LEGAL MEDICINE PEDRO P. SOLIS, M.D., LLB. Diploma in Criminology, University of Cambridge Medico-Legal Officer, National Bureau of Investigation Professorial Lecturer in Legal Medicis and Medical Jurisprudence, University of the Philippines, Far Eastern University and Manila Central University; Professor in Legal Medicine and Criminal Phenomet , Philippine College of Criminology PRINTED BY R. P. GARCIA Publishing Co. 811 Quezon Blvd. Ext. Q. C.C—O Copyright 1964 By Pepro P. SoLis All rights reservedPREFAGE Legal medicine occupies a unique position among the medical gpecialties. The interest of justice is its prime consideration rather than the life and health of the people. It is a courtroom application of medical science rather than the bedside of the patient. Although the basic principles of legal medicine is uni- form throughout the world, it lacks universality of application jn as much it must be tempered by the existing local laws. The purpose of this book is to correlate as much as pos- sible the principles of medicine to our substantive and procedural laws. The ideas are expressed in simple language so as to afford understanding by students and practitioners of medicine, law, police science and criminology. It is made in concise form be- cause of the limited period of instructions as prescribed in the curriculum. The book only include fundamentals of legal medicine. It is not the intention of the author to include. intricate problems and their solutions. Whenever specific problems arise in the legal proceedings, it is recommended that textbooks on medical specialties involved must be consulted.(CHAPTER Page » CONSIDE 5 nar a 2 of Legal Medicine 1 Some Principles Governing Application and Effec 5 _ Tiranches of Law Where Legal Medicine Is Applied ..... 7 Recommendations for Instruction of Legal Medicine in Medical Schools . v8 Reasons for the Insufficiency of Medico-Legal Investigation in the Philippines . oe 10 History of Legal Medicine in the Philippines 1 Medico-Legal Systems Commonly Adapted in Different Countries 13 fedical Evidence . 16 Forms of Medical Evidence 16 Methods of Preserving Evidence . 19 Degree of Proof in the Court of Justice . 20 Medical Aspect of Criminal Investigation - 22 Criminal Interrogation ... 22 Deception Detection Methods 26 Confession ~ 81 I, MEDICO-LEGAL ASPECT OF IDENTIFICATION Identification of Person and Remains . 34 Identification of Person .. 85 Points Applicable to the Living . 35 Points Applicable to the Living an 37 Extrinsic Factors in Identification . 41 thropometry a ingerprinting 42 Handwriting 44 (/Adentification of Ske 49 Light Facior in Identi 58 Determination of Sex 68 Identification of Age 60 [dentification of Blood and Blood Stains . 65 Identification of Hair and Other Fibers 1 Ul. MEDICO-LEGAL ASPECT OF DEATH Anis of Death . 81 igns of Death . 83 thangs in the Body Following Death . 98 Changes in the Muscles . 98 Changes in the Blood . 98 Autolytic or Autodigestive Changes - 102 Putrefactive Changes ae Special Modifications to e +A TABLE OF CONTENTS vi me age car Duration of Death .. . * . tee - He -TPresumption of Death .._ - . . se. 119 Presumption of Survivorship : seeee 120 Euthanasia . oo ae sseee 120 Causes of Death « . te eeeee 121 (Medico-Legal Cla: ation of the Causes of Death 122 Pathological Classification of the Causes of Death . 136 Judicial Death .. ceveeeees sees 140 Medico-Legal Investigation of Death .-. ee tag) Medico-Legal Post-mortem Examination seeeeeee MB Methods of Disposal of the Dead Body ............ 153 IV. MEDICO-LEGAL ASPECT OF PHYSICAL INJURIES Physical Injuries Brought about by Physical Violence .... 169 Classification of Wounds ee Type of Wounds . a Effects and Complications of Wounds 191 Medico-Legal Investigation of Wounds - 197 Physical Injuries in Different Parts of the Body - 209 Firearm Wound ........... ood Nature of the Gunshot Wound . = 240. Gunshot Wound in Different Parts of the Body . 253 Shot-gun .........-. cece sees 257 Gunpowder Examination ... 259 Firearm Identification 261 Thermal Injuries or Deaths .... 268 Death or Injury from Cold ... = 268 Death or Injury from Heat ..... = oo 270 Physical Injuries or Death by Lightning and Electrici 285 Death or Physical Injuries by Lightning - 285 Death or Physical Injuries from Electricity . + 288 Death or Physical Injuries Due to Radiation by Radio-active Substances ..... . 294 Atomic Bomb Explosion ...... . 295, X-ray Radiation ...... Death by Asphyxia ....... Asphyxia by Hanging ... 297 sense 298 - 300 Asphyxia by Strangulation ....... ener t 507 Asphyxia by Suffocation .........6.... + 312 Asphyxia by Submersion or Drowning .. - 818 Asphyxia by Compression or Crush Asphyxia ........ 820 Asphyxia by Breathing Irrespirable Gases ...... Death or Physical Injuries from Changes in Atmospheric P¥essure .eeeeee ee eeee Caison’s Disease .... Mountain Sickness 321 326 326 Brees 82t eoncee 328 to Vehicular Accidents ... 330 lo ceceseeneceees BBE Aireraft Injuries and Fatalities Death or Physical Injuries Due Death from Starvationenn CHAPTER v. VI. vu. vit. Ix, XI. TABLE OF CONTE: vii Page MEDICO-LEGAL ASPECT OF SEXUAL CRIMES Virginity and Defloration sees 838 Rape | sc: ieaeenseess pase acon ; ++ 846 Examination of Seminal Fluid and Spermatozoa .....--++. 354 Other Crimes against. Chastity cesses 859 Seductions = ruitarsses 809 Acts of Lasciviousness - 362 Abductions es 363 Corruption of Minors . 265 White Slave Trade . 365 Adultery. aoe 366 Coneubinage 367 Unnatural Sexual Offenses PREGNANCY Legal Importance’ of the Determination . 376 Medical Evidences of Pregnancy .... 378 DELIVERY ‘Methods of Delivery Signs of Recent Delivery . Signs of Remote Delivery Gocsg Post-mortem Findings in Recent Delivery . ABORTION Legal Provision ... ‘Methods of Inducing Abortion .... 391 391 Complications of Abortion 400 Medical Evidence of Abortion 402 Therapeutic Abortion ..... 404 Problems in Abortion ......... 406 BIRTH Legal Importance of the Study of Birth 409 Proof of Live Birth ..... 410 Proof of Length of Survival after Birth 414 Signs of Maturity of a Child at Birth 415 Causes of Still-birth .. eee 415 INFANTICIDE Penal Provision ........+ ee nopecsogao tt) Methods of Committing the Crime of Infanticide .......+ 416 Other Allied Crimes .. sees 418 PATERNITY AND FILIATION Legal Importance of Determining Paternity and Filiation .. 420 Legitimate Children . seeeee 421 Legitimated Children ceeees 428 Adopted Children ..... —_ Illegitimate Children 430 Artificial Insemination ...... 482 Evidences of Paternity and Filiation 435 ee oa er aVABLE OF CONTE viii cuartet oe SUL MEDLCOT ASPECT OF MARITAL UNION AND DISSOL! UUTION As to Requisites of a Valid Marria; + 437 s to Marital Relation . + 439 s to Annulment of Marriage + 442 As to Legal Separation . + 448 XU IMPOTENCY AND STERILITY Impotency ~ 445 Sterility .. + 448 XIV. MEDICO-LEGAL ASPECT OF DISTURBANCE OF MENTALITY Legal Importance of the Determination pane Hospitalization of Insane .. - a8e Manifestation of Mental Disorder - = £o7 Mental Deficiency + 460 Methods of Measuring the Degree of Intelligence + 462 Alcoholism .....0...... + 404 Prohibited Drugs and Opium Addiction ~ 479 Malingering . = 4 Other Conditions Manifesting or Simul of Mentality .. XV. MEDICO-LEGAL ASPECT OF POISONING Definition and Site of Action of Poisons . 491 Circumstances Affecting Action of Poison 492 Signs and Symptoms that Lead One to Suspect Poisoning . Differential Diagnosis of Poisoning . Treatment of Acute Poisoning Medical Evidences in Cases of Poisoning . Classification 6f Poisons Food Poisoning Laws on Poisons . Post-mortem Findings in Some Chemical Poisoning 494 495 496 ++ 498 501 APPENDIX — Basie Principles of Philippine Criminal Law ........ 519 REFERENCES 535Aur Juy ¥ Chaplers 1-3 GENERAL CC INSIDERATION LAEGAL MEDICINE is a branch of medicine which deals ith ihe application of medical knowledge to the purposes of law wit justice, It is the application of the basic and clinical, redi- cal and paramedical sciences to elucidate legal matters. - ‘orensic medicine are synonymous and in common practice are used interchangeably, although legal medi- cing strictly speaking means medicine applied to legal cases, while forensic medicine refers to the use of medical science to elucidate legal_problems. (Herzorg, p. 1). MEDICAL JURISPRUDENCE, on the other hand, is that branch of law which deals with the organization and regulation of the medical profession, with the contractual obligations exist- ing between practitioner and his patient, and with the duties im- posed on the practitioner by the State. Though a branch of law it is nonetheless a subject for him to know what is his status as « member of -the profession, what are the rights pertaining to the status, and his concomitant obligations. (Lyon’s Medical Juris- prudence by S. D. S. Greval, 10th ed. p. 1, 1953). For example, the testimony of a physician in court during the trial of violent death by stabbing, utilizing his knowledge of surgery and traumatic pathology, is an application of legal medicine, while the conduct of a medical practitioner in his rela- tion with the patient on matters regarding his duties and obliga- tions is within the scope of medical jurisprudence. Distinctions between Legal Medicine and Medical Jurisprudence: A; Legal_medicine is a branch of medical science, while medical jurisprudence is a branch of law. e applied to law and administration | jurisprudence is law applied to the Legal medicine and ft \ practice of medicine. 8. Legal _medicine basically originate from the development. of medical science, it being a branch of medicine, while medical jurisprudence emanates from acts of Congress, executive_or- ders, administrative circulars, customs and usages, and deci- 1LEGAL MEDICINE, 2 sions of tribunals which have relation lo the practice of medi- cine. 4, Legal medicine is based on the principles of coordination ; that legal medicine coordinate medicine to law and jus On the other hand, medical jurisprudence is based on the prin- ciples.of subordination; that it is the duty of a physician to obey the laws in as much as our government is established on the principle of government of laws and not of men and that no one is considered above the law. It is the duty of a physician to make himself a subordinate of the superior be- ing, the sovereign people, from whom the law emanates. PURPOSES OF THE STUDY: 1. To give students and practitioners of medicine a theoretical and practical knowledge of the subject in his relation to law. (Principles and Practice of Medical Jurisprudence by Taylor, 10th ed. p. 2). 2. To give information to physicians of his rights and duties and the manner in which the law expect him to act under certain circumstances. 3. To enable a lawyer find the principles which apply, and the laws and decisions which may govern, in any case involving medical questions, as well as the points upon which medical experts should be examined. (Herzorg, p. 2). Sec. 5, Par. 2, Rule 188, Rules of Court: No applicant shall be admitted to the bar examination unless he has satisfactorily completed the following courses in a law school or university duly recognized by the govern- ment: civil law, commercial law, remedial law, political law, labor and social legislation, medical jurisprudence, taxation and legal ethics. 4. To acquaint medical and law students and practitioners of the recent advances of forensic medicine and the medico-legal sys- tem and procedure adapted in different countries. Students of criminology and police sciences must be acquainted with the medical aspect of criminal investigation, their signifi- cance, interpretation and probative value in court. Scope of Legal Medicine: ___ The scope of legal medicine is quite broad. It is the applica- tion of all branches of medicine and other allied sciences to law and administration of justice. The knowledge of wounds has been \ i i | |GENERAL CONSIDERATION 3 i 4 en deaths in jved in suryery, abortion in gynecology, sudden h acquired in surge \ ; ‘ medicine, effects of trauma in pathology, ele., although viewed in a different angle. ; In as much as the knowledge of medicine is that one, which applied in law, it is also necessary for the students and prac- titioners to have a working knowledge of law wherein branches of medicine is applied for they will encounter certain difficulty in the appreciation of the subject matter without basically know- ing where it is applied. It is necessary for them to know the elementary principles of our substantive and procedural laws. Nature of Legal Medicine: knowledge of legal medicine means tnDapiity to acquire fact{{fhe power to arrange those facts in the logical order, and he application for purposes of law the conclusion: which they lead. (Coy’s Medico-Legal Companion, by Bhattacharyya, 2nd ed., p. 7). A physician should be an impartial observer, intent only or seeking the truth of a case in relation to its circumstances; the conscience with which he discharges his duties is but a corollary to his putting into practice the medico-legal knowledge he has acquired. (Taylor’s Principles and Practice of Medical Jurisprud- ence, 11th ed., p. 2). It is not only necessary that a physician should have-an im- partial and accurate observation of the facts but also must possess the power to impart in words or in writing all of his observations to others. He must convey all the facts he has observed and be able to give his logical opinion. Some members of the medical profession have been inclined to regard medico-legal matter with abhorence. They consider it as an addition to their usual duties. while others refuse to handle medico-legal cases because of fear, and waste of material time when being summoned in court. But, no physician in practice can ignore nor refuse to face the problem of legal responsibility and his duties to the court. A Medical Jurist (Medico-Legal Expert) is a physician who ecializes in the science of legal-medicine. He must possess a sufficient knowledge of pathology, surgery, toxicology, and other branches of medicine in its application to law and justice. Abitferences between an Ordinary Physician and a Medical ee 1. An ordinary physician sees an injury or disease on the poin of view of ¢reatment while a medical jurist sees injury or disease as revards tatSiuae™.LEGAL MEDICINE 4 phe purpose of an ordinary physician’s examination of a 4b patient is to institute remedy or treatment, while the purpose ak of a medical jurist in examining the patient is for law and justice to one where justice is due. or bodily lesions may be insignifi nt lo an ordinary phy- cant attention for they n ay not ni sical injuries of whatever nature, size and location preciated and de: It may prove force e the nature of the crime, or it may prove jus x1 on the part of the offender to inflict injuries on the Small abvasions on the hand of the victim of multiple ay not be worth the physician’s attention, but to the medical jurist, those small abrasions may be necessary to prove that the victim offered some degree of resistance, there- by modifying the nature of the crime committed. xvother Definitions: Autatd “1._Law is a rule of conduct, just, obligatory, laid by legitimate power for common observance and benefit. It is a science of moral laws founded on the rational nature of man which regu- late free activity for the realization of his individual and social ends under the aspect of mutual demandable independ- ence. (1 S-R.) The word “law” includes regulations and circulars which are issued to implement a law and have therefore the effect of law. » Characteristics of Law: a. It is a rule of conduct; b. It is dictated by legitimate power; and c. Compulsory and obligatory to all. (Padilla, Civil Code) Forms of Law: a. Written or Statutory Law (Lex Seripta) This is composed of laws which are produced by the country's legislations and which are defined, codified and incorporated by the law-making body. Example: Laws of the Philippines b. Unwritten or Common Law (Lex non Scripta) This is composed of the unwritten laws based on im- memorial customs and usages. It is sometimes referred Primer ned as ate ndGENERAL CONSIDERATION to as case law, common law jurisprudence or customary 19 as case law, jaw, law. Example: Laws of England 2. Medicine Medicine is a science ion of di nd_art dealing with prevention, se. It is that part of seience and cure and alle art of restoring and p: ‘The term medicine is als diagnosing, treating, curing and preventing di pain, improving the health of a person. plied to a science and art of , relieving Legal: Legal is that which or pertains to Jaw, arising out of by virtue of or included in law. It also refers to anything confermable to the letters or rules of law as it is administered by the court. te 4 Q u phe « Jurisprudence: Wim 4 aa Ay Laybh ~ It is a practical scfoncd whlch ‘Thvestigates*the nature, origin, development and functions of law. It is a science of giving a wise interpretation of the law and making just application of them to all cases as they arise. Judicial decisions applying or interpreting the laws shall form a part of the Philippine jurisprudence. The decisions contemplated are those rendered by the Supreme Court which is the final arbiter on legal issues. However, the decisions of the Court of Appeals may serve as precedent for inferior courts on points of law not covered by Supreme Court decisions. Principle of Star _ A principle that, when the court has once laid down a prin- ciple of law as applied to a certain state of facts, it will adhere to that principle, and apply it to all future cases where the facts are substantially the same. (Ad law The principle is one of policy, grounded on the theory that security and certainty require that accepted and established legal principles, under which right may accrue, be recognized and followed, though later found to be not legally sound, but whether previous holding of court shall be adhered to, modified or over-ruled is within the court's discretion under the cireum- stance of the case before it. (Black, Law Dictionary). Ci a a me Ignorance of the laeexcuses 00m from compliance there- with. (Art. 8, C. C.) (Ignorancia legis nominem excusat) : fadL MEDICINE 6 The main reason for the rule is to prevent ignorance of the law as a means of defense for violation of the law. Other. rN wise mere ignorance in fact of the law would furnish im- munity from punishment for violation of the penal code and jmmunity from liability for actual loss for violation of per- sonal and property right, The maxim is not inflexible. It is only applicable to a nifest and truly inexcusable ignorance of the law. A physician must not be held liable or penalized for having committed an honest error in the interpretation of the law Laws shall_have no retroactive effect, unless the contrary is provided. (Art. 4,C. C.) The general rule is that all laws have a prospective effect. It will be unjust if a law will be given a retroactive effect because it impairs vested rights and not in accord with sound legislation or with social compact. Exceptions: A law may have retroactive effects in the following instances? C, (atic Las how a. When the law provides the contrary (Art. 4, C. C.) b. Penal laws shall have retroactive effect if favorable to the accused who is not_a habitual delinquent. (Art. 22, R.P.C.) c. When the statute is remedial in nature because there is no vested right in the rules of procedure and evidence. d. When the law creates new substantive rights. 3. Rights, may be taived,unless the waiver is contrary to law, “public order, public policy, morals, good customs, or prejudicial to a third person with a right recognized by law. (Art. 6, aC.) Example: A physician has the right to demand compensation for the services rendered to patient, but the physician may waive his right to demand professional fee from patient thereby making his services gratuitous. Such waiver is not contrary to law, public order, public policy or prejudicial to a third person. A physician has the right to refuse emergency calls but in as much as such refusal is contrary to good customs, morals and prejudicial to a third person, he must ethically answer to the call of emergency,GENERAL CONSIDERATION 7 Customs which are contrary to law, public order or public policy shall not be countenaneed. (Art. 11, C. Cc.) A custom is an unwritten law, established by long usage and with the consent of our ance Usage is the legal evi- dence of custom and is defined as an established method of dealing, adopted in a particular place, which acquires legal force because people makes contract in re to it. In the Philippines, the Civil Code expr: customs should be applied in case there is no codal prov’ applicable. incipally Applied: (Bianches of Law Where Legal Medicine is P: 1. Civil Law: vil law is a mass of precepts that determines or regulates the relations of assistance, authority and obedience between members of a family, and those that exist between members of a society for the protection of private interest. (S. R.) It covers rules governing persons and family regulations to society for the protection of private interest. The civil law of the Philippines is embodied in the Civil Code which is divided into the following books: Book I. — Persons (Art. 87-413) Book II — Property, Ownership and its Modification (Art. 414-711) Book III — Different Modes of Acquiring Ownership (Art. 712-1155) Book IV — Obligations and Contracts (Art. 1156-1430) Miscellaneous Provisions (1481-2270) 2. Criminal Law: Criminal law is that branch or divisiop of law which de- ‘ines crime, “Yreats_of their nature, andUprovides for their punishments. shay Penal laws and those of public security and safety shall be obligatory upon all who live or sojourn in Philippine territory, subject to the principles of public international law and to treaty stipulation. (Art. 14, Civil Code) ‘The Philippine criminal law is codified in the “Revised Penal Code” and may also be found in the penal provisions of special laws.LEGAL MEDICINE . IEDICINI Remedial Law: Remedial law is that branch of Jaw which deals with the rules concerning pleadings, practice and procedure in all courts of the Philippines. Our remedial 1 e embodied in the “Rules of Court of the Philippines” and also the re laws. edial provisions of specis 4, Speciat Laws: a. Insurance Law (Act 2427 as amended) b. Workman’s Compensation Act ce. Employer's Liability Act d. Magna Carta of Labor RECOMMENDATIONS FOR INSTRUCTION OF LEGAL MEDI- CINE IN MEDICAL SCHOOLS: The Committee on Medico-Legal Problems of the American Medical Association has approved the publication of the follow- ing report of Louis J. Regan and Consultants: The Committee recommends that: 1. A strong department or division of legal medicine be developed in every medical school. 2. The department or division of legal medicine in each med- ical school incorporates in its curriculum a required course in legal medicine, a course dealing with basic material or general interest and importance to all physicians. 3. More detailed treatment of forensic specialties, or of par- ticular areas of interest, be developed as special (elective) courses. 4. Teaching should not be restricted to undergraduate medical students but opportunity should be provided for the train- ing of graduate physicians in the special techniques of medico-legal investigation, in forensic pathology, toxicol- ogy, hematology, immunology, etc. with fundamental re- search emphasized and encouraged. 5. Post-graduate seminars should be provided to meet the need of those engaged in medico-legal work, such as coro- ners, medical. examiners, pathologists, interested prac- ticing physicians, technicians in police science laboratories, and representative members of district attorney’s staff.GENERAL CONSIDERATION 9 6. The staff of the department or division of legal medicine should encourage the development, and participate in the conduct, or courses in the neighboring law schools. 7. There should be a direct and immediate relationship be- tween the staff of the department or division of legal medicine in the medical school and the local office of the coroner or the medical examiner. Further, it is de- sirable that the chief autopsy surgeon in that office and perhaps his first assistant, should have appointment on the teaching staff of the department. The Same Committee Recommends: 1. That, in the practice of medicine, no physician can avoid contact with the law and that no medical student should be permitted to receive his degree without instruction on his legal duties to his patients, community and govern- ment. 2. That formal instruction in the pathology of trauma is neglected in the average medical school; that, commonly, the material from autopsies of victim of trauma is siphoned into official channels divorced from academic sponsorship; and that consequently, not only the material is lost for scientific study but the presentation and interpretation in court of sound documented medical evidence is frequent. (Published in the Journal of the American Medical Asso- ciation, Oct. 18, 1952). METHODS OF INSTRUCTION: The students and practitioners of medicine has already re- ceived instructions on the fundamental and clinical aspect of medical science. Emphasis must only be given on the medico- legal significance and its application in investigation and in judi- cial and administrative proceedings. Law and jurisprudence as related to certain aspects of medicine must not be ignored in the instruction. Students will not very well appreciate the subject matter without proper instruction of the inter-relationship be- tween medicine and law. Most of the medical institutions in the Philippines offer legal medicine two hours a week during the first and second semesters of the fourth year. The whole of the first semester may be de- voted to legal medicine proper while medical laws, jurisprudence and ethics may be taken during the second semester.