CRMTCS 6: LEGAL MEDICINE

KNOWLEDGE
 Science – “Man’s explanation of everything in the universe.”
 Art or Philosophy – “Man’s appreciation of everything in the universe.”

CRIMINOLOGY
 Criminal Law and Jurisprudence
 Law Enforcement Administration
 Crime Detection and Investigation
 Criminalistics or Forensics
 Correctional Administration
 Criminal Sociology

CRIMINALISTICS
- 1: Forensic Personal Identification (Dactyloscopy)
- 2: Forensic Photography
- 3: Forensic Firearm Examination (Ballistics)
- 4: Forensic Questioned Document Examination
- 5: Forensic Lie Detection (Polygraphy)
- 6: Forensic Medicine

MEDICINE
 CLINICAL MEDICINE – *Obstetrics, *Paediatrics, *Internal Medicine (Neurology, Cardiology,
Pulmonology, etc.), *Surgery (Neurologic Surgery, Thoracic-Cardiovascular Surgery,
Orthopaedics, etc.)

 DIAGNOSTIC MEDICINE – *Pathology, *Radiology, etc.

 INVESTIGATIVE MEDICINE or Forensic Medicine as being offered or served by:

*Philippine National Police Crime Laboratory
*Medico-Legal Division of the National Bureau of Investigation
*Commission on Human Rights

 LEGAL MEDICINE – is a branch of medicine which deals with the application of medical knowledge
to the purpose of law in the administration of justice.

Originally, the terms legal medicine, forensic medicine and medical jurisprudence are synonymous
and, in common practice, are used interchangeably.

DISTINCTION BETWEEN LEGAL MEDICINE, FORENSIC MEDICINE AND MEDICAL

JURISPRUDENCE
1. Legal Medicine is primarily the application of medicine to legal cases.
2. Forensic Medicine concerns with the application of medical science to elucidate legal problems.
3. Medical Jurisprudence denotes knowledge of law in relation to the practice of medicine.

STAGES
Basic (Plain or Simple) level
Forensic level
Legal level

MEDICO-LEGAL ASPECTS OF ASSAULTS AGAINST HUMAN BEINGS

1. (Physical) Injury
2. Homicide
3. Sexual in Nature

BASIS
The (living) victim still live, or is still alive. – NON-FATAL or NON-MORTAL INJURY – Physical
Injury (slight, less serious, or serious), Mutilation, Administering Injurious Substance, OR P.I. resulting from
tumultuous affray
The (living) victim dies, or becomes dead. – FATAL or MORTAL INJURY – Homicide (parricide,
murder, infanticide), OR Death resulting from tumultuous affray

FETAL DEVELOPMENT
 1st month: eyeballs & limb buds;
 2nd month: nose & jaw;
 3rd month: nails & genitalia;
 4th month: bodily hairs;
 5th month: gums;
 6th month: eyelashes;
 7th month: testicles (in males only);
 8th to 9th months: COMPLETE ALREADY!
PUBERTAL GROWTH
 pubic hairs: 13 y/o (f) 14 y/o (m);
 mustache & beard: 16 – 18 y/o (m);
 breasts: 13 – 14 y/o (f);
 change in voice: 16 – 18 y/o (m&f);
 menstruation: 11 – 12 y/o (f).

OTHERS
Tooth Eruption Periods:
TEMPORARY: 0.5 – 2 y/o (m & f);
PERMANENT: 6 – 18 y/o (m & f).

Number of Bones:
CHILD: 200 pieces (m & f);
ADULT: 206 pieces (m & f);
Source of the additional six (6) bones: 3 pairs of ossicles or tiny bones found in both middle ears.

(PHYSICAL) INJURY

DEFINITION OF TERMS
 Physical – generally refers to the body of a human being, both external and internal;
 Assault – any form of violent and/or offensive action directed towards a subject;
 Physical Assault – any form of violent and/or offensive action directed towards a human being,
resulting to any form of injury, either external, internal, or both;
 Injury – any form of disruption in the integrity, state, and/or functioning of either a part of, many
parts of, or the whole human body;
 Physical Injury – a legal terminology of Criminal Law, “but a redundant Medico-Legal
terminology”.

Classification of Injury

 Based on body location;

 With reference to surface level: “superficial or deep”;
 With reference to body cavity: “external or internal”;
 With reference to body part: “head, neck, chest, abdomen, back, or limb (arm, forearm,
hand, thigh, leg, or foot)”

 Based on cause and/or agent;

 by mechanical. ex. gun-shot, stabbed, fist-blown
 by chemical. ex. corrosive-skin contact, toxic substance-ingestion
 by thermal. ex. burn, scald, frost-bite
 by electrical. ex. lightning-strike, electrocution
 by radiation. ex. nuclear explosion exposure, excessive ultra-violet ray

 Based on description;
 With reference to skin integrity: “penetrating or non-penetrating”;
 With reference to skin direction: “linear or non-linear”; With reference to skin opening:
“regularly-shaped edge or irregularly-shaped edge”

 Based on manner;
 Projectile or Distant infliction: ex. gun-fired, arrowed, speared, shrapnel-hit, explosion-
shocked
 Contact infliction: ex. stabbed, hacked, axed, bat-hit, fist-blown, slapped, side-swept,

 Based on mechanism;
 Intended : ex. surgical incision
 Induced: ex. stabbed wound
 Accidental: ex. fracture secondary to fall from a high location
 Consequential: ex. ruptured artery secondary to sudden increase in blood pressure

 Based on effect
 Fatal or Mortal
 Non-fatal or Non-mortal

 Based on status
 Situation #1: The skin is intact; therefore, there is no actual bleeding. – CLOSED INJURY
 Situation #2: The skin is not intact; therefore, there is actual bleeding. – OPEN INJURY or
WOUND

 Specifically-classified
 Closed injuries
1. Contusion (bruise) – a confined, dark discoloration of a surface of the skin or mucosa of
the body, caused by the escape of blood from its vessel, due to a sudden forceful impact
on that location by a blunt object or body part.
 2. Ecchymosis (“kiss-mark”) – similar to a contusion, in appearance and cause, but due to
a continuous vacuum force or negative pressure exerted on the surface of the skin
or mucosa of the body.
3. Hematoma (lump) – a circumscribed, dark discoloration of a surface of the skin or mucosa
of the body caused by the escape of blood from its vessel and accumulation into the
tissue space, due to a sudden forceful impact on that location by a blunt object or
body part.
4. Erythema (reddening) – a confined, reddish discoloration of a surface of the skin or
mucosa of the body caused by the temporary cessation of its blood flow, maybe due to
heat (like in direct sunlight exposure) or autonomic reaction of the body (like during
blushing), or due to a slight sudden impact on that location by a blunt object or body
part (like in an after-slapping incident).

 Open injuries or Wounds

1. Abrasion (graze / scratch) – a superficial break or disruption in the integrity of the skin
surface or mucosa of the body (including the vulva), caused by a sudden forceful
impact or continuous rubbing of that body part onto a rough surface.
2. Laceration (tear) – a deep break or disruption in the integrity of the skin surface or
mucosa of the body (including the hymen, vagina, and anus), with irregularly-shaped
edges, caused by a sudden forceful impact on that location by a blunt object or
body part.
3. Incision (slash / cut) – a superficial or deep break or disruption in the integrity of the
skin surface or mucosa of thembody, caused by a sudden or gradual, forceful strike of
a sharp-edged object.
4. Hack (chop) – a deep break or disruption in the integrity of the skin surface or mucosa of
the body, caused by a sudden, forceful strike of a heavy and sharp-edged object.
5. Puncture (poke) – caused by a sharp-pointed object;
6. Stab (knife-thrust) – caused by a sharp-pointed & sharp-edged object;
7. Gunshot (bullet-wound) – caused by a tiny blunt object which hit the skin surface or
mucosa of the body, at a very fast speed or at a very high velocity;

 Injuries caused by the clinician:

 Incision – a surgically-induced wound, intended solely to gain access into deeper portion
or cavity of the body, and to widen body opening; OR
 Extraction – a maneuver intended to remove a tooth on the jaw, or any foreign object
dislodged into a body cavity; OR
 Excision – a surgical operation intended to remove a part or a portion of the body; OR
 Amputation – a surgical operation intended to remove a body limb or a portion of it;

 Neither closed nor open injuries:

 Subluxation – a partial displacement of bones in a joint, caused by an external force.
 Dislocation – a total displacement of bones in a joint, caused by an external force.
 Decapitation – the total detachment of the head from the rest of the body, caused by a
sudden or gradual distracting force, or a strike by a sharp-edged object. (“ALWAYS
HOMICIDAL”)
 Fracture (bone-break) – a disruption in the integrity & continuity of the bone caused by a
sudden impact of external force exerted on any portion of it.
 Burn (scald / frostbite) – a disruption in the integrity of the skin surface or mucosa of the
body caused by contact with either a very hot or a very cold substance.
 Avulsion (dismember) – a forceful, sudden or gradual detachment of a part of the body.

HOMICIDE
Homicide can be defined
 based on its word origin combination;
prefix: homo- “man” + affix: -cide “killing”.

 based on its general meaning;

the killing of a human being.

 based on Medical (Forensic) context;

the violent and/or unnatural death of a human being.

 based on Legal (Criminal Law) context;

the killing of a human being by another.

Forensic (Medical) Context

1. With reference to the alleged incident;
ex. Drowning, Hanging, Electrocution, Fell, Hit

2. With reference to gross presentation;

ex. Burn, Decapitation, Starvation, Dehydration

3. With reference to the characteristic injury;

ex. Gun-shot, Stabbed, Hacked, Crushed
 4. With reference to combination of nos. 1 to 3
ex. Multiple Traumatic Injuries, Shock, Asphyxia

DIFFERENT FORMS OF HOMICIDE

 INFANTICIDE – the killing of a child less than three days old (<72 hours);
 PARRICIDE – the killing of a relative by blood in the direct line, or a spouse;
 SUICIDE – the killing of one’s self; &
 MURDER – the killing of a person (homicide) with any of the six (6) specific circumstances
defined in Article 248 of the Revised Penal Code.

MOST COMMON MEANS

 for INFANTICIDE: Smothering, Neglected to starve to death;
 for PARRICIDE: Beating to death, Manual strangulation;
 for SUIDICIDE: Gun-shooting, Over-consumption of sedating substance [upper class], Ingestion
of poisonous substance, Wrist slashing [middle class], Hanging, Jumping-off from height [lower
class];
 for MURDER: Gun-shooting [upper class], Made to ingest poisonous substance [middle class],
Stabbing [lower class];

GUN-SHOOTING
 results to gun-shot injury/wound on the body;
 there is ALWAYS a point of entry of the slug (of the bullet) on the body, once it hit ACROSS; but
NOT ALWAYS a point-of-exit, unless it is thru-and-thru;
 usually, the “point-of-entry” wound opening is narrower, compared to the “point-of-exit” wound
opening;
 there is ALWAYS a contusion or abrasion collar on an entry wound, but NEVER on an exit
wound;
 there is ALWAYS tattooing on the skin portion near the entry wound, if the muzzle’s tip of the gun
was fired WITHIN TWO FEET from the body surface; but NEVER on an exit wound; &
 there is ALWAYS smudging on the skin portion around the entry wound, if the muzzle’s tip of the
gun was fired while on-contact with the body surface;

“SHARP-POINTED” only
 results to a slit-shaped injury/wound;
 there is ALWAYS an entry wound, once the thrust was made, but NOT ALWAYS an exit wound,
unless it is thru-and-thru;
 usually, the “point-of-entry” wound opening is of SAME DIMENSION as the “point-of-exit” wound
opening; &
 definitely, there is NEITHER tattooing NOR smudging near the “point-of-entry” wound opening;

“SHARP-POINTED” & “SHARP-EDGED”

 results to a UNI-tapering-shaped injury/wound, if the object used for stabbing has only ONE
sharp-edged side;
 usually, the tapering side of the “point-of-entry” wound opening also has a tailing (like a straight
linear abrasion);
 results to a BI-tapering-shaped injury/wound, if the object used for stabbing has TWO sharp-edge
sides;
 there is ALWAYS an entry wound, once the thrust was made, but NOT ALWAYS an exit wound,
unless it is thru-and-thru;
 usually, the “point-of-entry” wound opening is of SAME DIMENSION as the “point-of-exit” wound
opening; &
 definitely, there is NEITHER tattooing NOR smudging near the “point-of-entry” wound opening;

CLASSIFICATION
 Natural Death:
1. Prematurity
2. Very Old Age
3. Disease-Caused
a. Organ Destruction (Cancer)
b. Ineffective (infectious) blood – Sepsis (Septicemia/Septic Shock)
c. Multiple Organ Failure – Cardio-Pulmonary (Respiratory) Arrest

 Non-natural Death:
1. Violent (mauling, stabbing, puncturing, incising, lacerating, hacking, gun-shooting, etc.)
2. “Crime-related” (felonious [intentional / deliberate or negligent / imprudent ] OR offensive)
3. MEDICO-LEGAL CASES
 VERY SEVERE INJURY OF THE VITAL ORGAN (of the brain or the heart)
 LOSS OF EFFECTIVE CIRCULATING BLOOD (HYPOVOLEMIA / HYPOVOLEMIC
SHOCK ) – “bleeding-to-death”
 LACK OF OXYGEN ENTERING THE LUNGS (ASPHYXIA )
 Unclassified (neither natural nor non-natural)
1. Self-homicidal (suicidal )
2. Self-accidental
3.Phenomenological(unexplainable)
a. Sudden Infant Death Syndrome (S.I.D.S.) or Crib Death
 b. Tension Pneumothorax
c. Acute Hemorrhagic Pancreatitis

ASPHYXIA by
1. Solid: Internal: CHOKING
External: STRANGULATION by Hanging, Smothering, Ligating, Manual gripping /
Throttling, or Compressing / Crushing.
2. Liquid: DROWNING in Water either salty / non-fresh or non-salty / fresh;
or Non-water

3. Gaseous: Non-oxygen: SUFFOCATION

or Non-carbon dioxide: CARBON MONOXIDE POISONING

SHOCK
1. Septicemia or SEPTIC SHOCK – blood infection or sepsis wherein there is always livor mortis.
2. Hypovolemia or HYPOVOLEMIC SHOCK – loss of blood in the circulation resulting in pallor
which is the opposite of livor mortis.

DEATH and the DEAD

Death is the …
 end-event of an organism or species
 termination of all the life processes;
 complete cessation of all the vital functions; &
 irreversible loss of all the properties of living matter;

Kinds of Death:
1. Somatic or Clinical
 complete, persistent, and continuous cessation of the vital functions of the brain, heart, and lungs;

2. Molecular or Cellular
 still presence of life among individual cells, after cessation of the vital functions of the brain, heart,
and lungs;

3. Apparent or “Not Really” – TOTALLY WRONG!

 state of suspended animation, and merely a transient loss of consciousness;
 temporary cessation of the vital functions of the brain, heart, and lungs

CRITERIA IN DETERMINING DEATH

 Brain Death (presence of deep irreversible coma, absence of electrical brain activity, and
complete cessation of all the vital functions without possibility of resuscitation)
 Cardio-Respiratory Death (presence of continuous and persistent cessation of heart and lung
functions)

GROSS SIGNS OF DEATH

1. Cessation of Heart Function (Circulation);
2. Cessation of Lung Function (Respiration);
3. Cooling of the Body (“Algor Mortis”)
4. Insensibility and Immovability of the Body
5. Dermatologic (Skin) Changes
6. Ophthalmologic (Eye) Changes
7. Non-Effect of Heat on the Skin

GROSS CHANGES AFTER DEATH

1. in the Muscle;
2. in the Blood;
3. Autolysis or Auto-digestion; &
4. Putrefaction of the Body

1. CHANGES IN THE MUSCLE

a) Stage of Primary Flaccidity (Post-mortem or Period of Muscular Irritability);
b) Stage of Post-mortem Rigidity (Cadaveric Rigidity / Death Stiffening / “Death Struggle of the
Muscles” / “Rigor Mortis” ); &
c) Stage of Secondary Flaccidity or Commencement of Putrefaction (Decay of the Muscle) /
Secondary Relaxation

2. CHANGES IN THE BLOOD

a) Coagulation of the Blood; &
b) Post-Mortem Lividity or Cadaveric Lividity / Post-Mortem Suggillation / Post-Mortem Hypostasis
/“ Livor Mortis”

3. AUTOLYSIS OR AUTODIGESTION
 proteolytic, glycolytic, and lipolytic ferments of glandular tissues continue to act, leading to the
autodigestion of organs;
 facilitated by weak acid, and high temperature;
 delayed by the alkaline reaction of the tissues of the body, and low temperature;
 appears early in the parenchymatous and glandular tissues
4. PUTREFACTION OF THE BODY
a) Changes in the Color of the Tissues;
b) Evolution of Gases in the Tissues; &
c) Liquefaction of the Tissues

DEAD is …
 an adjective word used to denote the state of DEATH;
 Synonymous: DECEASED, LIFELESS;
 non-living state of organisms or species; &
 commonly referred to as BODY in the expression “Body Count” which is for the non-living person,
(while “Head Count” is for the living person) in Military, Law Enforcement, and Investigative
settings

SEXUAL IN NATURE

MEDICO-LEGAL PURPOSES
1. for DETECTION OF ANY INJURY and DETERMINATION OF THE EXTENT OF SUCH INJURY
on the subject [victim], with much focus on the anal and/or genital portions;
2. for DETECTION OF SPECIMEN [assailant’s] on the subject [victim] and IDENTIFICATION OF
SUCH SPECIMEN, and if it is possible, its probable source [the assailant];
3. for COLLECTION with proper labeling, PROCESSING, and PRESERVATION of identified
specimen; &
4. for accurate DOCUMENTATION OF FINDINGS in the form of a report or certificate to be used as
corroborative evidence.

MEDICO-LEGAL PROCEDURES
1. PHYSICAL EXAMINATION of the subject [victim] with much focus on the anal and/or genital
portions;
2. SEMEN DETECTION ( on the subject [victim] and/or other surfaces;
3. SPERM DETECTION (through microscopy) from the subject [victim] and/or other surfaces;
4. MICROSCOPIC EXAMINATION OF DISCHARGE to detect infection;
5. SEROLOGIC EXAMINATION for blood typing and/or matching; &
6. D -e-oxyribo N -ucleic A -cid TESTING for genetic composition matching.

MEDICO-LEGAL EXAMINATION
1. First, IDENTIFICATION or IDENTITY DETERMINATION of the subject [victim], even if
deceased, (name, age, gender, sex background, etc.);
2. DETECTION OF ANY INJURY on the subject [victim] with much focus on the anal and/or genital
portions (anal orifice, penis and scrotum [male], and vulva [female]);
3. DETECTION OF PERTINENT SPECIMEN from the subject [victim] (oral, anal, urethral, and
vaginal orifices) and other surfaces (skin, haired-portions, clothes, linen, etc.); &
4. RECORDING OF ALL THE PERTINENT FINDINGS.

MEDICO-LEGAL FINDINGS
1. Injury, in the form of either a…
 Laceration;
 Abrasion;
 Contusion; or
 Combination of any, or all of the three injuries above-mentioned;
2. Presence of either a…
 Semen;
 Sperm;
 Blood;
 Pus (infected discharge);
 Foreign object; or
 Combination of any of the five specimens above-mentioned

SITES OF INJURY
 for LACERATION: hymen, anal orifice, fourchette, pudendum;
 for ABRASION: peri-hymenal portion, labia majora (outer / big lips), labia minora (inner / small
lips), peri-urethral portion, fourchette, pudendum [among females]; glans penis (head), penile
shaft (body) [among males]; anal orifice
 for CONTUSION: hymen, peri-hymenal portion, labia majora (outer / big lips), labia minora (inner
/ small lips), peri-urethral portion, fourchette, pudendum [among females]; glans penis (head),
penile shaft (body) [among males]; anal orifice

SITES OF SPECIMEN
 for SEMEN: oral cavity, vaginal canal, anal canal, pubic-haired portion, haired portion of the
head;
 for SPERM: oral cavity, vaginal canal, anal canal, pubic-haired portion, haired portion of the
head;
 for BLOOD: hymen, vaginal orifice, anal orifice;
 for PUS (infected discharge): urethral orifice [among males], vaginal orifice [among females];
 for FOREIGN OBJECT: vaginal canal, anal canal;
MISCONCEPTIONS
“Virginity is based on the INTACTNESS of all the anatomical structures on the genital portion [for
the females]; or the ABSENCE of any form of injury (either recent or remote) on the genital portion [for
both males and females].”

“If there is NO INJURY on the hymen [for the females] and/or anal orifice [for both males and
females], then there is NO RAPE.”