Chapter V

INVESTIGATION OF DEATH
An officer is an official of the state charged with the duty
of inquiring into certain matters. In a medico-legal investigation,
an inquest officer is the one charged with the duty of investigating
the manner and cause of death of a person. He is authorized to
summon witnesses and direct any person to perform or assist in the
investigation when necessary.
The following officials of the government are authorized to make
death investigations:
1. The Provincial and City Fiscals:
Sec. Revised Code:
The district health officer, upon the request of any provin-
cial fiscal of a province within his district, or of any judge of
a Court of the First Instance (now Regional Trial Court), or of
any justice of the peace (now, Municipal Trial Court), shall con-
duct in person, when practicable, investigations in cases of death
where there is suspicion that death was caused by the unlawful act
or omission of any person, and shall make such other inves-
tigations as may be required in the proper administration of
justice.
Sec. 38, Rep. Act 409 as amended by Rep. Act. 1934 (Revised
Charter of the City of
The City Fiscal shall also cause to be investigated the cause of
sudden deaths which have not been satisfactorily explained and
when there is suspicion that the cause arose from the unlawful
acts or omissions of other person, or from foul play, and, in
general, victims of violence, sex crimes, accidents, self-inflicted
injuries, intoxications, drug addiction, states of malingering and
mental disorders, which occur within the jurisdiction of the
City of Manila, and the examination of evidences and telltale
marks of crimes. For that purpose, he may cause autopsies to
be made and shall be entitled to demand and receive for pur-
poses of the office of the medical examiner, or the criminal
investigation laboratory of the Manila Police Department, or
subject to the rules and conditions previously established by
the Secretary of Justice, the aid of the medico-legal section
of the National Bureau of Investigation. If in case the fiscal
 INVESTIGATION DEATH
of the city deems it necessary to have further expert assistance for
the satisfactory performance of his duties in relation with medico-
legal matters or knowledge, including the giving of medical tes-
timony in the courts of justice, he shall request the same, in the
same manner and subject to the same rules and conditions as
above specified, from the office of the medical examiner, or from
the criminal investigation laboratory of the Manila Police Depart-
ment, or from the medico-legal of the said bureau, who shall
thereupon the assistance required in accordance with
his powers and facilities. He shall at all times render such pro-
fessional services as the Mayor or board may require and shall
have and perform such other duties as may be pre-
scribed by law or ordinance.
2. of the Courts of the First Instance (now Regional Trial
Courts) Sec. 983, Revised Administrative Code (Supra).
3. Justice of the Peace (now Municipal Trial Courts) Sec. 983,
Administrative Code (Supra).
4. The Director of the National Bureau of Investigation — Rep. Act.
157 (An act creating the National Bureau of Investigation).

Sec. 1. — There is hereby created a Bureau of Investigation

under the Department of Justice which shall have the following
functions:
(a) To undertake investigations of crimes and other offenses
against the laws of the Philippines, upon its own initiative and
as public interest may
(b) To render assistance, whenever properly requested in the in-
vestigation or detection of crimes and other offenses;
(c) To act as a national clearing house criminal and other
information for the benefit of all prosecuting and law-en-
forcement entities of the Philippines, identification records of
all persons without criminal convictions, records of identify-
ing characteristics, and ownership or possession of all
firearms as well as the test bullets fired therefrom;
(d) To give technical aid to all prosecuting and law-enforcement
officers and entities of the Government as well as courts that
may request its services;
(e) To extend its services, whenever properly requested in the
investigation of cases of administrative or civil nature in which
the government is
(f) To undertake the instruction and training of a representative
number of city and municipal peace officers at the request
of their respective superiors along effective methods of crime
 LEGAL MEDICINE
investigation and detection in order to insure greater efficiency
in the discharge of their duties;
(g) To establish and maintain an up-to-date scientific crime
laboratory and to conduct researches in the furtherance of
scientific knowledge in criminal
(h) To such other related functions as the Secretary (now
Minister) of Justice may assign from time to time.
Sec. 5. — The members of the investigation staff of the Bureau
of Investigation shall be peace officers, and as such have the
following powers:
(a) To make arrests, searches, and seizures in accordance with
existing laws and rules;
(b) To issue subpoena or subpoena duces tecum the appearance
at government expense of any person for investigation;
(c) To take and require sworn truthful statements of any person
or person so summoned in relation to cases under investigation,
subject to constitutional restrictions;
(d) To administer oaths upon cases under
(e) To possess suitable and adequate for their personal
protection in connection with their duties and for the proper
protection of witnesses and persons in custody; Provided, that
no previous special permit for such possession be required;
(f) To have access to all public records and, upon authority of
the President of the Philippines in the exercise of his visitorial
powers, to record of private parties and concerns.

5. The Chief of Police of the City of Manila:

Sec. 34, Rep. Act 409 (Revised Charter of the City of Manila)
as amended by Sec. 1, Rep. Act. 1934 — Chief of Police:
There shall be a chief of police. (who) shall cause medico-
legal examination by the medical examiner of the Manila Police
Department of victims of violence or foul play, sex crimes, acci-
dents, sudden death when the cause thereof is not known, self-
inflicted injuries, intoxication, drug addiction, states of malinger-
ing and mental disorders, which are being investigated by the
Manila Police Department or, in exceptional cases, by other
agencies requesting assistance of the Manila Police Department;
and shall cause examination by the medical examiner of the Mani-
la Police Department or by a criminal investigation laboratory
established within said department, or evidences and telltale
marks of crime. He shall have such powers and perform such
further duties as may be prescribed by law or ordinances.
 INVESTIGATION OF 159
6. Solicitor General:
Sec. 95 (b) P.D. 856 (Code of Sanitation of the Philippines)
Autopsies shall be performed in the following cases:

4. Whenever the Solicitor General, provincial or city fiscal

as authorized by existing laws, shall deem it necessary to
disinter and take possession of remains for examination to
determine the cause of death.
Stages of
1. Crime Scene Investigation (Investigation of the place of com-
mission of the crime).
2. Autopsy (Investigation of the body of the victim).
1. CRIME SCENE INVESTIGATION:
The crime scene is the place where the essential ingredients of
the criminal act took place. It includes the setting of the crime
and also the adjoining places of entry and exit of both offender
and
Not all crimes have a well-defined scene, like estafa, malver-
sation, continuing crimes, etc. However, where medical evidence
may be present, like murder, homicide, physical injuries, sex
crime, crime scene is almost invariably present.

Violent death in a vehicular accident scene.

160 LEGAL MEDICINE
Crime scene investigation includes appreciation of its condition
and drawing an inference from it. It also includes the collection of
the physical evidences that may lead to the identity of the per-
petrator, the manner the criminal act was executed, and such
other things that may be useful in the prosecution of the case.
Importance of Crime Scene Investigation:
A great amount of physical evidence may be lost or
if the investigation merely starts at the autopsy table or in the
cal examining room. Blood, semen and other stains, latent finger
and foot prints, and articles of value that may lead to the
tion of the offender and victim may be beyond the comprehension
of the investigator if the crime scene is not investigated.
In violent the manner and cause of death may be
inferred from the condition of the crime scene. The condition of
the crime scene may indicate struggle, handgun firmly grasped in
the palm of the hand of the deceased may indicate suicide, the
presence of a great quantity of shed blood may infer hemorrhage
as the cause of death of the victim.

The investigator has the earliest possible opportunity to inter-

view persons who have knowledge of the circumstances of actual
events in the commission of the criminal act. The proximity of
the narration to the actual occurrence makes it reliable than those
given after a lapse of time.

Persons to Compose the Search

a. A physician who has had previous knowledge and training in
medico-legal investigation must direct the search and assume
responsibility for an effective
b. A photographer who will take pictures of the scene and the
pieces of evidence recovered. He may also act as sketcher and
measurer.
An assistant who will act as the note taker, evidence collector
and helper. He must have previous knowledge and training
in evidence collection.

Equipment Needed in Crime Scene

a. Those needed in the search of physical evidence — Flashlight
and magnifying lens.
b. Those needed in the collection of evidence — forceps, knife,
screw driver, scalpel, cutting instruments like pair of
scissors and fingerprint kit.
 INVESTIGATION OF DEATH 161

D. WHEEL METHOD E. ZONE METHOD

METHODS OF SEARCH AT THE CRIME SCENE.

162 LEGAL MEDICINE

Those needed in the preservation and transportation of evidence

collected — Bottles, envelopes, test tubes, pins, thumb tacks,
labelling tag and pencil.
d. Those necessary for the documentation of the scene — Photo-
graphic camera, sketching kit, measuring tape, compass, chalk or
any writing instrument.
Methods of Conducting a Search:
Before the actual performance of the search, it is advisable to
stand aside and make an estimate of the situation. A picture of
the whole area must be taken and the area must be cordoned or
bystanders must not be allowed to get in. Depending upon the
size, terrain and condition of the crime scene, the following
methods of search may be
a. Strip Method — The area is blocked out in the form of a rect-
angle. The searcher proceeds slowly at the same pace along the
path parallel to one side of the rectangle.
b. Double Strip or Grid Method — The searchers will traverse first
parallel to the base and then parallel to the side.
Spiral Method — The searchers follow each other in the path in
the spiral manner beginning from the center towards the outside
or vice
d. Wheel Method — The searchers gather at the center and proceed
outwards along radii or spokes.
e. Zone Method — Whole area is divided into subdivisions or
quadrants and search is made in the individual quadrants.
Disposal of the Collected
All evidences collected must be protected, identified and
preserved. Reasonable degree of care must be exercised to pre-
serve shape, to minimize alterations due to contamination, che-
mical changes, addition of extreneous substances. In the process
of transferring of the evidences, the number of persons who
handle them must be kept at a minimum and each transfer should
be receipted.
Examination of the Dead Body in the Crime Scene:
After a complete search, the investigating physician must make
a thorough inspection of the dead body. Special consideration
must be made on the following:
a. Evidences which will tend to prove identity.
b. Position of the
Condition of the apparel worn.
d. Approximate time of
 INVESTIGATION OF DEATH 163
e. Presence of wounding instrument and its approximate distance
from the body.
f. Potential cause of death.
In a death by gunshot, the clothing must be left Undisturbed
at the crime scene. A lot of information may be gathered from

a. The bullet might have produced an exit on the skin but failed to
cause mark or tear on the clothings which through improper
handling may not be recovered.
b. Examination may be useful in the determination of
the site of entrance and exit of the bullet and also the trajectory
of the shot.

2. AUTOPSIES:
An is a comprehensive study of a dead body, per-
formed by a trained physician employing recognized dissection
procedure and techniques. It includes removal of tissues for
further examination.
Autopsies vs. Post-mortem
Post-mortem examination — refers to an external examination
of a dead body without incision being made, although blood and
other body fluids may be collected for examination.
Autopsy — indicates that, in addition to an external exami-
nation, the body is opened and an internal examination is con-
ducted.
(Modern Legal Psychiatry and Forensic Science by
and Petty, p. 51 footnote).
Kinds of Autopsies:
a. Hospital or Non-official Autopsy
b. Medico-legal or Official Autopsy
a. Hospital or
This is an autopsy done on a human body with the consent
of the deceased relatives for the purposes deter-
mining the cause of death; (2) providing correlation of clinical
diagnosis and clinical symptoms; (3) determining the effective-
ness of therapy; (4) studying the natural course of disease pro-
cess; and (5) educating students and physicians (Forensic
Pathology, A Handbook for Fisher and Petty, July
1977, p. 1).
Inasmuch as previous consent of the next of kin is necessary
before a non-official autopsy can be performed, the Civil
164 LEGAL MEDICINE

Code states who is the rightful person to give such consent.

The order is provided in Articles 294 and 305.
The consent shall be obtained The spouse; (2) the
descendants of the nearest degree; (3) the ascendants, also of
the nearest degree; (4) the brothers and sisters (Art. 294,
Civil Code).
In case of descendants of the same degree, or of brothers
and sisters, the oldest shall be preferred. In case of ascendants,
the paternal shall have a better right (Art. 305, Civil Code).
b. Medico-Legal or Official
This is an examination performed on a dead body for the
purposes of: (1) determining the cause, manner (mode), and
time of death; (2) recovering, identifying, and preserving
evidentiary material; (3) providing interpretation and cor-
relation of facts and circumstances related to death; (4) pro-
viding a factual, objective medical report for law enforce-
ment, prosecution, and defense agencies; and (5) separating
death due to disease from death due to external cause for
protection of the innocent (Forensic Pathology, A Hand-
book for Pathologists, Fisher and Petty, July 1977, p.
In cases which require a medico-legal autopsy, the dead
body belongs to the state for the protection of public interest
until such time as a complete and thorough investigation into
the circumstances surrounding the death and the cause thereof
has been completed. The physician entasked to perform such
autopsy is considered to be the authoritative agent and re-
presentative of the state who has the "property right" of the
dead body.
All that need to be turned over to the next of kin respon-
sible for burial of the deceased is that remaining portion or
portions of the body not needed for any medicolegal purposes
(Forensic Medicine by Eckert & Vol. II,
p. 972).
Sec. Revised Administrative Code — Investigation into
cause of death (supra p. 156).
Sec. 1089, Revised Administrative Code — Proceedings in cases
of suspected violence or crime:
If the person who issues a death certificate has any reason
to suspect or if he shall observe any indication of violence or
crime, he shall at once notify the justice of the peace (now
Municipal Trial Judge), if he be available, or if neither the
justice of the peace nor the auxiliary justice be available, he
shall notify the municipal mayor, who shall take proper steps
 INVESTIGATION OF DEATH

to ascertain the circumstances and cause of death; and the

corpse of such deceased person shall not be buried or interred
until permission is obtained from the provincial fiscal, if he be
available, and if he be not available, from the mayor of the
municipality in which the death occurred.
When shall an Autopsy be Performed on a Dead Body:
Sec. 95 (b), P.D. 856, Code of Sanitation:
a. Whenever required by special laws;
b. Upon order of a competent court, a mayor and a provincial or
city fiscal;
Upon written request of police authorities;
d. Whenever the Solicitor Provincial or city fiscal as
authorized by existing laws, shall deem it necessary to disinter
and take possession of the remains for examination to determine
the cause of and
e. Whenever the nearest kin shall request in writing the authorities
concerned in order to ascertain the cause of death.
Persons who are Authorized to Perform Autopsies and Dissections:
The following are authorized to perform autopsies and dissections:
a. Health Officers;
b. Medical officers of law enforcement agencies; and
Members of the medical staff of accredited hospitals.
(Sec. 95 (a) P.D. 856).
a. Health
The health officers referred to by the Sanitation Code are
the district health officer (now provincial health officer) and
local health officer (now the rural officer).
(1) Health Officer (see Sec. 983, Revised Administrative
Code (supra, p. 156).
(2) Local Health Officer:
Sec. 984, Revised Administrative Code to make
— When it is not practicable for the district
health officer to conduct such investigation in person, he
may require any local health officer or member of a muni-
cipal board of health who is a registered physician to
perform such and where the services of a registered
physician in the Government service cannot be thus ob-
tained, he may require a ministrante" who is a
member of the board or a sanitary inspector to act in the
matter.
b. Medical of Law Enforcement
166 LEGAL MEDICINE
(1) Medical examiner of the City of Manila (See Sec. 34 and
38 of Rep. Act 409 as amended by Rep. Act. 1934).
(2) Medical of the National Bureau of Investigation
which is composed of those assigned in the central
in Manila under the Section and those
assigned in the regional offices of the Bureau in ac-
cordance with the administrative implementing
Rep. Act. 157.
(3) officers of the Philippine Constabulary
assigned in the Philippine Constabulary Crime Laboratory
and those assigned in different regional com-
mands.
Insofar as medico-legal investigation of criminal cases
occurring within the jurisdiction of the City of Manila is
concerned, there are two officers qualified to make the

(a) The medical examiners of the Manila Police Depart-

and
(b) The Medico-Legal Officers of the National Bureau of
Investigation.
The Medical examiner or medico-legal officer
investigate cases of sudden deaths, which have not
been satisfactorily explained and when there is
suspicion that the case arose from unlawful acts or
omissions of other persons, or from foul play, and in
general victims of violence, sex crimes, accidents,
self-inflicted injuries, intoxication, drug
(Sec. 38, Act. 409 as amended by Rep. Act. 1934).
Members of the medical staff of accredited
Distinction between Pathological and Medico-
legal (Official) Autopsies:
Pathological Autopsy Medico-legal Autopsy
a. Requirement Must have the consent It is the law that gives
of the next of kin. the consent. Consent of
relatives are not needed.
b. Purpose Confirmation of Correlation of tissue
findings of re- changes to the criminal
search. act.
Emphasis Notation of all ab- Emphasis laid on effect
normal findings. of wrongful act on the
body. Other findings
 INVESTIGATION OF DEATH

may only be noted in

mitigation of the cri-
minal responsibility.
e. Conclusion Summation of all ab- Must be specific for the
normal findings irre- purpose of determining
spective of its corre- whether it is in relation
lation with clinical to the criminal act.
findings.
Minor or Need not be men- If t he investigator
non-patho- tioned in the report. thinks it will be useful
logical in the administration of
justice, it must be in-
cluded.
Other Salient Features Peculiar to Autopsies:
a. Clinical history of the deceased in most instances absent,
sketchy or doubtful.
b. The identity of the deceased is the responsibility of the foren-
sic pathologist.
The time of death and the timing of the tissue injuries must
be answered by the forensic pathologist.
d. The forensic pathologist must alert himself of the possible
inconsistencies between the apparent cause of death and his
actual findings in the crime scene.
e. A careful examination of the external surface for possible
trauma including the clothings to determine the pattern of
injuries in relation to the injurious agent.
f. The autopsy report is written in a style that will make it easier
for laymen to read and more clearly organized insofar as the
mechanism of death is concerned.
g. professional and environmental climate of a forensic
pathologist is with the courts, attorneys and police who make
scrutiny of the findings and conclusion.
The following Manner of Death should be Autopsied:
a. Death by violence.
b. Accidental death.
Suicides.
d. Sudden death of persons who are apparently in good health.
e. Death unattended by physician.
f. Death in hospitals or clinics (D.O.A.) wherein a physician was
not able to arrive at a clinical diagnosis as the cause of death.
g. Death occurring in an unnatural manner.
 LEGAL MEDICINE

PROCEDURE OF AUTOPSY
Guidelines in the Performance of Autopsies:
1. Be it an or non-official autopsy, the patho-
logist must be properly guided by the purposes for which autopsy
is to be performed. In so doing the purpose of such dissection will
be served.
2. The autopsy must be and must not leave some
parts of the body unexamined. Even if the findings are already
sufficient to account for the death, these should not be a suf-
ficient reason for the premature termination of the autopsy. The
existence of a certain disease or injury does not exclude the pos-
sibility of another much more fatal disease or injury. The findings
of coronary disease does not exclude the probability of injury or
poisoning.
3. Bodies which are severely mutilated, decomposing or damaged by
fire are still suitable for autopsy. No matter how putrid or
fragmentary the remains are, careful examination may be pro-
ductive of information that bears the identity and other physical
trauma received. Frequently a reluctance to per-
form an autopsy on decomposed body is due to the odor or
vermin rather than to his belief that the examination would not
be productive.
4. All autopsies must be performed in a manner which show respect
of the dead body. Unnecessary dissection must be avoided.
A wife consented to the performance of an autopsy but
specifically stated that it must be performed in a
manner. The autopsy was done in broad daylight in the
metery in full view of all the neighborhood residents.
held that the condition was violated and she was awarded
damage even though she has consented to the examination
(Hill V. Travelers Co. 294 S.W. Tenn. 1927).
5. Proper identity of the deceased autopsied must be established in
non-official autopsy. An autopsy on a wrong body may be a
ground damages.
Two patients occupying adjoining beds died within a five-
minute interval. There was authorization to perform an autop-
sy on one of them but the nurse interchanged the tags. The
deceased wherein there was no authorization given was autop-
sied. The next of kin brought an action against the hospital
administrator, the pathologist and the coroner for
 INVESTIGATION OF DEATH

autopsy. The liability was made on the nurse who un-

fortunately was not made as one of the defendants (Schwalb
v. 2d 667,
The award for damages for wrongful autopsy is not on account
of the mutilation of the deceased body but for the injury to the
feelings and mental suffering of the living because of the illegal
act.
After the death of the husband and without the consent of
the wife, an autopsy was performed on the body of the de-
ceased. The widow filed a suit for unlawful autopsy and failure
to replace the brain, heart and organs. The court held that
there is no justification for the autopsy and dismemberment
and have injured the feelings of the widow. The sum of $1,000
was awarded as reasonable damages (Gould v. State of New
York, 181 884, 46 N. Y.S. 2d 313).
6. A dead body must riot be embalmed before the autopsy. The
embalming fluid may render the tissue and blood unfit for toxico-
logical analyses. The embalming may alter the gross appearance
of the tissues or may result to a wide variety of artifacts that tend to
destroy or obscure evidence. An embalmer who applied embalming
fluid on a dead body which in its very nature is a victim of vio-
lence is liable for his wrongful act.
7. The body must be autopsied in the same condition when found
at the crime scene. A delay in its performance may fail or modify
the possible findings thereby not serving the best interest of
justice.
Precautions to be Observed in Making Post-mortem
Examination:
The physician must have all the necessary or author-
ization to perform such an examination. Such permit must be
issued by the inquest officer. The absence of such authorization
may hold the physician civilly and criminally liable.
2. The physician must have a of the previous symp-
toms and condition of deceased to be used as his guide in the
post-mortem examination.
3. The of the deceased must be ascertained. If no one
claims the body, a complete date to reveal his identity must
taken.
4. Examination must be made in a Well-lighted place and it is ad-
visable that no unauthorized person should be present.
 LEGAL MEDICINE

5. All external findings must be properly described and if possible a

sketch must be made or photograph must be taken to preserve the
evidence.
6. All steps and findings in the examination must be recorded.

Rules in the Examination:

1. Look before you cut.
2. Never cut unless you know exactly what you are cutting.
3. Weigh and measure everything that can be weighed or measured.

Stages in the Post-mortem Examination of the Dead Body:

Preliminary Examination:
a. Examination of the Surroundings (Crime Scene):
Attention must be focused on the furniture; bullet holes on
the ceiling, floor and walls; amount, color, shape and degree of
spread of the blood stains, position of the wounding weapon;
foot and and hairs and clothes.
b. Examination of the Clothings:
Look for marks to establish identity, kind and quality of the
garment, stains, grease, cut and or other marks of resistance
and violence.
Identity of the
Determine the height, weight, color of the hair and eyes,
complexion, condition and number of teeth, bodily deformity,
scars and tattoo marks, clothings, dog tag and fingerprints.
2. External Examination:
a. Examination of the Body Surfaces:
Inspect the natural orifice of the body. All wounds must be
described in detail, blood stains and foreign bodies.
b. Determination of the Position and Approximate Time of Death:
In this stage, the presence and degree of hypostasis, rigor
mortis and putrefaction and color of the blood stain must be
noted. Examination of the hands for the presence of cadaveric
spasm and wounding weapon may be necessary for the proper
solution of the crime.
3. Internal Examination:
Examine all body orifices for blood and foreign bodies. Blood
coming out of the nostrils may imply fracture on the base of the
anterior cranial fossa. Hemorrhage of the ears may imply fracture
of the middle cranial fossa.
 INVESTIGATION OF DEATH

Advantages of Starting Autopsy on the Head:

If the autopsy starts on the chest or abdomen, excision of the
organs cause the blood content of the brain and the meninges
to necessarily lose its original pattern;
2. There is the unavoidable contamination of the body associated
with the autopsy, which prevents liable of microor-
ganisms from the cranial contents;
3. Manipulation of other blood vessels, specially at the neck may
result in air being artificially drawn into the cerebral
vessels, impairing fair evaluation of air embolism that might have
occurred during (Forensic Medicine, Vol. 1, by Tedeschi,
Eckert and Tedeschi, p.
A primary incision must be made from the suprasternal notch to
the pubic symphysis passing to the left of the umbilicus. Cut the
rectus abdominis muscle at several points to expose the abdominal
cavity and flap the skin at the region of the chest from the primary
incision to the lateral aspect of the chest exposing the ribs. Dis-
articulate the joint and cut the ribs medial to the
junction. Remove the breast and begin examining
the
Abdominal and Chest Wall:
Fat — Amount, color, moisture, fibrosis.
Musculature — Development, color, thickness,
atrophic changes.
Peritoneal
Fluid — Amount, character, color, consis-
tency, purulent or bloody material.
Omentum — Amount fat, extent, adhesions,
blood distribution.
Liver — Level of the anterior border, ad-
hesions, blood distribution, color,
Chest fatty or atrophic changes.
Fluid — Amount, color, character, con-
sistency, purulent or bloody ma-
terial.
Adhesions — Kind, extent, concommitant di-
sease, distribution.
Pleura — Luster, hemorrhage, disease.
— Enlargement of the lymph nodes,
Mediastinum tumor.
— Weight, lobulation, fatty degener-
Thymus ation.
172 LEGAL MEDICINE

See a tabulation regarding the weight of the thymus gland with

respect to age.
Open the pericardial sac and examine its contents, principally the
heart. The normal pericardial fluid is from 5 cc. to 6 cc. and yel-
lowish in color. Remove the heart by cutting the root of the blood
vessels connected with it. Examine the heart on the following
points:
Weight Normal in men — 300 grams; wo-
men 250 grams.
External — Size, shape, consistency, contrac-
tion or relaxation of the ventricle.
Epicardium — Adhesions, amount of fat, luster,
petechial hemorrhages, milky
patches.
Cavities — Amount of blood, blood clots,
emboli, dilatation.
Measure of the Orifices — Normal: Tricuspid — 12
pulmonary — 8.0 mitral —
10.0 aortic — 7.0
Thickness of the Ventricle — Normal: left — 1.4 right —
cm.
Endocardium — Ulceration, vegetation and sclerosis
of the valves, mural endocardium,
thrombi, cordae trabe-
papillary muscles. Mottling
(Tigroid heart).
Myocardium — Color, consistency, resistance to sec-
tion infraction, sclerosis, fibrosis
edema.
Coronary Vessels — Special attention must be made to
the anterior branch of the left
coronary artery, sclerosis, atheroma,
embolism.
Removed both lungs by cutting the region of the After
examining the fluid or adhesions within the chest wall, the following
points must be considered in the
Weight — Normal: right — 400 grams; left —
350 grams.
External Examination — State of collapse, size, consistency,
color, crepitation, consolidation,
luster, exudate, pete-
chiae, blood distribution.
 INVESTIGATION OF DEATH 173
1. Size:
Larger — Emphysema, pneumonia, edema.
Smaller — Compression, atelectasis.
2. Shape:
Congenital changes — Abnormal furrows, increased num-
ber of lobes.
Acquired changes — deformans, retractions due
to fibrosis in the lung itself, furrows
corresponding to the first rib,
partial enlargement due to localized
emphysema, change due to ad-
hesions.
3. Weight:
Increased — Edema, inflammation, congestion,
induration.
Diminished — Emphysema.
4. Color:
Grayish-red — Variation due to age, occupation,
content of air and blood.
Slaty-black — Anthracosis.
Bluish-red — Atelectasis.
Light-brownish — Hemosiderin brown induration.
5. Air content and
Note the softness, and compressibility.
Marked softness — Formation of cavity or post-
mortem decomposition.
Firm consistency — Consolidation.
Compressibility — Emphysema.
Cut Surface — Color, condition of consolidation,
amount of air and fluid exuding on
pressure, bronchi, blood vessels.
Bronchial Lymph Nodes — Enlargement, tubercu-
losis.
Examine the mediastinum for enlargement of the lymph glands,
hemorrhage, inflammatory conditions and other pathology.
Abdominal
Go to the abdominal cavity and remove the spleen by pulling it
and cutting the vessels at the region of the Examine the spleen
on the following
Weight — Very variable, approximately 150
grams.
174 LEGAL MEDICINE

External Examination — Size, color, consistency, thickness

of the capsule, smoothness or
wrinkling of the capsule.
Cut Surface — Resistance to cutting, bulging of
cut surface, color, prominence of
the corpuscles, and
trabeculae, consistency of the pulp
by scraping with sharp edge of
knife.
Separate the intestine by cutting the mesentery near its attach-
ment with the intestine from the jejenum downward. Open the
duodenum and verify the potency of the common bile duct. Se-
parate the stomach, duodenum, and pancreas by cutting at the
cardiac end of the stomach.

Stomach — Distention, shape, contents, con-

dition of the mucosa, post-mortem
changes.
Small Intestine — Length, external appearance, con-
tents, mucosa, lymphoid follicles
and patches, obstruction,
diverticulum, parasites.
Large Intestine — Length, external appearance, con-
tents, mesocolic glands, epiploic
appendages, thickness of the walls,
condition of the mucosa, inflam-
mation, ulcerations, condition of
the appendix, parasites.
Rectum — New growth, hemorrhoid, dysen-
teric ulcers,
The liver is removed by separating it from the diaphragm, but
avoid cutting the suprarenal glands at the upper pole of the kid-
neys. The following points must be taken into consideration in the
examination of the
Weight Male — 1,400 grams; Female:
1,200 grams (Filipino).
Size, color, consistency, sharpness
External Examination of the edges, rib markings, scars,
thickness of the capsule, lobulation,
granulation.
Resistance to cutting, amount of
Cut Surface blood vessels, condition of the bile
duct.
 INVESTIGATION OF DEATH 175
Gall Bladder — Adhesions, distention, color and
consistency the bile,
and staining of the mucosa, thick-
ness and adhesions of the walls,
concretion, obstruction of the
cystic, hepatic and the common
bile duct.
The kidneys must be removed after the removal of the adrenals
and examine them on the following points:
Weight — 120 to grams. The left is
heavier than the right.
External Examination — Perirenal tissue, size, shape and
consistency, color, thickness and
adherence of the capsule, external
surface of the cortex, granulation,
cyst, fetal lobulation, condition
of the veins.
Cut Surface — Condition of the cut edges (everted
or not). Proportionate thickness
of the cortex and the medulla
(normal — 1.3), cortical
pyramidal striation.
Pelvis — Pelvic fat, stones, inflammatory

Ureter — Obstruction, dilatation, inflam-

matory changes.
Bladder — Distention and contents, condition
of the mucosa and trigonum,
opening of the ureter.
Genital Organs:
Male Remove the prostate and the seminal vesicle with
the urinary bladder. The testicle and the epi-
didymis is removed by pushing through the in-
guinal glands and opening the internal inguinal
ring. Note the condition of the testicle, epididy-
mis, seminal vesicle and prostate.
Female Remove the uterus and its adnexa together with
the upper portion of the vagina.
Ovary — Corpus hydatid cyst, tumor.
Fallopian Tube — Distention, hydrosalpinx, pyosal-
hematosalpinx adhesions.
Uterus — Resting, menstruating, gravid, in-
voluting, atrophic, tumor.
176 LEGAL MEDICINE

System:
Aorta Sclerosis, atheroma, syphilis, aneu-
rysm.
Veins Thrombosis, phlebitis.
Neck Organs:
Remove the larynx, pharynx and tongue tonsils.
The condition of the lymph glands, obstruction and edema of the
glottis, foreign body and materials in the larynx and trachea, condi-
tion of the thyroid gland, and condition of the tongue and tonsils
should be
Head:
The scalp is incised from the mastoid process of one side passing
the vertex to the mastoid process on the opposite side. The flaps
are turned down to the back and to the front. Note the presence
of hemorrhage, bruise, hematoma and fracture of the skull. Open
the skull by sawing at the forehead above the eyebrow to the region
of the upper portion of the ear and another vertically a little behind
the vertex and meeting the horizontal cut at the region of the upper
portion of the ear. Remove the flap of bone and note the condition
of the meninges. Remove the brain after cutting it from its attach-
ment and the tentorium cerebelli. Examine the brain for patholo-
gical condition, hemorrhage, laceration, softening, and the base and
side of the cranial box for hemorrhage and fracture. Make several
incisions on the brain and study the injury or disease.

Examination of the Extremities:

There is no technical incision for the extremities. Just open what
is deemed necessary and appropriate for the occasion.

and Measure of the Organs

The specimen which are collected for further study must be placed
in clean jars and brought to the laboratory
for toxicological examination.
2. Slices of organs for study.
(For a more detailed examination of post-mortem examination,
consult any textbook on

AVERAGE MEASUREMENT OF INDIVIDUAL

ORGANS
HEART: Male Both Female
Weight of heart 300 250 gms.
 INVESTIGATION OF DEATH 177
Relative weight of
heart to body 1 to 169 1 to 162
Length of heart —9
Circumference of
Mitral orifice 10.9 cms. 10.4 cms.
Tricuspid orifice cms. 12.0 cms.
Aortic orifice 8.0 cms. 7.7 cms.
Pulmonary orifice 9.2 cms. 8.9 cms.
Pulmonary artery 8.0 cms.
Circumference base
of ventricle 28.8 cms.
Thickness of the wall of
Left ventricle 1.1 cms.
Right ventricle 0.5 — 0.7 cms.
SPLEEN:
Weight of spleen 150 gms.
Measurement 12.0 x 4.5 x 3.0 cms.
PANCREAS:
Weight of pancreas 90 — 120 gms.
Measurement 23.0 x 4.5 x 2.8 cms.
LIVER:
Weight 1500 to gms.
Measurement
Length from right to left 25 — 32 cms.
Width of right lobe 18 — 20 cms.
Vertical diameter of right lobe 20 — 22 cms.
Vertical diameter of left lobe 15 cms.

KIDNEYS: Male Both Female

Weight gms.
Measurement 11 x 5 x 4.5 cms.
Thickness
Cortex 4.6 cms.
Medulla 1 — 3 cms.
Relation to body weight
Relation to weight of heart 1:1.1
OVARY:
Weight 7.0 gms.
BRAIN:
Weight 1,358 gms. 1,234 gms.
178 LEGAL MEDICINE

ADRENALS:
Weight 4.8 — 7.3 gms.
Measurement 40 x 20 x 2
OF THYMUS: Both
Newborn 13.26 gms.
- 5 years 22.08 gms.
6 10 years 26.18 gms.
- 1 5 years 37.52 gms.
20 years
- 20 gms.
25 years
21 - 25 24.73 gms.
35 years
26 - 35 gms.
45 years
36 - 45 gms.
55 years
46 - 55 12.85 gms.
65 years
56 - 65 6.08 gms.
75 3years 6.00 gms.
Mistakes in Autopsies:
1. Error or omission in the collection of evidence for identification:
a. Failure to make frontal, oblique and profile photographs of the
face;
b. Failure to have fingerprints made;
Failure to have a complete dental examination performed.
2. Errors or omission in the collection of evidence required for
establishing the time of death:
a. Failure to report the rectal temperature of the
b. Failure to observe changes that may occur in the intensity and
distribution of rigor mortis — before, during and after autopsy.
Failure to observe the ingredients of the last meal and its
location in the alimentary tract.
3. Errors or omission in the collection of evidence required for other
examination:
a. Failure to collect specimens of blood and brain for deter-
mination of the contents of alcohol and barbiturates;
b. Failure to determine the blood group of the dead person if
death by violence was associated with external bleeding;
Failure to collect nail scrapings and samples of hair if there is
reasonable chance that death resulted from assault.
d. Failure to search for seminal fluid if there is a reasonable
chance that the fatal injuries occurred incident to a sexual

e. Failure to examine clothings, skin and the superficial portion

of the bullet tract for residue of powder, and the failure to
 INVESTIGATION OF DEATH 179
collect samples of any residue for the purpose of chemical

f. Failure to use an X-ray for a bullet or fragments of

bullet if there is any doubt with regard to their presence and
location;
g. Failure to protect bullet from defacement, such as is likely
to occur if they are handled with metal instruments.
h. Failure to collect separate specimens of blood from the right
and left sides of the heart in instances in which the body was
recovered from water.
Failure to strip the dura mater from the and base of the
skull. Many fractures of the skull have been missed because the
pathologist did not expose the surface of the fractured bone.
4. Errors or omission result in the production of undesirable artifacts
or in the destruction of valid evidence:
a. Opening of the skull before blood is permitted to drain from
the superior vena cava. If the head opened before the blood
drained from it, blood will almost invariably escape into the
subdural and subarachnoidal space, and such an observation
may then be interpreted as evidence of ante-mortem hemorrhage.
b. The use of a hammer and chisel for opening the skull. A
hammer and chisel should never be used for the purpose in a
medico-legal autopsy. Fracture produced by the chisel are
frequently confused with ante-mortem.
Failure to open the thorax under water if one wishes to obtain
evidence of pneumothorax.
d. Failure to tie the great vessels between sites of transection and
the heart when air embolism is suspected.
e. Failure to open the right ventricle of the heart and the pul-
monary artery in situ if pulmonary is
suspected.
Failure to remove the uterus, vagina and vulva en masse if rape
or abortion is suspected.
(From the American Journal of Medicine and Pathology,
Vol. 2, No. 4 (Dec. 1981) p. 306).
Negative Autopsies — An autopsy is called a negative autopsy if after
all including gross and microscopic studies and
fail to reveal a cause of death. It is an autopsy which
after a meticulous examination with the aid of other examinations
does not yield any definite cause of death.
180 LEGAL MEDICINE

There are reports that approximately 2 to of the total autopsy

cases in medico-legal centers yield a negative result although theo-
retically there must be a cause of death.
Negligent Autopsy — An autopsy wherein no cause of death is found
on account of imprudence, negligence, lack of skill or lack of fore-
sight of the examiner. The act or omission which may be inadvertent
or deliberate may
1. Failure to have an adequate or and circumstances
surrounding the death. Special circumstances surrounding death
may require special autopsy techniques which the pathologist may
fail to do during the autopsy. Air embolism, drug reaction, vagal
inhibition may be left unnoticed because of absence of history.
2. Failure to make a thorough external examination — Animal bites,
injection marks, electrical necrosis may be overlooked in a hasty
external examination.
3. Inadequate or improper internal examinations — Condition of
the organs, presence of air in pneumothorax or bubbles of air in
the circulatory system may remain unnoticed by the pathologist.
4. Improper histological examination — Tissue blocks may not be
taken in the proper areas, poor preparation of the microscopic
slides and improper lighting during the process of examination
may lead to an erroneous interpretation.
5. Lack of or other laboratory aids — A qualitative and
quantitative determination of toxic materials or its metabolites
must be shown. Sometimes difficulty is encountered by the
forensic chemist because of the lapse of time and rapid elimination
of the drug.
6. Pathologist incompetence — The examiner must have had vast
experience in autopsy investigation and must have the capacity
to distinguish pathological changes in the body tissues.
(Handbook of Forensic Pathology by Abdullah Fatteh, pp.
255).

Religious Objections to Autopsies:

There is no place in the Bible, in the Talmudic or ic
writings, is there evidence that post-mortem examination is pro-
hibited. According to traditional interpretation, which is not neces-
sarily accepted by all Jewish groups, autopsies and transplantation of
organs are permitted only in those cases where the gave
consent.
 INVESTIGATION CF DEATH 181

There is no statement the Catholic Church which can

be construed as prohibiting autopsies. Autopsies have been encour-
aged when it appeared that benefit would accrue from them. Simi-
larly, there appears to be nothing in the writings of the Protestant
clergy to point to the prohibition of autopsies.