CHAPTER 4: LEGAL MEDICINE

Legal medicine
-is a branch of medicine which deals with the application of medical knowledge to the purposes of law
and in the administration of justice.
Legal – pertains to law, arising out of, by virtue of or included in law.
HISTORICAL BACKGROUND (Philippines)
• 1858 – the first textbook in Legal Medicine and its practice by Dr. Rafael Genard Y Mas, who
is a Spanish chief army physician was published and is entitled “Manual De Medicina
Domestica.”
• 1871 – legal medicine was included in the curriculum of the college of medicine in the
University of Santo Thomas.
• March 31, 1876 – the “medico titulares” which took charge of public sanitation and medico-
legal aid for the purpose of justice was created by the King of Spain in his Royal Decree No.
188.
• 1894 – the “medico Titulares of Forensic” which is about the regulation and its practice was
published.
• 1895 – a medico-legal laboratory was established in manila to handle medico-legal cases.
• 1898 – during the American regime, the Spanish Forensic Medicine System was preserved.
• 1901 – the provincial, insular and municipal boards of health (Acts 157, 307, 308) were
created by the Philippine Commission which are about the medico-legal duties of “medico-
tetulares” of the Spanish regime and its assignment to the health officers of the respective areas.
• 1908 – legal medicine was taught in all medical school in the Philippines.
• 1919 – the department of Legal Medicine and Ethics of the University of the Philippines was
created under Dr. Sixto de los Angeles as the chied.
• January 10, 1922 – the department of Legal Medicine and Ethics of the University of the
Philippines with its department head was incorporated to the Philippine General Hospital.
• March 10, 1922 – the Philippine legislature enacted Act No. 1043 which became incorporated
in the administrative code as Section 2465 and provides that the department of Legal Medicine
and Ethics of the University of the Philippines became a branch of the Department of Justice.
• December 10, 1937 – the creation of the Division of investigation under the department of
Justice was done by the Commonwealth Act 181 in which a medico-legal section was under the
division with Dr. Gregorio T. Lantin as the head.
• March 3, 1939 – The Department of Legal Medicine and Ethics of the University of the
Philippines was abolished and their functions were transferred to the medico-legal section of the
Department of Investigation.
 • July 4, 1942 – a medico-legal section of the Manila Police Department was created under Dr.
Pablo Anzures.
• 1945 – the Provost Marshall of the United States Army created the criminal investigation
laboratory with the Medical Examiner as an integral part under Dr. Mariano Lara as the Chief
Medical Examiner.
• June 28, 1945 – the Division of Investigation was reactivated under Department of Justice.
• June 29, 1947 – the Bureau of Investigation was created by the Republic Act 157. Then, the
Bureau of Investigation was made the National Bureau of Investigation by the executive order
from the President of the Philippines. The medico-legal section was created under the National
Bureau of Investigation with its Head Dr. Enrique V. de Los Santos.
• The existence of the medico-legal division in the criminal laboratory of the G-2 of the Philippine
Constabulary also occurred.
• At that time, all provincial, municipal and city health officers, physicians of hospitals, health
centers, asylums, penitentiaries and colonies became ex-officio medico-legal officers.
• In remote places, the service of “Cirujano Ministrate” or the Sanitary Inspector may perform
the medico-legal work if a registered physician is not available.
Medico-legal aspect of identification
When an unknown body is found, the following should be noted by the investigator to facilitate
investigation:
1. Place where body is found
2. Time when found
3. What is the Cause of death
4. Time when death occurred
5. Approximate age
6. Supposed profession
7. Description of body
Points of identification applicable to both living and dead before onset of decomposition:
• Occupational marks
• Race: color of skin; shape of skull;
• Stature
• Teeth
• Tattoo marks
• Weight
• Deformities
 • Birth marks
• Injuries leaving permanent result
• Moles
• Scars
• Trial marks
• Sexual organ
• Blood group
• Fingerprints
Witness – is a person who has knowledge about the case.
Types of WITNESS:
1. Ordinary Witness:
-Witness as to the fact. Nothing to do with the medical practice.
2. Expert Witness:
-One who assist the law by giving an expert opinion and certain facts
3. Professional Witness
-Doctors give factual evidence of something he did or saw during his medical work.
STAGES OF MEDICO-LEGAL INVESTIGATION
Crime scene investigation
-investigation of the place of commission of the crime to include external examination of the dead body.
Autopsy and Post-mortem examination compared:
Post-mortem Examination – it refers to external examination of a dead body without incision being
made, although blood and other body fluids maybe collected for examination while
Autopsy – indicates that, in addition to external examination, the body is opened and an internal
examination is conducted
Types of Autopsy:
• Clinical/Hospital Autopsy
-Which focuses on the internal organ findings.
(To confirm the clinical diagnosis, presence and extent of disease, any medical condition that were
overlooked and appropriateness and outcome of therapy)
• Forensic/Medico Legal Autopsy
-To determine the cause of death and confirm the manner of death often used in criminal proceedings.
Person who are authorized to perform autopsies and dissections:

 health officers
 medical officers of law enforcement agencies
 member of the medical staff or accredited hospitals
Items to be collected for Laboratory Examination:
• Victims clothing;
• Blood Examinations, DNA and Blood typing;
• Bullets recovered from the body on hands swabs in case of gun shooting (paraffin test).
• Anal and Vaginal swabs combings from the heads and pubic hair in case of sex related cases.
• Vomitus and other gastric secretions.
External Examination
• Broad overview of the condition of the body and clothing;
• General Characteristics of the Body:
A. Sex and Approximate age
B. Height and Weight
C. Body Built
D. Probable cause of Death
E. Presence of Tattoo and Trial marks
  Stippling, peppering or tattooing around the bullet hole.
External Examination-consist of classifying injuries. These include abrasions, contusion, laceration and
sharp injury wounds. Hemorrhage in the eyelid as they can be indicative of asphyxia by strangulation.
Genital examination in suspected sexual abuse. Characteristics markings on skin in cases of firearms
wounds or commotive of shoot and gun powder.
Internal Examination-consist of the removal of the individual organs through a Y and T shape incision
beginning at the tap of the back shoulder and extending between to the public bone.
Internal organs are weighted, sectioned and send for pathologic examinations Blood is routinely tested to
determine alcohol and other toxic substances.
Pulmonary edema- fluid accumulates in the lungs is commonly found in victims of chronic and
amphetamine abuse. Stomach contents for digested food or dissolved tablets.
Chapter 5: DEATH INVESTIGATION
Death Investigation
-It deals with the postmortem investigation of sudden and unexpected death.
Forensic Pathology
-Is the branch of medicine associated with the study of structural changes in the body caused by
disease or injury.
Branches of Pathology:

 ANATOMIC- Which deals with structural alterations of the human body.

 CLINICAL- Which deals with laboratory examination of samples removed from the body.
Role of Forensic Pathologist:
a) Establishing cause of death
b) Establishing manner of death
c) Estimating the time of death
d) Inferring the type of weapon used.
e) Establishing the identity of the deceased
f) Determining the additive effect of trauma or pre-existing conditions
Establishing the Facts of Death:
Death – death is defined as the absence of life in a living matter.
Types of Death:

 Brain death – there is irreversible coma, absence of electrical brain activity and complete
cessation of all the vital functions without possibility of resuscitation.
 Cardio-respiratory death – there is continuous and persistent cessation of heart action and
respiration.
Kinds of Death
1. Somatic Death – Clinical Death
-It is a complete, continuous, persistent cessation of respiration, circulation and almost all brain
functions of an organism. It is usually pronounced by a physician or other members of the
family.
Clinical Types of Death:
1. Sociological Death – the withdrawal and separation from the patient by others producing a
sense of isolation and abandonment.
2. Psychic Death – the condition of death wherein the patient regresses, gives up or surrenders
accepting death prematurely and refuses to continue living.
 3. Biological Death or Brain Death – it is characterized by absence of cognitive function or
awareness, although artificial support system may maintain organs functioning.
4. Physiological Death – all vital organs cease function.
2. Molecular Death- Cellular Death
-It is the cessation of life of the individual cells in the whole body, which occurs one at a time
after somatic death.
3. Apparent Death – State of Suspended Animation
-It is the state of temporary cessation of vital activities of the body or vital processes were
depressed to the minimum compatible with life.
Signs of Death:
1. Cessation of respiration
2. Cessation of Heart Beating and Circulation
3. Cooling of the body
4. Insensibility of the body and loss of power to move
5. Changes in the eyes
6. Changes in the skin
External Signs of Death:
1. Loss of Power to Move and Insensibility of the Body.
2. Stoppage of Respiration
CAUSE OF DEATH -This is a specific medical diagnosis denoting a disease or injury (e.g.,
myocardial infraction, strangulation, gunshot wound, etc.)
Two types of Cause of Death:

 Proximate Cause of Death – the initial that lead to sequence of events, which caused the death
of the victim.
 Immediate Cause of Death – the injury or disease that finally killed the individual.
MANNER OF DEATH -This determination deals with the legal implications superimposed on biological cause
and mechanism of death.

 Suicide- The victim caused his/her death on purpose.

 Accidental- The individual falls victim to an accident. Misadventure, outside owns will.
 Natural Cause- It is the death due to a disease ailment in the body.
SPECIAL DEATHS
-Death caused by tumultuous affray
-Any legally married person who having surprised his spouse in the act of having sexual intercourse
with other person.
VIOLENT DEATH
-It is death due to injuries of some forms of outside force wherein the physical injuries inflicted is the
approximate cause of death.
Classification of Physical Injuries:
1. Physical Force
2. Thermal Injuries
3. Electrical injuries
4. Change in atmospheric pressure
5. Radio active injuries
Methods of judicial death:
1. Electrocution
2. Lethal Injection
3. Firing squad
4. Gas Chamber
5. Hanging
6. Decapitation
Determination of the Time of Death (Death Estimates)
POST-MORTEM CHANGES- Changes in the body after death
POSTMORTEM-is in reference to events or changes that occur after death.
ANTE MORTEM-is in reference to events or changes that occur before death.

1. ALGOR MORTIS (Cooling of the body)

 -The body cools following death at approximately 1.5 degrees F per hour, under normal
conditions and assuming the body’s temperature at death is 95 degrees F (35 degrees C).
 Post-mortem caloricity – is the rise of temperature of the body due to rapid and early
putrefactive changes or some internal changes. (observed in the first two hours after death)
Changes in the body following death:
Stage of primary flaccidity – (post mortem muscular irritability) relaxed and capable of contracting
when stimulated; last about 3-6 hours after death; and one hour fifty-one minutes in warm places.
2. POST MORTEM RIGIDITY (Rigor Mortis-Stiffening of the body)
-Stiffening of the body which occurs 2-6 hours after death and is characterized by hardening of
the muscles; the chemical reaction that causes rigidity in the muscle groups or stiffening of the
body after death due to the disappearance of Adenosine Triphosphate (ATP) from the muscle.
Condition Simulating Rigor Mortis:
1. Heat Stiffening
-a condition characterized by hardening of the muscles due to coagulation of muscle protein when the
dead body is exposed t intense heat as by burning immersion in a hot liquid.
2. Cold Stiffening
- condition characterized by a hardening of a muscle due to solidification of fats, muscles and fluid
when the dead body is extremely cold temperature.
3. Cadaveric Spasm or Spontaneous Rigidity
-instant stiffening of certain group of muscles which occurs immediately at the moment of death.
Stage of secondary flaccidity – commencement or putrefaction; muscle become flaccid; no longer
capable or responding mechanical or electrical stimulus and the reaction alkaline.
ONSET AND STAGE OF DECOMPOSITION
Decomposition- is the action of bacteria on the dead body. The Onset of decomposition is 1 to 2 days
after death and then finally the dead body becomes skeletal remains in months considering the factors
that influence the rate of putrefaction.
Putrefaction - this is the usual course of decomposition leading to liquefaction of tissues.
CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURRING IN
TROPICAL REGION
CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS
BEEN SUBMERGED IN WATER

SPECIAL FORMS OF PUTREFACTION:

• MUMMIFICATION - a condition where there is a removal of body fluid before
decomposition sets in that resulted to shrinking and preservation of the dead body.
A. NATURAL MUMMIFICATION- the dead body is buried or exposed to a dry, hot,
sandy, soil with considerable air movement.
B. ARTIFICIAL MUMMIFICATION- some chemicals are added on the dead body like
formalin, phenol, arsenic or mercury and covering the skin with plastic of Paris

• ADIPOCERE FORMATION – it is the formation of a soft friable, brownish white greasy

substance called adipocere formed by hydrolysis and dehydrogenation of body fats.
LIFE CYCLE OF FLIES (Entomology of Cadaver)
-The eggs of ova laid by the flies on the dead body will hatch to form maggots within 24 hours. The
maggots will feed vigorously on the damaged dead body, then transform into pupal stage and finally into
adult flies within a few days.
a. Appropriate time of death of death using files
b. Usual time for the egg to hatch in the larva is 24 hours
c. If there are maggots in the cadaver, one can conclude that death has occurred more than 24 hours.

CHANGES IN THE BLOOD

-The blood remains fluid in the body after death after 6-8 hours. After which it gradually clotted or
coagulated in a slow process until 12 hours wherein the lividity is already fully developed.
3. POST-MORTEM LIVIDITY (Livor Mortis)
-Discoloration of the body after death, setting of blood in the dependent portions of the body
following death)
The Color of Lividity may indicate the Cause of Death:
 Carbon monoxide poisoning/ cyanide – cherry red to pinkish color
 Asphyxia – dark lividity
 Phosphorous poisoning – dark brown
TYPES OF LIVIDITY
1. Hypostatic – Blood is still in fluid form inside blood vessel; change as position of the body changes.
Blood remains fluid in the blood vessel for 6- 8 hours.
2. Diffusion – Coagulated inside blood vessel. Change in position will not change its location.
Importance of Post-Mortem Lividity:
1) It is a sign of death
2) It enables the investigator to estimate the time of death
3) It determines the position of the body after death
4) It may indicate the cause and manner of death
CHARACTERISTICS OF POST-MORTEM LIVIDITY:
 It occurs in the most extensive areas of the most dependent portion of the body.
 It involves the superficial layer of the skin, lungs, intestines, kidneys, and brain.
 Color is uniform in the tissues.
 It is not elevated from the skin, lungs, intestines, kidneys and brain.
 There is no injury to the tissues.
 The color may appear and disappear in the tissues by shifting the position of the body in the earlier
stages of death.
Duration of Death
Rigor Mortis – in warm countries like the Philippines
Sets from 2-3 hours after death
Fully developed after 12 hours
Last from 18-36 hours
Post-Mortem Lividity – usually develops 3-6 hours after death
Onset of Decomposition – 24-48 hours after death
CHANGES IN STOMACH
It usually takes three to four hours for the stomach to empty its contents after meals.
Stage of digestion of food in the stomach– average time for meals to evacuated in the stomach 3-4 hours
Disposal of dead body:
a. Embalming
-It is a method of preservation of dead body by the removal of the body fluid and replacement of the
same by chemical like formalin, alcohol or phenol.
b. Burial, interment, inhumation
-It is a method of placing the dead body into the grave.
c. Cremation
-Pulverization of the body by using intense heat.
d. Disposal of the body to the sea
e. Use of dead body for scientific purpose
EUTHANASIA (Mercy Killing)
-deliberate and painless acceleration of death of a person usually suffering from an incurable or
distressing disease
Types of Euthanasia:
Active Euthanasia – intentional or deliberate application of the means to shorten the life of a person.
Passive Euthanasia – there is absence of the application of the means to accelerate death but the natural
cause of the disease it allowed to have its way to extinguish the life of a person.
Orotonasia – when an incurable ill persons is allowed to die natural death without the application of
any operation or treatment.
Dysthanasia – when there is an attempt to extend the life span of a person by the use of extraordinary
treatment without which the patient would have died earlier.
Ways of performing Euthanasia:
 Administration of a lethal close of poison
 Over dosage of Sedatives, hypnotics of other pain relieving drugs
 Injection of air into the blood stream
 Application of strong electric current
 Failure to institute the necessary management procedure essential to preserve the life of a patient
Who may perform Euthanasia?
 The patient himself
 The physician with or without the knowledge or consent of the patient “the physician may be held
criminally liable under Art. 253 of the RPC”
 Penal code (giving assistance to suicide)

CHAPTER 6: MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

Physical Injuries -effects of application of stimulus to the body.
STIMULUS – anything that applied in the body produces reaction in varying degrees.
Stimuli that produce physical injuries:
 Heat -------------- burn (dry heat)/scald (moist heat)
 Cold -------------- frostbite
 Strong light ---------- sore eyes/blindness
 Radiation ----------- burns
 Electrical energy ----------- shock/burn
 Chemical energy --------- burn
 Change in atmospheric pressure ---------------- hypobarism
 Physical violence --------------- wounds
Injuries brought about by physical violence – lead to production of wound
 Wound – the solution of the natural continuity of tissue of the living body
 Vital reaction – sum total of all reactions of tissue and organs for which activities of living cells
are necessary.
 Defense wound – result of instinctive reaction of self-protection
COMMON FORMS OF EXTERNAL VIOLENCE:
CLOSED WOUNDS-when there is no breach of continuity of skin or mucous membrane.
a. Superficial Closed Wounds-are pinpoint, round spots that appear on the skin as a result of
bleeding. The bleeding causes the petechiae to appear red, brown or purple. 
Petechiae- Petechiae commonly appear in clusters and may look like a rash
Contusion (bruise) – an injury in the substance of the skin, discoloration of the surface due to
extravasation of blood. This is due to the application of a blunt instrument.
Bruisability depends on:
1. Age
2. Sex
3. Body Site
4. Natural Disease
4-5 days color changed to green
7-10 days it becomes yellow and gradually disappear on the 14th or 15th day
Hematoma (blood tumor) -extraversions of blood in a newly farmed cavity
Ecchymosis – a form of hematoma only that the extent of extraversion of blood is wider but thinner.

b. Deep Closed Wounds:

Musco-skeletal injuries:
1. Fracture – solution of continuity of bone resulting from violence or some existing pathology.
2. Strained/Strain – tearing or rupture of muscle fibers or over stretching
3. Cerebral or brain concussion – the jarring of the brain leading to some commotion of the
cerebral substance
4. Internal Hemorrhage – intracranial, rupture of organs, or laceration of organs
OPEN WOUNDS -when there is communication with the outside or break in the skin or mucous
membrane.
a. Abrasion – an open wound characterized by the removal of the epithelial layer of the skin brought
about by the friction against hard, rough object.
Forms of Abrasion:
 Linear
 Multi-linear
 Confluent – almost indistinguishable due to severity of friction and roughness of the object
 Multiple – several abrasion noted on the body surface of a person.
Types of Abrasion:
 Scratches
 Grazes
 Impact or imprint abrasion
 Pressure or friction abrasion
Lacerated wound – tearing of the skin due to forcible contact of a blunt instrument.
Site of the application of force and location of injury:
1. Coup – signifies that the injuries are located beneath the impact (usually caused by blow)
2. Contre-Coup – the injuries are on the opposite side from where the blow was initiated.
3. Coup Contrecoup – damage to the brain on both sides: the side that received the initial impact
(coup) or blow and the side opposite the initial impact (countrecoup).
Locus minoris resistancia -injury found both at the site or opposite the site of the application of the
force but in some areas offering least resistance to the force applied.
Extensive injury – injury involving a greater area beyond the site of the application of force.
a. Incised wound – produced by forcible contact on the body by sharp edge instrument.
b. Stab wound – produced by the forcible application and penetration of a sharp instrument.
c. Punctured wound – penetration of a sharp pointed weapon
Avulsion – soft tissue injury where a flap of tissue has been removed or is barely attached. Avulsion
also may refer to an injury of the bone where a tendon or ligament has been ripped away from its
insertion point.
Mutilation – cutting-off a part of the body
Gunshot Wounds
Two Types of Wounds:
1. Entrance wound
2. Exit wound
CHARACTERISTICS BETWEEN GUNSHOT OF ENTRANCE AND EXIT:
1. Size of the wound of entrance is smaller then the missile while, the point of the exit is bigger than the
missile.
2. The edge of the wound of entrance is inverted while the exit wound is everted.
3. Contusion collar is present in the wound of entrance and absent in the wound of exit.
4. The shape of the wound in the entrance is oval while the exit wound has no definite shape
5. Gunpowder tattooing – present in contact fire, absent point of exit
6. Paraffin Test – positive in the point of entrance , negative in the point of exit
Determination whether the wound is suicidal, homicidal, or accidental
Evidence to prove that gunshot wound is suicidal:
1. The fire is usually in contact or near contact, as shown by the presence of burning, singeing and
tattooing of the area around the gunshot wound.
2. The presence of usually but one gunshot wound. In most cases, after a shot, especially at the head, the
victim can no longer voluntarily act to inflict another shot.

3. Portions of
the body
involved are 4. History of
those despondency,
accessible to family problem
which may
cause him to
commit suicide.

Evidence to show that the wound is accidental:

 Usually there is but one shot.
 There is no special area of the body involved
 Testimony of the witnesses
Evidence to show that the wound is homicidal:

LEGAL CLASSIFICATION OF INJURIES:

Mutilation- is cutting off or causing injury to a body part of a person so that the part of the body is
permanently damaged, detached or disfigured.
Serious Physical Injury- means impairment of a person's physical condition which creates a
substantial risk of death or which causes death or serious and protracted
Less Serious Physical Injury- when the offender has inflicted physical injuries which shall incapacitate
the offended party for labor from one to nine days, or shall require medical attendance during the same
period.
Slight Physical Injury and Maltreatment- when the offender has inflicted physical injuries which
shall incapacitate the offended party for labor from one to nine days, or shall require medical attendance
during the same period.