MEDICO-LEGAL ASPECT OF PHYSICAL INJURIES

Physical Injury – is the effect of some form of stimulus on the body. The effect of the
application of stimulus may be immediate (as in gunshot wound) or may be delayed as
injury brought about by infection). It is a specific impairment of body structure caused
by an outside force or agent; therefore, it is an injury to the body caused by physical
agents.

Causes of physical injury:

1. Physical Violence
2. Extremes of temperature
3. Electrical energy
4. Chemical agent
5. Radioactive substance
6. Changes in environmental pressures
7. Infection

Wound – is the solution of the natural continuity of any tissue of the living body. It is the
disruption of the anatomic integrity of a tissue of the body.

Inflammation – is a specific tissue response to injury by the living agents, or to electrical,

chemical or extremes of temperature or mechanical traumas characterized by vascular
dilatation, fluid exudation or accumulation of leucocytes in the tissue.

The inflammation of tissues had been used as basis to differentiates ante-mortem from
post mortem body injuries. The ante mortem injuries in the body usually produced
inflammation which does not occur in post-mortem injuries. (presence of vital
reaction)

Classification of Wounds
1. As to severity:
a. Mortal wound – wound which is caused immediately after the infliction or shortly
thereafter is capable of causing death.
Example:
brain or upper portion of the spinal cord
heart and big blood vessels
b. Non-mortal wound – wound which is not capable of producing death immediately
after infliction or shortly thereafter.
2. As to the kind of instrument used:
a. Wound brought about by blunt instrument (contusion, hematoma, lacerated wound)
b. Wound brought about by sharp instrument:
i. Sharp-edge instrument (incised wound)
ii. Sharp-pointed instrument (punctured wound)
iii. Sharp-edge and sharp-pointed instrument (stab wound)
c. Wound brought about by tearing force (lacerated wound)
d. Wound brought about by change of atmospheric pressure (barotraumas)
e. Wound brought about by heat or cold (frostbite, burns or scald)
f. Wound brought about by chemical explosion (gunshot or shrapnel wound)
g. Wound brought about by infection
3. As to manner of infliction:
a. Hit – by means of bolo, blunt instrument, axe.
b. Thrust or stab – bayonet dagger, knife
c. Gunpowder explosion – projectile or shrapnel wound.
d. Sliding, rubbing or abrasion.
e. tearing or stretching
4. As regard to the depth of the wounds:
a. Superficial – when the wound involves only the outer layer of the skin.
b. Deep – when the wound involves the inner structure of the skin.
i. Penetrating – one in which the wounding agent enters the body but did not come
out in the mere piercing of a solid organ or tissue of the body.
ii. Perforating – when the wounding agent produces communication between the
inner and outer portion of the hallow organs. It may also mean 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 the site of the 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 – physical injury found opposite the site of application of force.
c. Coup contre-coup – physical injury located at the site and also opposite the site of
application of force.
d. Locus minoris resistencia – physical injury located not at the site nor opposite the
site of the application of force but in some areas offering the lest resistance to the
force applied.
e. Extensive injury – physical injury involving a greater area of the body beyond the site
of the application of force. It has not only the wide area of injury but also varied
types of injury.
6. Special type of wounds:
a. Defense wound – wound which is the result of a person’s instinctive reaction of self-
projection. Injuries suffered by a person to avoid or repel potential injury
contemplated by the aggressor.
b. Patterned wound – wound in the nature and shape of an object or instrument and
which infers the object or instrument causing it.
c. Self-inflicted wound – is a wound produced on oneself. As distinguish from suicide,
the person has no intention to end his life.

LEGAL CLASSIFICATION OF PHYSICAL INJURIES

1. Mutilation
2 kinds of mutilation
a. by intentionally mutilating another by depriving him, either totally or partially
of some essential organs of the reproduction;
b. by intentionally making other mutilation, that is, by looping and clipping off
any part of the body of the offended party, other than the essential organ for
the reproduction, to deprive him of that part of the body.

*As distinguished from avulsion, the latter is defined as a sudden, accidental removal of a
certain part of the body secondary to physical violence.
Example: removal of an arm in a motor-vehicle accident

2. Serious physical injury

Requisites:
a. permanent loss of any part of the human body
b. loss of the use of any part of the human body
c. deformity – physical ugliness that is visible and not disappear through
natural healing process
d. the victim is incapacitated from work for more than 30 days, regardless of
the duration of medical treatment required
3. Administering injurious substances and beverages
Elements:
a. that the offender inflicted upon another any serious physical injury
b. that is done knowingly administering to him any injurious substance or
beverage or by taking advantage of his weakness of mid or credulity
c. that he had no intent to kill
4. Less serious physical injury
Elements:
a. that the incapacitated party is incapacitated for labor for 10 days or more
but not more than 30 days, or needs medical attendance for the same period
of time
b. that the physical injuries must not be those describe in the serious physical
injury
5. Slight physical injury and maltreatment
Kinds:
a. physical injuries which incapacitated the party for labor from 1 to 9 days, or
required medical attention during the same period
b. physical injuries which did not prevent the offended party from engaging in
his habitual work or which did not require medical attendances
c. ill-treatment of another by deed without causing any injury
 6. Physical injuries in a tumultuous affray
Elements:
a. there is a tumultuous affray;
b. participant(s) suffered from serious physical injuries;
c. the persons who inflicted such serious physical injuries cannot be identified;
d. all those who appear to have used violence upon the person of the offended
party shall be penalized by arresto menor, from five to fifteen days.

TYPES OF WOUNDS (Medical Classification):

1. Closed wound- these are 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.
i. Petechiae – is a circumscribed extravasation of blood in the subcutaneous tissue
or underneath the mucous membrane. Ex. Insect’s bite
ii. Contusion (bruise) – 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. Its extent of violence applied; and its distribution may
indicate the character and manner of injury.

Age of contusion:
The age of contusion can be appreciated from its color changes. 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 red blood corpuscles and liberation of hemoglobin.
The contusion is red sometimes purple soon after its complete development.
In 4 to 5 days, the color changes to green.
In 7 to 10 days, it becomes yellow and gradually disappears on the 14 th or 15th day.
The ultimate disappearance of color varies from one to four weeks depending upon
the severity and constitution of the body. The following are factors influencing the
degree and extent of contusion:
1. vitality of tissue
2. Parts involved
3. Amount of force applied
4. Accompanying diseases
5. Age
6. Sex

iii. Hematoma (blood cyst, blood tumor, “bukol”) – is the extravasation or

effusion of blood in a newly formed cavity underneath the skin. It is usually
develops when the blunt instrument is applied in a part of the body where bony
tissue is superficially located like head, chest, anterior aspect of the legs. The force
applied cause the subcutaneous tissue to rupture on account of the presence of a
hard structure underneath.

b. Deep
i. Musculo-Skeletal injuries:
1. Sprain – partial or complete disruption in the continuity of a muscular or
ligamentous support of a joint. It is usually caused by a blow, kick or torsion force.
2. Dislocation – displacement of the articular surface of bones entering into a
formation of a joint. It can be simple or compound.
a. Simple – dislocation where there is a displacement of bone but without
external wound.
b. Compound – dislocation where there is a displacement of the bones
accompanying break or wound in the skin.

3. Fracture – solution of continuity of bone resulting from violence or some

existing pathology. It can be simple, compound or comminuted.
a. Simple – there is the line of fracture but the alignment of the bone is still
in intact.
b. Compound – there is a break in the bone and loss of alignment of the
affect bone.
c. Comminuted – there is a break in the bone, loss of alignment in the
affected bones and separation of fragments of bones.
 4. Strain – the over-stretching, instead of an actual tearing of the rupture of a
muscle or ligament which may not be associated with the joint.
5. Subluxation – incomplete or partial dislocation.

ii. Internal Hemorrhage – rupture of blood vessel which may cause due to the
following:
 traumatic intracranial hemorrhage – bleeding in the cranial cavity
 rupture of parenchymatous organ – injury of the hollow organ inside
the body characterized by extravasations of blood
 laceration of other parts of the body – laceration of an organ inside
the body secondary to violence characterized by bleeding.

iii. Cerebral Concussion – is 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.

2. Open Wound
a. Abrasion (Scratch, graze, impression mark, friction mark) – injury characterized by
the removal of the superficial epithelial layer of the skin caused by a rub or friction
against a rough surface.

As distinguished from erosion, the latter is the removal of the superficial layer of the
skin due to some other causes other than friction or sliding.

This is characterized by:

a. There is a removal of epithelial layer of the skin.
b. It involves the outer layer or superficial portion of the skin or tissues.
c. The raw area exudes blood and lymph.

Forms of Abrasion
1. Linear – appears as a single line.
2. Multi-Linear – develops when the skin is rubbed on a hard rough object
thereby producing several linear marks parallel to one another.
3. Confluent – the linear marks on the skin are almost indistinguishable on
account of severity of friction and roughness of the object.
4. Multiple – several abrasions of varying size and shapes may be found in
different parts of the body.
Types of Abrasion
 Scratches – brought about by the stroke of sharp-pointed instrument over
the skin producing the injury.
 Grazes – due to the forcible contact with a rough, hard object resulting to
irregular removal of the skin surface.
 Impact or Imprint abrasions – due to contact with a rough, hard object in
which the structural form of the object is reflected over the skin.
 Pressure of Friction Abrasion – due to pressure applied and with the
accompanying movement over the skin.

Distinction between ante-mortem from post mortem abrasion:

Ante-mortem Post-mortem

Color Reddish brown Yellowish and translucent

Over bony prominences which comes in

Location Any Area
contrast with the rough surface it rest

Vital reaction Present Absent

b. Incised Wound (cut, slash, slice) – produced by a sharp-edge (cutting) or sharp-

linear edge of the instrument, like a knife, razor, bolo, edge of oyster shell, metal
sheet, glass, etc.
o edges are clean-cut, regular and well defined
 o there is no swelling or contusion around the wound
o examination by means of magnifying glass shows that the hair bulbs are cut

Changes that occur in an incised wound:

After 12 hours ----- edges are swollen; adherent with blood and with
leucocytes infiltration
After 24 hours ----- proliferation of the vascular endothelium and
connective tissue cells
After 36 – 48 hours ----- capillary network complete
After 3 -5 days ----- vessels shows thickening and obliteration

Incised wounds may be Suicidal, Homicidal and Accidental depending upon the location,
direction and the presence or absence of hesitation cuts.

1. Suicidal – located in a peculiar parts of the body like the neck, flexor
surfaces of the extremities, wrist and accessible to the hand in inflicting the
injury.
2. Homicidal – usually deep, multiple and involve both accessible and non-
accessible part of the body to the hands of the victim.
3. Accidental – usually brought about by the broken glasses, edges of the iron
steel, and many others

c. Stab wound – produced by the penetration of sharp-pointed and sharp-edge

instrument. If the sharp-edge portion of the wounding instrument is the first to
come in contact with the skin, the wound produced is incised wound, but if the
sharp-pointed portion first comes in contact, then the wound is a stab wound. The
edges are clean-cut, regular and distinct.

d. Punctured wound – is the result of thrust of a sharp-pointed instrument. It is

commonly produced by an ice-pick and the like. External hemorrhage is quite
limited although internal injuries may be severe.

e. Lacerated wound (tear, rupture, stretch, “putok”) – is a tear of the skin and the
underlying tissues due to forcible contact with a blunt instrument

o edges are roughly cut, irregular and ill-defined.

o there is swelling and contusion around the wound
o examination with a magnifying glass shows that the hair bulbs are preserved

****Loss of blood incompatible with life – blood constitute about 1/20 of the body weight
of an adult. An average size adult has 5 to 6 quarts of blood (one quart is 946 cc).

Points to consider in the Reporting of Wound

1. Character of the Wound

2. Location of Wound in the body
3. Measurement of the wound
- Length
- Width
- Depth
4. Number of Wound
5. Direction of Wound
6. Organs Involved
7. Severity of the Wound
8. Period of healing or incapacity of the victim

MEDICO-LEGAL INVESTIGATION OF WOUND

1. General investigation of the surroundings

2. Examination of the wounded body
3. Examination of the wound
 Character
 Location
  Depth
 Condition
 Extent
 Direction
 Number
 Condition of the locality
Extrinsic evidence in wound
1. Evidence from the wounding weapon
 Position of the weapon
 Blood on weapon
 Hair and other substance on weapon
2. Evidence in the clothing of the victim
3. Evidence derived from the examination of the assailant
4. Evidence derived from the scene of the crime

GUNSHOT WOUND
Firearm shot – injury is caused by the missile propelled by the explosion of the
gunpowder located in the cartridge shell and at the near of the missile.

Entrance wound Exit wound

1. appears to be smaller than the missile

1. always bigger than the missile
owing to the elasticity of the tissues

2. edges are inverted 2. edges are averted

3. usually oval or round depending upon

3. it does not manifest any definite shape
the angle of approach of the bullet

4. “contusion collar” or “contact ring” is

present, due to invagination of the skin and 4. “contusion collar” is absent
spinning of the missile

5. tattooing or smudging may be present

5. always absent
when firing id near

6. underlying tissues may be seen

6. underlying tissues are not protruding
protruding from the wound

7. may be absent if missile is lodge in the

7. always present after fire
body

8. paraffin test is always negative

8. paraffin test may be positive

THERMAL INJURIES OR DEATH

1. Death or injury from cold

Signs and symptoms

a. Gradual lowering of the body temperature is accompanied by increasing stiffness,
weariness and drowsiness.
b. The person may be lethargic, passing the stage of coma to death.
c. Person may be suffering from delusion, convulsion and delirium.
d. Palpation of the coetaneous surface shows hardening and coldness.

2. Death or injury from heat

 a. Heat cramps (miner’s cramps, fireman’s cramps, stoker’s cramp) – involuntary
spasmodic painful contraction of muscles essentially due to dehydration and
excessive loss of chloride by sweating.
b. Heat exhaustion (heat collapse, syncopal fever, heat syncope, heat prostration) – is
due to heat failure primarily caused by heat and precipitated by muscular exertion
and warm clothing.
c. Heat stroke (sunstroke, heat hyperpyrexia, comatose form, thermic fever) – usually
occurs among those working in ill-ventilated places with dry and high temperatures
due to direct exposure to the sun.

Local effect of heat

1. Scald – injuries produced by the application to the body, liquid at or near boiling point,
or in its gaseous state.
2. Thermal burns – lesions which are caused by the application of heat or chemical
substances to the external or internal surfaces of the body, the effect of which is
destruction of the tissue of the body.

DEATH OR PHYSICAL INJURY BY LIGHTNING

Lightning – an electric charge in the atmosphere. The flash of lightning is due to

the passage from a thundercloud to the earth of a direct electric current of enormous
potential, amounting to something like 1,000 million volts and about 2,000 amperes.

The injury is flash burn, which caused by superheated air. This is always
accidental and no one is liable.

DEATH OR PHYSICAL INJURY FROM ELECTRICITY

The main cause of death in electricity is SHOCK. Voltage is not only the factors
causing the injury but rather the amperage or intensity of the electrical current is the
principal factor. An increase in the conductivity of the body will promote more injury. The
electrical burns is sometimes “electrical necrosis”.

DEATH CAUSED BY ASPHYXIA

Asphyxia – is the general term applied to all forms of violent death which result
primarily from the interference with the process of respiration or the condition in which
the supply of oxygen to the blood or to the tissue or both has been reduced below normal
level.

Classification:
1. Asphyxia by hanging – a form of violent death brought about by the suspension of the
body by a ligature with encircles the neck and the constricting force is the weight of the
body.
Classification of asphyxia by hanging:
a. Typical – when the ligature runs from the midline above the thyroid cartilage
symmetrically encircling the neck on both sides to the occipital region.
b. Complete – when the body is completely suspended and the constricting is the
whole weight.
c. Symmetrical – when the knot or noose is at the midline of the body either at the
occipital or below the chin.
2. Asphyxia by strangulation
Kinds of Asphyxia by strangulation:
a. by ligature – produced by the compression of the neck by means of ligature
which is tightened by a force other than the weight of the body.
b. by manual strangulation or throttling – this is a form of asphyxial death
whereby the constricting force applied in the neck is the hand
Special form of strangulation
a. palmar – the palm of the offender is pressed in front of the neck without
employing the fingers.
b. Garroting – any object is placed around the at the and tightened at the back.
c. Mugging – the assailant standing at the back and the forearm is applied in front
of the neck.
d. compression of the neck with a stick
3. Asphyxia by suffocation – exclusion of air from the lungs by closure of opening or
obstruction of the air passageway from the external opening of the air sacs.
 Kinds:
a. Smothering – caused by the closing of external respiratory orifice, either by the
used of the hand or by some other means.
b. Choking – brought about by the impaction of foreign body in the respiratory
passage.
4. Asphyxia by submersion or drowning – the nostrils and mouth has been submerged in
any watery, viscid or pultaceous fluid for a time to prevent the free entrance of air into
the air passage and lungs.
5. Compression Asphyxia – form of asphyxia whereby the free exchange of air in the lungs
is prevented by the immobility of the chest and abdomen due to external pressure or
crush injury.
6. Asphyxia by breathing irrespirable gases

DEATH FROM STARVATION

 Cause may be due to suicidal, homicidal or accidental. The human body without food
losses 1/24 of its weight daily and 40% loss may result to death.

Factors that influence the length of survival: age, condition of the body,

MEDICO-LEGAL ASPECT OF DEATH

Life – is the sum total of all the process of vital organ by which the physical
integrity of the body is maintained.
Death – it is the complete or persistent cessation or stoppage of the vital functions
and processes of the body.

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 for claims which does not survive is dismissed upon death of the
defendant.

Kinds of Death
1. Somatic or clinical death – the state of the body in which there is a complete
persistent cessation or stoppage of the vital function of the brain, heart and lungs.
Characteristics:
a. face and lips are pale
b. muscles become flaccid
c. sphincters are relaxed
d. the lower jaws turns to drop
e. eyelids remain open
f. skin losses its elasticity
2. Molecular or circular death – after cessation of the vital functions of the body, 3 – 6
hours this kind of death will occur.
3. Apparent or “state of suspended animation” – merely a transient loss of the
consciousness or temporary cessation of the vital function of the body. It may arise
especially in hysteria, uremia, catalepsy and electric shock.

Forensic pathology studies the clues to the cause of death found in the corpse as a
medical phenomenon.

Signs of Death
1. Cessation of the heart function and circulation
There must be an entire and continues cessation of the heart action and flow of the
blood in the whole vascular system. A temporary suspension of the heart action is still
compatible with life. As a general rule, if there is no heart action for a period of five
minutes death is regarded as certain.
Methods of detecting the cessation of heart action and circulation:
a. Examination of the heart:
i. Palpation of the pulse
- Made at the region of the wrist and the neck.
ii. Auscultation for the heart sound at the precordial area.
- The rhythmic contraction and relaxation of the heart is audible by means of
stethoscope or by placing the ear at the precordial area.
iii. Fluoroscopic examination
- Examination of the chest will reveal the shadow of the heart in its rhythmic
contraction and relaxation.
iv. By the use of the electrocardiograph (ECG)
b. Examination of the peripheral circulation
i. Magnus’ test
Procedure:
A ligature is applied around the base of the finger with moderate tightness.
In a living person, there appears a bloodless zone at the site of the application of
ligature and the livid area distal to the ligature. If such ligature is applied to the
dead finger of a dead man, there is no such change in color.
ii. Opening of the small artery
In the living, the blood escapes in jerk at the distance. In dead man, the
blood vessel is white and there is no jerking escape of the blood but may only ooze
towards the nearby skin
iii. Icard’s test
This consists of the ejection of a solution of fluorescein subcutaneously. If
circulation is still present, the dye will spread all over the body and the whole skin
will have a greenish-yellow discoloration due to fluorescein. In a dead man, the
solution will remain at the site of ejection.
iv. Pressure on the fingernails
If the pressure is applied on the fingernail intermittently, there will be a zone
of paleness at the site of the application of pressure which become livid on release.
v. Diaphanous test
The fingers are spread wide and the finger webs are viewed through the
strong light. In living, the color is red but yellow in dead.
vi. Application of heat on the skin
If heated material is applied on the skin of the dead man, it will not produce
true blister. There is no sign of congestion or other vital reaction. However, if
applied to a living person, blister formation, congestion, and other vital reactions of
the injured area will be observe.
vii. Palpation of the radial pulse
viii. Dropping of the melted wax
If the person is dead, there will be no inflammatory edema at the
neighborhood of the dropped melted wax.

2. Cessation of respiration
Like heart action, respiration must be persistent and continuous. A person can
hold his breath for a period not longer than 3-1/2 minutes.

Methods of detecting cessation of respiration:

a. Expose the chest ad abdomen and observe the movement during inspiration and
expiration.
b. Examination with the use of stethoscope.
c. Examination with the mirror.
The surface of the cold-looking glass is held in front of the mouth or nostrils. If
there is a dimming of the mirror after a time, there is still respiration.
d. Examination with a feather or cotton fiber.
Placed a fine feather or a strip of cotton in front of the lips and nostrils. If there
is movement of the feather or cotton not due to external air, respiration is present.
e. Examination with a glass of water
Placed the half full of water at the region of the chest. If the surface of the water
is stable and smooth, there is no respiration taking place.
f. Winslow’s test
 There is no movement of the image formed by the reflecting artificial or sun light
on the water or mercury contained in the saucer and place on the chest or abdomen if
respiration is not taking place.

CHANGES AFTER DEATH

1. PALLOR MORTIS (POST MORTEM PALENESS- paleness of death) is a postmortem
paleness which happens in those with light skin almost instantly in the 15–20 minutes
after the death) because of a lack of capillary circulation throughout the body because the
blood sinks down into the lower parts (according to gravity) of the body creating the livor
mortis.

2. Cooling of the body (ALGOR MORTIS)

After death, the metabolic process inside the body ceases. No more heat is
produced but the body loses slowly its temperature by evaporation or by conduction to the
surrounding atmosphere. The rate of cooling of the body is not uniform. It is rapid during
the first two hours after death. The fall of temperature of 15 to 20 degrees
Fahrenheit is considered as a certain sign of death. As decomposition occurs, the
internal body temperature tends to rise again.

Post mortem caloricity – it is the rise of temperature of the body after death due to rapid
and early putrefactive changes or some internal changes. It is usually observed in the first
two hours after death.
*Post mortem Caloricity is a condition where the temperature of the body remains raised for the
first two or so hours after death. In certain conditions, instead of promoting the process of cooling of the
body, act in a way, so that, the body temperature is either high at the time of death or is increased for
sometimes after death, so that, at a particular time after death the body may appear disproportionately
warmer than what it should have been. This is termed as Post Mortem Caloricity and the conditions are
****Eventually, the temperature of a dead human body (or any other sort of dead body) is the same
as the atmosphere around the body. There is no mechanism functioning to either raise or lower the
temperature to something else.

For a brief period after death (a couple of hours or so), the temperature may rise due to a
phenomenon called “postmortem caloricity.” A recently dead body may feel decidedly “feverish” before the
temperature starts to go back down towards the ambient temperature of the environment.

This is for several reasons - one is that all the individual cells die on their own after the entire
organism is dead - sort of like the lone survivors on islands in the south pacific carrying on long after WW 2
was over. Since the organism as a whole is dead, the cells have no support - no food, no oxygen, no cooling- and
so they all die at their own rate. But while they live, they are still producing heat which would normally be
carried away through the blood stream and ultimately discharged in your warm breath. So the production of
heat continues until all these cells die, but cooling has already stopped. Body heat rises.
1.      Post mortem Glycogenolysis
a.       This is a normal phenomenon and the rise is 3.6oF or 2oC
2.      Various Causes of Death such as
a.       Septicaemia,
                                             i.      Infectious diseases,

                                         ii.      Bacteremia

                                       iii.      Tetanus, Rabies, yellow fever

b.      Asphyxial Conditions
c.       Severe convulsions
                                            i.      Tetanus
                                       ii.      Strychnine

d.      Hyperpyrexia at death
                                           i.      Heat Stroke (sun stroke)

                                        ii.      Pontine Haemorrhage

e.       High Atmospheric Temperature

f.        Peritonitis, Meningitis, Nephritis
 g.       Alcohol poisoning

Factors affecting Algor mortis:

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
Factors accelerating cooling:
1. Leaness of the body
2. Extreme age
3. Long-standing illness
4. Chronic pyrexial disease with wasting - a disease that causes a person to
gradually become very thin and weak:

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:
a. When the body temperature is normal at the time of death, the average rate of fall of
the temperature during the first two hours is one-half of the difference of the body
temperature and that of the air.
b. To make an approximate estimate of the duration of death from the body temperature,
the following formula has been suggested: (Glaister Equation)

(Normal Temperature) 98.4ºF – Rectal temperature)

= Approximate Number of Hours After

Death
1.5

c. Chemical Method:

Schourup’s formula for the determination of the time of death of any cadaver
whose Cerebro-spinal Fluid (C.S.F.) is examined for the concentration of Lactic Acid (L.A.),
Non-protein Nitrogen (N.P.N.) and Amino Acid (A.A.) and whose axillary temperature has
been taken at the time the cerebro-spinal fluid has been removed.

36 – T + antilog, L.A. + N.P.N. – 15 + A.A. – 1

180 16.7 7.35

T = temperature 1 = axillary’s temperature

= 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.
3. Insensibility of the body and loss of power to move
After the death of the whole body is insensible. No kind of stimulus is capable of
letting the body have voluntary movement.

4. Changes in the skin

a. The skin is pale and waxy looking due to the absence of circulation.
b. Loss of the elasticity of the skin after death.
c. Application of pressure on the skin surface makes the surface flatten.
d. Opacity of the skin.
e. Application of melted wax would not produce blister.

5. Changes in and about the eye

a. Loss of corneal reflex - corneal reflex, also known as the blink reflex, is an
involuntary blinking of the eyelids elicited by stimulation of the cornea (such
as by touching or by a foreign body), though could result from any
peripheral stimulus.
b. Clouding of the cornea
c. Flaccidity of the eyeball
d. The pupil is in the position of rest

6. Action of heat on the skin

If death is real, only a dry blister will produced. The epidermis is raised but on
pricking the blister, no fluid is present. In the living, the blister contains plenty of serum.

Changes in the body following death

1. Changes in the muscles
After death, there is complete relaxation of the whole muscular system. The
entire muscular system is contractile for three to six hours after death, and later
rigidity sets in. Secondary relaxation of the muscles will appear just when
decomposition sets in.

3 stages in muscular changes:

a. Stage of primary flaccidity (post mortem muscular irritability)

The muscles are relaxed and capable of contracting when stimulated. The pupils
are dilated, the sphincters are relaxed and there is incontinence of urination and
defecation.

b. Stage of post mortem rigidity (cadaveric rigidity, or death struggle of muscles,

death stiffening or “rigor mortis”)
The whole body becomes rigid to the contraction of the muscles. This develops three
to six hours after death and may last from twenty-four to thirty-six hours.

Factors influencing the time of onset of rigor mortis:

1. Internal factors
- state of the muscles
- age
- integrity of the nerves
2. External factors
- temperature (>75 degrees will produce heat stiffening)
- moisture

c. Stage of secondary flaccidity or commencement of putrefaction (decay of the

muscles)
The muscles become flaccid, no longer capable of responding to mechanical or
electrical stimulus and the reaction becomes alkaline.

Conditions simulating rigor mortis

1. Heat stiffening:
 If the body is exposed to temperature, above 75 degree Celsius, it will coagulate the
muscle protein and caused the muscle to be rigid. The stiffening is more or less
permanent and may not easily affected by putrefaction.
2. Cold stiffening:
Manifested when the body is frozen, but exposure to warm condition will make
such stiffening disappear. This is due to the solidification of fats.
3. Cadaveric spasm:
This is the instantaneous rigidity of the muscles, which occurs at the moment of
death due to extreme nervous tension, exhaustion and injury to the nervous system or
injury to the chest.

Rigor Mortis Cadaveric Spasm

Time of appearance 3-6H after death Immediately after death

Muscles involved All muscles Certain group

Occurrence Natural phenomena May or may not appear

Medico-legal Approximates time of Determine nature of
significance death death

2. Changes in the blood

a. Coagulation of the blood:

Blood may remain fluid inside the blood vessel six to eight hours after death. Blood
will coagulate due to cessation of circulation.

b. Post mortem lividity, or cadaveric lividity, or post mortem suggillation or post

mortem hypostasis or livor mortis:
Livor mortis is a settling of the blood in the lower
(dependent) portion of the body, causing a purplish red
discoloration of the skin. When the heart is no longer
agitating the blood, heavy red blood cells sink through the
serum by action of gravity and so, blood begins to
accumulate in the most dependent portion of the body.
This appears three to six hours after death. The whole
area becomes dull-red or purplish in color. 

Kinds of post mortem (cadaveric) lividity:

a. Hypostatic lividity – the blood merely gravitates into the most dependent portion of
the body but inside the blood vessels and still in fluid form.
b. Diffusion Lividity – appears during the latter stage of its formation when the blood is
coagulated inside the blood vessels or has diffused into the tissues of the body.

Physical characteristics of Post-mortem CadavericLividity

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

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.

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.

4. Putrefaction of the body

Putrefaction – it is the breaking down of the complex proteins into simpler
components associated of the evolution of foul smelling gasses and accompanied by the
change of color of the body.

Forensic taphonomy specifically studies the processes of decomposition in order to apply

the biological and chemical principles to forensic cases in order to determine post-mortem
interval (PMI), post-burial interval as well as to locate clandestine graves.

a. Changes in the color of the tissue:

red/reddish-brown greenish-yellow greenish-blue

greenish-black in color.

Greenish in color of the skin seen at the region of the right iliac fossa and it is
gradually spreads over the whole abdominal wall.

***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.

b. Evolution of gasses in the tissues:

CO2, NH4, H2, Sulphurated H2, Phosphoretted H2, CH4S and small amount of
mercaptan are gases formed. Fluids come out to both nostrils and mouth.

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

c. Liquefaction of the soft tissues

As decomposition progresses, the soft tissues of the body undergo softening and
liquefaction. The eyeballs, brains, stomach, intestines, and liver putrefy rapidly, while
highly muscular organs and tissues relatively putrefy late.

Factors modifying the rate of putrefaction:

a. Internal factors
i. Age – healthy adults decomposed later than infants.
ii. Condition of the body – the full-grown and highly obese person decomposed more
rapidly than skinny ones.
iii. Caused of death – death due to infection decomposed rapidly.
b. External factors
i. Free air – will hasten the decomposition.
 moderate moisture – accelerate decomposition
 temperature of the air – increase in temperature will hasten decomposition
 light – absence of light will increase decomposition
ii. Earth – dry absorbent soil retards decomposition and vise versa.
iii. Water – decomposition in running water is more rapid than in still water.
 iv. Clothing – hasten putrefaction by maintaining body temperature in the later
stage, clothing delay decomposition by protecting the body from the ravages of
flies and other insects. Tight clothing delays putrefaction.

In general, the following factors affecting putrefaction are roughly arranged

according to degree of importance:

1. Temperature;
2. The availability of oxygen;
3. Prior embalming;
4. Cause of death;
5. Burial, depth of burial, and soil type;
6. Access by scavengers;
7. Trauma, including wounds and crushing blows;
8. Humidity, or wetness;
9. Rainfall;
10. Body size and weight;
11. Clothing;
12. The surface on which the body rests;
13. Foods/objects inside the specimen's digestive tract (bacon compared to lettuce).

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 PUTREFACTIVECHANGES

A. 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

B. IN TROPICAL COUNTRIES
12 HOURS Rigor mortis all over, greenish discoloration

24HOURS Rigor mortis is absent all over, abdominal distention

48 HOURS Ova of flies, trunk bloated, face discolored

 72 HOURS Whole body grossly swollen, hairs and nails loose

ONE WEEK Soft viscera putrified

TWO WEEKS Soft tissuesd largely gone

ONE MONTH Body skeletonized

WHEN 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

Abdomen distended, skin of hands/ feet come off with

6 – 8 WEEKS
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 

To understand the effect of temperature of the environment to the body after death
in relation to decomposition, a basic guide is given as Casper's Law (or Ratio):
“If all other factors are equal, then, when there is free access of air a body
decomposes twice as fast than if immersed in water and eight times faster than if buried in
earth.”

Ultimately, the rate of bacterial decomposition acting on the tissue will be depend
upon the temperature of the surroundings. Colder temperatures decrease the rate of
decomposition while warmer temperatures increase it.

Special Modification of Putrefaction:

a. Mummification – is the dehydration of the whole body which results in the shivering
and preservation of the body.
b. Saponification or adipocere formation – this is a condition wherein the fatty tissues
of the body are transformed to soft brownish-white substance known as adipocere.
c. Maceration – is the softening of the tissues when in a fluid medium in the absence of
putrefactive microorganism which is frequently observed in the death of the fetus en
utero.

Duration of death
1. Presence of rigor mortis
In warm countries, rigor mortis sets in from 2 to 3 hours after death and develops
in the body after 12 hours. It may last from 18 to 36 hours.
2. Presence of post mortem lividity
It develops 3 to 6 hours after death and it appears as a small petechia-like red spot
in the dependent portion of the body.
3. Onset of decomposition
 In tropical countries, decomposition is early and the average time is 24 to 48 hours
after death.
4. Stage of decomposition
The approximate time of death may be inferred from the degree of decomposition,
although it must be made with extreme caution.
5. Entomology of the cadaver
Use of flies present in the cadaver, it is necessary to know the life cycle of the flies.
Usually twenty four hours before eggs are hatched.

Forensic entomology studies the insects and other vermin found in corpses;
the sequence in which they appear, the kinds of insects, and where they are found in
their life cycle are clues that can shed light on the time of death, the length of a
corpse's exposure, and whether the corpse was moved.

6. Stage of digestion of food in the stomach

I It takes normally 3 to 4 hours for the stomach to evacuate its content after meal.
The approximate time of death may be deduced from the amount of food in the
stomach in relation to his last meal.
7. Amount of urine in the bladder

SKELETONIZATION - refers to one of the final stages of decomposition, during which

time the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the
point that the bones of the skeleton are exposed. By the end of the skeletonization process,
all soft tissue will have been eliminated, leaving only disarticulated bones.

Forensic anthropology is the branch of physical anthropology that studies

skeletons and human remains, usually to seek clues as to the identity, race, and sex of
their former owner

Presumption of death
1. Disputable presumption – that a person not heard from for seven years is dead. After
an absence of seven years, it being unknown whether or not the absentee still lives, he
shall be presumed dead for all purposes, except for those of succession. The absentee
shall not be presumed dead for the purpose of opening his succession till after an
absence of ten years.

Examples:
a. A person on board a vessel lost during a sea voyage, or an airplane which is missing,
who has not been heard of for four years since the lost of vessel or airplane.
b. A person in AFP who has taken parts in war, and has been missing for four years.

Presumption of survivorship
- based on strength, age and sex
1. If both were under the age of 15, the older is presumed to have survived.
2. If both were above the age of 60, the younger is presumed to have survived.
3. It one is under 15 and the other above sixty, the former is presumed to have survived.
4. If both be over 15 and under 60, and the sexes be different, the male is presumed to
have survived; if the sexes be the same, then the older.
5. If one be under 15 or over 60, and other between those ages, the latter is presumed to
have survived.

MEDICO-LEGAL INVESTIGATION OF DEATH

1. Stage of post mortem examination of the dead

a. examination of the surroundings
b. examination of the clothing
c. examination of the identify of the body

2. External examination
a. examination of the body surface
b. determination of the position and approximate time of death
Post mortem examination – refers to an external examination of the dead body without
incision being made, although blood and other body fluids may be collected for
examination.

3. Internal examination
Autopsy – is a comprehensive study of a dead body, performed by a trained
physician employing recognized dissection procedure and techniques. It includes
removal of the tissues for further examination.

Purpose of Autopsy:
a. Determine cause of death
b. Correlate clinical diagnosis and symptoms
c. Determine effectiveness of treatment
d. Study the natural course of the disease
e. Educate students and physicians

The following manner of death should be autopsied:

a. Death by violence
b. Accidental deaths
c. Suicides
d. Sudden death of persons who are in good health
e. Death unattended by physician
f. D.O.A. with no clinical diagnosis
g. Death occurring in an unnatural manner

How is an autopsy performed?

The extent of an autopsy can vary from a single organ such as the heart or
brain to a very extensive examination. Examination of the chest, abdomen, and brain
is probably considered by most as the standard autopsy and one technique is briefly
described below. The autopsy begins with a complete external examination. The body
weight and height are recorded, and identifying marks such as scars and tattoos are
documented.
 
The internal examination begins with the creation of a Y or U-shaped incision
from both shoulders joining over the sternum and continuing down to the pubic bone.
The skin and underlying tissues are then separated to expose the rib cage and
abdominal cavity. The front of the rib cage is removed to expose the neck and chest
organs. This opening allows the trachea (windpipe), thyroid gland, parathyroid glands,
esophagus, heart, thoracic aorta and lungs to be removed. Following removal of the
neck and chest organs, the abdominal organs are cut (dissected) free. These include
the intestines, liver, gallbladder and bile duct system, pancreas, spleen, adrenal
glands, kidneys, ureters, urinary bladder, abdominal aorta, and reproductive organs.
To remove the brain, an incision is made in the back of the skull from one ear to the
other. The scalp is cut and separated from the underlying skull and pulled forward.
The top of the skull is removed using a vibrating saw. The entire brain is then gently
lifted out of the cranial vault. The spinal cord may also be taken by removing the
anterior or posterior portion of the spinal column. In general, pieces of all of the major
organs mentioned above are converted into thin sections of tissue that can be placed
on slides and studied under a microscope. The organs may be returned to the body or
may be retained for teaching, research, and diagnostic purposes.

Mistakes in autopsy:
a. Error or omission in the collection of evidence for identification
b. Errors or omission in the collection of evidence required for establishing the time of
death
c. Errors or omission in the collection of evidence required fro the medico-legal
examination.. d. Errors or omission result in the production of undesirable artifacts or
in the destruction of valid evidence

Negative autopsies happened if after all efforts including gross and microscopic studies
and toxicological analysis fail to reveal a cause of death.
 Negligent autopsy happened when no cause of death is found due to imprudence,
negligence, lack of skill, lack of foresight.

MEDICO-LEGAL CLASSIFICATION OF THE CAUSE OF DEATH

1. Natural death – caused by natural disease condition in the body.

Examples:
- affection of the central nervous system
- affection of the circulatory system
- affection of the respiratory system
2. Violent or unnatural death – death due to injuries inflicted in the body by some force
of outside force.

Penal Classification of Violent Death

1. Accidental death – vehicular accident
2. Negligent death – due to reckless imprudence, lack of skill and lack of foresight.
3. Suicidal death – destruction of one’s self.
- the law does not punish the person committing suicide, but a person who give
assistance to the commission of the suicide of another is punishable.
4. Parricidal death – killings of one’s relative (father, mother, child whether legitimate or
illegitimate or any of his ascendant or descendant or his spouse)
- killing of common law wife is not parricide.
5. Infanticidal death – killing of child less than 3 days old.
6. Murder – intentional killing of person with the present of aggravating circumstances.
7. Homicidal death
8. Judicial Death
– Art. III Sec.1 Par. 19 Philippine Constitution, “cruel and unusual punishment shall
not be inflicted”: electrocution, hanging, musketry, gas chamber, lethal injection etc.

Pathological Classification of the Causes of Death

1. Death from syncope – this is due to fatal and sudden cessation of the action of the
heart with circulation included.
2. Death from asphyxia
3. Death from Coma – state of unconsciousness with the insensibility of the pupil and
conjunctivae, and inability to swallow, resulting from the rest of the function of the
brain.

Euthanasia – is a deliberate and painless acceleration of death of a person usually

suffering from incurable and distressing disease.
Suicide – (self-destruction) is usually the unfortunate consequences of mental illness and
social disorganization.

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.

DISPOSAL OF THE DEAD BODY

1. Embalming – is the artificial way of preserving body after death by injecting 6 – 8

quartz of antiseptic solution of formalin, perchloride of Hg or As, which is carried into
the common carotid and the femoral arteries.
2. Burial or inhumation – if a person died of a communicable diseases then bury within
12 hours after death. Without communicable diseases, bury within 48 hours after
death.
3. Cremation – it is the pulverization of the dead body into ashes by the application of
heat.
4. Disposing of the dead body from the sea – part of a religious belief and will of the
disease.
5. Use of the dead body for scientific purposes.