PRE-FINAL

Legal Medicine is a branch of medicine which deals with the application of medical knowledge to the
purpose of law and in the administration of justice. The application of basic and clinical, medical and
paramedical science to elucidate legal matters.
Forensic – denotes anything belonging to the court of law or used in court or legal proceedings or
something fitted for legal or public argumentation.
Medicine science and art dealing with prevention, cure and alleviation of disease; it is that part of science
and art of restoring and preserving health.
Forensic Medicine deals with application of medical science to elucidate legal problems.
Medico-Legal Office System used in the Philippines at present which is handled by a Medical Jurist or
Medico-Legal Officer who is a registered physician duly qualified to practice medicine in the Philippines.
Medico-Legal Officer is the one who investigate medico-legal cases of death; physical injuries, rape and
other sexual crimes
FORENSIC PATHOLOGISTS IN THE PHILIPPINES
1. Dr. Raquel Barros del Rosario-Fortun, the first Filipina forensic pathologist practicing in the
Philippines.
2. Dr. Maria Cecilia Lim

In all crimes that have caused an immediate or eventual death, the work of the forensic pathologist is
crucial. He is medical doctor with special training in those aspects of pathology associated with crime, as
contrasted with the ordinary pathologist, who is more concerned with death and disease.
Suspicious deaths are a major concern of the forensic pathologist, who must obtain the information
by which they may be classified as natural (disease), self-destruction, murder, or accident. His efforts will
generally be supplemented in this task by investigator who can provide a background for the event. In
some offices of the coroner or medical examiner, there are such investigators on the staff. In others, the
police department or sheriff’s office must be relied on. Here the actual cause of death is generally the most
important part of the information, and this is generally available only through autopsy. In modern date
facilities, such as those medical examiners in the NBI Crime Laboratory and the PNP Crime Laboratory,
autopsies are performed in all suspicious death case.
Some forensic pathologists perform toxicological examinations as well as pathology. Generally, this
is not good practice because few pathologists qualify in both fields; in many offices, a toxicologist is part of
the staff.
Tracing of bullet tracts through the body, though a very common activity is not always simple. But in
reconstruction of a shooting, this can make the difference between knowing what happened and mere
speculation. Analysis of other wounds.

Identification of Persons:
In case of unknown dead human body found elsewhere by the investigator, the ff. points should be
taken with consideration:
 Place where the body was found
 Date and time when found
 Cause of death
 Time when death occurred
 Approximate age
  Complete description of the body

Points to consider in identifying the person: Face, Eyes, Nose, Head, Condition of the hair, Ears,
Mouth, Body Built, Height, Weight, Gait, Complexion, Mannerism, Teeth, Hands and Feet.

Death is the complete cessation of all the vital functions without possibility of resuscitation. The absence of
life in a living matter. Upon death the organism returns to a stable equilibrium, both physically and
chemical. In medico- legal death, it refers to the death which involves in crime or medico-legal cases to
prove or disapprove that a foul play had been done. Usually, death from sickness in the hospital or at home
is a natural death and therefore is not classified under medico-legal death because there is no foul play or
crime involved.
Medico-legal importance of determining death:
 Basis for immediate removal of vital organs and for transplantation;
 Civil personality of a natural person is extinguished upon death. The effect of death upon the rights,
powers and obligations of the deceased is determined by law, contract and will.
 Property of a person is transferred among the heirs at the time of death. Art. 774, Civil Code.
 Criminal liability of a person is extinguished by death. Art. 89, RPC.
 Civil case for claim which does not survive is dismissed upon the death of the defendant. Rule 3,
Sec. 21, Rules of Court.

Kinds of Death:
 Somatic Death – Clinical Death: It is a complete, continuous, persistent cessation of respiration,
circulation and almost all brain functions of an organism. The immediate signs of death in a person
are the sudden cessation of upward and downward movement of the chest in the process of
respiration; sudden pale color of the face and lips; the pulse and the heart beat stops; the jaw or
head drops down and flaccidity of the muscles occurs; the presence of dilated pupils as well as the
loss of corneal and light reflexes.

Clinical types of Death

1. Sociological death: It is a type of death wherein 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. Psychic death
occurs prematurely if the patient has excessive fear of his illness and views it as lending
to immediate death.
3. Biologic Death: The type of death characterized by the absence of cognitive function or
awareness, although artificial support system may maintain organ functioning.
4. Physiologic Death: A type of death when all vital organs have ceased to function.

 Molecular Death – Cellular Death: It is the cessation of life of the individual cells in the body
which occurs one at a time after somatic death. The blood contains food and oxygen that is ended
by the tissues. Nerve cells and brain cells die earlier about 5 minutes after somatic death while
muscle cells live longer until the onset of rigor mortis which is about 2-6 hours.

 Apparent Death – “State of Suspended Animation”. It is a state of temporary cessation of vital

activities of the body or the vital processes were depressed to the minimum compatible with life.
This condition is not actually death although classified under the kinds of death because the person
or organism is still alive although it seems that there are no signs of life.
Signs of Death
1. CESSATION OF HEART ACTION AND CIRCULATION
2. CESSATION OF RESPIRATION
3. COOLING OF THE BODY latin term (ALGOR MORTIS
4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE
5. CHANGES IN THE SKIN
6. CHANGES IN THE EYE
7. ACTION OF HEAT ON THE SKIN

The signs of death must be determined not only for its medico-legal implication but also to exclude
apparent death by the early as well as late changes which occurred in the body at the time of death or
within the next few minutes extending into the first and subsequent hours.
1. Cessation of Heart Beating and Circulation
Upon death, the heart stops beating in a persistent and continuous manner which cannot be revived by
cardiac massage and other resuscitative measures for about a period of five minutes.

Subsequently, the pulse beat stopped and also the circulation or blood flow to different parts of the body. In
this condition, the person is pronounced to be dead. In case of decapitation or cutting of the head and
judicial hanging, the heart beat persist for 15 minutes to 1 hour.

Methods of detecting cessation of heart action and circulation:

 Palpation of the pulse and heart beat – There will be no pulse and heart beat when palpated in a
person. Auscultation with the aid of stethoscope or placing the ear at the region of the heart in the
left chest to hear the heart sounds. Upon death, no heart sounds heard observance of the point of
maximum impulse at the region of the left chest. No point of maximum impulse observed upon
death.
 Fluoroscopic examination – By fluoroscopic examination, the movement of the shadow of the heart
can be seen if the heart still contracting and relaxing in a living person, but upon death, this
movement disappears.
 Electrocardiography – (EEG) The heart in a living person undergo certain electrical discharge and
emission following a conducting system in its contraction and relaxation which can be recorded in
an electrocardiographic machine. The recorded tracings of the living heart are different from the
tracings of a dead heart.

2. Cessation of Respiration – It has been observed that when a prson is dying the breathing
becomes irregular and then suddenly in gaps separated by long periods of interval until a last
expiratory movement which is usually accepted as the outward and visible sign of death which had
occurred. A person can hold his breath not longer than 3 and a half- minute but a persistent,
continuous cessation of breathing after 5 minutes without spontaneous breathing and repeated
testing for at least two minutes interval at each testing is considered as a respiratory failure.

Methods of detecting respiratory failure:

o Observance of upward and downward movement of the chest and abdomen in the process of
breathing. No movement observed upon death.
o Palpation of the respiratory movement by placing the palm of the hand on the chest and abdomen.
There will be no feel of the movement upon death.
o By auscultation with the aid of stethoscope or placing the ear at the region of the chest to hear the
breath sounds. No breath sounds are heard upon death.
o Examination with the aid of a mirror – A clean looking glass or mirror is placed in front of the mouth
and nose of a person. If there is cloudening or dimming of the mirror, the person is breathing and
therefore alive, however, the person is dead when there is no change in the mirror.
o Examination with the aid of feathers or fibers: The feather or fiber is placed in front of the mouth
and nose of a person. If there is no movement of the feather or fiber, the person is dead. This test
should be done indoor because the wind is a factor that may cause error.
 o Examination using a glass of water: A glass of water is placed on the chest of the person lying on
his back. If the person is breathing and there is movement of the chest, there will also be
movement of the surface level of water in the glass. No such movement occurs upon death.
o Examination using lighted candle, match or any material: The flame of the lighted material is placed
near and in front of the mouth and nose of a person. If a person is not breathing and therefore
dead, there will be no movement or more glowing of the flame. The wind is also a factor that may
cause error.
o Winslov Test: It is a test to determine cessation of respiration when there is no movement of the
reflected image on the water or mercury in a container and placed on the chest of a person lying on
his back.

3. Cooling of the body The metabolic process and other biochemical changes in the body producing
heat and energy as well as the function of the hypothalamus controlling the body temperature
stopped upon death, thereby the body temperature gradually decreases until it assumes the
temperature of the environment.

The lowering of the body temperature is one of the earliest sign of death and the body cools by
radiation, conduction and convection. The rate of fall of the body temperature is most rapid in the
first four after death and then progressively slower during the next 6-9 hours until it reaches the
temperature of the surroundings beyond 12 hours.

The normal body temperature in a living person is 37 degrees Celsius or 98.3 degrees Fahrenheit
but upon death the temperature gradually decreases. The fall of 15 degrees Fahrenheit to 20
degrees Fahrenheit is considered as death of the body.

In post-mortem caloricity or post-mortem Glycogenolysis, there is an increase of temperature due to

fast, early putrefactive and chemical changes in the body, which occur in about 1-3 hours after
death. Post-mortem caloricity occurs especially in persons who died from infectious diseases and
strychnine poisoning.

4 Changes in the Body following Death

1. Changes in the Muscle
2. Changes in the Blood
3. Autolytic or Autodigestive Changes after death
4. Putrefaction of the Body

1. CHANGES IN THE MUSCLE

Muscle is a soft tisuue found in most animals. The function of the muscle is to produce force and
motion.

THREE (3) types of Muscles

Stages of muscular changes
1. Stage of primary flaccidity (Post-Mortem Muscular Irritability) It is the stage of muscular change
upon death characterized by relaxation of muscles and loss of their natural tone so that the jaw or
the head drops down; the thorax collapses and the limbs becomes flaccid; the iris assumes a mid
position and the sphincter relaxes. This is the reason why the dead person may still urinate,
defecate or excrete the waste product of metabolism thru pores in the skin because of the relaxation
of the sphincters.

2. Stage of Post- Mortem Rigidity or Rigor Mortis aka CADAVERIC RIGIDITY, DEATH
STRUGGLE OF MUSCLES, RIGOR(rigidity) MORTIS (Death) = Rigor Mortis is rigidity of the
muscles after death
This stage of muscular change which occurs 2-6 hours after death and is characterized by
hardening of the muscles due to biochemical changes of the muscle proteins that will ultimately
result to decrease of adenosine triphosphate (ATP), which is a protein substance of the muscle
fibers. The rigor mortis involved both voluntary and involuntary muscles which usually start at the
muscles of the jaw and face and then spreads to the neck, upper limbs, trunk and lower limbs until
the whole body assumes a board like rigidity after about 12 hours. The duration of rigor mortis in a
dead person varies in cold, temperature and tropical countries. In temperate countries, rigor mortis
will be present for 2 to 3 days while in tropical countries the duration is 2 days although during
summer rigor mortis will last for 36-48 hours after death.
Conditions Simulating Rigor Mortis
1. Heat stiffening: A condition characterized by hardening of the muscles due to coagulation of
muscle proteins when the dead body is exposed to intense heat as by burning or immersion in
a hot liquid.
2. Cold Stiffening: A condition characterized by hardening of the muscles due to solidification of
fats, muscles and fluid when the dead body is exposed to extremely cold or freezing
temperature.
3. Cadaveric Spasm or Instantaneous Rigor: It is the instant stiffening of a certain group of
muscles which occurs immediately at the moment of death and although its cause is unknown
is associated with violent death due to extreme nervous tension, fatigue and injury to the
nervous system. This voluntary contraction of muscles has a medico-legal implication because
it records the last act of life in a person.
Other names of CS
- Instantaneous Rigor
- Cataleptic Rigidity
- Instantaneous Rigidity
- Death Grip
- Post Mortem Spasm

3. Stage of secondary flaccidity A muscular change characterized by the softness and flaccidity of
the muscles in which no longer response to mechanical or electrical stimulation due to dissolution of
the muscle proteins that have been previously coagulated during the stage of rigor mortis. This
stage is the onset of putrefaction and occurs many hours in rigor mortis.

Putrefaction It is the process of dissolution of tissues by the digestive action of its enzymes and
bacteria that results to softening and liquefaction of tissues and usually accompanied by the liberation
of foul-smelling gases and change of color of the tissues. The flies will be attracted to the dead body
during putrefaction and sipped the juicy portion of the tissues: lay eggs which hatch within 24 hours to
form maggots and which again feed vigorously in the damage tissues.
Approximate Sequence of Events in Putrefaction of Dead Body in Tropical Countries:
After 1-2 days (24-48 hours) Putrefactive changes: Rigor mortis absent; muscles soft and flaccid; greenish
discoloration over the abdomen; some veins beneath the skin seen as interlacing purplish brown network
over the shoulder, chest and abdomen; flies and ova are present.

3rd day (72 hours) Putrefactive Changes: Abdomen distended with gases; trunk bloated; hair and nails
loosened from its attachment; formation of blisters and blebs; face grossly swollen and discolored; maggots
seen.

1 week (7 days) Putrefactive Changes: Further bloating of the body and discoloration of the skin; bursting
of the thorax and abdomen; further dissolution of the more resistant viscera.

2 weeks (14 days) Putrefactive Changes: Detachment of hairs and nails from its attachment; bursting of the
thorax and abdomen; further dissolution of the more resistant viscera.

1 month – Putrefactive Changes: Body Skeletonized

The decomposition of the dead body in temperate countries differs from those in the tropical
countries because of the differences in environmental temperature, air pollution and bacterial activity. In
temperate countries, the body when exposed to air will be reduced to skeleton in 5-6 months time but when
buried in a well drained soil will take about ten years before an adult dead body be reduced to skeleton if
embalmed.
Decomposition of dead body proceeds about twice as slowly as it is in air; but there are many
factors that interplay in the rate of decomposition like the temperature of the water, depth to which the body
is submerged, bacterial content of the water and the role of fishes and other aquatic animals.

Changes in the blood after death

Changes of Color After death and when heart stops beating and subsequently followed by cessation of
circulation, the blood flow in the whole body also stops. The stasis in the circulation will drain the blood from
the capillaries and veins to accumulate in the most dependent portions in the body because of the pull of
gravity producing a discoloration in those areas of the body not subjected to pressure. Post-mortem lividity
or mortis is therefore, a discoloration of the body after death when the blood tends to pool in the blood
vessels of the most dependent portion of the body and which appears 20-30 minutes after death and
complete in about 12 hours. The usual color is dull-red or reddish purple with some bluish-black petechia
due to rupture of small engorged capillaries. However, in carbon monoxide and cyanide poisoning as well
as exposure to cold temperature the color is pink while it is lead color in asphyxia. In 12 hours, the lividity is
more or less complete and the color becomes darker and permanent.
Coagulation of the blood (Clotting) When the heart beat stops, subsequently cessation of circulation,
there will be stasis of the blood which may enhance the coagulation of the blood inside the blood vessels.
The anti-clotting factors in the blood will undergo chemical changes and these will also enhance the
coagulation of the blood. The clotting of the blood occurs in a slow process after 6-8 hours of death in such
manner that the blood separates and formed a re clot at the lower level and above it is a white clot known
as chicken-fat clot.
Importance of Post-mortem Lividity: It is a sign of death
o It approximate the time of death in a person,
o It determines the position of the body after death,
o It may indicate the cause or manner of death.
Kinds of Post-mortem Lividity
o Hypostatic Lividity: It is the lividity when the discoloration is due to the blood pooled in the
most dependent areas of the body.
 o Diffusion Lividity: It is a fixed or permanent discoloration when the blood vessels or has
diffused to different parts of the body.

Basis in Estimating the Time of Death: The following points may be used as basis to be taken into
consideration in estimating the time of death in a person:
 General physical changes. A warm supple of the body with moist, transparent cornea and moist lips
as well as the absence of post-mortem lividity in the most dependent portions of the body is a
condition of recent death in a person. Considering the effects of the body and environmental
factors, the time of death may be within previous hour.
 Post-mortem Lividity – Livor Mortis. The onset of post-mortem lividity is 20-30 minutes in the
most dependent portions of the body and is completed in about 12 hours when the blood has
already clotted or diffused to different parts of the body wherein the discoloration its darker and
permanent
 Post-mortem Rigidity – Rigor Mortis. Onset – 2-6 hours after death and is completed in about 12
hours duration; 24-48 hours in the Philippines and other tropical countries; 36-48 hours during the
summer in the Philippines and other tropical countries.
 Onset and stage of Decomposition. In tropical countries, the onset of decomposition is 1-2 days
after death and the finally the dead body becomes skeleton in a month’s time considering the
factors that influence the rate of putrefaction.

Changes in the blood The blood remains fluid in the body after death for 6-9 hours. After which it
gradually clotted in a slow process until 12 hours wherein the lividity is fully developed.

 Changes in the cerebro-spinal fluid – (15 hours following death).

 Changes in the aqueous and vitreous fluid in the eyes. The fluids in the eyeball consist of the
aqueous fluid in the anterior and posterior chamber and the vitreous fluid in the body of the eyeball,
their composition, though complex is very similar and the vitreous component is easier to use. The
potassium level rises and has been thought to be a helpful change. The drying cornea produces
haziness in the eyes within the minutes of death.
 Changes in the stomach. The rate of emptying of the stomach varies so that it is very difficult to
estimate the time of death in a person, however, the state of the stomach and its contents might
help in the estimation of the time of death. It usually takes 3-4 hours for the stomach to empty its
contents after meal.
 Changes in the hair. A knowledge of the rate of growth of facial hair allows an estimate to be made
of the age of the beard reckoned from time of the last shaved. The rate of growth of hair has been
estimated from 0.4 mm. to 0.5 mm. per day, but the individual hairs of the same areas varies from
place to place on the face and in different individuals as well as seasonal variation. The length of
the beard hair is measured by shaving the corpse, placing the shaved hairs between two glass
slides, and measure the enlarged image projected on to a screen. About 80% of hairs will be found
of similar length.
 Changes in the Urinary Bladder. The amount or urine bladder may indicate the time of death when
taken into consideration the time when a person urinates or evacuates his urinary bladder.
 State of Clothing. The wearing apparel of a dead person may create a suspicion of the time of
death as well as the placed of death. If the dead person is well-dressed, it is more likely that death
occurs at day time, but if wearing pajamas or nightgowns, it is possible that death occurs at night
time and probably at home.
 Presence or absence of life of the fleas in the clothing of dead person in water. The fleas maybe
seen in the clothing of drowned person and is used to estimate the time of death in such a person.
If fleas in the clothing of the drowned person are still alive, then the person has been dead in water
for less than 24 hours and therefore the person has been dead for more than 24 hours.
 Changes in the Bones. Upon death, when the soft tissues have already disappeared, the bones left
will be used to estimate the time of death of a person or the age of the bones by considering the
degree of erosion of epiphyseal end of long bones, pulverization of flat bones and the reduction of
weight due to the loss of animal matter. The radio-active carbon or carbon-14 maybe used for
assessing the age of ancient remains. After death, the carbon-14 content of the bones gradually
decreases and the radioactivity weakens although the rate occurs at a slow process. Therefore, if
 the carbon-14 activity of bones is measured and compared with what is known to exist in the body
during life, a reasonable estimate can be made of the age of ancient remains.
Medico-legal Investigation of Death: The purpose of the investigation of death is mainly to determine the
cause of death. It also classify the case of death whether suicide, murder or homicide. The dead body is
subjected to autopsy by the physician or medico-legal officer and the post-mortem findings will be
presented to the court as evidences to prove or disprove that a crime or foul play had been done to the
victim