CHAPTER IV –MEDICOLEGAL ASPECT OF DEATH

 Importance of Death Determination: (CPDECC)

1. Civil Personality of a natural person is extinguished by death
2. Property of a person is transmitted to his heirs at time of death
3. The death of a partner is one of the causes of dissolution of
partnership agreement
4. Death of either principal or agent is a mode of extinguishment of
agency
5. Criminal Liability of a person is extinguished by death
 Death – the termination of life. It is the complete cessation of vital
function without possibility of resuscitation.
1. Dying – process
2. Death – event
 By criterion, Death may be:
1. Brain Death – absence of electrical brain activity and cessation of
all vital functions without possibility of resuscitation
2. Cardio Respiratory Death – continuous and persistent cessation
of heart action and respiration. (Flat ECG)
 Criteria in Bioethics “pulling out the plug”
1. Chances of Surviving
2. Capacity to pay
 Way to Determine:
1. ECG
2. EEG
3. Pupil
4. Pulse
 Brain Death Characteristic (“irreversible coma”):
1. Unreceptivity and unresponsibility
2. No movements or breathing
3. No Reflexes
4. Flat Electro-encephalogram(ECG)

 KINDS OF DEATH
1. Somatic or Clinical Death (“soma” = body) (siomai = cat)
 complete, persistent and continuous cessation of the vital
functions of the brain, heart and lungs which maintain life and
health

2. Molecular or Cellular Death

 evidence by the presence of excitability of muscles and ciliary
movements and other functions of individual cells.
  influenced by several factors. Previous state of health,
infection, climatic condition, cellular nutrition, etc. influence its
occurrence.
3. Apparent Death or “State of Suspended Animation”
 transient loss of consciousness or temporary cessation of the
vital functions of the body on account of disease, external
stimulus or other forms of influence.
 SIGNS OF DEATH (May not be in the exam)
1. CESSATION OF HEART ACTION AND CIRCULATION
 Methods of Detecting the Cessation of Heart Action and
Circulation:
 Palpation of the Pulse
 Auscultation for the Heart Sound at the Precordial Area
 Flouroscopic Examination
 By the Use of Electrocardiograph
2. CESSATION OF RESPIRATION
3. COOLING OF THE BODY (ALGOR MORTIS)
4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO
MOVE
5. CHANGES IN THE SKIN
6. CHANGES IN AND ABOUT THE EYE
7. ACTION OF HEAT ON THE SKIN

 CHANGES IN THE BODY FOLLOWING DEATH

1. CHANGES IN THE MUSCLE
 primary flaccidity (post-mortem muscular irritability):
 muscles are relaxed and capable of contracting when
stimulated
 post-mortem rigidity (rigor mortis) [take note of this]
 whole body becomes rigid due to the contraction of the
muscles
 This develops three to six hours after death and may last
from twenty-four to thirty-six hours.
 secondary flaccidity or commencement of putrefaction (Decay
of the muscles)
 muscles become flaccid, no longer capable of responding
to mechanical or electrical stimulus and the reaction
becomes alkaline
 Medico-legal viewpoint, post mortem rigidity may be used [Side
Note]
1. to approximate the length of time the body has been dead. In
temperate countries it usually appears three to six hours after
death, but in warmer countries it may develop earlier
 2. In temperate countries, rigor mortis may last for two or three days
but in tropical countries the usual duration is twenty-four to forty-
eight hours during cold weather and eighteen to thirty-six hours
during summer. When rigor mortis sets in early, it passes off quickly
and vice versa.
 Distinctions Between Rigor Mortis and Cadaveric Spasm: [Memorize by
Heart]
1. Time of Appearance:
 Rigor mortis appears three to six hours after death, while
cadaveric spasm appears immediately after death.
2. Muscles Involved:
 Rigor mortis involves all the muscles of the body whether
voluntary or involuntary, while cadaveric spasm involves only
a certain muscle or group of muscles and are asymmetrical.
3. Occurrence:
 Rigor mortis is a natural phenomenon which occurs after
death, while cadaveric spasm may or may not appear on a
person at the time of death.
4. Medico-Legal Significance:
 Rigor mortis may be utilized by a medical jurist to approximate
the time of death, while cadaveric spasm may be useful to
determine the nature of the crime.
 Physical Characteristics of Post-mortem Lividity: (Lividity =
unnatural color of the skin)
1. It occurs in the most extensive areas of the most dependent
portions of the body
2. It only involves the superficial layer of the skin.
3. It does not appear elevated from the rest of the skin
4. The Color is uniform but the color may become greenish at the start
of decomposition
5. There is no injury of the skin
 Kinds of Post-mortem (Cadaveric) Lividity:
1. Hypostatic Lividity:
 Any change of position of the body leads to the formation of
the lividity in another place. This occurs during the early stage
of its formation
 This appears during the later stage. Any change of position will
not change the location of the lividity.
 Importance of Cadaveric Lividity: [Memorize this]
1. It is one of the signs of death
2. It may determine whether the position of the body has been
changed after its appearance in the body
3. The color of the lividity may indicate the cause of death
 PUTREFACTION OF THE BODY
 breaking down of the complex proteins into simpler
components associated with the evolution of foul smelling
gasses and accompanied by the change of color of the body.
 Marbolization [not sure if this is important]
 he prominence of the superficial veins with reddish
discoloration during the process of decomposition which
develops on both flanks of the abdomen, root of the neck and
shoulder and which makes the area look like a "marbled"
reticule of branching veins. This is observed easily among
dead persons with fair complexion

CHAPTER VI-CAUSES OF DEATH

 Primary purpose of medico-legal autopsy is determination of the cause
of death.
 The cause of death is the injury, disease or the combination of both
injury and disease responsible for initiating the trend or physiological
disturbance, brief or prolonged, which produce the fatal termination. It
may be immediate or proximate. [May not come out of the exam]
1. Immediate (Primary) Cause of Death - when trauma or disease kill
quickly that there is no opportunity for sequelae or complications to
develop.
2. Proximate (Secondary) Cause of Death - The injury or disease was
survived for a sufficiently prolonged interval which permitted the
development of serious sequelae which actually caused the death.
 MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH
[May also not come out]
1. Natural Death - when the fatality is caused solely by disease
2. Violent Death - Death due to injury of any sort
a) Accidental Death
b) Negligent Death
c) Infanticidal Death
d) Parricidal Death
e) Murder
f) Homicidal Death
CHAPTER XIII-GUNSHOT WOUND
 Definition of Firearm:
1. Technical Definition:
a. is an instrument used for the propulsion of a projectile by the
expansive force of gases coming from the burning of
gunpowder
2. Legal Definition:
 a. Section 877, Revised Administrative Code — "Firearm"
defined: "Firearm" or "arm", as herein used, includes; rifles,
muskets, shotguns, revolvers, pistols, and all other deadly
weapons from "which a bullet, all, shot, shell, or other missile
may be discharged by means of gunpowder or other
explosives.
 Range:
1. Loose Contact or Near Fire:
a. Entrance wound may be large circular or oval depending upon
the angle of approach of the bullet.
b. Abrasion collar or ring is distinct
c. Smudging, burning and tattooing are prominent with singeing
of the hair
d. Muzzle imprint may be seen depending upon the degree of
slapping of the skin of the gun muzzle
e. There is blackening of the bullet tract to a certain depth
f. Carboxyhemoglobin is present in the wound and surrounding
areas
2. Short Range Fire (1 to 15 cm. distance):
a. Edges of the entrance wound is inverted
b. If within the flame reach (about 6 inches in rifle and high
powered firearms and less than 3 inches from an ordinary
handgun), there is an area of burning.
c. Smudging is present due to smoke
d. "Powder tattooing” is present
e. Abrasion ring or collar is present
3. Medium Range Fire (more than 15 cm. but less than 60 cm.):
a. Gunshot wound with ‘inverted edges' and with abrasion collar
is present.
b. Burning effects (skin bum and hair singeing) is absent.
c. Smudging may be present if less than 30 cm. distance.
d. “Gunpowder tattooing" is present but of lesser density and has
a wider area of distribution.
e. Contact ring is present.
4. Fired More Than 60 cm. Distance:
a. Gunshot wound is circular or oval depending on the angle of
approach with abrasion collar.
b. Wound of entrance has ‘no’ burning, smudging or tattooing.
c. Contact ring is present.
 Distinction between Gunshot Wound of Entrance and Wound of
Exit:
1. Entrance Wound
 a. Appears to be smaller than the missile owing to the elasticity
of the tissue
b. Edges are inverted.
c. Usually oval or round depending upon the angle of approach
of the bullet.
d. "Contusion collar" or "Contact ring" is present, due to
invagination of the skin and spinning of the missile
e. Tattooing or smudging may be present when firing is near
f. Underlying Tissues are not protruding
g. Always present after fire
h. Paraffin test may be positive
2. Exit Wound
a. Always bigger than the missile.
b. Edges are everted
c. It does not manifest any definite shape.
d. "Contusion collar" is absent
e. Always absent
f. Underlying tissues may be seen protruding from the wound.
g. May be absent, if missile is lodged in the body
h. Paraffin test always negative
[“READ” this next Part]
 Distances when the Number of Gunshot Wounds of Entrance is
Less than the Number of Gunshot Wounds of Exit in the Body of
the Victim:
1. A bullet might have entered the body but split into several
fragments, each of which made a separate exit.
2. One of the bullets might have entered a natural orifice of the body,
e.g. mouth, nostrils, thereby making it not visible and then
producing a wound of exit
3. There might be two or more bullets which entered the body through
a common entrance and later making individual exit wounds.
4. In near shot with a shotgun, the pellets might have entered in a
common wound and later dispersed while inside the body and
making separate wounds of exit.
 Instances when the Number of Gunshot Wounds of Entrance is
More than the Number of Gunshot Wounds of Exit in the Body of
the Victim:
1. When one or more bullets are not through and through and the
bullet is lodged in the body.
2. When all of the bullets produce through and through wounds but
one or more made an exit in the natural orifices of the body, e.g.
eyes, mouth, nostrils.
 3. When different shots produced different wounds of entrance but
two or more shots produced a common exit wound.
 Instances when there is No Gunshot Wound of Exit but the Bullet
is Not Found in the Body of the Victim:
1. When the bullet is lodged in the gastro-intestinal tract and expelled
through the bowel", or lodged in the pharynx and expelled through
the mouth by coughing
2. Near fire with a blank cartridge produced a wound of entrance but
no slug may be recovered.
3. The bullet may enter the wound of entrance and upon hitting the
bone the course is deflected to have the wound of entrance as the
wound of exit
 Evidences to show that the Gunshot Wound is Homicidal:
1. The site or sites of wound of entrance has no point of election.
2. The fire is made when the victim is usually at some distance from
assailant
3. Signs of struggle (defense wounds) may be present in the victim.
4. There may be a disturbance of the surroundings on account of
previous struggle.
5. Wounding firearm usually is not found at the scene of the crime.
6. Testimony of witnesses.
 Evidences to show that the Gunshot Wound is Accidental:
1. Usually there is but one shot
2. There is no special area of the body involved.
3. Consideration of the testimony of the assailant and determination
as to whether it is possible to be accidental by knowing the relative
position of the victim and the assailant.
4. Testimony of witnesses.

CHAPTER XVII-DEATH BY ASPHYXIA

 Asphyxia - general term applied to all forms of violent death which
results primarily from the interference with the process of respiration or
the condition in which the supply of oxygen to the blood or to the tissues
or both has been reduced below normal level.
 Types of Asphyxial Death: [Probable question is to differentiate]
1. Anoxic Death - failure of the arterial blood to become normally
saturated with oxygen.
2. Anemic Anoxic Death - decreased capacity of the blood to carry
oxygen.[e.g. Kidney Failure]
3. Stagnant Anoxic Death - failure of circulation.
4. Histotoxic Anoxic Death - failure of the cellular oxidative process
 Phases of Asphyxial Death:
1. Dyspneic Phase
 a) due to the lack of oxygen and the retention of carbon dioxide
in the body tissue.
b) The breathing becomes rapid and deep, the pulse rate
increases, and there is a rise in the blood pressure. The face,
hands and fingernails become bluish, especially in the case of
infants.
2. Convulsive Phase:
a) due to the stimulation of the central nervous system by carbon
dioxide.
b) The cyanosis becomes more pronounced and the eyes
become staring and the pupils are dilated. Examination of the
visceral organs shows small petechial hemorrhages,
commonly known as Tardieu Spots.
3. Apneic Phase:
a) due to the paralysis of the respiratory center of the brain.
b) The breathing becomes shallow and gasping and the rate
becomes slower till death. The heart later fails.
 Classifications of Asphyxia:
1. 1. Hanging.
2. 2. Strangulations:
a) a. Strangulation by ligature.
b) b. Manual strangulation or throttling.
c) c. Special forms of strangulations:
 (1) Palmar strangulation.
 (2) Garroting.
 (3) Mugging or yoking.
 (4) Compression of the neck with stick.
3. 3. Suffocation:
a) a. Smothering or closing of the mouth and nostrils by solid
objects.
b) b. Choking or closing of the air passage by obstruction of its
lumen.
4. 4. Asphyxia by submersion or drowning.
5. 5. Asphyxia by pressure on the chest (Traumatic crush asphyxia).
6. 6. Asphyxia by irrespirable gases.

 Asphyxia by Hanging: form of violent death brought about by the

suspension of the body by a ligature which encircles the neck and the
constricting force is the weight of the body.

 Difference of Hanging and Strangulation with Ligature

1. Hanging
 a) Hyoid bone is frequently injured.
b) Direction of the ligature mark is inverted V-shape with the apex
as the site of the knot.
c) Ligature is usually at the level of the hyoid bone.
d) Ligature groove is deepest opposite the site of the knot.
e) Vertebral injury is frequently observed.
2. Strangulation with Ligature
a) Hyoid bone is frequently spared
b) Ligature mark is usually horizontal and knot is on the same
horizontal plane.
c) Ligature is usually below the larynx.
d) Ligature groove is uniform in depth in its whole course
e) Vertebral injury is not observed.

 Accidental, Homicidal or Suicidal Manual Strangulation:

1. Suicidal throttling is not possible
2. Accidental throttling may occur but the victim never died of
asphyxia but of some other causes.
3. Homicidal manual strangulation is the most common.
 Special Forms of Strangulation:
1. Palmar Strangulation:
a) The palm of the hand of the offender is pressed in front of the
neck without employing the fingers. The pressure must be
sufficient to occlude the lumen of the windpipe.
2. Garroting:
a) A ligature, a metal collar or a bowstring is placed around the
neck and tightened at the back.
3. Mugging (Strangle-hold):
a) This is a form of strangulation with the assailant standing at the
back and the forearm is applied in front of the neck.
4. Compression of the Neck with a Stick:
a) The assailant with a piece of stick placed in front of the neck
pulls with two hands passing on both sides of the post
backwards with sufficient strength to occlude the trachea.
 ASPHYXIA BY SUFFOCATION
1. SMOTHERING: form of asphyxial death caused by the closing of
the external respiratory orifices, either by the use of the hand or by
some other means.
a) Overlaying is the most common accidental smothering in
children.
 The children may be suffocated either from the pressure
of the beddings and pillows or from the pressure of
unconscious or a drunk mother.
 b) Accidental smothering of epileptic
 A person may suffer from epileptic or epileptiform fit and
accidentally bury his face on soft object like pillow,
bedding or sand and die.
c) Gagging
 linen or other clothing matters to prevent air to have
access through the mouth or nostrils. The pressure might
be so severe that it may cause injury to the buccal mucosa
arfd teeth
d) Plastic bag suffocation
 Plastic bags are made of synthetic polyethylene that is
transparent, tough and waterproof material commonly
used as a container.
2. CHOKING:[Heinlich Maneuver] form of suffocation brought about
by the impaction of foreign body in the respiratory passage. The
most common foreign bodies impacted are:
a) Vomitus - especially when the person is under the influence of
alcohol.
b) Regurgitation of food - from the stomach, as coagulated milk
in children.
c) Bolus of food –
d) Detached membrane in diphtheria
e) False set of teeth.
f) Blood in tonsillectomy operation.
g) Respiratory hemorrhage as in tuberculosis.
 ASPHYXIA BY SUBMERSION OR DROWNING: This is a form of
asphyxia wherein the nostrils and mouth has been submerged in any
watery, viscid or pultaceous fluid for a time to prevent the free entrance
of air into the air passage and lungs.
 Causes of Death in Drowning:[Just Enumeration on this part]
1. Typical Drowning: ordinary submersion in water is asphyxia.
2. Atypical Drowning:
a) Cardiac inhibition - submersion due to the stimulation of the
vagus nerve.
b) Laryngeal spasm due to submersion - inhaled water may
cause spasm of the larynx
c) Submersion when unconscious - A person may be drunk, or
suffering from cerebral aneurysm, cerebral hemorrhage, heart
disease, and suddenly collapse and falls in a body of water and
be unconscious when submerged.
CHAPTER XVIII-DEATH or PHYSICAL INJURIES DUE TO AUTOMOTIVE
CRASH or ACCIDENT
 Factors Responsible to an Automotive Crash:
1. Human Factor (Driver):
a) Mental Attitude
b) Perceptive Defect
c) Delayed or Sluggish Reaction Time
d) Disease
e) Chemical Factor - Alcohol is the most common
2. Environmental Factor: Bad or poorly maintained roads, poor
visibility, atmosphere, rain, blind intersection, parked vehicle
obstructing the view, trees too close to the road, absence of road
signs, etc.
3. Mechanical Factor: Defect in the steering wheel, poor brake,
transmission failure, worn out tires, unstable body are potential
source of vehicular crash.
4. Social Factor: “Speed Tripping”
5. Pedestrian:
a) Injuries and Death on the Driver and Passengers.
 In automotive crash, there are two collisions that take
place
o First Collision - the impact of the moving vehicle with
another vehicle or a fixed object. The moving vehicle
rapidly decelerates and stops after the impact.
o Second Collision - This is the impact of the
unrestrained occupants with the interior of the
vehicle. Immediately, after the first collision, the
occupants move in the same direction and at the
same velocity towards the point of impact. That is, in
the front impact, the occupants moves forward and in
the side impact the passengers or driver moves
towards the side that was involved in the first collision.
[Next Part is probably just definitions]
 Side Impact Crash
1. impact crash may occur when a vehicle strikes on the side of
another vehicle or when a vehicle skids sideways into another fixed
object.
2. The lateral impact to the chest may cause fracture of the ribs,
contusion with laceration of the lungs. Laceration of the spleen and
kidneys and pelvic fracture may also be observed in side impact.
 Rear Impact Crash:
1. High velocity rear impact may occur following change of lane in an
express way or crash at the rear of a parked vehicle
 2. The backward and forward movement of the head is known as
"acceleration-deceleration injury" or "whiplash".
 Roll Over Crash (Turn-Turtle Impact):[Fast Turning Speed]
1. In the process of rolling, the occupants may be pinned, crushed or
may be thrown away and fall on the ground.
2. On account of the long period of the process of rolling, the
passenger usually does not sustain severe injuries. The rolling
process causes the different sides of the vehicle to absorb the force
of the impact.
 PEDESTRLAN-VEHICLE COLLISION: Pedestrian's injury or death is
usually the result of two impacts both of which are capable of causing
severe trauma.
1. Primary Impact:
a) This is the first violent contact between the pedestrian and the
motor vehicle. Usually, the front bumper hits the leg of the
victim.
2. Secondary Impact:
a) This is the subsequent impact of the pedestrian to .the ground
after the first impact. The injury sustained by the pedestrian
depends mostly on the force of the ground impact, nature of
the road and part of the body involved.
3. Run Over Injuries:
a) Children who receive the primary impact above the center of
gravity may fall on the ground with the car wheel passing over
the body
4. Hit-and-run Injuries:
a) A fast moving vehicle may run over, hit or side-swipe a
pedestrian or collide with another vehicle or fixed object and
get away from the scene without regard to the unfortunate
victim.

CHAPTER XXI –MEDICOLEGAL ASPECTS OF SEX CRIMES

 Virginity - a condition of a female who has not experienced sexual
intercourse and whose genital organs have not been altered by carnal
connection.
 Kinds of Virginity
1. Moral Virginity - The state of not knowing the nature of sexual life
and not having experienced sexual relation.
2. Physical Virginity - A condition whereby a woman is conscious of
the nature of the sexual life but has not experienced sexual
intercourse. The term applies to women who have reached sexual
maturity but have not experienced sexual intercourse
 [Take Note] If the findings show absence of laceration of the
hymen, distinction should be drawn between true and false physical
virginity

a) True Physical Virginity - A condition wherein the hymen is

intact with the edges distinct and regular and the opening small
to barely admit the tip of the smallest finger of the examiner
even if the thighs are separated.
b) False Physical Virginity - A condition wherein the hymen is
unruptured but the orifice is wide and elastic to admit two or
more fingers of the examiner with a lesser degree of
resistance.
3. Demi-Virginity - This term refers to a condition of a woman who
permits any form of sexual liberties as long as they abstain from
rupturing the hymen by sexual act.
4. "Virgo Intacta" - Literally the term refers to a truly virgin woman; that
there are no structural changes in her organ to infer previous sexual
intercourse and that she is a virtuous woman.

[Take Note]The condition of the breast is not a reliable

evidence to determine virginity.
 Degree of laceration: This refers to the extent of damage to the hymen
which may be:
1. Incomplete laceration - Rupture or laceration of the hymen is
considered incomplete when it does not involve the whole width or
height of the hymen. Incomplete laceration may be:
a) Superficial - The laceration does not go beyond one-half of the
whole width of the hymen.
b) Deep - The laceration involves more than one-half of the width
of the hymen but not reaching the base.
2. Complete laceration - The hymenal laceration involves the whole
width but not beyond the base of the hymen.
3. Compound or complicated laceration - The laceration involves the
hymen and also the surrounding tissues. It may involve the
perineum, vaginal canal, urethra or rectum.

Notches [May Scar without rape] - Indentation of the hymen

simulating lacerations. They may be symmetrical and may extend
to the vaginal wall. The mucous membrane over the notch is intact.
Notches may be mistaken for laceration.
 Duration of the laceration: The determination as to how long the
laceration took place can be approximated by the changes observed in
the lacerated tissue.
1. Fresh bleeding laceration - The laceration is of recent origin.
2. Fresh healing with fibrin formation and with edema of the
surrounding tissue - Usually after 24 hours.
3. Healed laceration with congested edges and with sharp
coaptible borders - Depending upon the degree of laceration and
the presence or the absence of complications, the said laceration
could have occurred 4 to 10 days. Sometimes, the said finding is
termed "recently healed" laceration.
4. Healed laceration with sharp coaptible borders without
congestion - Some times have passed by after the laceration has
healed. Ordinarily it can be inferred that hymenal laceration took
place approximately more than ten days or 2 to 3 weeks.
5. Healed laceration with rounded non-coaptible borders and
retraction of the edges - Laceration took place long before the
date of the examination which is probably more than a month's
time.