum period or a fine not exceeding P50 when the
offender shall ill treat another by deed without causing any injury.

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.
So 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.
( Parag 3 )

PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC

Elements:
1. There is a tumultuous affray
2. Participants suffered from serious physical injuries.
3. The person who inflicted serious physical injuries cannot be identified.
4. All those who appear to have used violence upon the person of the offended party shall
be penalized by arrest from 5 to 15 days.
TYPES OF WOUNDS ( MEDICAL CLASSIFICATION)

1. CLOSED WOUND – no breach of continuity of the skin or mucous membrane.

a. Superficial – When the wound is just underneath the layers of the skin
or mucous membrane.
a.1 –PETECHIAE – is a circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous membrane.
Example : mosquito bite, blood disease, hanging
a.2 – CONTUSSION – is the effusion of blood into the tissues
underneath the skin on account of the rupture of the blood
vessels as a result of the application of blunt force or violence.
= size of contusion greater than the size of the object.
= Location of the contusion is not always the site of
application of the force. Example: Black eye> Forehead

Medico-legal point of view:

A contusion as indicated by its external pattern may correspond to the

27
 > shape of the object or weapon used.
Extent > the possible degree of violence applied.
Distribution> indicates the character and manner of injury as in manual
strangulation around the neck.
Age of Contusion: appreciated from its color change
The size tends to become smaller from the periphery to the center
and passes through a series of color changes as a result of the
> Disintegration of the RBC and liberation of hemoglobin.
The contusion is red, purple soon after its complete development.
4 to 5 days > green
7 to 10 days > yellow and gradually disappears on the 14th or 15th day.
The ultimate disappearance of color varies from 1 to 4 weeks
depending upon the severity and constitution of the body.
The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM HYPOSTASIS

Contusion
Below the epidermis in the true skin in small bruises or extravasations,
below this in larger ones and often much deeper still.
The epidermis has no blood vessels to be ruptured.
Post mortem Hypostasis
In the epidermis or in the cutis as a simple stain or a showing through the
epidermis of the underlying engorged capillaries.
Contusion
Cuticle was probably abraded by the same violence that produced the
bruise. In small punctures such as fleas bites, this is not observed.

Post-mortem hypostasis
Cuticle unabraded, because the hypostasis is a mere sinking of the blood,
there is no trauma.
Contusion
A bruise appears at the seat of and surrounding the injury. This may or may
not be a dependent part.
Post-mortem hypostasis
Always in a part which for the time of information is dependent.
Contusion
Often elevated because elevated blood and subsequent inflammation swell
the tissues.
Post-mortem hypostasis
Not elevated, because either the blood is still in the vessels or at most has
simply soaked into and stained the tissues.
Contusion
Incision shows blood outside the vessels. This is the most certain test of
difference and can be observed even in very small bruises.

28
Post-mortem hypostasis
Incision shows the blood is still in its vessels and if any oozing occurs drops
can be seen issuing from the cut mouths of the vessels.
Contusion
Color variegated. This is only true of bruises that are the same days old due
to the changes in the hemoglobin produced during life.
Post-mortem hypostasis
Color is uniform. The well known change in color produced in blood
Extravasated Into living tissues does not occur in dead tissues with the
same regularity.
Contusion
If the body happens to be constricted at or supported on a bruised place,
the actual surface of contact may be a little lighter than the rest of the bruise
but will not be white.
Post-mortem hypostasis
In a place which would otherwise be the seat of hypostasis pressure of any
kind even simple support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling with blood.

White lines or patches of pressure bordered by the dark color of hypostasis

are produced and marks of floggings, strangulation, etc. are thus
sometimes simulated.

FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION

1. General condition of the patient.
2. Part of the body affected. Fatty tissues, bloody parts > contused easily
Fibrous areas, muscle > less
3. Amount of force applied –The greater the force, the more effusion of blood.
4. Disease – Contusion may develop with or without application of force.
Example: Aplastic anemia, whooping cough
5. Age – Children and old age tend to bruise easily.
6. Sex – women, obese easily develops unlike boxers.
7. Application of heat and cold

The distinction between ante-mortem and post-mortem contusions in an undecomposed

body is that in ;
1. Ante-mortem bruising: there is swelling, damage to epithelium, extravasation,
coagulation and infiltration of the tissues with blood
2. Post-mortem bruising there are no such findings.

a.3 HEMATOMA

29
 - is the extravasation or effusion of blood in a newly formed cavity underneath the skin.
When the blunt instrument hit a hard part of the body like a bony part which is
superficially located.
- Force causes the subcutaneous tissue to rupture on account of the presence of a hard
structure underneath..

DISTINCTION BETWEEN CONTUSION AND HEMATOMA

1. In contusion- the effused blood are accumulated in the interstices of the tissues
underneath the skin
In hematoma blood accumulates in a newly formed cavity underneath the
skin.
1. in contusion, theskin shows no elevation and is ever elevated, the elevation is slight and
is on account of inflammatory changes
In hematoma – the skin is always eelevated.
2. In contusion, puncture or aspiration with syringe of the lesion, no blood can be
obtained.
In hematoma – shows presence of blood and subsequent depression of the elevated
lesion.
Abscess, gangrene, hypertrophy, fibroid thickening and even malignancy
are potential complications of hematoma.

MUSCULO-SKELETAL INJURIES
1. Sprain - partial or complete disruption in the continuity os a muscular or ligamentous
support of a joint, due to a blow, kick or torsion force.
2. Dislocation – displacement of the articular surface of bones entering into the formation
of a joint.
3. Fracture – solution of continuity of bone resulting from violence or some existing
pathology.
a. Close or Simple Fx – no break in continuity of the overlying skin.
b. Open or Compound Fx – Fx is complicated by an open wound
caused by the broken bone which protruded with other tissues of the
broken skin.
c. Comminuted Fx – Fractured bone is fragmented into several pieces.
d. Greenstick Fx – Fx wherein only one side of the bone is broken
while the other is merely bent.
e. Linear Fx – when the Fx forms a crack usually in flat bones.
f. Spiral Fx – break in the bones forms a spiral manner as seen in long
bones.
g. Pathologic Fx – Fx caused by weakness of the bone due to disease.

4. Strain – the over-stretching instead of an actual tearing or the rupture of a muscle or

ligament which may not be associated with the joint.

5. Sublaxation – Incomplete or partial dislocation.

30
INTERNAL HEMORRHAGE
- rupture of blood vessels which may cause hemorrhage due to the following:
a. Traumatic intracranial hemorrhage.
b. Rupture of parenchymatous organs.
c. Laceration of other part of the body.

CEREBRAL CONCUSSION ( COMMOTIO CEREBRI )

- THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED BY MORE OR LESS COMPLETE
SUSPENSION OF ITS FUNCTIONS AS A RESULT OF INJURY TO THE HEAD WHICH LEADS TO SOME
COMMOTION OF THE CEREBRAL SUBSTANCE.

- is more severe when the moving or mobile head struck a fixed hard object as compared
when the head is fixed and struck by a hard moving object.

Signs and Symptoms

1. unconsciousness which is more or less complete.
2. muscles are relax and flaccid.
3. eyelids are closed and the conjunctivae are insensitive.
4. surface of the body is pale, cold and clammy.
5. respiration is slow and sighing.
6. pulse is rapid, weak, faltering and scarcely perceptible to the fingers.
7. temperature is subnormal.
8. sphincters are relaxed with unconscious evacuation of the bowel and bladder.
9. reflexes are present but sluggish and in severe cases may be absent.

Loss of memory for events just before the injury is a constant effect of cerebral concussion
and is of medico-legal importance.

2. OPEN WOUNDS
a. ABRASION ( Scratch, graze, impression mark, friction mark )
- it is an injury characterized by the removal of the superficial epithelial
layer of the skin caused by a rub r friction against a hard rough object.
- Contussion with abrasion = forcible contact before friction occurs.
- the shape varies and the raw surface exudes blood and lymph which later
dries and forms a protective covering as SCAB or CRUST.

Characteristics of abrasion:
1. It develops at the precise point of the force causing it.
2. Grossly or with the aid of a hand lens the injury consists of parallel linear
injuries which are in line with the direction of rub or friction causing it.
3. It may exhibit the pattern of the wounding material.
4. Usually ignored by attending physician. Medico-legal viewpoint
= abrasions caused by fingernails may indicate struggle or assault

31
 and are usually located in the face, neck, forearms and hands.
= abrasions resulting from friction on rough surfaces are located in
bony parts and are usually associated with contusion or
laceration.
= nature of the abrasion may infer degree of pressure, nature of
the rubbing object and the direction of movement.

5. Abrasion heals in a short time and leaves no scar unless if not

infected or if the whole thickness of the skin is involved.

Forms of abrasion
1. Linear abrasion – appears as a single line, straight or curve.
= pinching with fingernails = curve a.
= sliding the point of a needle = straight linear ab.

2. Multi-linear – develops when the skin is rubbed on a hard rough

object producing several linear marks parallel to one another.
Example: MVA

3. Confluent – linear marks in the skin are almost indistinguishable

on account of the severity of friction and roughness of the object.

4. Multiple – several abrasions of varying sizes and shapes may be

found in different parts of the body.

Types of abrasion
1. Scratch – caused by sharp pointed object which slides across the skin,
like pin, thorn or fingernail.
- Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of commencement with
tailing at the end.
2. Graze – usually caused by forcible contact with rough, hard objects
resulting to irregular removal of the skin surface.
= course indicated by a clean commencement and tags on the end.
3. Impact or imprint abrasion ( patterned abrasion, stamping abrasion,
abrasion a la signature)
- those whose pattern and location provides objective evidence to
show cause, nature of the wounding instrument and the manner
of assault or death.
= marks of grid of radiator, thread marks of wheel, teeth marks.
4. Pressure or friction abrasion – caused by pressure accompanied by
movement usually observed in hanging or strangulation.
= spiral strands of the rope as seen in the skin in hanging.

32
 Differential diagnosis:
1. Dermal erosion - gradual breakdown or very shallow ulceration of the
skin which involves only the epidermis and heals without scarring.
2. Marks of insects and fishes bites – skin injury is irregular with no vital
reaction and usually found on angles of the mouth, margins of
nose, eyelids and forehead.
3. Excoriation of the skin by excreta – found in infants and the skin
lesions heals when the cause is removed.
No apparent history of rubbing trauma on the affected area.
4. Pressure sore – usually found at the back at the region of bony
prominence. History of longstanding illness, bed ridden.

ANTEMORTEM ABRASION POSTMORTEM ABRASION

COLOR reddish-bronze due to slight yellowish and transparent

exudation of blood

LOCATION any area over bony prominence

Rough handling of the cadaver

VITAL with intravital reaction shows not vital reaction and

REACTION may show remains of damaged is characterized by a separation
Epithelium of the epidermis from
Complete loss of the former.

b. INCISED WOUND ( cut, slash, slice)

– produced by a sharp-edged ( cutting)
– or sharp-linear edge of the instrument like a knife, razor, bolo, glass etc.
= Impact cut > when there is forcible contact of the cutting instrument
with the body surface.
= Slice cut > when cutting injury is due to the pressure accompanied
with movement of the instrument
= Chopped or Hacked wound > when the wounding instrument is a
heavy cutting instrument like saber
> injury is severe

Characteristics of incised wound:

1. Edges are clean cut.
2. The wound is straight
3. Usually the wound is shallow near the extremities and deep at the middle portion.
4. Profuse hemorrhage because of the clean cut on the vessels.
5. Gaping is usually present due to the retraction of the edges.

33
 6. Clothes will also show a clean cut if cut by the instrument.
7. Faster healing if without complications.
8. Incised wound made by broken glasses maybe irregular, needs to be removed.

Changes that occur in an incised wound:

1. After 12 hours – edges are swollen, adherent with blood and with leukocyte infiltration.
2. After 24 hours – proliferation of the vascular endothelium and connective tissue cells.
3. After 36 to 48 hours –capillary network complete, fibroblasts running at right angles to
the vessels.
4. After 3 to 5 days – vessels show thickening and obliteration.

Why a person suffers from incised wound:

1. As a therapeutic procedure.
2. As a consequence of self-defense
3. Masochist may self-inflict incised wounds for self-gratification.
4. Addicts and mental patients.

Suicidal wounds – usually located in peculiar parts of the body, accessible to the hand.
- the most common site is the wrist, radial artery and the neck.

Homicidal wounds – usually deep, multiple and involves both accessible and non-accessible
parts.
- clothing are usually involved
- Defense and other forms of wounds are present.

Accidental wounds – multiple incised wounds observed on the passenger and driver of MVA
due to broken windshields.
- kitchen knives in the preparation of food.

SUICIDAL WOUNDS HOMICIDAL WOUNDS

DIRECTION Oblique from below left ear,
downwards across front neck
just above Adams apple
SEVERITY Usually not so deep and
may only involve trachea,
carotid and esophagus
Usually horizontal below
the adams apple
Usually deep and may cause
involvement of the cartilage
and bones.

SUICIDAL WOUNDS HOMICIDAL WOUNDS

SUPERF’L Usually present before the Practically absent but may
CUT commencement of deeper rarely be present when the
wound. victim struggled when attacked

POSIT’N OF May be sitting or facing a Usually victim lying on bed

THE BODY mirror or standing or in other place.

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WOUNDING Firmly grasp (cadaveric spasm) Weapon is absent
WEAPON or found lying beside the
victim.

BLOOD Bld found in front part of body Bld found at the back of neck.
DISTRIBUTION Hand smeared with blood. Hands are clean.

MOTIVE History of mental depression, Absence of such history

Financial, social problems, alcoholism

PREVIOUS Hx May be present Always absent

Of SELF-DESTRUCT’N

3. STAB WOUNDS – is produced by the penetration of a sharp and a sharp

edged instrument like a knife, scissors.
- if the sharp edge is the one that comes in contact with the skin then it is an incised
wound.
- If the sharp pointed portion first come in contact, it is a stab wound.
= surface length may reflect the width of the wounding instrument.
= smaller when the wound is not so deep.
= wider if upon withdrawal is not in the same direction as seen in
slashing movement. The presence of an abrasion from the extremity of
the skin defect is in line with direction of the slashing movement.

The extremities of stab wound may show the nature of the instrument used.
- a doubled bladed weapon shows both extremities to be sharp.
- A single bladed weapon – one of its extremities as rounded and contused, not seen if
instrument is quite thin.
The direction of the surface defect may be useful in the determination of the possible relative
position of the offender and the victim when the wound was inflicted.

As to whether the wound is slit-like or gaping depends on the direction of the wound to the
Langers line.

The depth of the wound may be influence by:

1. size and sharpness of the instrument.
2. area of the body involved
3. the degree of force applied

Hemorrhage is always the most serious consequence of stab wound due to the severance of
blood vessels or involvement of bloody organs.

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 How to describe stab wound:
1. length of the skin defect – edges must be coaptated first
Tailing – the direction of withdrawal of the wounding weapon.
2. condition of the extremities
= sharp extremity > sharpness of the instrument used.
= If Both extremity are sharp > double bladed weapon is used.
3. condition of the edges.
= edges are regular and clean cut> due to one stabbing act.
= serrated or zigzag in appearance > several stabbing wounds ( series of thrust
and withdrawal.)
4. linear direction of the wound – it may be running vertically, horizontally, or upward
medially or laterally.
5. location of the stab wound – to include exact measurement from anatomical landmarks.
6. direction of the penetration – must be tridimentional
7. depth of the penetration
8. tissue and organs involved

Stab wounds may be:

A.Suicidal
1. Located over vital parts of the body.
2. Usually solitary
3. Located over covered parts of the body, the clothing is not involved
4. Stab wound is accessible to the hand of the victim
5. Hand of victim is smeared with blood
6. Wounding weapon is firmly grasp by the hand of the victim.
7. If stabbing is accompanied with slashing movement
> the wound tailing abrasion is seen towards the hand inflicting
the injury.
8. Suicide not may be present
9. Presence of a motive for self destruction.
10. No disturbance in the death scene with wounding instrument found
near the victim.

B. Homicidal – stabbing with homicidal intent is the most common

Characteristics:1. Injuries other than stab wound may be present .
2. Stab wound may be located in any part of the body.
3. Usually more than one stab wound
4. A motive for stabbing, if none then the offender either
insane/drugs
5. Disturbance in the crime scene

Medical evidence showing the intent of the offender to kill the victim:
1. there are more than one stab wounds

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 2. stab wounds located in different parts of the body
3. stab wounds are deep
4. serrated stab wounds means thrust and withdrawal of the wounding weapon to increase
internal damages.
5. irregular or stellate shape skin defects> due to changing direction of the weapon with the
portion of the instrument at the level of the skin as the lever.

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

instrument.

= External injury is quite small but the depth is to a certain degree.; ice-pick, nail
- Nature of the external injury depends on the sharpness of the end of the
wounding instrument:
= contusion of the edges> if end is not sharp
= opening may be> round, elliptical, diamond shaped or cruciate.
- External hemorrhage is limited although internal injuries may be severe.> blood
vessels and bloody organs is fatal if no intervention applied.
- Site of external wound can be easily sealed by dried bld, serum, or clotted bld.
- Punctured wounds are usually accidental

Characteristics:
1. The opening of the skin is very small, wound is much deeper than it is wide.
2. External hemorrhage is limited than internally may be severe.
3. Sealing of external opening is favorable for the growth and multiplication of
anaerobic organism like bacillus tetani.
Homicidal -
1. multiple and usually located in different parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of struggle in the crime scene.
Suicidal -
1. located in areas of the body where the vital organs are located.
2. usually singular, if multiple located in one area.
3. parts of body involved is accessible by the hand of the victim.
4. clothing usually not involved.
5. wounding is made while the victim is in sitting or standing position , bleeding is
towards the lower part of the body or clothing.
6. no disturbance in the crime scene.
7. wounding instrument found near the body.
Puncturing wound with puncturing instrument loaded with poison:
1. poison dart – cyanide or nicotine
2. fish spines
3. dog bites with hydrophobia virus
4. injection of air and poison as a way of euthanasia.

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5.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK”)
- is a tear of the skin and the underlying tissues due to forcible contact with a blunt
instrument.
- May be produced by a hit with a piece of wood, iron bar, fist, stone, butt.
- If the force is applied to a tissue is greater than its cohesive force and elasticity> the
tissue tears and a laceration is produced.
Characteristic:
1. shape and size of the injury does not correspond to the wounding instrument
2. tear on the skin is rugged with extremities irregular, ill-defined.
3. injury developed where the blunt force is applied.
4. borders of the wound are contused and swollen.
5. developed in areas where the bone is superficially located.like scalp.
6. examination with the aid of hand lens shows bridging tissue joining the edges and
hairs bulbs are intact.
7. bleeding is not extensive due to blood vessels are not severed evenly.
8. healing process is delayed and has a tendency to develop a scar.
Classification of lacerated wounds:
1. Splitting caused by crushing of the skin between two hard objects.
Ex: laceration of scalp hit by a bunt instrument, cut eyebrow of a boxer.
2. Overstretching of the skin
- When pressure is applied on one side of the bone> the skin over the area will be
stretched up to a breaking point to cause laceration and exposure of the fractured bone.
- In avulsion: the edges of the remaining tissue is that of laceration.
3. Grinding compression
- the weight and the grinding movement may cause separation of the skin with the
underlying tissues.
4. Tearing
- this may be produced by a semi-sharped edged instrument which causes
irregular edges on the wound like hatchet and choppers.

Lacerated wounds are rarely suicidal.

INCISED WOUNDS LACERATED WOUNDS

Edges are clean cut, regular, well defined
No contusion or swelling around the
Incised wounds
INCISED WOUNDS
Extremities of the wound are sharp, may be extremities are ill-defined and irregular
Round, or contused
Examination by means of a hand lens
Shows that hair bulbs are cut
Healing is faster
Caused by sharp edged instrument
edges are roughly cut, irregular, ill-defined
swelling and contusion around the
lacerated wounds
LACERATED WOUNDS
hair bulbs are preserved
healing is delayed
caused by a blunt instrument

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GAPING OF WOUND
- Separation of the edges especially in deep wound may be due to the
following:
1. mechanical stretching or dilatation
- the presence of a mechanical device on the edges to prevent coaptation will cause
separation. Example: drain in an abscess, retractor during operation.
2. loss of tissue due to:
a. Destruction due to pressure, inf’tion, cell lysis, burning, chemical reaction.
b. Avulsion or physical or mechanical stretching resulting to separation of a
portion of the tissue.
c. Trimming of the edges – debridement of the skin which come in contact with the bullet at
the entrance and exit of GSW and removal of necrotic materials.
3. retraction of the edges
- underneath the skin are dense networks of fibrous and elastic connective tissue fibers
running on the same direction and forming a pattern more or less present in all persons.
- This pattern of fiber arrangement is called cleavage direction or lines of cleavage of the
skin and their linear representation on the skin is called Langers line.

Practical ways of determining how much of the skin surface is involved in an injury or disease:
- skin functions as a mechanical protection of the body, storage of water.
- Determination of how much skin is involved is important in the mode of treatment and
prognosis especially in burns, contusion..
= burns of 70% in children and older age group are fatal.

= rule of nine is used. Head and neck 9% 9%

one upper extremity 9% 18%
front chest and abdomen 18% 18%
posterior chest and abdo 18% 18%
one lower extremity front 9% 18%
one lower ext(back) 9% 18%
pudendum 1% 1%

Factors responsible for the severity of the wound:

1. Hemorrhage may influence the severity of wound by:
a. loss of blood incompatible with life
- blood constitutes 1/20 of the body weight of an adult.
- 5 to 6 quarts of blood ( one quart is 946 cc)
- loss of 1/10th of its volume will cause no significant change.
- loss of one quart> fainting
- loss of 1/3rd to 2/5th > irreversible shock
- males can withstand more loss of blood than females.
- hypertension causes more excessive and rapid bleeding.

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 b. Hemorrhage may result in an increase in pressure in or on the vital
organs to affect the normal function.
- intracranial hemorrhage cause compression of the vital centers of
the brain.
- hemopericardium > pericardial tamp
- hemorrhage to the chest> diminution of the respiratory output>anoxia.

c.. Hemorrhage may cause mechanical barriers to the function of organs.

- into tracheo-bronchial lumina> asphyxia
- into muscles > disturbance in their contractility.

Causes of hemorrhage:
a. trauma - destruction of its blood vessel wall
b. natural causes
- intracerebral hemorrhage(apoplexy)> lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage > saccular berry aneurysm
- rupture of arteriosclerotic aneurysm
- rupture of esophageal varices
- pulmonary hemorrhage due to PTB, lung abscess, bronchiectasis
- ruptured ectopic pregnancy

2. Size of injury - burns greater than 1/3rd of the body are fatal
3. Organs involved – usually fatal to heart, brain, lungs.
4. Shock – blow to genitalia, slight burns to young and old.
5. Foreign body or substance introduced into the body - bacterial, viral, foreign
body, chemical,

TOXIN.
1. snake bites> 2 punctured wds at the center of the reddened affected area. The venom is
injected through its fangs which is connected to the poison gland.

Snake venom toxicity will depend on:

1. potency of venom injected
2. amount of venom injected by the fang will depend on
- season of the year
- the length of time the snake has eaten.
- if a snake has just killed its prey> toxic content is smaller.
3. size of the patient
4. immediate treatment instituted.

Snake venoms are two principal classes:

1. Neurotoxic – primarily paralysis the respiratory and cardiac center of the brain.
- may cause N,V, ascending paralysis, coma, convulsion, c/p arrest

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2. Hematoxic - affects particularly the blood
- manifestations are pain, swelling on the affected area, IV hemolysis,
N,V, pulmonary and cardiac edema.

Emergency treatment may be:

1. incision of the wound to promote more external hemorrhage to drain the venom.
2. tourniquette above the site of the wound
3. placing ice on the bite site
4. sucking the wound to drain venom with the mouth
5. administration of anti-snake venom serum.

2. Scorpion venom
- venom has toxic, hemolytic, hemorrhagic
- one punctured wound on the center of a reddened area
- pain, edema and reddening

3. Coelenterate sting ( jellyfish )

- tentacles penetrate into the skin and cause explosion of the nematocyst
and liberation of the venom.
- extreme pain. Urticarial rash, dilated pupils, paleness, labored breathing

6. Absence of medical or surgical intervention – wound may not be fatal but

due to neglect or ignorance of its management, may be serious and fatal.

FATAL EFFECT OF WOUNDS:

1. Wounds may be directly fatal by reason of:
a. hemorrhage – neck due to carotid bleed.
b. Mechanical injuries on vital organs
c. shock
2. Wounds may be indirectly fatal by reason of:
a. secondary hemorrhage following sepsis
b. specific infection
c. scarring effect
d. secondary shock

NATURE OF DEATH DUE TO SECONDARY CAUSES

1. Changes whose natural sequence are direct & obvious – sepsis, tetanus
2. Changes producing separate pathological lesions which in turn proves to be fatal
Ex: operation to ligate vessel but died of peritonitis despite diligence/skill
3. Changes where a definite pathological condition was present before the
injury. Ex. Person with tumor and stabbed , stab is not capable of death
but accused is responsible for his death.
4. Changes where a definite pathological condition of totally different nature
arises after the wounding and the consequential sequence is doubtful.

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 Ex. TB meningitis ffg blow to the head

COMPLICATIONS OF TRAUMA OR INJURY

1. Shock due to injury to nervous system, anoxemia, endothelial damage
2. Hemorrhage
3. Infection
a. from the instrument
b. from the organs involved in trauma ex. Bowels injured
c. injury may depress general vitality
d. deliberate intro of micro-organism
4. Embolism

HEALING OF WOUNDS
1. Power of the human tissue to regenerate – replaced the destroyed tissue by newly
formed similar tissue.
Regenerates rapidly : C.T., blood forming tissues,surface epith. skin
Slow to regenrate:sm. Muscles, neurons of CNS, highly specialized
glandular tiss.
Time of healing is dependent on:
a. vascularity
b. age of person
c. degree of rest or immobilization
d. nature of the injury

2. Aberrated healing process:

a. formation of exuberant granulation or proud flesh
b. keloid formation
c. stricture
d. fistula or sinus formation

CHAPTER X
MEDICO-LEGAL INVESTIGATION OF WOUNDS

Rule to follow by a physician:

1. all injuries must be described
2. description of wound must be comprehensive, sketch/photograph
3. examination must be influenced be any other information obtained from others in
making a report or a conclusion.

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Outline of the medico-legal investigation of physical injuries:
1. General investigation of the surroundings:
a. examination of place where crime is committed.
b. Examination of clothing, stains, cuts, hair, f.b. in the crime scene
c. Investigations on possible witnesses to the incident
d. Examination of the wounding instrument
e. Photography, sketching, accurate description of the crime scene.

2. Examination of the wounded body

a. examinations applicable to living or the dead
- age of the wound from the degree of healing
- determination of the weapon used
- reasons for the multiplicity of wounds
- determination if the wound is accidental, suicidal or homicidal
b. examination applicable only to the living
- determination if injury is fatal
- determination if injury will produce permanent deformity
- determination if wound produces shock
- determination if wound produces complications
c. examination applicable to a dead victim only
- determination if wound is pre-mortem or post-mortem
- determination whether wound is mortal or not
- determination whether death is accelerated by a disease present at time
of injury.
- determination whether wound cause by A,S, H

3. Examinations of wound
- character of wound : abrasion, hematoma, laceration etc
- location of wound : from some fixed area
> to determine trajectory/course
- depth of wound : not in the living , only if the outer and inner are fixed
- conditions of the surroundings of the wound -
= near GSW – burning, tattooing
= suicidal cuts – superficial tentative cuts or hesitation cuts
= lacerated wounds – contusion on neighboring skin
- extent of the wound
= extensive injury – marked degree of force applied in the
production of the wound.
= homicidal cutthroats are deeper, extensive, numerous than
suicide
- direction of the wound > impt. in the position of the victim to the offender
- number of wounds – several> homicidal
- conditions of locality
a. degree of hemorrhage

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 b. evidence of struggle
c. information as to the position of the body
d. presence of suicide note
e. condition of the weapon

ANTE-MORTEM WOUNDS POST-MORTEM WOUNDS

HEMORRHAGE More profuse, arterial Slight or none, venous
due to loss of tone of vessels,
Absence of heart action
Post-mortem clotting of
blood inside b.v.
Marks of spouting of blood No spouting of blood
from arteries
Clotted blood Bld not clotted,or soft clot
SIGNS OF Inflammation & reparative None
INFLAMMATION process
Swelling in the area,
Effusion of lymph, pus
Adhesion of the edges
Unless if victim is weakened

SIGNS OF Fibrin formation No time of repair

REPAIR growth of epithelium
Scab or scar formation

RETRACTION Deep staining of the edges Not deeply stained

OF THE EDGES and cellular tissues can be removed by washing
OF THE WOUND which is not removed by washing
Edges gape owing to the reaction Edges do not gape, but are
of the skin and muscle fibers closely approximated to
Each other unless if the
wound is 1 to 2 hrs
after death

DETERMINATIONS IF WOUND IS:

HOMICIDAL SUICIDAL ACCIDENTAL
ABRASIONS Not common unless Rarely observed Extensive
If dragged abrasions MVA
Or if victim resisted

CONTUSION Rare except when Found in any portion

jumping from a height of the body - Fall

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INCISED Commonly observed Commonly observed Frequent but rarely WOUNDS
* depth, location and surroundings cause of death

Points to consider in the determinat’n as to whether the wounds is A, S, H.

1. external signs and circumstances related to the position and attitude of the body when
found.
2. location of the weapon or the manner in which it was held
3. the motive in the commission of the crime
4. the personal character of the deceased
5. the possibility for the offender to have purposely changed the truth of the condition.
6. other information
a. signs of struggle
b. number and direction of wounds
c. direction of wound
d. nature and extent of the wound
e. state of clothing

LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF THE WOUND

1. degree of healing> signs of repair of wound appear in less than a day after the infliction
of injury.
2. changes in the body in relation to the time of death >systematic changes in the body =
wasting, anemia, bed sore.
3. age of blood stain – not reliable
4. testimony of witness when the wound was inflicted.

POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE INJURIES

1. contusion – blunt
2. incised wound – sharp-edged instrument
3. lacerated wounds- blunt
4. punctured wounds – sharp pointed
5. abrasion – body surface is rubbed on a hard surface
6. GSW – the diameter of the wound of entrance may approximate the caliber of the
wounding instrument.

Could the injury have been inflicted by a special weapon?

A physician cant determine that a specific weapon was used in inflicting a
wound.
It is possible that it is caused by a certain instrument presented.
He must be cautious in giving categoric statements

Which of the injuries sustained by the victim caused death?

If with conspiracy – no need coz the act of one is the act of all.
If none- offenders are only responsible for their individual acts.

45
 If multiple injuries: which of the wound injured a vital organ.
Or if same organ which caused the degree of damage.

Which of the wounds was inflicted first?

If multiple for the qualification of the offense committed.
First – treachery , murder
Last - homicide
Consider:
1. relative position of the assailant and the victim when the first injury was inflicted on the
latter.
2. trajectory/course of the wound inside the body of the victim
3. organs involved and the degree of injury
4. testimony of witness
5. presence of defense wounds – inflicted first.
Effect of medical and surgical intervention on the death:
If death followed after operation> offender is responsible if death was inevitable and that
even with operation death is normal and direct consequence of the injury, and the physician is
competent and in spite of exercise of degree of diligence still death is the outcome.
If death ensued even the wounds are minor, and death due to the negligence or
incompetence of the physician then the offender cant be responsible.

Effect of negligence of the injured person on the death

If death occurred from complications arising from a simple injury owing to the
negligence of the injured person in its proper care and treatment
= the offender is responsible for the death
= a person is not bound to submit himself to medical tx for the injuries
received during the assault.
= unless if it is proven that the negligence of the victim is deliberate so
offender is not responsible but only for physical injuries.

Power of volitional acts of the victim after receiving a fatal injury:

= dying declaration, attempt to kill the offender after the first blow of the offender

Relative position of the victim and assailant when injury was inflicted:
1. location of the wound
2. direction of the wound
3. nature of instrument used in inflicting the injury
4. testimony of the witness

EXTRINSIC EVIDENCES OF THE WOUNDS

1. evidences from the wounding weapon
= position of the weapon - near or grasp by victim

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 = blood on weapon - may be stained with blood
= hair and other substance on weapon
2. evidences in the clothing of the victim
= soaked with blood - hemorrhage
= gunpowder - distance
= tears - struggle
3. evidences derived from the examination of the assailant
= paraffin test, tears in clothing, blood stains, intoxication etc.
4. evidences derived from the crime scene
= amount of hemorrhage, wounding instrument etc.

47