LEGAL MEDICINE

• ANTONIO ROQUE PARADELA, M.D.,FPCS, LLB

• VICENTE SOTTO MEMORIAL MEDICAL CENTER
• CEBU CITY, PHILIPPINES
General Objective: The student will learn the concept
and the practice of Legal Medicine
Specific Objectives:
1. Can differentiate between Legal Med and Medical Jurisprudence.
2. Scope and nature of Legal Med
3. Differentiates between an ordinary physician and Medical jurist.
4. Defines law , it’s sources and principles.
5. Knowledgeable in the importance of medical evidence, types,
forms, weight and sufficiency of evidence.
 DEFINITION
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.
• Based on the principle of coordination between Medicine to Law in
administering justice. Ex: Paternity case

Medical jurisprudence – is a branch of law which deals with the

knowledge of law applied to medical practice
• Based on the principle of subordination
It concerns with the study of the rights, duties and obligations of a
medical practitioner with particular reference to those arising from
doctor-patient relationship. Ex: Negligence
SCOPE: Application of medical and paramedical sciences as
demanded by law and administration of justice.

NATURE OF THE STUDY OF LEGAL MED:

- The ability to acquire facts, arrange them and
draw a conclusion from facts in the
administration of justice.

• Medical jurist, Medical examiner, Medicolegal

officer, Medicolegal expert
- A physician who specializes primarily with medico-
legal duties, possess sufficient knowledge of
pathology, surgery, gynecology, toxicology
Imhotep – 2980 B.C. earliest medico-
legal expert.
 ORDINARY MEDICO-LEGAL OFFICER
DIFFERENCE : PHYSICIAN

a) Injury/Disease Treatment Cause

point of view

b) Examine a Diagnose Testify / justice

patient

c) Minor injuries Ignored Records all / qualify

crime
LAW
• Rule of conduct, just, obligatory, laid by legitimate power for
common observance and benefit.
Characteristics of Law:
a. It is a rule of conduct;
b. It is dictated by legitimate power; and
c. Compulsory and obligatory to all
Forms of Law:
a. Written or Statutory Law (Lex Scripta): enacted by Congress
b. Unwritten or Common Law (Lex non Scripta): customs and usages.
SOURCES OF LAW
• WRITTEN OR STATUTORY - Passed by Congress: Defined, codified and
incorporated by the law-making body Ex: Medical Act of 1959
• CONSTITUTIONAL LAW - Rights, privileges. and responsibilities
that are from the Philippine Constitution
• ADMINISTRATIVE LAW - Law made by administrative bodies granted
by the authority to act in this manner Ex: Board of Medicine
• COMMON LAW - Composed of the unwritten laws based in the
customs and usages ExL Principle of Stare Decisis
CLASSIFICATION
Law which is NOT ENFORCED by the State

• Natural Law : Guidance of human conduct, discovered

by rational thinking of man. • e.g. law of gravity, law
of nature
• DIVINE LAW : Followed to make one be closer to his
Creator Example: the 10 Commandments
• MORAL LAW : Enforceable by the dictate of one’s
conscience to be the right conduct.
Law which is ENFORCED by the state

Observance of which is compulsory or

obligatory to everybody.

• Classification:
= As to purpose
= As to nature of the subject matter
1. AS TO PURPOSE:

• SUBSTANTIVE LAW : Prescribes the rights and obligations of person in

their daily relation with each other and with society ex; property rights
• PROCEDURAL OR REMEDIAL LAW : Concerned with mechanical rules
that govern the means by which substantive rights and duties are
enforced.
• Rules by which litigation are conducted. Ex: Law on criminal procedure
2. AS TO NATURE OF THE SUBJECT MATTER
• PUBLIC LAW: Rules and regulation which regulate the relationship
between state and subject
= Concerned with the state in its political and sovereign capacity
Ex: Criminal, Political, Int’ Law
• PRIVATE LAW : Private matters that do not concern the public at large
= Regulates the relationship of individuals.
= Concerns with the definition, regulation and enforcement of right
in his relation with other persons Ex: Civil, Commercial Law
BRANCHES OF LAW
WHERE LEGAL MEDICINE MAY BE APPLIED
• CRIMINAL LAW - Defines crimes, treats of their nature and provides for
their punishment. Ex: Crimes against Persons, SW, GSW

• CIVIL LAW Mass of precepts that determines and regulates the relation of
assistance, authority and obedience between members of a family and
those which exist among members of a society for the protection of
private interest Ex: Determination and termination of
civil personality, marriage and legal separation, paternity and filiation
• REMEDIAL LAW - Intended to afford a private remedy to a
person injured by the wrongful act Ex: P. E. of a person;
Rules of evidence

• SPECIAL LAWS - Ex: Dangerous Drug Act; Youth and Child

Welfare; Insurance Law;

15 days – needed for a law to be implemented with it being

published in the official gazette
 PRINCIPLE OF STARE
DECISIS:

• When the court has once

laid an interpretation of law
as applied to certain facts, it
will adhere to and apply to
all future cases where the
facts are substantially the
same.
BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS:
• “Ignorantia legis nominem excusat “ – prevent use as defense
in violation

• Law shall have no retro-active effect - A law can only be

applied to cases after its promulgation and must not be given
retroactive application
Retroactive effect can only be done if it is curative
Ex: A death convict had their cases downgraded to life
imprisonment but if a convict whose penalty is life sentence,
then it cannot be upgraded to death penalty because it is not
curative.
• Rights may be waived, unless the waiver is contrary to law, public order,
public policy, morals or good customs, or prejudiced to a third person
with a right recognized by law.

• Customs which are contrary to law, public order or public policy shall not
be countenanced. A custom must be proved as a fact according to the
rules of evidence
- If the custom is contrary to the existing law or to public order and
policy, the law must prevail.

• Laws are repealed by subsequent ones, and their violation or non-

observance shall not be excused by dis-use, custom or practice to the
contrary.
• Administrative or executive acts, orders and regulations shall be valid
only when they are not contrary to the laws of the constitution.
Persons authorized to perform autopsies:
• Health Officers
• Medical officer of law enforcement agencies.
• Members of the medical staff of accredited
hospitals.
 Autopsies shall be
performed in the following cases.
• Required by special laws
• Order of competent court, mayor, fiscal
• Written request of police officers
• SolGen, fiscal disinter to determine cause of death.
• Written request of nearest kin to ascertain cause of death.
MEDICAL EVIDENCE
- is the means sanctioned by the rules of court of ascertaining
in a judicial proceeding the truth respecting a matter of fact.
• Types of evidence:

1. Autoptic or Real evidence – made known to the senses

2. Testimonial evidence – oral under oath
3. Experimental evidence
4. Documentary evidence

Same rules in all cases: rules of evidence shall be the same in all
courts and in all trials and hearings whether civil or criminal
AUTOPTIC OR REAL EVIDENCE
• Evidence perceived by the senses – sight, hearing, taste, smell and
touch
• Limitations: Indecency and Impropriety; Repulsive objects and
those Offensive to sensibilities
Ex: The body of the victim
TESTIMONIAL EVIDENCE
• A physician may be commanded to appear before a court to give his
testimony
• Given orally and expressed under oath

Physicians as witnesses
• Criminal cases: involving deaths or injuries from violent acts
• Civil personal injury litigation: to recover money damages
• Administrative adjudication of patient claims for government benefits:
claims for SSS or GSIS disability benefits
• Civil litigation involving business aspects of practice: suits regarding
denial or revocation of medical license
Two kinds of witnesses
1. Ordinary witness
Exceptions : Privilege of communication (confidential) between
physician and patient (he is not allowed to disclose that
information to others as regards to matters he perceived from his
patient during the relationship)
Hearsay information: A medical witness can only testify on matters
derived by his own perception. Not Admissible in court except:
Dying Declaration
2. Expert Witness
EXPERIMENTAL EVIDENCE
• A medical witness may be allowed by the court to confirm or
corroborate his allegation.
Ex: the issue as to how long a person can survive after administration
of lethal dose of poison can be shown by administrating the said poison
to experimental animals in view of the court.
DOCUMENTARY EVIDENCE
• A document is an instrument on which is recorded by means of letters,
figures, or marks intended to be used for the purpose of recording.
Ex: Medical Certificate

Order of importance
1. Best evidence rule: original document or writing
Ex: original copy of birth certificate
2. Secondary evidence: substitutionary evidence which becomes admissible
when the best evidence or original document is not available
3. Parole evidence rule: parole or oral evidence is not admissible to vary,
modify or contradict best evidence
PHYSICAL EVIDENCE
• Articles and materials which are found in connection with the
investigation and which aid in establishing the identity of the
perpetrator or the circumstances under which the crime was
committed.

• Types:
• Corpus Delicti: objects or substances which may be a part of the body
of the crime. Proves that the crime existed.
Ex: body of the victim, prohibited drugs, dagger with blood stains
• Associative Evidence: link the suspect to the crime. Ex: weapon with
fingerprints, garments with hair of the suspect
• Tracing Evidence: may assist the investigator in locating the suspect.
Ex: aircraft or ship manifest and cellphone trackers
CRIMINALISTIC EVIDENCE
• Identification, collection, preservation and mode of presentation
of physical evidence
• Application of sciences in crime, detection and investigation
• Admissibility of evidence: evidence is admissible when it is
relevant to the issue and is not excluded by these rules

• Relevancy of evidence : evidence must have such a relation

to the fact in issue as to include belief in its existence or
non-existence; therefore, collateral matters shall not be
allowed.

• Collateral matters are those different from or do not

correspond with the matters in issue
Methods of preserving evidence:
• Photo, videotape,photocopy
• Manikin method
• Sketching
• In the mind of the witness
• Description
• Special methods: embalming
KINDS OF EVIDENCE NECESSARY FOR
CONVICTION

• Direct Evidence
• Circumstantial Evidence
• Corroborative Evidence
DIRECT EVIDENCE
• That which proves the fact in dispute without the aid of any
inference or presumption
• Corresponds to the precise or actual point at issue
Ex: A woman was killed by multiple gunshot wounds and the
offender was caught at the scene of the crime firing a gun, with his
hands and clothes stained with fresh blood and gun powder.
• “Evidence that can stand on its own”
Ex: DNA of suspect found on the victim
CIRCUMSTANTIAL EVIDENCE
• The proof of fact or facts from which, taken either singly or collectively, the
existence of a particular fact in dispute may be inferred as a necessary or
probable consequence

Sufficient evidence to produce conviction when...

• There is more than 1 circumstance
• The facts from which the inferences are derived are proven
• When the combination of all the circumstances is such as to produce a
conviction beyond reasonable doubt
• Example: a woman died of multiple SW wherein the knife stacked in the
chest of the victim. The knife has finger prints. Near the body of the victim,
an identification card showed the picture and personal information of a
man who was later on found to also own the fingerprints found imprinted
on the knife. Upon inquiry, it was found out the night the killing took place,
the man did not go to his work. All circumstances point to one suspect
CORROBORATIVE EVIDENCE
• Collection of facts and information that backs up someone’s story or
support a proposition that is already supported by some initial
evidence
• In a court of law, corroborating evidence is used to uphold the
testimony of witnesses
Ex: when a witness testifies that he saw the suspect killed the victim
which is backed by the CCTV footage of the scene
WEIGHT AND SUFFICIENCY OF EVIDENCE

• Preponderance of evidence

• Proof beyond reasonable doubt

PREPONDERANCE OF EVIDENCE
• Civil Cases
• The party having the burden of proof must establish his case by
preponderance of evidence (amount or number of evidence)

PROOF BEYOND REASONABLE DOUBT

• Criminal Case
• The defendant is entitled to an acquittal, unless his guilt is proven
beyond reasonable doubt
Factors must be considered which party's
evidence preponderate
a. All the facts and circumstances of the case.
b. The witnesses' manner of testifying, their intelligence, their means
and opportunities of knowing the facts to which they are testifying.
c. The nature of the facts to which the witnesses testify.
d. The probability and improbability of the witnesses' testimony.
e. The interest or want of interest of the witnesses.
f. Credibility of the witness so far as the same may legitimately
appear upon the trial.
g. The number of witnesses presented, although preponderance is
not necessarily with the greatest number.
 DECEPTION
AND DETECTION

• Knowledge of truth is
important in the
administration of justice, lies
solely in the ability to
evaluate the statement given
by the suspect or witness.
General Objective The student can differentiate
detection deception in crime
Specific Objective:
1. Knowledgeable in the different scientific methods used in the
detection deception.
2. Reasons for the Inadmissibility To the Court of the Result of
Polygraph Examination and
3. Knowledgeable in other techniques in detection deception.
 Methods of Deception and Detection
1. Devices which record the psycho- 3. Hypnotism
physiological response:
a) Use of a polygraph or lie detector 4. By observation
machine
b) Word association test 5. Scientific interrogation
c) Psychological stress evaluator
6. Confession
2. Use of drugs that try to “ inhibit the
inhibitor”
a) Administration of the truth serum
b) Narcoanalysis or Narcosynthesis
c) Intoxication
1. Devices which record the psycho-physiological response:

a) Use of a polygraph or lie detector machine

b) Word association test
c) Psychological stress evaluator
POLYGRAPH/LIE DETECTOR
• Records physiologic changes that occur with lying in a polygraph.
Phases:
• Pre-test interview
To determine medical ,psychiatric condition or drugs: prevent testing
To explain the purpose of the examination
• Actual Interrogation and recording through the instrument
Relevant questions: must be very specific Ex: Did you kill Mr. X?
Control Questions: unrelated to the matter under investigation but
are of similar nature although less serious Ex: Do you have a gun?
• Post-test interrogation : clarify, additional inputs
RECORDING OF
PSYCHO-PHYSIOLOGICAL RESPONSE
• Sympathetic – influenced by physical and emotional stimuli,
effects
• Parasympathetic – works to restore things

A. Use of a Lie Detector or Polygraph

= The fear of the subject when not telling the truth activates
the symp.
= To a series of automatic and involuntary physiological
changes which are recorded by the instrument.
= Use of control questions > Most reliable & effective
questioning technique.
Reason for non-admissibility to the court of the result of
Polygraph exam
• Have not received the degree of standardization of acceptance.
• Trier of fact is apt to give almost conclusive weight to the experts
opinion
• No way to assure the a qualified examiner administered the test.
• May waive right against self-incrimination.
• It has many errors.
 Factors responsible to 25% errors:

• Nervousness experienced by a subject who is telling the

truth
- apprehension by the fact that he is a suspect.
- over-anxiety to cooperate
• Physiological abnormalities > BP inc. or dec., Cardiac prob.
• Mental abnormalities
• Unresponsiveness in a guilty subject – no fear of detection
• Attempt to beat the machine
Can a person be compelled to a lie detector test?

No, use of intelligence and other faculties.

Supplementary tests:

• Peak of tension test – building of tension from series of questions;

subject not yet informed of details of the offense
• Guilt complex test – used if response to relevant and control
questions are inconclusive; new series of relevant questions are asked
which subject could not have committed
• Silent answer test – used if verbal response causes distortion in the
tracing
USE OF WORD ASSOCIATION TEST

• A list of stimulus and non-stimulus words is read to the subject who

is instructed to answer as quickly as possible. Answers may be yes
or no.
• Like the use of the lie detector, the subject cannot be compelled to
the test without his consent.
USE OF PSYCHOLOGICAL TEST EVALUATOR (PSE)
• Detects measures and graphically displays the voice modulations that we
cannot hear when the person is under stress while lying
• Minute oscillations in the muscles when a person speak consists of audible
and inaudible frequencies 8-14 cycles per minute
• PSE measures inaudible frequencies
• Inaudible frequencies are registered in the machine if a person is relaxed.
Under stress these disappear
• Microtremors are suppressed moderately or completely when a person is
under stress/lying
Advantages:
• Not require attachment of sensors
• Need not be carefully controlled environment
• Normal body movement is not restricted
 USE OF DRUGS THAT INHIBIT THE INHIBITOR
- Not admissible in court
• Administration of truth serum
- Hyocine hydrobromide given hypodermically until state of delirium
which the subject feels a compulsion to answer the question
truthfully. It acts as a depressant on the nervous system
• Guilty subject forgets his alibi and may give details of acts or even
implicate others
• Statements taken from the subject while under the influence of truth
serum are involuntarily obtained hence they are not admissible in
court.
NARCOANALYSIS OR NARCOSYNTHESIS
• Utilizes the administration of anesthetic or hypnotics drugs prior to
interrogation
• Commonly used drugs: sodium amytal or sodium pentothal
• Causes depression of the inhibitory mechanism of the brain and the
subject talks freely
• Administered by a psychiatrist and with long experience
• Results are also not admissible in court because it is an involuntary
act
INTOXICATION WITH ALCOHOL
“In Vino Veritas”-In wine there is truth

• When there is alcohol influence, the power of control is diminished

• Questions must be propounded during the excitatory state when he
has the sensation of wellbeing and actions, speech and emotions are
less strained.
• Not reliable in the depressive state
• Confessions made by the subject while under the influence of alcohol
may be admissible if he is physically capable to recollect the facts that
he has uttered after the effects of alcohol have disappeared and
admit the truth of the statement given by him
Methods of deception detection
III. HYPNOSIS
- Alteration of consciousness, not all subjects can be hypnotized
IV. OBSERVATION
Physiological and psychological signs and symptoms of guilt:
Sweating, color change, Dryness of the mouth ,Excessive activity of adams apple,
Fidgetting, Peculiar feeling inside, Swearing, spotless past record, Inability to look
at the investigator

V. INTERROGATION - emotional appeal, mutt and jeff technique

VI. CONFESSION - expressed acknowledgement of his guilt.

TOKYO DECLARATION
- contains guidelines to be observed by physician concerning torture, inhuman
and degrading punishment.
HYPNOSIS
• Alteration of consciousness and concentration in which the subject
manifests a heightened sense of suggestibility while awareness is
maintained
• Confessions while under hypnotic spell is not admissible because such
“psychiatric treatment” is involuntary and coercive
• Answers to questions are doubtful because person’s answers might be
under control or suggestion of the hypnotist
Not admissible:
• No scientific basis to ascertain truthfulness or falsity
• Possibility of Deliberate fabrication of answer
• State of hypnosis may produce distortion of fact
• Subjective
SCIENTIFIC INTERROGATION
• Questioning of a person suspected of having committed an offense
or of persons who are reluctant to make disclosure of information in
his possession which is pertinent to the investigation.
• A suspect is a person who’s being accused of the wrongdoing.
• A witness is a person, other than the suspect, who is requested to
give information concerning the incident.
Attitude:
• Create the impression that you are a truth seeker and not seeker of
confession and conviction
• Use mild words take, shoot, tell the truth
• Sit close to the subject
• Give undiverted attention to the suspect
• Avoid impression of lack of interest
• Use of simple words depending on educational attainment of subject
• Project a fearless position – do not handcuff or Scheckel in an
interrogation room
Requirement for the admissibility of evidence
obtained through interrogation
1. No person shall be compelled to be a witness against himself
2. Any person under investigation for the commission of an offense
shall have the right to remain silent and to counsel, and be informed of
such right
3. No force, violence, threat and intimidation, or any other means
which vitiates the free will shall be used against him
4. Any confession obtained in violation of this section shall be
inadmissible in evidence.
 MEDICO-LEGAL ASPECTS OF IDENTIFICATION

• Determination of the
individuality of a person

Antonio Roque R. Paradela, MD, LLB

Vicente Sotto Memorial Medical Center
General Objectives: The student will be knowledgeable in
the different aspect of identification and importance.
Specific Objectives:
• Can determine the duration of interment.
• Can determine race, age, sex, height, handwriting and dental
• Knowledgeable in scientific methods of identification like
fingerprinting, DNA
• Determines blood and blood stains
• Different fibers, hairs human or not.
 Importance of identifying a person:
• In the prosecution of a crime, the identity of the offender
and victim.
• Settlement of estates, retirement, insurance
• Resolves anxiety of nest of kin.
• In some transactions – sales, release of dead body
METHODS OF IDENTIFICATION
• BY COMPARISON- Identification criteria recovered during an investigation are
compared with the records available in the file or post-mortem findings are
compared with ante-mortem records.
Ex: Identity of a burn victim through dental records
• BY EXCLUSION - If two or more persons have to be identified and all but one is
not yet identified, the one whose identity has not been established may be
known by the process of elimination.
• BY FACIES/FACIAL EXPRESSION
Hippocratic – nose is pinched, temple hollow, eyes sunken, ears cold, lips relaxed
and skin livid.
Mongolian – Almond eyes, pale complexion, prominence of cheek bone
Leonine – Lion-like (commonly related to leprosy)
Myxedemic – pale, non-pitting edematous face, dullness of intellect, slow
monotonous speech, muscular weakness and tremors
Rules in personal identification
• Law of multiplicity of evidence in identification – greater
number of similarities
• Value of different points of identification – fingerprints ,
moles
• Visual recognition of relatives –lesser value than
fingerprints/dental
• The longer interval between death the more experts are
needed in establishing the identity.
• The team to act in shortest time because it is perishable.
• No rigid rule in the procedure of identification of the
person.
IDENTIFICATION OF PERSONS
A. Ordinary methods of identification
Characteristics which may easily be changed:
a) growth of hair, beard d) grade of profession
b) clothing e) body ornamentations
c) frequent place of visit

Characteristics that may not be easily be changed:

a) mental memory f) hands and feet
b) speech g) complexion
c) gait h) changes in the eyes
d) mannerism i) facies
e) handedness-left /right j) degree of nutrition
Points of identification applicable to both living and dead
before onset of Decomposition:
• Occupational marks – painters have stains, trigger finger
• Race: Malay:brown, flat nose round face, Round head,
Wearing apparel
• Stature: Tips of middle fingers of both hands extended
laterally
• Tatoo marks
• Weight – not good point – changes from time to time
• Deformities, injuries leaving permanent deformities
• Birth marks moles, scar
• Tribal marks, Sexual organs, blood exam
Race
METHODS OF APPROXIMATING THE HEIGHT OF A PERSON:

• Measure the distance between the tips of the middle fingers of both
hands with the arms extended laterally and it will approximately be
equal to the height
• Two times the length of one arm plus 12 inches from the clavicle
and 1.5 inches from the sternum is the approximate height
• Two times the length from the vertex of the skull to the pubic
symphysis is the height.
METHODS OF APPROXIMATING THE HEIGHT OF A PERSON:

• The distance between the suprasternal notch and the pubic

symphysis is about one-third of the height
• The distance from the base of the skull to the coccyx is about 44% of
the height
• The length of the forearm measured from the tip of olecranon
process to the tip of the middle finger is 5/19 of the height
• Eight times the length of the head is approximately equal to the
height of the person
ANTHROPOMETRY ( BERTILLON SYSTEM)
Alphonse Bertillon- utilizes anthropometrical measurement of the
human body for identification.
Basis:
• Human skeleton is unchangeable after 20 years.
• No two human beings have exactly the same bones.
• Use of simple instrument

Information:
• Descriptive data – color of hair, eyes, shape of nose…
• Body marks
• Anthropometric measurement – height
• Measurement of the head, limbs
 Portait Parle ( spoken picture)
– picturesque description of a person
Extrinsic factors in identification:
• ornamentation
• personal belongings
• wearing apparel
• foreign bodies
• identification by close friends, police
records, photographs
 Light as a factor in identification:
• Clearest moonlight = Less than 16-17 yards
• Starlight = Less than 10-13 yards
• Broad daylight = Not farther than 100 yards not seen
before
• Almost strangers =recognized at 25 yds

• Flash of firearm
= 2 inch’s letters can be read with the aid of the flash
of 22 caliber at a distance of 2 feet.
• Flash of lightning – sufficient light to identify
• Artificial light – relative to the intensity of light
B. Scientific methods of identification

• DNA
• Fingerprinting
• Dental identification
• Handwriting
• Identification of skeleton
• Determination of Sex, Age
• Identification of blood, blood stains
• Identification of hair, fibers
1. DNA
One in a million billion , for siblings
one in 10 million
2. FINGERPRINTING :most valuable method of identification.
a) No two identical fingerprints 1 : 64,000, 000, 000
b) Not changeable - 4th month formed in the fetus

= Practical uses
• Identity of dead bodies
• Prints recovered at crime scene
• Prints on file for comparison
• Right thumb print is substitute for signature

= DACTYLOGRAPHY : art and study of recording fingerprints as means of id.

= DACTYLOSCOPY: art of identification by comparison of fingerprints
= POROSCOPY : study of pores found on the papillary friction ridges of skin
Fingerprints can’t be effaced:
=as long as the dermis of the bulbs of the finger is not completely
destroyed.
 3. DENTAL IDENTIFICATION

• Possibility of 2 persons to have the same is

remote
= enamel is the hardest substance of the body,
outlast other tissues in putrifaction
4. HANDWRITING
• BIBLIOTIC : Science of handwriting analysis
• GRAPHOLOGY : study of handwriting for the purpose of determining the writers
personality, character and aptitude.
• Disguised Writing –Deliberate attempt on the part of the writer to alter his
writing habit by endeavoring to invent a new writing style or imitate the writing
of another person
• Signature Forgery Examination – The most common activity of a question,
document, examiner. Such document may be found in checks, deeds of
conveyances, anonymous letters, suicidal notes, receipts, etc.

Classification of Signature Forgery

• Traced
• Simulated
• Spurious
5. IDENTIFICATION OF THE SKELETON
Human – shape, size, general nature
Single individual – plurality or excess of bones
Height – add 1 to 1 ½ in. for the soft tissues

• Pearson’s formula – for the reconstruction of the living stature of long bones
• Topinard and Rollet - two French anatomist devised a formula for the
determination of the height fro males and females.
• Humphrey’s table - Table of different height of bones for different ages and
their corresponding statures.
• Manouvrier – made the following co-efficient for the determination of height.
Determination of sex of the To measure the height:
skeleton:
• Femur
a) Pelvis
• Humerus
b) Skull
• Tibia
c) Sternum
• Radius
d) Femur
e) Humerus
 Difference PELVIS MALE FEMALE

Construction wall Heavier Lighter

More pronounced Less pronounced

Height Greater Lesser

Pubic arch Narrow & less round Wider/rounder

Diameter of the true Less Greater

pelvis
Curve of iliac crest Reaches higher level Lower level
Difference PELVIS MALE FEMALE

Greater Sciatic notch Narrow Wide

Body of pubis Narrow Wider

Iliopectineal line Sharp Rounded

Obturator foramen Egg-shaped Triangular

Sacrum Short and narrow Long and wide

CRANIUM MALE FEMALE
Shaft Less curve More curve

Mastoid Larger Smaller

process

Cranium Mastoid process Occipital and

placed Maxillary bones
horizontally

Styloid Shorter Longer/slender

process

Forehead Higher, more less high,

oblique more vertical

Superciliary Less sharp, more Sharper

ridges rounded

Zygomatic More prominent Less prominent

arches

Lower jaw Larger & wider Narrower and

lighter
Face Larger in Smaller
proportion to
cranium
Basis of the estimate for duration of interment:

• Presence or absence of soft tissue adherent to the bones.

• Firmness and weight, brittleness, dryness of the bones.
• Degree of erosion of the surface of the bones.
• Changes in the clothings, coffin, and painting.
6. Legal Importance of Sex Determination
• As an aid in identification
• To determine whether an individual can exercise certain investigations
vested by law to
one sex only
Ex. Compulsory military service training refers only to males, 20 years of
age of above
• Marriage
Any male of the age 16 years or more, and any female at the age of 14 or
more, may contract marriage (Solis)
Any male or female age 18 and above (Present law under the family code
of the PH)
• Rights granted by law are different to different sexes
• There are certain crimes wherein a specific sex can only be the
offender of victim
- In rape, seduction, abduction, or abuse against chastity, a woman is
the victim
- In case of prostitution, the offender must be a woman
- In adultery, the offender is a married woman and in concubinage,
the offender is the husband
6. IDENTIFICATION OF SEX
Test to determine the sex:
 Social test Genital test
• Gonadal test Chromosomal test – barr cells in
females
ences of sex:
1. Presumptive evidence
= General features, hair in some parts
= Transvestism – sexual deviation by desire to assume the
attire and be accepted as a member of the opposite sex.

2. Highly probable = vagina, large breast

3. Conclusive evidence = ovary in females

 7. DETERMINATION OF AGE
• Legal importance
• Aid to identification
• Determination of criminal liability
• Determination of right of suffrage
• Determination whether a person can exercise civil rights
• Determination of the capacity to marriage
• Requisite to certain crimes

• Determination of age of fetus:

Hess’s rule or Haase’s rule
a) Fetus of less than 25 cm long- get square root of length in cm, result in
months
b) > 25 cm- divide the length of the fetus by 5 and the result is the age in
month.
8. IDENTIFICATION OF BLOOD AND BLOOD STAINS Legal importance:

• Disputed parentage
• Circumstantial evidence against perpetrator of a crime
• Determination of the cause of death
• Determination of the direction of the escape
• Determination of the appropriate time crime was committed
• Determination of the place of the crime
• Determination of the presence of certain diseases.
8. IDENTIFICATION OF BLOOD AND BLOOD STAINS
Physical examination tests:
• Solubility test : Recent Bloodshed is soluble in saline
and imparts a bright red color
• Heat test : Imparts a muddy precipitate
• Luminescence test:Stains on dark fabric mixed with
mud, paint, etc. emit bluish white luminescence due to
presence of hematin.
• 3 amino-phtalic-acid-hydrazide-HCL,
• sodium peroxide , distilled water
> Bluish-white in a dark room
Chemical examination tests:
• Saline extract of the blood plus ammonia – Brownish tinge due to the
formation of alkaline hematin
• Benzidine test – Blue color in white filter paper
- A positive result is not conclusive.
• Guaiacum test ( Van Deen’s Dyas or Schombein’s test) – blue
- A positive result is not conclusive.
• Phenolpthalein test ( Kastle-Meyer test) – pink
- A positive result is not conclusive.
• Leucomalachite Green test (+) = bluish green or peacock blue
• Microscopic examination
- saline extract of stain

 Micro-chemical tests:
1. Hemochromogen crystal or Takayama test:This test is positive
to any substance containing hemoglobin
2. Teichmann’s blood crystals or Hemin crystal test-
= Sodium chloride – dark brown rhombic prisms of chloride,
hematin formed
= Best of the micro-chemical test.
3. Acetone-haemin or Wagenhaar test
• Spectrospcopic examination
- blood pigments have the power to absorb light of certain length and
produce the characteristic absorption bands on the spectrum.

• Fresh blood – Oxyhemoglobin, Hemoglobin, reduced hematin or

hemochromogen
• Olders stains – Methemoglobin, alkaline hematin, hematoporphyrin,
reduced hematin
• Other blood preparations - Acid hematin, alkaline hematin,
carboxyhemoglobin, hematin
• Biologic examinations
• Precipitin test – blood is human or not ( along with semen)
• Blood grouping - All human beings have their blood belonging to
any of the principal blood groups.

- Value: may solve disputed parentage.

A positive result is not conclusive, but a
negative result is conclusive that he is not the child of the
alleged parents
AGE OF THE BLOOD STAINS
• When blood is exposed to the atmosphere or some other instances,
its hemoglobin is converted to methemoglobin or hematin. The
color is changed from red to reddish brown.
• The presence of acid accelerates the formation of hematin.
• These changes take place in warm weather within 24 hrs.
DIFFERENTIAL CHARACTERISTICS OF BLOOD FROM
DIFFERENT SOURCES
• Arterial Blood - Bright scarlet in color, leaves the blood vessel with pressure, high
oxygen content
• Venous Blood - Dark red in color, does not spill far from the wound, low oxygen
content
• Menstrual Blood - Does not clot, acidic in reaction owing to mixture with vaginal
mucus. There are vaginal epithelial cells, contains large number of Doderlein bacilli.
• Man’s or Woman’s Blood • No method differentiating a man from a woman’s blood.
Probably, presence of sex hormone in the blood may be a point of differentiation
• Child’s blood • At birth, it is thin and soft compared to that of an adult
• Red blood cells are nucleated and exhibit greater fragility
• Red blood cell count more that in adult
 9. IDENTIFICATION OF HAIR AND FIBERS
Differences between Hair Forcibly Extracted and Naturally Shed Hair:
• Forcibly extracted: bulb is irregular in form with an undulating surface
• Naturally shed: bulb has a rounded extremity, a smooth surface and
most probably shows signs of atrophic or fatty degeneration, especially
in an elderly person
Vegetable and Animal Fibers may be Differentiated
with the following tests
• Ignition test
• Chemical tests (use of concentrated nitric acid)
• Picric acid test
• Millon reagent test
• Soaked in tannic acid
• Heated with 10% NaOH
Once the fibers are found to be animal in origin, the next step is
examination to determine whether these fibers are human hair or
hair of other animals.
 9. IDENTIFICATION OF HAIR AND FIBERS
HAIR HUMAN ANIMAL
MEDULLA
Air network In fine grains large or small sacks
Cells Invisible w/out Easily visible
tx in H2O
Fuzz w/out Fuzz w/ medulla
medulla
CORTEX
Looks like a Fairy thin hollow cylinder
thick muff
Pigments in Irregular grains
the form of
fine grains
CUTICLE
Thin scales Thick scales
 LEGAL MEDICINE

ANTONIO ROQUE PARADELA,M.D.

VICENTE SOTTO MEMORIAL MEDICAL CENTER
CEBU CITY, PHILIPPINES
Why is it important that a person
is dead?
• The civil personality of a natural person is
extinguished by death.

Rights and obligations of the deceased is

determined by law, by contract and by will
(Art. 42, Civil Code).

 The property of a person is transmitted to

his heirs at the time of death.
Importance of Death determination
• The death of a partner is one of the causes of
dissolution of partnership agreement.
The death of either the principal or agent is a
mode of extinguishment of agency.
• The criminal liability is extinguish by death.
• The civil case for claims which does not
survive is dismissed upon death of the
defendant.
Kinds of death:
• Somatic or clinical death – persistence of vital
functions
• Molecular or cellular death – 3 to 6 hours after
cessation of life
• Apparent death or State of suspended animation –
transient loss of consciousness in hysteria,
uremia, electric shock

• Death – is the termination of life.

 Signs of death:
• 1. Cessation of heart action and circulation., Usually the
auricle contract after somatic death for a longer period than the ventricle, last to
stop so called ULTIMEN MARIENS.

Methods of detecting the cessation of heart action and

circulation:
a) Examination of the heart- pulse, auscultation, flouro, ECG

b) Examination of peripheral circulation

= Magnus test – application of ligature around the base
of the finger bloodless area at site of application
* dead man – no change

= Opening of small artery- spurting

• Icards test – injection of flourescein SQ
- greenish yellow discoloration in the whole skin
- dead man only in the area of injection

• Pressure on fingernails

• Diaphanous test – fingers are spread wide through a

strong light- Red
• Application of heat on the skin - blister
• Palpation of Radial pulse
• Dropping of melted wax
 2. Cessation of respiration – more than
3 ½ minutes

Methods of detecting cessation of

respiration:
• Observance of movement of chest and abdomen
• With the aid of stet.
• Examination with a mirror
• Examination with a feather or cotton fibers
• Examination with a glass of water
• Winslow’s test – no movement in the image formed
by reflecting artificial light on the water in a saucer and
placed in the chest if respiration is taking place.
3. Cooling of the body ( ALGOR MORTIS)
• After death the metabolic process inside the body ceases.
• The progressive fall of the body temp. is one of the most prominent
signs.
• First two hours after death the cooling is rapid.
• Fall of temp. of 15 to 20 degrees Fahrenheit is considered as
a certain sign of death.

• POST-MORTEM CALORICITY – is the rise of temp. of the

body after death due to rapid and early putrefactive changes. Usually
in the first 2 hours.
= seen in cholera, liver abscess, tetanus, RF, Strynine, poisoning,
Peritonitis
A. Conditions connected with the body
Factors delaying the rate of cooling of the body:
• Acute pyrexial disease
• Sudden death in good health
• Obesity of person
• Death from asphyxia
• Death of the middle age

Factors accelerating cooling:

• Leaness of the body
• Extreme age
• Long-standing illness
• Chronic pyrexial disease with wasting
B. Conditions that are connected with the
surroundings
Factors delaying cooling:
• Clothings
• Want of access of air to the body
• Small room
• Warm surroundings
Factors accelerating cooling:
• Unclothed body
• Conditions allowing the access of air
• Large room permitting the dissipation of heat
• Cooling more rapid in water than in air
Methods of estimating how long a person has
been dead from the cooling of the body:

•If body temp. is normal at the time of

death:
= the average rate of fall of the temp. during the
first 2 ½ hours is ½ of the difference of the body
temperature and that of the air.

= the body attains the temp. of the surrounding

air from 12 to 15 hours after death in tropical
countries.
2. Chemical Method ( Schourup’s formula)
For the determination of the time of death of any cadaver
whose CSF is examined for the concentrations of L.A., NPN,
A.A.
= L.A> 15 mg to 200 mg/100cc rapid in 1st 5 hours.
= NPN inc. from 15 to 40 mg/100 cc in 1st 15 hours
= A.A. inc. from 1 mg to 12 mg% 1st 15 hours.
 4. INSENSIBILITY OF THE BODY
AND LOSS OF POWER TO MOVE

= may be seen in the living with- apoplexy, epilepsy ,

trance, catalepsy, hysteria
• CHANGES IN THE SKIN – opacity, flattening, loss of
elasticity

6. CHANGES IN AND ABOUT THE EYE

a) Loss of corneal reflex – seen I n live pts:
G.A., uremia, narcotic poisoning
b) Clouding of cornea
c) Flaccidity of the eyeball
d) Pupil in the position of rest.
e) TACHE NOIR DE LA SCLEROTIQUE – spot
found in the sclera after death.
7. ACTION OF HEAT ON THE SKIN

• Heat applied while alive – produced blister with serum and

redness around the area.

• Following combinations of signs show death has occurred:

• Loss of animal heat to a point not compatible with life
• Absence of response of muscle stimulus
• Onset of rigor mortis.
CHANGES IN THE BODY FOLLOWING DEATH
CHANGES IN THE MUSCLE – complete relaxation of the whole
muscular system.
(i) Stage of Primary flaccidity ( POST-MORTEM IRRITABILITY)
= muscle relax, may contract, dilated pupil,
sphincters are relaxed
= presence of molecular life
= warm place: 1 hour and 51 minutes
= chemical reaction of muscle is alkaline
Three Stages
After Death: (II) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY ,
DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS)
= whole body is rigid due to contraction of the muscles
= starts at muscle of neck, lower jaw
= Reaction is acidic due to inc. of lactic acid
= develops 3 to 6 hours after death in temperate, earlier
in warm
= last from 2 to 3 days in temperate, warm: 24-48H cold
weather 18-36 H summer
Three Stages After Death

c) Stage of Secondary flaccidity or Commencement of

putrefaction
( DECAY OF MUSCLES)
= muscle are flaccid, not respond to stimuli,
reaction is alkaline
= due to dissolution of muscle proteins
FACTORS INFLUENCING THE TIME OF ONSET OF
RIGOR MORTIS
(1) Internal Factors
a) State of the muscles
= healthy – appears late
= Onset is hastened in:
a.1 hunted animal
a.2 prolonged convulsion/lingering illness
a.3 death from- TY, Cholera, Phthisis, typhus
b) Age
= early onset – aged and newborn
= delayed – good health, good muscular development
c) Integrity of nerves
= section of the nerve will delay onset, paralyzed
muscle
(2) External factors
a) Temperature
= Hastened by high temperature
= > 75 degrees will produce heat stiffening
b) Moisture
= rapidly but with short duration in moist air
Conditions simulating RIGOR MORTIS:
1. Heat stiffening - > 75 degrees coagulates muscle proteins
resulting to rigidity.
= “ Pugilistic attitude” flexed upper and lower limb
= Hands clenched, flexor stronger than extensors,
burned to death

2.Cold stiffening
= Due to solidification of fats when exposed to cold temp.

3. Cadaveric spasm or Instantaneous Rigor

= Instantaneous rigidity due to extreme nervous tension, exhaustion,
injury to the nervous system.
= Weapon in hand, weeds
 RIGOR MORTIS MUSCLE
CONTRACTION

Contracted muscle Losses transparency More or less

transparent

Elasticity Loss elasticity Very elastic

Litmus reaction Acidic Neutral or sl. alkaline

Contraction Absolute flaccidity Possess inherent

contraction
 RIGOR MORTIS CADAVERIC SPASM
Time of appearance 3-6 hours after death Immediately after
death
Muscles involved All muscles Certain group of
muscles
Occurrence Natural phenomena May or may not
appear
Medico-legal Approximates time Determine nature of
significance of death death
CHANGES IN THE BLOOD
Coagulation of blood= blood may remain fluid inside the
blood vessels 6-8H after death
ANTE-MORTEM POST-MORTEM
CLOT CLOT

Consistency Firm Soft

Surface of blood Raw after clots Smooth, healthy

are removed after clots are
vessels removed
Clots Homogenous Can be stripped
can’t be stripped off in layers
off in layers
Post-mortem Lividity or Cadaveric Lividity , or Post-mortem
Suggilation or Post-mortem Hypostasis or Livor Mortis

= Stoppage of heart action and

loss of tone of b.v. accumulates
in dependent areas except in
bony areas.

= capillaries coalesce > purplish

in color called
= appears 3 – 6 H after
Post-mortem lividity.
death and fully developed
12 H after death. = Hasten by death due to
cholera, uremia, Typhus fever
Physical characteristics of Post-
mortem Cadaveric Lividity

• Occurs in the most dependent

areas.
• Involves the superficial layer of
the skin
• Does not appear elevated from
the rest of the skin.
• Color is uniform.
• No injury of the skin
• Kinds of Post-mortem Cadaveric Lividity Hypostatic
lividity, Diffusion lividity
Importance of Cadaveric lividity:
• One of the signs of death.
• Determines the position of the body has been changed after it’s
appearance in the body.

Color of lividity may indicate the cause of death.

• Asphyxia – lividity is dark
• CO poisoning – pink
• Hemorrhage – less marked
• Hydrocyanic acid – bright red
• Phosphorus – dark brown
• Potassium chlorate – coffee brown

Determines how long the person has been dead

Gives us an idea as to the time of death.
Points to be considered which may infer the position of the
body at the time of death:

• Posture of the body when found.

• Post-mortem hypostasis or lividity
• Cadaveric spasm
 CONTUSSION (BRUISE) POST-MORTEM
HYPOSTASIS
Small Below epidermis in true skin In the epidermis or
bruises ,larger ones-below this cutis

Cuticle Abraided by the same violence Unabraided

that produce the bruise.

Bruise Appears at the seat or

surrounding may or may not be
dependent Always dependent

Elevated, inflammatory condition Not elevated, blood

in b.v.
Incision of blood outside the b.v. Blood inside the
the b.v. = most certain test vessels

Color variegated Uniform color

 POST-MORTEM SIMPLE
LIVIDITY OF ORGANS CONGESTION

Post-mortem Irregular, most Uniform, all organs

staining in organs dependent parts

Mucous membrane Dull, lusterless Not in congestion

Inflammatory Not seen Not seen
exudate
Other changes in the blood
1. Hydrogen ion concentration – acid pH CO2, L.A., After 24H alkaline ammonia.
2. Breakdown of liver glycogen leads to accumulation of dextrose in the IVC and
the right side of the heart.
3. Rise in NPN and Free A.A.

4. Chemical:
= chloride in the plasma/RBC decrease due to extravascular
diffusion, in 72 H only ½ of its content.
= Mg – increases due to diffusion from without.
= K – increases due to diffusion from the vascular
endothelium.
3. AUTOLYTIC OR AUTODIGESTIVE
CHANGES AFTER DEATH

- After death, proteolytic, glycolytic

and lipolytic ferments of the glandular
tissues continue to act which lead to
the autodigestion of organs.

4. PUTREFACTION OF THEBODY
- Is the breaking down of complex
proteins into simpler components
associated with the evolution of foul
smelling gasses and accompanied by
the change of color of the body.
•Tissue changes in putrefaction:
1. Changes in the color of the tissue
Hemolysis of blood within blood vessels > Hgb diffuses
through the walls Reddish-brown in color
In the tissues > Hgb undergo chemical change
Greenish-yellow 1st seen at R Iliac fossa

MARBOLIZATION – prominence of the superficial veins

with reddish discoloration which develops on both flanks of
the abdomen, neck, and shoulder
= look like “marbled” reticule of branching veins.
2. Evolution of gasses in the tissues
CO2, ammonia, H2, Suphurated hydrogen,

methane.= offensive odor

• Effects of pressure of gasses of putrefaction:

• Displacement of the blood – bleeding in open
wounds
• Bloating of the body
• Fluid coming out from nostrils, mouth
• Extrusion of the fetus in a gravid uterus
• Floating pf the body
Liquefaction of the soft tissues
• Putrefy rapidly : Eyeball, lining of trachea,
larynx , brain, stomach, intestine, liver,
spleen

• Putrefy late : Highly muscular organs

and tissues, Esophagus, diaphragm, heart,
lungs, kidneys, U.B., uterus, P.G.
• Factors modifying the RATE of putrefaction:

1. INTERNAL FACTORS
• Age : healthy adults, NB not yet fed, later than infants
• Condition of body : full grown/obese – rapid , Stillborn- late
• Cause of death : infection - rapid

2. EXTERNAL FACTORS
• Free air
a.1 Air : free air hastens decomposition
a.2 Moderate moisture - accelerates
a.3 Loaded with septic bacteria – early aerobes, later anaerobic
- Clostridium welchii= decomposition
b) Earth
b.1 Dry absorbent soil - retards
b.2 Moist fertile soil - accelerates

c) Running water- more rapid than still water

d) Clothings – early it hastens but delays in the later stage.
- tight clothings - delay
Factors influencing the changes in the body
after burial:

• State of the body before death – thin slower,

mummify
• Time elapsed between death and burial and
environment of the body
• Effect of coffin – later
• Clothings and other coverings on the body
when buried – pressure, insects
• Depth at which the body was buried - greater
the later
Factors influencing the changes
in the body after burial:
• Condition and type of soil
• Inclusion of something in the grave which will
hasten decomposition-food
• Access of air to the body after burial
• Mass grave – rapid
• Trauma to the body – violent death - slow
CHRONOLOGICAL SEQUENCE OF
PUTREFACTIVE CHANGES OCCURING IN
TEMPERATE REGIONS

• 1-3 DAYS AFTER DEATH - greenish discoloration

over iliac fossa, soft eyeballs
• 3-5 DAYS - frothy blood from mouth, nostrils
• 8-10 DAYS - abdominal distention, nails firm
• 14-20 DAYS - blisters all over the body, maggots
• 2-5 MONTHS - skull exposed, orbits empty
TROPICAL REGION
• 12 HOURS Rigor mortis all over, hypostasis,
greenish-discoloration caecum
• 24 HOURS Rigor mortis absent all over,
abdominal distention
• 48 H Ova of flies, trunk bloated, face discolored
• 72 H Whole body grossly swollen, hairs and nails
loose
• ONE WEEK Soft viscera putrefied
• TWO WEEKS Soft tissues largely gone
• ONE MONTH Body skeletonized
 BEEN SUBMERGED IN WATER

• FIRST 4 OR 5 DAYS Cold water little change, in

rigor mortis
• FROM 5 – 7 DAYS Skin on hands, feet is
bleached, face faded white
• 1 – 2 WEEKS Face swollen and red, skin of
hands and feet wrinkled
• 4 WEEKS Skin wrinkled, nail intact
• 6 – 8 WEEKS Abdomen distended, skin of
hands/ feet come off with nails
 Factors influencing the floating of the
body in water:
• Age – fully developed, well nourished – rapid
• Sex – females floats sooner
• Conditions of the body – obese float quicker
• Season of the year – moist hot air – putrefaction – floats due to gas
• Water- shallow and stagnant water of creeks, higher specific gravity
- sea water floats sooner than fresh water, higher specific
gravity
• External influence – heavy-wearing apparel - slower
• Only teeth, bones and hair remain for an indefinite time.
• Flat bones disintegrates faster than round bones.
SPECIAL MODIFICATION OF PUTREFACTION
1. Mummification
= is the dehydration of the whole body which results in the shivering and
preservation of the body.
= usually occurs when buries in a hot, dry with free access of hot air

2. Saponification or Adipocere fromation

= a condition where the fatty tissues of the body are transformed to soft
brownish-white substance known as ADIPOCERE at SQ level.

3. Maceration
= softening of the tissues when in fluid medium in the absence of
putrefactive mircro-org, seen in death in utero
– reddish or greenish color, skin peeling off and arms flaccid and frail.
HOW LONG A PERSON HAS BEEN DEAD?
DURATION OF DEATH
1. Presence of rigor mortis : 2-3 hours after death
12 H fully developed
18-36 H disappears concomitant with putrefaction
2. Presence of Post-mortem lividity : 3-6 H after death
appears as small petechia-like red spots
3. Onset of decomposition
24-48 H after death manifested watery. foul smelling
froth, mouth, nostrils
4. Stage of decomposition
5. Entomology of the cadaver – 24 H before eggs are hatched,
maggots
6. Stage of digestion - 3-4 H gastric empty , 6-8 distal ileum,
cecum
7. Presence of live flies in the clothing in the drowning victim –
less than 24H
8. State of clothings - pajama , night
9. Changes in CSF
10. Blood clots inside the b.v. in 6 –8 H after death.
11. Soft tissues of the body may disappear 1 to 2 years after
burial
Post-mortem conditions simulating
disease, poisoning or injury:
• Post mortem hypostasis – contusion, inflammation ,
poisoning
• Blisters of the cuticle – scald and burns
• Swelling, detachment or splitting - injury
PRESUMPTION OF DEATH
• Disputable presumption - not heard in 7 years

• Presumption of death
Absence of 7 years except succession 10 years
Vessel for 4 years
Armed forces 4 years
In danger of death 4 years
PRESUMPTION OF SURVIVORSHIP
• under 15 y.o. – older survives
• above 60 y.o.- younger
• under 15, above 60 – former
• over 15 and under 60 y.o. – male, older
• under 15, or over 60 y.o. and the other in between - latter
MEDICO-LEGAL INVESTIGATION OF DEATH
• Inquest Officer – is an official of the state charged with the duty
of inquiring into certain matters.
- in medico-legal examination: manner and cause of death

The following officials of the government are authorized to make

death investigations:
• Provincial and City Prosecutors
• Judges of the RTC, MTC
• Director of NBI
• SolGen
Stages of MEDICO-LEGAL INVESTIGATION
1.Crime Scene Investigation – investigation of place of commission of the crime
2.Autopsy - investigation of the body of the victim

1. Crime Scene Investigation

- place where the essential ingredients of the crime
took place.
- Person composed the Search Team:

Physician MLI trained

Photographer
Assistant, evidence collector, note taker
 2. Autopsy
- comprehensive study of a dead body, in addition to the external
examination . Post-mortem examination- external exam without
incision being made.

Purpose of autopsy:
Determine cause of death
Correlate clinical diagnosis and symptoms
Determine effectiveness of treatment
Study the natural course of the disease
Educate students and physicians

MEDICO-LEGAL OR OFFICIAL AUTOPSY:

Determine cause, manner, time of death
Recovering, identifying, preserving evidentiary material
Provide interpretation and correlation of facts related to death
Provide factual, objective medical report
Separating death due to disease from external causes.

Dead body belongs to the state for cases that requires medico-legal autopsy.
 PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY
Requirement Consent of next of Law that gives the
kin consent

Confirmation Clinical findings of Correlate tissue

research changes to
criminal act
Emphasis Notation at all Effect of wrongful
abnormal findings act
Conclusion Summation of all Specific to the
abnormal findings purpose
Minor Need not be Included if useful
mentioned
The following manner of death should be autopsied:

• Death by violence
• Accidental deaths
• Suicides
• Sudden death of persons who are in good
health
• Death unattended by physician
• D.O.A. with no clinical diagnosis
• Death occurring in an unnatural manner
Mistakes in autopsy:
• Error or omission in the collection of evidence for identification
• Errors or omission in the collection of evidence required fro establishing the time
of death
• Errors or omission in the collection of evidence required fro the medico-legal
examination.
• Errors or omission result in the production of undesirable artifacts or in the
destruction of valid evidence.

Negative autopsies
• - if after all efforts including gross and microscopic studies and toxicological
analysis fail to reveal a cause of death.

Negligent autopsy
• No cause of death is found due to imprudence, negligence, lack of skill, lack of
foresight.
 CAUSES OF DEATH
• Primary purpose of a medico-legal autopsy:
Determination of the cause of death.
• Death is the direct and the proximate
consequence of the criminal or negligent act.
• Defense wounds on the victim:
Qualify the crime to homicide.
• Series of cuts in the borders of the wound:
Multiple trust- intent to kill.
Cause of death:
• is the injury or disease or both which initiates the physiological
disturbance resulting to a fatal termination.

• Immediate or Primary cause of death – when injury or

disease kills quickly the victim and no opportunity for
complications to develop.
Ex: extensive brain injury
• Proximate cause or Secondary cause - the injury or disease
was survived for a longer period
 Mechanism of death
: is the physiologic derangement or biochemical disturbance
incompatible with life which is initiated by the cause of death.
Ex: Hemorrhagic shock, pulmonary depression, cardiac arrest,
tamponade metabolic problem.

Manner of death: is the explanation as to how the cause

of death arose.
• Natural death – fatality is cause solely by disease. Ex:
pneumonia, cancer
• Violent or unnatural death – due to injury

Medico-legal masquerade- violent deaths may be

accompanied by minimal or no external evidence of injury or
natural death where signs of violence may be present.
Degree of Certainty to the cause of death:
• Structural abnormalities established beyond doubt the
cause of death. Ex. SW with H.
• Degree of probability amounting to the cause of death.
Ex: Electrical shock
• History establishes cause of death and confirmed by
anatomic or chemical findings.

• When neither history, laboratory and anatomic findings,

taken individually or in combination is sufficient to
determine the cause of death but merely speculate as to
the cause of death.
Ex. Crib death among infants.
Steps in the Intellectual Process in the
determination of the cause of death:
• Recognition of the structural organic changes or
chemical abnormalities responsible for the cessation
of vital functions.
• Understanding and exposition of the mechanism by
which the anatomic and other deviations from
normal caused the death.

• Instantaneous physiologic death or Death from

inhibition, death from primary shock, Syncope
with instantaneous exitus.
Steps in the Intellectual Process in the
determination of the cause of death:

• This is sudden death which is cause within seconds or minute

or two after a minor trauma or peripheral stimulation of
relatively simple nature.

• The peripheral stimulation initiates the cardio-vascular

inhibitory reflex.
Ex: Vagocardiac slowing or stoppage of the heart.
Blow to the larynx, solar plexus, scrotum,
pressure to the carotid sinus.
Diseases with no specific findings of
a disease:
• Sudden infant death syndrome (SIDS) or crib death
• Sudden unexplained nocturnal death (SUND)
DOA – means actually dead or dying, provided the
physician had not been given ample opportunity to
arrive at a working diagnosis as to the cause of
death.
Undetermined - if the physician cannot determine
the cause of death.
MEDICO-LEGAL CLASSIFICATION OF
THE CAUSES OF DEATH
Natural death – cause by natural disease condition in the body.

Violent death
• Accidental death , Negligent death
• Infanticidal death , Parricidal death
• Murder , Homicidal death

If signs of violence are associated with the natural cause of death:

Did the person die of a natural cause and were the physical injuries
inflicted immediately after death?
- Violence applied in a dead person : Impossible crime.
Was the victim suffering from a natural disease and
the violence only accelerate the death?
• Offender responsible of the death of the victim.
= Criminal liability shall be incurred by any person
committing a felony although the wrongful act done be
different from which he intended.
(Art.4 no.1 RPC)
Did the victim die of a natural cause independent of
the violence inflicted?
• Accused will not be responsible for the death but merely for the
physical injuries he had inflicted.
Ex. Slapping a person with heart problem, only slight physical injury.

• To make the offender liable for the death of the victim, it must be
proven that the death is the natural consequence of the physical
injuries inflicted.
The following are deaths due to natural
causes:
• Affection of the CNS
• Cerebral apoplexy – sudden loss of
consciousness followed by paralysis or death
due to Hemorrhage from thrombosis or
embolism in the cerebral vessels.
• Abscess of the brain
• Meningitis of the fulminant type
Affection of the circulatory system
• Occlusion of the coronary vessels :
= Most common cause of Sudden death due to natural causes.
• Fatty or myocardial degeneration of the heart.
• Rupture of the aneurysm of the aorta
• Valvular heart disease
• Rupture of the heart
Affections of the Respiratory system
• Acute edema of the larynx
• Tumor of the larynx
• Diptheria
• Edema of the lungs
• Pulmonary embolism
• Lobar pneumonia
• Pulmonary hemorrhage
Affections of the GIT
• Ruptured PUD
• Acute intestinal obstruction
Affections of the GUT
• Acute strangulated hernia
• Ruptured tubal pregnancy
• Ovarian cyst with twisted pedicle
Affection of the glands
• Status thymico-lymphaticus
• Acute hemorrhagic pancreatitis
• Sudden death in young children
• Bronchitis
• Congestions of the lungs
• Acute broncho-pneumonia
• Acute gastroenteritis
• Convulsion
• Spasm of the larynx
 B. Violent death
• Are due to injuries inflicted in the body by some forms of
outside force.
• The physical injury must be the proximate cause of death.
= That the victim at the time the physical injuries were
inflicted was in normal health.
= That the death may be expected from the physical injuries
inflicted.
= That the death ensued within a reasonable time.
CLASSIFICATION OF TRAUMA OR INJURIES

• Physical injury – trauma sustained through the use of

physical force.
• Thermal injury – injury by heat or cold
• Electrical injury – electrical energy.
• Atmospheric injury – due to change of atmospheric
pressure.
• Chemical injury – chemicals
• Radiation injury – radiation
• Infection – microbic invasion
 PENAL CLASSIFICATION OF VIOLENT DEATHS

• Accidental deaths – due to misadventure or accident. Art. 12 RPC

Any person who while performing a lawful act with due care,
causes an injury by mere accident without fault or intention of
causing it.
Ex. Patient died of ATS injection after proper skin test.
Negligent death – felonies may be committed when the wrongful act
is due to reckless imprudence, negligence, lack of skill or foresight.
Ex. Surgeon left a pack – Homicide through reckless imprudence
PENAL CLASSIFICATION OF VIOLENT DEATHS

• Suicidal death , destruction of one’s self

- not punished, unfortunate being.
- Art 253 RPC Giving assistance to suicide. Punishable
because he has no right to destroy or assist in the
destruction of life of another.
PENAL CLASSIFICATION OF VIOLENT DEATHS

• Parricidal deaths Art. 246 father, mother, child, (leg/illeg)

ascendant, descendant, spouse (leg.)
• Infanticidal deaths – Art. 255 killing of a child less than 3 days
• Murder Art. 248 treachery, consideration, means of inundation,
occasion of calamities, evident pre-meditation, cruelty
• Homicidal deaths Art 249

DEATHS UNDER SPECIAL CIRCUMSTANCES

• Death caused in a tumultuous affray Art 251.
• Deaths or physical injuries inflicted under exceptional
circumstances. Art 247
2. PATHOLOGICAL CLASSIFICATION OF THE
CAUSES OF DEATH
• Death due to syncope – fatal and sudden cessation of the action of the
heart.

• Death from asphyxia – a condition in which the supply of oxygen to the

blood or to the tissues or to both has been reduced below normal working
level.
Stage of increasing dyspnea 1 min
Stage of Expiratory convulsion
Stage of exhaustion 3 min

• Death from coma

SPECIAL DEATHS
• Judicial deaths – Art. III Sec.1 Par. 19 Phil.
Const. “cruel and unusual punishment shall
not be inflicted. ; electrocution, hanging,
musketry, gas chamber.
• Euthanasia or mercy killing
• Suicide
• Automatism - due to drug may be
considered as accidental rather than
suicidal.
Evidences that will infer death is
suicidal:
• History of depression, mental disease.
• Previous attempt
• Injuries are located in areas accessible to hand.
• Effects of the act of self-destruction may be found
in the victim;, empty bottle
• Presence of suicidal note.
• Secluded, not in public view.
• Evidences which rule out H,M, P
Death from starvation :

• Cause may be due to suicidal, homicidal or

accidental.
• The human body without food losses 1/24th of its
weight daily.
 And 40% loss>death
Factors that influence the length of survival: age,
condition of the body, sex, environment.
DISPOSAL OF THE DEAD BODY
• Sec.1103 Revised Administrative Code : Persons charged
with the duty of burial.

• Deceased was married: the surviving spouse

• If unmarried : the nearest of kin of the deceased; adults,
within the Phil. And in possession of sufficient means to
defray the necessary expenses.
• If none of the above – municipal authorities.
Sec 1104 RAC Right of custody
• Any person charged by law with the study of burying
the body of a deceased person is entitled to the custody
of such body for the purpose of burying it, except when
an inquest is required by law for the purpose of
determining the cause of death.

• If communicable, the local board of health or local

health officer or municipal council.
Concept of possession
• The right of custody over a dead body.. The right of
custody does not mean ownership of the dead
body.

• Executors right of custody superior to the right of

spouse dead body. An executor is the person
mentioned in a will who will carry on the provision
of the will. In the absence of a testamentary
disposition, the right of the surviving spouse is
paramount.
METHODS OF DISPOSAL OF THE DEAD BODY
• Embalming – 6 to 8 quarts of antiseptic solutions of formalin, perchloride of mercury or arsenic which is
carried into the internal carotids and the femoral arteries.

• Burial or inhumation
a. Sec 1092 RAC buried within 48 hours if unembalmed. Within 12 hours, if communicable.

Except: 1. Subject of legal investigation.

2. Authorized by the local health authorities that may be buried more than 48H.
3. Impliedly when embalmed.

• b. Death certificate necessary before burial:

Sec. 1087 RAC Requirement of Death Cert . and the duty of the physician to issue or the
local health officer, or if none by the mayor, secretary, councilor of the municipality to issue the
certificate..
Sec 91 P.D. 856 Code of Sanitation ;
Burial requirement - death cert., issued by physician.

c. Permission from the Provincial fiscal or from the municipal may is

necessary if death is due to violence .
= Sec. 91(f) P.D. 856 Code of Sanitation
Sec. 1094 Revised Administrative Code – Disposition of body
and belonging of person dying of dangerous communicable disease.
Ex. Meningococcemia in Bagiuo City
• The body of a person who died of any dangerous communicable disease
shall not be carried form place to place except for burial or cremation.
• Duty of the local health official to disinfect the body before being prepared
for burial; the furniture, house, either disinfect or burned if capable of
conveying infection.
Sec. 1091 RAC Death Certificate must be presented before burial.
Sec. 91(h) P.D. 856 Code of Sanitation
• Remains shall be buried within 12 hours after death.
Cause of death is due to a dangerous communicable
disease;
• Not to be taken any place of public assembly.
• Only adult members of the deceased are allowed to
attend the funeral.

• Sec. 1091 RAC Death Certificate must be presented

before burial.
Sec. 1099 the placing of the body of any deceased person in an
unsealed overground tomb is prohibited unless if permanently sealed.
Except: 1. Tombs and vaults which are strictly receiving vaults
for bodies or remains awaiting final disposition.
2. Embalmed bodies awaiting final disposition.
Sec. 1100 of RAC, Sec. 91© of P.D. 856 Code of
Sanitation
• The depth of the grave must be at least 1 ½ meters deep, filled well
and firmly.
Sec. 2695 RAC
• Penalizes the desecration of burial premises; tombstone, plant,
tree, fence, post or wall. P200/ not greater than 6 months.
Sec. 90 code of Sanitation
Burial Grounds requirements
• It shall be unlawful for any person to bury the remains in places
other than those legally authorized .
• At least 25 meters from any dwelling house and no house shall
be constructed within the same distance from any burial ground.
• Not within 50 meters from any water source.
Other burial requirements:

• Shipment of remains abroad shall be governed by

the rules and regulations of the Bureau of
Quarantine.
• The burial or remains in city or municipal grounds
shall not be prohibited due to race, nationality,
religious or political reasons.
• Except when required by legal investigation or
when permitted by the local health authority, no
embalmed remains shall remain unburied longer
than 48 hours.
 FUNERALS
Art. 305 CC The duty and the right to make
arrangements for the funeral of a relative shall be in
accordance with the order of support under Art.294.

• Descendants : Eldest
• Ascendants : Paternal

For support as mentioned in Art. 294

• Spouse
• The descendants of the nearest degree
• Ascendant of the nearest degree
• Brothers and sisters
Funeral provisions:
• Art. 306 CC ; In keeping with the social position of the
deceased.
• Art. 307 CC ; In accordance to the expressed wishes of
the deceased.
Art. 309 CC ; Showing of disrespect to the dead shall be
liable to the family of the deceased for damages,
materials or moral.
Art. 132 RPC: Interruption for religious worship.
• Art 133 RPC: Offending the religious feeling
• Art. 2219 CC: Provides for the moral damages may be
recovered for acts mentioned in Art. 309 CC.
LIMITATIONS TO THE FUNERAL RITES
= Will of the deceased.
= Burial of a person sentenced to death must not be held with pomp.
= Restrictions as to funeral ceremonies in cases of deaths due to
communicable disease.

Disposing of the dead body in the sea

• Provided the deceased is not suffering from dangerous
communicable deceased.
• Sec. 1093 RAC Permit for conveyance of body to sea for burial.
4. Cremation
– is the pulverization of the body into ashes by the application of heat.
• First must be identified,
• Permit and in a crematory made for the purpose.

NOT GRANTED:
• If the deceased left a note.
• Identity of the person is not definite.
• Exact cause of death cannot be ascertained and the need for
further inquiry or examination.

5. Use of body for scientific purposes

- Corpse of prisoners
- Any person to be buried for public expense and which is
unclaimed for 24 hours.
Sec. 98 P.D. 856 Code of Sanitation
Special precautions for safe handling of cadavers containing
radioactive isotopes.
i
RA 349 as amended by RA 1056
Permission to use Human organs or any portions of the human
body for medical, surgical or scientific purposes under certain
conditions.
- in writing, specific use, signed by the grantor and two
disinterested witness.

Sec. 96 Code of Sanitation;

Donation of human organs for medical , surgical and scientific
purposes according to the Sanitation Code.
Persons permitted to detach human organs:
• Licensed physicians
• Known scientist
• Medical or scientific institutions

Requirements for a valid authorization:

• It must be in writing
• It must specify the person or institution grated the authorization.
• Must specify the organ or part to be removed.
• Signed by the grantor and two disinterested person.
• Copy of the authorization must be submitted to the Secretary of
Health.
EXHUMATION
• The deceased buried may be raised or disinterred upon the lawful order of the
proper authorities.
Sec 1082 RAC Cemetery permits even to NBI agents
• Sec. 1097 RAC Exhumation in case of death from dangerous communicable
disease after 5 years from burial.
• Sec 92 Code of Sanitation
3 years if non-dangerous communicable disease.
Remains shall disinfected before burial.

Requirements to be satisfied in exhumation:

• Duration of interment as required.
• Exhumation permit
• Compliance of sanitary requirements
Requirements to be satisfied in exhumation:
Duration of interment as required.
Exhumation permit
Compliance of sanitary requirements

Procedures followed in MedicoLegal Exhumations:

• A formal request from any of the law enforcement agency or any person
authorized by law.
• Name of the person, place of interment, date of interment, suspicion as to
cause of death.
• To determine the cause of death.
• To determine as to identity of the person.
• To recover organs or tissues for further examination for :
= Toxicological analysis
= Histopath exams
= Smears from vaginal canal and blood for alcohol
determination
• Set the date and time of exhumation, if physician has a
strong reason to believe that for the justification and
strong probability.
• Written request to the Regional director or Secretary of
Health.
• Grave must be properly identified by the person who was
present when the body was interred.
• After opening the coffin, the body must be viewed by any
person who can identify the deceased.
• Actual autopsy and adoption of the procedure is
needed to accomplish the purpose of the exhumation.
• Disinfection of the body and all areas involved must
be carried out with the assistance of the local health
officer and the return of the body to the burial place.
GOD BLESS AND STAY SAFE.....
LEGAL MEDICINE
PHYSICAL
INJURIES

ANTONIO ROQUE PARADELA,M.D.

VICENTE SOTTO MEMORIAL MEDICAL CENTER
CEBU CITY, PHILIPPINES
MEDICO-LEGAL ASPECTS OF
PHYSICAL INJURIES
Physical injury :
= Is the effect of some of stimulus on the body.
= Stab wound the effect is immediate but a blunt object
is delayed production on the contusion.

Causes of Physical Injuries:

Physical violence
• Heat or cold
• Electrical energy
• Chemical energy
• Radiation by radioactive substances
• Change of atmospheric pressure
• Infection
1. PHYSICAL INJURIES BROUGHT ABOUT BY
PHYSICAL VIOLENCE
= The effect of the application of physical injury on person is the
production of wound.
= A disruption of the anatomic integrity of the tissues of the
body.
= However, not all physical violence will result in the production
of wound.

Physics of wound production:

MV2

a. Kinetic energy = __________

`Velocity component is the important factor:

M16 rifle with a velocity of 3200 ft/ sec causes damage more
than a heavier .38 caliber.
 PHYSICAL INJURIES BROUGHT
ABOUT BY PHYSICAL VIOLENCE
b.Time
= The shorter the period of time needed for the transfer of energy,
the greater the likelihood of producing damage.
= If a person is hit on the body and the body moves towards the
direction of the force applied, the injury is less as when the body
is stationary.
= The longer the time of contact between the object or instrument
causing the injury, the greater will be the dissipation of energy.
c. Area of transfer
= The larger the area of contact between the force applied on the body, the
lesser the damage to the body
= By applying an equal force, the damage caused by stabbing is greater
compared to a blunt instrument.
 d. Other factors
= The less elastic and plastic the tissue > the greater that
a laceration will result.

= Elasticity :
• Ability of the tissue to return to its normal sizes and
shape after being deformed by a pressure.

= A force transmitted through a tissue containing fluid

will force the fluid away from the area of contact in all
directions equally, frequently causing the tissue to
lacerate.
VITAL REACTION = It is the sum total of all
reactions of tissue or organ to trauma, either observed
micro or macroscopically.

a RUBOR – redness or congestion of the area due to an increase of blood

.

supply as a part of the reparative mechanism.

b. CALOR – Sensation of heat or increase in temperature.
c. DOLOR - pain due to involvement of the sensory nerve.
d. LOSS OF FUNCTION- due to trauma, the tissue may not function.

The presence of vital reaction differentiates an ante-

mortem from a post-mortem injury.

EXCEPT: vital reactions not seen even if injury inflicted during life:
1. During agonal state of a living person were cells don’t react to
the trauma.
2. Sudden death as in sudden coronary occlusion.
CLASSIFICATION OF WOUNDS:
AS TO SEVERITY
 Mortal wound – caused immediately after infliction that is capable
of death.
Parts of body that are mortal – heart, vessels, CNS, lungs, etc.
Non-mortal wound - Not capable of producing death after
infliction.
AS TO KIND OF INSTRUMENT USED
a. Blunt instrument – contusion, hematoma, lacerated wound.
b. Sharp instrument
= Sharp-edge instrument> incised wound
= Sharp pointed > punctured wound
= Sharp edge and sharp-pointed > stab wound
c. Wounds brought about by tearing force – lacerated wound
d. By change in atmospheric pressure – barotraumas.
e. Wounds brought about by heat or cold – frostbite, scald, burns.
f. Wounds brought about by chemical explosion – GSW, shrapnel
wound
g. Wounds brought about by infection.
CLASSIFICATION OF WOUNDS:
AS TO THE MANNER OF INFLICTION
a) HIT – means of bolo, blunt instrument, axe.
b) TRUST or STAB – bayonet dagger
c) GUN POWDER EXPLOSION – Projectile or
shrapnel wound.
d) SLIDING or RUBBING or ABRASION

AS REGARDS TO THE DEPTH OF THE WOUND

a) Superficial – wound involves only the
layers of the skin.
b) Deep – inner structures beyond the layers of
the skin.
• PENETRATING WOUND -
Wounding agent did not come out
or piercing a solid organ.

• PERFORATING WOUND –
Wounding agent produces communication
between the inner and outer portion of the
hollow organs.

• OR piercing or traversing completely a particular

part of the body causing communication between
the points of entry and exit of the instrument or
substance producing it.
 CLASSIFICATION OF WOUNDS:
AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE
AND THE LOCATION OF INJURY

a. Coup Injury – Physical injury which is located at the site of the

application of force.
b. Contre-coup injury – opposite the site of the application of force.
c. Coup contre-coup injury – site and also opposite of application
of force.
CLASSIFICATION OF WOUNDS:
d. Locus minoris resistencia – Physical
injury not located at the site nor opposite
the site of the application of force but in
some areas offering the least resistance to
the force applied. Ex: Blow in fore head >
contusion on the region of the eyeball.

e.Extensive injury – Physical injury

involving a greater area of the body beyond
the site of the application of force.
Ex: Fall or MVA
AS TO REGIONS OR ORGANS OF THE BODY INVOLVED - Injuries in
various parts of the body

SPECIAL TYPES OF WOUNDS

a) DEFENSE WOUNDS – Instinctive reaction of self-
preservation.
> hands/fractures

b) PATTERNED WOUND – Wound in the nature and shape

of
the instrument. > Wheels, abrasions from rope.
imprints

c) SELF-INFLICTED WOUNDS - Wound produced on

oneself but no
intention to end his life.
Motive of producing self-inflicted wounds:
• To create or deliberately magnify an existing injury or
disease for pension or workman’s compensation.
• To escape certain obligations or punishment.
• To create a new identity.
• Gain attention or sympathy.
• Psychotic behaviour.

Some ways of self-mutilation:

• Head banging or bumping
• Exposure of body to heat radiation from open fires, radiators
• Penetrating nail to chest wall
• Castration by amputation of the penis
• Trichotillomania- pulling of body hair
LEGAL CLASSIFICATION OF PHYSICAL INJURIES

1. MUTILATION = Art. 262 RPC

Kinds of mutilation:
• Intentionally depriving a person, totally or partially of
some of

The essential organs for reproduction.

• Intentionally depriving a person of any part or
parts of the human body other than the organs for
reproduction.
• Mutilation to be punishable it must be
intentional or not physical injury.
• MAYHEM – is the unlawful and violent
deprival of another of the use of a part of the
body so as to render him less able in
fighting, either to defend himself or to annoy
his adversary.

• Vasectomy/Tubal ligation are not mutilation

and a legitimate method of contraception
despite the fact that it is done intentionally
and deprives a person of his power of
reproduction.
 SERIOUS PHYSICAL INJURIES Art. 263 RPC
•

Any person who shall wound, beat or assault another Art. 263 and
administering injurious substance, without intent to kill Art. 264.

The main purpose of dividing the provision into four paragraphs

a) Is to graduate the penalties depending upon the nature and character of the wound
inflicted
b) Their consequences on the person of the victim.

1. Prison mayor – because of the physical injuries inflicted, the injured person becomes
insane, imbecile, impotent or blind.
2. Prision correctional in its medium and maximum periods
- loss of speech, hear or smell
- loss of eye, hand, foot, arm, leg
= loss of the use or incapacitated for the habitual work he used to do.
3. Prision correctional in its minimum and medium periods.
- person injured shall be deformed.
- lost any other part of the body, incapacitated for more than 90 days.
4. Arresto mayor in its maximum period to prision correctional
- If the physical injuries shall have cause
the illness or incapacity from
labor for more than 30 days.
SERIOUS PHYSICAL INJURIES Art. 263 RPC
Is the offense shall be committed against any of the persons enumerated
in Art. 246 Or with attendance of any of the circumstances mentioned in
Art. 248
= The case covered by subdivision number 1 of this art. Will be
punished by reclusion temporal in its medium and maximum periods.
= Subdivision number 2 by Prision correctional in its maximum period
to prision mayor in its minimum period.
= Subdivision number 3 by prision correctional in its medium and
maximum
= Subdivision number 4 prision correctional in its minimum and medium
periods.
The provisions of the preceding paragraph shall not be applicable to
a parent who shall inflict physical injuries upon his child by excessive
chastisement.
ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES
Art 264 RPC
Elements:
• The offender inflicted upon another any serious physical injury,
• There is knowledge that the substance or beverage
administered is injurious Or took advantage of the victims
weakness of credulity.
• There is no intent to kill in the part of the offender.
• If intentional so> frustrated murder. Treachery is inherent in
Art. 264 RPC

• RA 7610.
It may be committed through a simple negligence or
imprudence.
LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC
Any person who shall inflict upon another physical injuries not described
in the preceding articles,

= But which shall incapacitate the offended party for labor 10 days or more
= Or shall require medical attendance for the same period
Both of which is 10 days but not more than 30 days and there must be proof
to it..

The crime of less serious physical injuries may be qualified and a fine of a higher
penalty is imposed when:
= There is a manifest intent to insult or offend the injured person.
= There are circumstances adding ignominy to the offense.
= The victims is the offender’s parents, ascendants, guardian, curators,
teachers.
= The victim is a person of rank or person of authority, provided the crime is not
direct assault.

P.D. 169 Obligation imposed on Physicians treating persons suffering serious and
less serious physical injuries required to report to law enforcement agencies.
 SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266
RPC
• Arresto menor- when the offender has inflicted physical injuries which shall
incapacitate the offended party from labor for 1 to 9 days or shall require
medical attendance of the same period

• Aresto menor or fine not exceeding P200 and censure when the offender has
cause physical injuries which do not prevent the offended party from engaging
in his habitual work nor require medical attendance.

• Arresto menor in its minimum period or a fine not exceeding P50 when the
offender shall ill treat another by deed without causing any injury.

• If there is no evidence to show actual injury or incapacity for labor or period of

medical attendance, the accused can only be guilty of slight physical injuries.
• So a tender slap on the face, holding the arm tightly, application of pressure in
some parts of the body or mild blow which show no sign of physical violence
may still be considered slight physical injuries or maltreatment. ( Parag 3 )
PHYSICAL INJURIES INFLICTED IN A TUMULTOUS
AFFRAY Art 252 RPC

Elements:
• There is a tumultuous affray
• Participants suffered from serious physical injuries.
• The person who inflicted serious physical injuries cannot be
identified.
• All those who appear to have used violence upon the person of the
offended party shall be penalized by arrest from 5 to 15 days.
TYPES OF WOUNDS
( MEDICAL
CLASSIFICATION)

CLOSED WOUND
– no breach of continuity of the skin or mucous membrane.

a. Superficial – When the wound is just underneath the

layers of the skin or mucous mn.

a.1 –PETECHIAE – is a circumscribed extravasation of

blood in the SQ or underneath the mucous membrane
Ex : mosquito bite, blood disease, hanging
a.2 – CONTUSSION
– is the effusion of blood into the tissues underneath the
skin on account of the rupture of the blood vessels as a
result of the application of blunt force or violence.

= Size of contusion greater than the size of the object.

= Location of the contusion is not always the site of
application of the force.
Ex: Black eye> Forehead

Medico-legal point of view: A contusion as indicated by

its external pattern may correspond to the > shape of the
object or weapon used.
Extent > the possible degree of violence applied.
Distribution> indicates the character and manner of injury
as in manual strangulation around the neck.
Age of Contusion: appreciated from its color change
The size tends to become smaller from the periphery to the
center and passes through a series of color changes as a
result of the
> Disintegration of the RBC and liberation of hb.

The contusion is red, purple soon after its complete

development.
4 to 5 days > green
7 to 10 days > yellow and gradually disappears on
the 14th or 15th day.
The ultimate disappearance of color varies from 1 to 4
weeks depending upon the severity and constitution of the
body.
The color changes starts at the periphery.
Contusion
• Color variegated. This is only true of
bruises that are the same days old due to the
changes in the hemoglobin produced during life.
 Contussion Post mortem Hypostasis

Below the epidermis in the true skin in small bruises or In the epidermis or in the cutis as a
extravasations, below this in larger ones and often much simple stain or a showing through
deeper still. the epidermis of the underlying
The epidermis has no blood vessels to be ruptured. engorged capillaries.

Cuticle was probably abraded by the same violence that Cuticle unabraded, because the
produced the bruise. In small punctures such as fleas bites, hypostasis is a mere sinking of the
this is not observed. blood, there is no trauma.

A bruise appears at the seat of and surrounding the injury. Always in a part which for the time
This may or may not be a dependent part. of information is dependent.

Often elevated because elevated blood and subsequent Not elevated, because either the
inflammation swell blood is still in the vessels or at
the tissues. most has simply soaked into and
stained the tissues.
 Incision shows blood outside the vessels. This Incision shows the blood is still in its vessels
is the most certain test of and if any oozing occurs drops
difference and can be observed even in can be seen issuing from the cut mouths
very small bruises. of the vessels.

Color variegated. This is only true of bruises Color is uniform. The well known change in
that are the same days old due color produced in blood
to the changes in the hemoglobin Extravasated Into living tissues does not
produced during life. occur in dead tissues with the
same regularity.
If the body happens to be constricted at or In a place which would otherwise be the seat of
supported on a bruised place, hypostasis pressure of any
the actual surface of contact may be a little kind even simple support is sufficient to
lighter than the rest of the bruise but will not obliterate the lumen of the venules and
be white. capillaries and so to prevent their filling with
blood.

White lines or patches of pressure

bordered by the dark color of hypostasis are
produced and marks of floggings,
strangulation, etc. are thus sometimes
simulated.
 FACTORS INFLUENCING THE DEGREE AND
EXTENT OF CONTUSSION

• General condition of the patient.

• Part of the body affected.
Fatty tissues, bloody parts > contused easily
Fibrous areas, muscle > less
• Amount of force applied –The greater the force, the
more effusion of blood.
• Disease – Contusion may develop with or without
application of force.
Example: Aplastic anemia, whooping cough
• Age – Children and old age tend to bruise easily.
• Sex – women, obese easily develops unlike boxers.
• Application of heat and cold
Distinction between ante-mortem and post-
mortem contusions in an undecomposed
body is that in ;

• Ante-mortem bruising: there is swelling,

damage to epithelium, extravasation,
coagulation and infiltration of the tissues with
blood

• Post-mortem bruising there are no such

findings.
 a.3
HEMATOMA

• is the extravasation or effusion of blood in

a newly formed cavity underneath the
skin. When the blunt instrument hit a hard
part of the body like a bony part which is
superficially located.

• Force causes the subcutaneous tissue to

rupture on account of the presence of a
hard structure underneath..
 CONTUSION HEMATOMA
The effused blood are Hematoma blood accumulates in a
accumulated in the interstices of newly formed cavity underneath the
the tissues underneath the skin skin.

The skin shows no elevation and if The skin is always elevated.

ever elevated, the elevation is
slight due to inflammatory
changes
Puncture or aspiration with Shows presence of blood and
syringe of the lesion, no blood can subsequent depression of the
be obtained. elevated lesion.

Abscess, gangrene, hypertrophy, fibroid thickening and even

malignancy are potential complications of hematoma.
 MUSCULO-SKELETAL INJURIES
• Sprain - partial or complete disruption in the continuity os
a muscular or ligamentous support of a joint, due to a
blow, kick or torsion force.

• Dislocation – displacement of the articular surface of

bones entering into the formation of a joint.

• Strain – the over-stretching instead of an actual tearing or

the rupture of a muscle or ligament which may not be
associated with the joint.

• Sublaxation – Incomplete or partial dislocation

• Fracture – solution of continuity of bone resulting from
violence or some existing pathology.

a. Close or Simple Fx – no break in continuity of the overlying

skin.
b. Open or Compound Fx – Fx is complicated by an open caused
by the broken bone which protruded with other tissues of the
broken skin.
c. Comminuted Fx – Fractured bone is fragmented into several
pieces.
d. Greenstick Fx – Fx wherein only one side of the bone is
broken while the other is merely bent.
e. Linear Fx – when the Fx forms a crack usually in flat bones.
f. Spiral Fx – break in the bones forms a spiral manner as seen in
long bones.
g. Pathologic Fx – Fx caused by weakness of the bone due to
disease.
 INTERNAL HEMORRHAGE

• Rupture of blood vessels which may cause

hemorrhage due to the following:
• Traumatic intracranial hemorrhage.
• Rupture of parenchymatous organs.
• Laceration of other part of the body.
CEREBRAL CONCUSSION
( COMMOTIO CEREBRI )
• The jarring or stunning of the brain
characterized by more or less complete
suspension of its functions as a result of
injury to the head which leads to some
commotion of the cerebral substance.

• Is severe when the moving or mobile

head struck a fixed hard object as
compared when the head is fixed and
struck by a hard moving object.
CEREBRAL CONCUSSION } Signs and Symptoms
• Unconsciousness which is more or less complete.
• Muscles are relax and flaccid.
• Eyelids are closed and the conjunctivae are insensitive.
• Surface of the body is pale, cold and clammy.
• Respiration is slow and sighing.
• Pulse is rapid, weak, faltering and scarcely perceptible to the
fingers.
• Temperature is subnormal.
• Sphincters are relaxed with unconscious evacuation of the bowel
and bladder.
• Reflexes are present but sluggish and in severe cases may be
absent.
• Loss of memory for events just before the injury is a constant effect
of cerebral concussion and is of medico-legal importance.
2. OPEN WOUNDS
a. Abrasion ( Scratch, graze, impression mark, friction mark )

• it is an injury characterized by the removal of the

superficial epithelial layer of the skin caused by a
rub or friction against a hard rough object.

• Contussion with abrasion = forcible contact

before friction occurs.
• the shape varies and the raw surface exudes
blood and lymph which later dries and forms a
protective covering as SCAB or CRUST.
 Characteristics of abrasion:
• It develops at the precise point of the force causing
it.
• Grossly or with the aid of a hand lens the injury
consists of parallel linear injuries which are in line
with the direction of rub or friction causing it.

• It may exhibit the pattern of the wounding material.

• Usually ignored by attending physician.

• Medico-legal viewpoint
= abrasions caused by fingernails may indicate
struggle or assault and are usually located in the
face, neck, forearms and hands.
Characteristics of abrasion:
= Abrasions resulting from friction on rough
surfaces are located in bony parts and are
usually associated with contusion or
laceration.
= nature of the abrasion may infer degree
of pressure, nature of the rubbing object
and the direction of movement.

• Abrasion heals in a short time and leaves no

scar unless if not infected or if the whole
thickness of the skin is involved.
 Forms of abrasion
• Linear abrasion – appears as a single line, straight or curve.
= pinching with fingernails = curve a.
= sliding the point of a needle = straight linear ab.
Multi-linear – develops when the skin is rubbed on a hard
rough object producing several linear marks parallel to one
another. Example: MVA

• Confluent – linear marks in the skin are almost

indistinguishable on account of the severity of friction and
roughness of the object.

Multiple – several abrasions of varying sizes and shapes may

be found in different parts of the body.
Types of abrasion
.
1 Scratch – caused by sharp pointed object which
slides across the skin, like pin, thorn or fingernail.
- Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of
commencement with tailing at the end.

2. Graze – usually caused by forcible contact with

rough, hard objects resulting to irregular removal of
the skin surface.
= course indicated by a clean commencement and
tags on the end.
3. Impact or imprint abrasion ( patterned abrasion,
stamping abrasion, abrasion a la signature)
those whose pattern and location provides
objective evidence to show cause, nature of the
wounding instrument and the manner of assault or
death.
= marks of grid of radiator, thread marks of wheel,
teeth marks.

4. Pressure or friction abrasion – caused by pressure

accompanied by movement usually observed in
hanging or strangulation.
= spiral strands of the rope as seen in the skin in
hanging.
Differential diagnosis:
1. Dermal erosion - gradual breakdown or very shallow
ulceration of the skin which involves only the epidermis
and heals without scarring.
2. Marks of insects and fishes bites – skin injury is
irregular with no vital reaction and usually found on
angles of the mouth, margins of nose, eyelids and
forehead.
3. Excoriation of the skin by excreta – found in infants
and the skin lesions heals when the cause is removed.
No apparent history of rubbing trauma on the affected
area.

4. Pressure sore – usually found at the back at the region

of bony prominence. History of longstanding illness, bed
ridden.
Parameter ANTEMORTEM POSTMORTEM ABRASION
ABRASION
COLOR Reddish-bronze due to Yellowish and transparent
slight exudation of
blood
LOCATION Any area Over bony prominence
Rough handling of the
cadaver
VITAL With intravital reaction Shows not vital reaction
REACTION may show remains of and is characterized by a
damaged Epithelium separation
of the epidermis from

Complete loss of the

former.
b. Incised wound ( cut, slash, slice)
• produced by a sharp-edged ( cutting) or sharp-linear
edge of the instrument like a knife, razor, bolo, glass etc.
= Impact cut > when there is forcible contact of the
cutting instrument with the body surface.

= Slice cut > when cutting injury is due to the pressure

accompanied with movement of the instrument

= Chopped or Hacked wound > when the wounding

instrument is a heavy cutting instrument like saber
> injury is severe
 Characteristics of
Incised wound:
• Edges are clean cut and the wound is straight
• Usually the wound is shallow near the extremities and deep at
the middle portion.
• Profuse hemorrhage because of the clean cut on the vessels.
• Gaping is usually present due to the retraction of the edges.
• Clothes show a clean cut if cut by the instrument.
• Faster healing if without complications.
• Incised wound made by broken glasses maybe irregular,
needs to be removed.
Changes that occur in an incised wound:

• After 12 hours – edges are swollen, adherent with

blood and with leukocyte infiltration.
• After 24 hours – proliferation of the vascular
endothelium and connective tissue cells.
• After 36 to 48 hours –capillary network complete,
fibroblasts running at right angles to the vessels.
• After 3 to 5 days – vessels show thickening and
obliteration.
 Why a person suffers from incised wound:
As a therapeutic procedure.
As a consequence of self-defense
Masochist may self-inflict incised wounds for self-gratification.
Addicts and mental patients.
Suicidal wounds – usually located in peculiar parts of the body,
accessible to the hand.
the most common site is the wrist, radial artery and the neck.
Homicidal wounds – usually deep, multiple and involves both
accessible and non-accessible parts.
clothing are usually involved
Defense and other forms of wounds are present.
Accidental wounds – multiple incised wounds observed on the
passenger
and driver of MVA due to broken windshields.
kitchen knives in the preparation of food.
 SUICIDAL WOUNDS HOMICIDAL WOUNDS

DIRECTION Oblique from below left ear Usually horizontal below the
downwards across front neck just Adam’s apple
above Adams apple
SEVERITY Usually not so deep may involve Usually deep may cause
trachea, carotid, esophagus involvement bones/cartilage
SUPERFICIAL CUT Usuall present before Practically absent but may
commencement of deeper wd. be pesent when pt.
Struggled when attacked
POSITION OF THE May be sitting or facing a mirror or Usually victim lying on bed
BODY standing or in other place
WOUNDING Firmly grasp, or found near the Weapon absent
WEAPON victim
BLOOD Bld found in front part of body Hand Bld found at the back of
DISTRIBUTION smeared with blood neck, hands clean
MOTIVE Hx of mental depression, Financial, Absence of such history
social prob.,
alcoholism
PREV. HX OF SELF May be present Always absent
DESTRUCTION
 3. STAB
WOUNDS
– is produced by the penetration of a sharp pointed and a
sharp
edged instrument like a knife, scissors.
= If the sharp edge is the one that comes in contact with the
skin
then it is an incised wound.
= If the sharp pointed portion first come in contact, it is a
stab wound.

= Surface length may reflect the width of the wounding

instrument.
= smaller when the wound is not so deep.
= wider if upon withdrawal is not in the same direction as seen
in
slashing movement.
The presence of an abrasion from the extremity of the skin
defect is in line with direction of the slashing movement.
• The extremities of stab wound may show the nature of the
instrument used.

• A doubled bladed weapon shows both extremities to be sharp.

• A single bladed weapon – one of its extremities as rounded and
contused, not seen if instrument is quite thin.
• The direction of the surface defect may be useful in the
determination of the possible relative position of the offender
and the victim when the wound was inflicted.
= As to whether the wound is slit-like or gaping depends on the
direction of the wound to the Langers line.
 The depth of the wound may be
influence by:
• Size and sharpness of the instrument.
• Area of the body involved
• Degree of force applied

• Hemorrhage is always the most serious

consequence of stab wound due to the
severance of blood vessels or involvement of
bloody organs.
 How to describe stab wound:
1. Length of the skin defect – edges must be coaptated first
Tailing – the direction of withdrawal of the wounding weapon.
2. Condition of the extremities
= sharp extremity > sharpness of the instrument used.
= If Both extremity are sharp > double bladed weapon is used.
3. Condition of the edges.
= edges are regular and clean cut> due to one stabbing act.
= serrated or zigzag in appearance > several stabbing wounds
(series of thrust and withdrawal.)

• Linear direction of the wound – it may be running

vertically, horizontally, or upward medially or laterally.
• Location of the stab wound – to include exact
measurement from anatomical landmarks.
• Direction of the penetration – must be tridimentional
• Depth of the penetration
• Tissue and organs involved
Stab wounds may be: A.Suicidal
1. Located over vital parts of the body, usually solitary
2. Located over covered parts of the body, the clothing is not
involved
3. Stab wound is accessible to the hand of the victim
4. Hand of victim is smeared with blood
5. Wounding weapon is firmly grasp by the hand of the victim.
6. If stabbing is accompanied with slashing movement > the
wound tailing abrasion is seen towards the hand inflicting the
injury.
7. Suicide not may be present
8. Presence of a motive for self destruction.
9. No disturbance in the death scene with wounding instrument
found near the victim.
 B. Homicidal
• – stabbing with homicidal intent is the most common

Characteristics:
1. Injuries other than stab wound may be present .
2. Stab wound may be located in any part of the
body.
3. Usually more than one stab wound
4. A motive for stabbing, if none then the offender
either insane/drugs
5. Disturbance in the crime scene
 Medical evidence showing the intent
of the offender to kill the victim:
Medical evidence showing the intent of the offender to
kill the victim:
• there are more than one stab wounds
• stab wounds located in different parts of the body
• stab wounds are deep
• serrated stab wounds means thrust and withdrawal of
the wounding weapon to increase internal damages.
• irregular or stellate shape skin defects> due to
changing direction of the weapon with the portion of
the instrument at the level of the skin as the lever.
 4. PUNCTURED WOUND
- The result of a sharp pointed instrument.
= External injury is quite small but the depth is to
a certain degree.; ice-pick, nail
- Site of external wound can be
easily sealed by dried bld,
serum, or clotted bld.
- Punctured wounds are
usually accidental
 Nature of the external injury in a Punctured wound
depends on the sharpness of the end of the
wounding instrument:
• Contusion of the edges> if end is not sharp
• Opening may be> round, elliptical,
diamond shaped or cruciate.
• External hemorrhage is limited although internal
injuries may be severe.> blood vessels and bloody
organs is fatal if no intervention applied.
Characteristics: Punctured wound
• The opening of the skin is very small, wound is
much deeper than it is wide.
• External hemorrhage is limited than internally
may be severe.
• Sealing of external opening is favorable for the
growth and multiplication of anaerobic organism
like bacillus tetani.

Homicidal -
• Multiple and usually located in different parts of
the body.
• Wound are deep
• There are defense wounds on the victim.
• Signs of struggle in the crime scene.
 Punctured wound : Suicidal
• Located in areas of the body where the vital organs are located.
• Usually singular, if multiple located in one area.
• Parts of body involved is accessible by the hand of the victim.
• Clothing usually not involved.
• Wounding is made while the victim is in sitting or standing
position , bleeding is towards the lower part of the body or
clothing.
• No disturbance in the crime scene.
• Wounding instrument found near the body.

Puncturing wound with puncturing instrument loaded with poison:

• Poison dart – cyanide or nicotine
• Fish spines, dog bites with hydrophobia virus
• Injection of air and poison as a way of euthanasia.
 5.LACERATED WOUNDS ( TEAR,
RUPTURE, STRETCH “PUTOK”)

• Is a tear of the skin and

the underlying tissues
due to forcible contact
with a blunt instrument.
• May be produced by a hit with a piece of wood,
iron bar, fist, stone, butt.
• If the force is applied to a tissue is greater than
its cohesive force and elasticity> the tissue tears
and a laceration is produced.
Characteristic: Lacerated wound
• Shape and size of the injury does not correspond to
the wounding instrument
• Tear on the skin is rugged with extremities irregular,
ill-defined.
• Injury developed where the blunt force is applied.
• Borders of the wound are contused and swollen.
= Developed in areas where the bone is superficially
located like scalp.
= Examination with the aid of hand lens shows bridging
tissue joining the edges and hairs bulbs are intact.
= Bleeding is not extensive due to blood vessels
are not severed evenly.
= Healing process is delayed and has a tendency
to develop a scar.
 Classification of lacerated wounds:
1. Splitting caused by crushing of the skin between two hard objects.
Ex: laceration of scalp hit by a bunt instrument, cut eyebrow - boxer.

2. Overstretching of the skin

When pressure is applied on one side of the bone> the skin over the area will be
stretched up to a breaking point to cause laceration and exposure of the fractured
bone.
In avulsion: the edges of the remaining tissue is that of laceration.

3. Grinding compression
the weight and the grinding movement may cause separation of the skin with the
underlying tissues.

4. Tearing
- this may be produced by a semi-sharped edged instrument which causes
irregular edges on the wound like hatchet and choppers.

Lacerated wounds are rarely suicidal.

 INCISED WOUNDS LACERATED WOUNDS

Edges are clean cut, regular, well Roughly cut, irregular, ill-defined
defined

No contusion or swelling around the swelling and contusion around the

Incised wounds lacerated wounds

Extremities of the wound are sharp, extremities are ill-defined and

may be Round or contused irregular
Examination by means of a hand lens hair bulbs are preserved
Shows that hair bulbs are cut

Healing is faster healing is delayed

Caused by sharp edged instrument caused by a blunt instrument

 GAPING OF WOUND
- Separation of the edges especially in deep wound may be
due to the following:
1. Mechanical stretching or dilatation the presence of a
mechanical device on the edges to prevent coaptation will
cause separation.
Ex: drain in an abscess, retractor during operation.
2. Loss of tissue due to:
a. Destruction due to pressure, inf’tion, cell lysis, burning,
chemical reaction.
b. Avulsion or physical or mechanical stretching resulting
to separation of a portion of the tissue.
c. Trimming of the edges – debridement of the skin which
come in contact with the bullet at the entrance and exit of
GSW and removal of necrotic materials.
3. Retraction of the edges underneath the skin are
dense networks of fibrous and elastic connective
tissue fibers running on the same direction and
forming a pattern more or less present in all persons.
• This pattern of fiber arrangement is called
cleavage direction or lines of cleavage of the skin
and their linear representation on the skin is called
Langers line.
Practical ways of determining how much of the
skin surface is involved in an injury or disease:
• Skin functions as a mechanical protection of the body, storage of water.
• Determination of how much skin is involved is important in the mode of
treatment and prognosis especially in burns, contusion..
• Burns of 70% in children and older age group are fatal.

= Rule of Nine is used. Head and neck 9% 9%

one upper extremity 9% 18%
front chest and abdomen 18% 18%
posterior chest and abdo 18% 18%
one lower extremity front 9% 18%
one lower ext(back) 9% 18%
pudendum 1% 1%
 Factors responsible for the severity of the wound:
1 . Hemorrhage may influence the severity of wound by:
a. loss of blood incompatible with life
- blood constitutes 1/20 of the body weight of an adult.
- 5 to 6 quarts of blood ( one quart is 946 cc)
- loss of 1/10th of its volume will cause no significant change.
- loss of one quart> fainting
- loss of 1/3rd to 2/5th > irreversible shock
- males can withstand more loss of blood than females.
- hypertension causes more excessive and rapid bleeding.

b. Hemorrhage may result in an increase in pressure in or on the vital

organs to affect the normal function.
- intracranial hemorrhage cause compression of the vital centers of
the brain.
- hemopericardium > pericardial tamp
- hemorrhage to the chest> diminution of the respiratory output>anoxia.

c.. Hemorrhage may cause mechanical barriers to the function of organs.

- into tracheo-bronchial lumina> asphyxia
- into muscles > disturbance in their contractility.
 Causes of hemorrhage:
a. Trauma - destruction of its blood vessel wall
b. Natural causes
- intracerebral hemorrhage(apoplexy)> lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage > saccular berry aneurysm
- rupture of arteriosclerotic aneurysm
- rupture of esophageal varices
- pulmonary hemorrhage due to PTB, lung abscess, bronchiectasis
- ruptured ectopic pregnancy

2. Size of injury - burns greater than 1/3rd of the body are fatal

3. Organs involved – usually fatal to heart, brain, lungs.

4. Shock – blow to genitalia, slight burns to young and old.

5. Foreign body or substance introduced into the body - bacterial, viral, foreign
body, chemical,
 TOXIN.
• Snake bites> 2 punctured wds at the center of the reddened affected area. The
venom is injected through its fangs which is connected to the poison gland.

Snake venom toxicity will depend on:

• potency of venom injected
• amount of venom injected by the fang will depend on
- season of the year
- the length of time the snake has eaten.
- if a snake has just killed its prey> toxic content is smaller.
• size of the patient
• immediate treatment instituted.

• Snake venoms are two principal classes:

1. Neurotoxic – primarily paralysis the respiratory and cardiac center of the brain.
- may cause N,V, ascending paralysis, coma, convulsion, c/p arrest

2. Hematoxic - affects particularly the blood

- manifestations are pain, swelling on the affected area, IV hemolysis,
N,V, pulmonary and cardiac edema.
 Emergency treatment may be:
• incision of the wound to promote more external hemorrhage to drain
the venom.
• tourniquette above the site of the wound
• placing ice on the bite site
• sucking the wound to drain venom with the mouth
• administration of anti-snake venom serum.

2. Scorpion venom
- venom has toxic, hemolytic, hemorrhagic
- one punctured wound on the center of a
reddened area
- pain, edema and reddening
3. Coelenterate sting
( jellyfish )
• Tentacles penetrate into the skin and cause explosion
of the nematocyst and liberation of the venom.
- extreme pain. Urticarial rash, dilated pupils,
paleness, labored breathing

• Absence of medical or surgical intervention – wound

may not be fatal but due to neglect or ignorance of its
management, may be serious and fatal.
 FATAL EFFECT OF WOUNDS:
1. Wounds may be directly fatal by reason of:
• Hemorrhage – neck due to carotid bleed.
• Mechanical injuries on vital organs
• Shock

2. Wounds may be indirectly fatal by reason of:

• Secondary hemorrhage following sepsis
• Specific infection
• Scarring effect
• Secondary shock
NATURE OF DEATH DUE TO
SECONDARY CAUSES

• Changes whose natural sequence are direct

& obvious – sepsis, tetanus

• Changes producing separate pathological

lesions which in turn proves to be fatal

Ex: Operation to ligate vessel but died

of peritonitis despite diligence/skill
NATURE OF DEATH DUE TO
SECONDARY CAUSES
• Changes where a definite pathological condition was
present before the injury.
Ex: Person with tumor and stabbed , stab is not capable
of death but accused is responsible for his death.
• Changes where a definite pathological condition of totally
different nature arises after the wounding and the
consequential sequence is doubtful.
Ex: TB meningitis ffg blow to the head
 COMPLICATIONS OF TRAUMA OR INJURY

1. Shock due to injury to nervous system,

anoxemia, endothelial damage
2. Hemorrhage
3. Infection
• from the instrument
• from the organs involved in trauma ex. Bowels injured
• injury may depress general vitality
• deliberate intro of micro-organism
4. Embolism
 HEALING OF WOUNDS
• Power of the human tissue to regenerate – replaced the destroyed tissue
by newly formed similar tissue.
= Regenerates rapidly : C.T., blood forming tissues ,surface epith. skin
= Slow to regenerate: Sm. Muscles, neurons of CNS,
Highly specialized glandular tiss.

1. Time of healing is dependent on:

• Vascularity , Age of person
• Degree of rest or immobilization , Nature of the injury

2.Aberrated healing process:

• Formation of exuberant granulation or proud flesh
• Keloid formation , Stricture
• Fistula or sinus formation
MEDICO-LEGAL INVESTIGATION OF WOUNDS

Rule to follow by a physician:

• All injuries must be described

• Description of wound must be comprehensive,
sketch/photograph
• Examination must be influenced be any other
information obtained from others in making a report
or a conclusion.
Outline of the medico-legal investigation
of physical injuries:
1. General investigation of the surroundings:
• Examination of place where crime is committed.
• Examination of clothing, stains, cuts, hair, f.b. in the crime
scene
• Investigations on possible witnesses to the incident
• Examination of the wounding instrument
• Photography, sketching, accurate description of the crime
scene.

2. Examination of the wounded body

a. Examinations applicable to living or the dead
- Age of the wound from the degree of healing
- Determination of the weapon used
- Reasons for the multiplicity of wounds
- Determination if the wound is accidental, suicidal or
homicidal
b. examination applicable only to the living
- determination if injury is fatal
- determination if injury will produce permanent deformity
- determination if wound produces shock
- determination if wound produces complications

c. examination applicable to a dead victim only

- determination if wound is pre-mortem or post-mortem
- determination whether wound is mortal or not
- determination whether death is accelerated by a disease
present at time of injury.
- determination whether wound cause by A,S, H
 Examinations of wound
- Character of wound : abrasion, hematoma, laceration etc
- Location of wound : from some fixed area > to determine
trajectory/course
- Depth of wound : not in the living , only if the outer and inner
are fixed
Conditions of locality
• Degree of hemorrhage
• Evidence of struggle
• Information as to the position of the body
• Presence of suicide note
• Condition of the weapon
Conditions of the surroundings of the wound -
= Near GSW – burning, tattooing
= Suicidal cuts – superficial tentative cuts or hesitation cuts
= Lacerated wounds – contusion on neighboring skin
- extent of the wound
= Extensive injury – marked degree of force applied in the
production of the wound.
= Homicidal cutthroats are deeper, extensive, numerous than
suicide
- direction of the wound > impt. in the position of the
victim to the offender
 ANTE-MORTEM WOUNDS POST-MORTEM WOUNDS

HEMORRHAGE More profuse, arterial due to loss of tone of vessels, Slight or none, venous
Absence of heart axn
Post-mortem clotting of bld inside b.v.
Marks of spouting of blood from art. No spouting of blood
Clotted blood Bld not clotted,or soft clot
SIGNS OF Inflammation & reparative process, None
INFLAMMATION ,Swelling in the area, Effusion of lymph, pus
Adhesion of the edges Unless if victim is weakened

SIGNS OF REPAIR Fibrin formation growth of epith. No time of repair

Scab or scar formation
RETRACTION OF Deep staining of the edges Not deeply stained can be removed by
THEEDGES OF THE and cellular tissues which is not removed washing
WOUND by washing

Edges gape owing to the reaction of the skin and Edges do not gape, but are closely
muscle fibers approximated to each other unless if
the wound is 1 to 2 hrs after
death
 HOMICIDAL SUICIDAL ACCIDENTAL

ABRASIONS Not common unless Rarely observed Extensive abrasions

if dragged or victim MVA
resisted
CONTUSION Rare except when Found in any
jumping from a portion of the body -
height Fall

INCISED WOUNDS Commonly Commonly Frequent but rarely

observed observed cause of death
Depth, locations Depth, locations
and surroundings and surroundings
Points to consider in the determinat’n as to whether
the wounds is A, S, H.
• External signs and circumstances related to the position
and attitude of the body when found.
• Location of the weapon or the manner in which it was held
• The motive in the commission of the crime
• The personal character of the deceased
• The possibility for the offender to have purposely changed
the truth of the condition.
• Other information
• signs of struggle
• number and direction of wounds
• direction of wound
• nature and extent of the wound
• state of clothing
• LENGTH OF TIME OF SURVIVAL OF THE
VICTIM AFTER INFLICTION OF THE WOUND

• Degree of healing> signs of repair of wound appear

in less than a day after the infliction of injury.
• Changes in the body in relation to the time of death
>systematic changes in the body = wasting, anemia,
bed sore.
• Age of blood stain – not reliable
• Testimony of witness when the wound was inflicted.
 POSSIBLE INSTRUMENTS WHEN USED BY
THE ASSAILANT IN INFLICTING THE INJURIES

• Contusion – blunt
• Incised wound – sharp-edged instrument
• Lacerated wounds- blunt
• Punctured wounds – sharp pointed
• Abrasion – body surface is rubbed on a hard surface
• GSW – the diameter of the wound of entrance may approximate the
caliber of the wounding instrument.
 Could the injury have been
inflicted by a special weapon?
• A physician cant determine that a specific weapon was used in
inflicting a wound.
• It is possible that it is caused by a certain instrument presented.
• He must be cautious in giving categoric statements

• Which of the injuries sustained by the victim caused death?

• If with conspiracy – no need coz the act of one is the act of all.
• If none- offenders are only responsible for their individual acts.

• If multiple injuries: which of the wound injured a vital organ.

• Or if same organ which caused the degree of damage.
Which of the wounds was inflicted first?
• If multiple for the qualification of the offense committed.
• First – treachery , murder
• Last - homicide

Consider:
• relative position of the assailant and the victim when the first
injury was inflicted on the latter.
• trajectory/course of the wound inside the body of the victim
• organs involved and the degree of injury
• testimony of witness
• presence of defense wounds – inflicted first.
 Effect of medical and surgical
intervention on the death:

• If death followed after operation> offender is responsible if

death was inevitable and that even with operation death is
normal and direct consequence of the injury, and the
physician is competent and in spite of exercise of degree
of diligence still death is the outcome.

• If death ensued even the wounds are minor, and death

due to the negligence or incompetence of the physician
then the offender cant be responsible.
 Effect of negligence of the
injured person on the death
• If death occurred from complications arising from a simple injury owing
to the negligence of the injured person in its proper care and treatment
= the offender is responsible for the death
= a person is not bound to submit himself to medical tx for the
injuries received during the assault.
= unless if it is proven that the negligence of the victim is
deliberate so offender is not responsible but only for
physical injuries.

• Power of volitional acts of the victim after receiving a fatal injury:

= dying declaration, attempt to kill the offender after the first blow of
the offender
Relative position of the victim and
assailant when injury was inflicted:
• location of the wound
• direction of the wound
• nature of instrument used in inflicting the injury
• testimony of the witness
EXTRINSIC EVIDENCES OF THE WOUNDS
1. evidences from the wounding weapon
= position of the weapon - near or grasp by victim
= blood on weapon - may be stained with blood
= hair and other substance on weapon
2. evidences in the clothing of the victim
= soaked with blood - hemorrhage
= gunpowder - distance
= tears - struggle
3. evidences derived from the examination of the assailant
= paraffin test, tears in clothing, blood stains, intoxication etc.
PHYSICAL INJURIES IN THE DIFFERENT
PARTS OF THE BODY
1. HEAD AND NECK
= not be underestimated
= bleeding from ears, nose, mouth > basal fractures
= may have normal x-rays yet with severe head injury

Factors influencing the degree and extent of head injuries :

a. nature of the wounding weapon> degree of violence applied depends on the thickness of the scalp
and the weight of the weapon.
b. Intensity if the force > intensity and heavy agent
c. point of impact >extensive in fx of vaults at side or back
d. mobility of the skull at the application of force if head is mobile, free
> effect on the brain is due to the shearing movement imparted to the brain.
> may produce contusion, laceration without fx.

If head is fixed and unsupported> jarring movement of the brain is absent

but the fracture is extensive.
Head injuries are classified as to the site
of the application of force:
1. Direct or Coup injuries
2. Indirect injuries
• contre-coup injuries
• remote injuries – fall hitting buttocks> basal fx
• locus minoris resistencia - injury in areas with less resistance
3. Coup-contre-coup injuries ( direct and indirect injuries)
Wounds in the Scalp:
• it is difficult to prevent the spread of infection
• there is proximity of the scalp to the brain
• there are free vascular connection between the structures inside and
outside the brain
• it is frequently difficult to determine the extent of damage of the skull.

• FRACTURES OF THE SKULL p. 302

GUNSHOT WOUNDS
Death or physical injuries brought about by
powdered propelled substances:
• Firearm shot
• = the injury is caused by the missile
propelled by the explosion of the gunpowder
located in the cartridge shell and the rear of
the missile.

• detonation of high explosives - grenades

= explosion inside the metallic container will
cause fragmentation of the container.
I. FIREARM WOUND
• = Firearm : is an instrument used for the propulsion of a
projectile by the expansive force of gasses coming from the
burning of gunpowder. (technical definition)

= includes rifles, muskets, shotguns, revolvers, pistols,

other deadly weapons which a bullet, ball, shell or
other missile may be discharged by means of
gunpowder or other explosives.

= includes air rifle except of small calibers and limited range.

= the barrel of any firearm shall be considered as a complete firearm for
all purposes thereof.
Penal provisions of laws relative to firearm:
• Sec. 2692 RAC – unlawful manufacture, dealing in
acquisition, disposition or possession of firearms or
ammunitions therefore or instrument used or intended to
be used in the manufacture of firearms or ammunition.

• Sec. 2690 RAC – selling of firearms to unlicensed

purchaser.

• Sec. 2691 RAC - failure of personal representative of

deceased licensee to surrender firearm.

• Art. 155 RPC - Alarms and Scandals

• .Art. 254 RPC – Discharge of firearms
CLASSIFICATION OF SMALL FIREARMS:
Small firearms - are those which propel projectile of less than
1 inch in diameter.
1. As to wounding power:
= low velocity firearm >muzzle velocity of not more than 1400 ft per sec. Ex. Revolver
= high power firearm > muzzle velocity more than 1400 ft. per second > usual is 2200
to 2500 ft per second or more.
2. As to nature of the bore:
= smooth bore weapon >inside portion of the barrel that is perfectly smooth from the
firing chamber to the muzzle. Ex. shotgun
= rifled bore firearm > the bore of the barrel with a number of spiral lands and
grooves which run parallel with one another but twisted spirally from breech to
muzzle. Ex. Military rifle
3. as to manner of firing
= pistol – fired with a single shot Ex. Revolver
= rifle – may be fired from the shoulder Ex. Shotgun

4. As to the nature of the magazine

= cylindrical revolving magazine – the cartridge is
located in a cylindrical magazine which rotates at
the rear portion of the barrel Ex. Revolver

= vertical or horizontal magazine – the cartridge is

held one after another vertically or
horizontally and also held in place by a spring side
to side or end to end. Ex. Automatic pistol
Types of small firearms which are of medico-legal
interest:

• Revolver – usual muzzle velocity is 600 feet per second

• Automatic pistol – self-loading firearm, muzzle velocity of
1200 feet per second
• Rifle - muzzle velocity of 2500 feet per second and a range of
3000 feet.
• Shotgun - projectile is a collection of pellets

A weapon in order to cause injury must have two principal component parts:
1. the cartridge or ammunition - bullet primer, cartridge
case, powder charge
2. firearm – instrument for the propulsion of a projectile
force of gases from a burning powder.
 ENTRANCE WOUND EXIT WOUND

Appears to be smaller than the missile Always bigger than the missile
Owing to the elasticity of the tissue

Edges are inverted Edges are everted

Usually oval or round depending upon the angle of Does not manifest any definite shape
approach of the bullet
Contusion collar or contact ring is present due to Absent
invagination of the skin and spinning of the missile

Tattooing or smudging may be present when Absent

when firing is near
Underlying tissues are not protruding Underlying tissues may be seen
protruding from the wound

Always present after fire May be absent, if missile is

lodged in the body
Paraffin test may be positive Negative
Skin Foreign Body. A bullet from a remote gunshot wound
came to the skin surface of the right posterior chest wall. The
bullet was removed (inset) at the patient’s request. (Photo
contributor: Lawrence B. Stack, MD.)
“Comet-Tailed” Abrasion Collar. The “comet tail” abrasion collar
located on the lateral aspect of the wound indicates that the bullet
entered the wound at an angle. The “comet tail” also indicates the
bullet’s direction of travel: from left to right. (Photo contributor:
William S. Smock, MD.)
ENTRANCE WOUND EXIT WOUND
Exit Gunshot Wound. Stellate tears in an exit wound from a
.22 caliber long rifle bullet that impacted the radius and ulna.
The stellate configuration of an exit wound should not be
confused with that of a contact wound. Exit wounds lack soot
and seared skin. (Photo contributor: William S. Smock, MD.)
Intermediate-Range Gunshot Wound. Punctate abrasions present on
the skin are the result of impact from gunpowder that is either wholly or
partially unburned. This phenomenon is termed tattooing or stippling.
Tattooing is pathognomonic for intermediate-range (less than 48 inch)
gunshot wounds. (Photo contributor: William S. Smock, MD.)
• Photographic representation of the gunshot entrance wounds after application
of an image editing program. The black areas correspond to the abrasion collars
and the yellow areas within reflect the bullet holes. Top row round nose,
middle row flat nose, and bottom row truncated cone
Distant Gunshot Wound. An abrasion collar surrounds the wound defect and is created
from the friction of a bullet passing through the skin. All entrance wounds will have an
abrasion collar with the exception of entrance wounds to the palms and soles. The lack of
soot, seared skin, or gunpowder tattooing confirms this is a “distant” range of fire.
(Photo contributor: William S. Smock, MD.)
INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT
APPROXIMATE THE CALIBER OF THE FIREARM

In distant fire, the rule is that the diameter of the GSW of

entrance is almost the same as the caliber of the wounding
firearm except:
• 1. Factors which make the wound of entrance bigger than the caliber:
• in contact or near fire
• deformity of the bullet which entered
• bullet might have entered the skin sidewise
• acute angular approach of the bullet

• 2. Factors which make the wound of entrance smaller than the caliber
• fragmentation of the bullet before penetrating the skin
• contraction of the elastic tissues of the skin
Other evidences or findings used to
determine entrance of GSW
1. Examination of the clothing, if involved in the course of the
bullet
a. fabric shows punch in destruction
b. particle of gunpowder

2. Examination of the internal injuries caused by the bullet, bone

fragments, cartilage, soft tissues are driven away from entrance
wound destruction of the bone is oval, with sharp edges at the
exit it is irregular, bigger and bevelled

3. Testimony of witness
Determination of the trajectory of the bullet inside the
body of the victim
1. External examination
a. Shape of wound of entrance
= When bullet is fired at right angle with the skin> the wound of entrance is circular
except in case of near fire.
= If fired at another angle , it is oval
= When the bullet is deformed no such characteristics findings will be observed.

b. Shape and distribution of the contusion collar

= Contusion collar is widest at the side of the acute angle of approach of the bullet.
= If the bullet hits the skin perpendicularly> collar will have a uniform width around the
GSW except when bullet is deformed or in near fire.

c. Difference in level between the entrance and exit wounds

d. By probing the wound of entrance – not with too much force

Determination of the trajectory of the bullet inside the
body of the victim

2. Internal examination
a. Actual dissection and tracing the course of the wound at autopsy
b. Fracture of bones and course in visceral organs
c. Location of bone fragments and lead particle
d. X-ray exam

3. Other evidences to show trajectory

a. Relative difference in the vertical location of entrance and exit in the
clothing
b. Relative position and distance of the assailant from the victim in the
reconstruction of re-enactment of the crime.
c. Testimony of witness
EXIT WOUNDS OR OFFSHOOT WOUND
• Does not show characteristic shape unlike the entrance
wound due to the absence of external support beyond
the skin so the bullet tends to tear or shatter the skin.

• Shored GSW of exit: if pressed on a hard object like

when victim is lying:
• Wound of exit is circular or nearly circular with abrasion.

ODD AND EVEN RULE IN GSW

= If the number of entrance and exit wound is even so
presumption that no bullet is lodge in the body.
= Verified by x-ray
Shored Gunshot Exit Wound. A “shored exit” or “false abrasion collar”
associated with a gunshot wound of exit. The false abrasion collar
results when the skin is supported by a firm surface as the bullet exits.
Shored exits occur when epithelium is pressed against a supporting
surface (ie, floor, wall, chair, firm mattress, or, as in this case, wallet).
(Photo contributor: William S. Smock, MD.)
How to determine the number of fires
made by the offender:

• Determination of the number of spent shells

• Determination of entrance wounds in the body of
the victim – number of entrance wounds may not
show the exact number of fire:

• Not all fire made may hit the body of the victim
• The bullet may in the course of its flight hit a hard
object thereby splitting it and each fragment may
produce separate wounds of entrance.
• Bullet may have perforated a part of the body and then
made another wound in some other parts of the body.
 Number of shots heard by the witness
Instances when the number of GSW of entrance is less than the
number of GSW of exit in the body of the victim:

• Instances when the number of GSW of entrance is

less than the number of GSW of exit in the body of
the victim:
• A bullet might have entered the body but split into
several fragments, each of which made separate
exit.
• One of the bullets might have entered a natural
orifice of the body. Ex. nose
• There might be two or more bullets which entered
the body through a common entrance and later
making individual exit wounds .
• 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 GSW of
entrance is more than the number of
GSW of exit in the body of the victim:

1. When one or more of the bullet is 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.
3. when different shots produced different wounds of
entrance but two or more shots produced a common
exit wound.
Instances when there is no GSW of exit
but the bullet is not found in the body
of the victim:

• When the bullet is lodged in the GIT and expelled through

the bowel or lodged in the pharynx and expelled through
the mouth.
• Near fire with a blank cartridge produced a wound of
entrance but no slug may be recovered.
• 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.

• Antemortem GSW
– hemorrhage, swelling, vital reaction.
- microscopically: congestion and leucocytic
infiltration.
Problems confronting Forensic Physician in the
identification of GSW:

• Alteration of the lesion due to natural process:

drying of wound, infection, healing process..
• Medical and surgical intervention: refer to clinical record of pt.
• Embalming
• Problems inherent to the injury itself.
• X-ray exam – migratory, external souvenirs

The effects of the clothing on the movement of the bullet depend

on:
• Number of layers of fabric between the muzzle and subjacent
skin
• Nature of the fabric; closely woven
• Muzzle- clothing distance
 Examination of the external wearing apparel of the
victim of GSW may be significant in investigation
because:

1 1. it may establish the possible range of the fire:

a. Contact fire
= Tear in the clothing covering the skin, fibers turn outward away from body
= Soot deposit, gunpowder tattooing, burning of fibers around the turned
fiber
= Muzzle imprint
= Dirt and greasy deposit may be wipe out and visible in the torn clothing

b. Not contact but near shot

= Same with (a) except for absence of muzzle imprint and beyond flame
range

c. Far fire
= There is a hole tear with inward direction of the thread
2. it may be useful in the determination as to which
is the point of entry and of exit of the bullet.
Entry- the fiber are inverted.

3. it may be useful in locating the bullet

Special consideration on bullets

• souvenir bullet
• bullet migration
• tandem bullet
Contact Gunshot Wound with Muzzle Abrasion. A contact
gunshot wound to the right temple from a 9 mm semiautomatic
handgun. Note the triangle-shaped tears, soot, seared wound
margins and a muzzle-abrasion at the 2-o’clock position. The
muzzle abrasion or muzzle imprint was the result of the
injection of gases into the skin, causing a rapid and forceful
expansion of the skin against the barrel. (Photo contributor:
William S. Smock, MD.)
Close-Range Gunshot Wound. The deposition of
carbonaceous material or soot is seen on the palm from a
close-range or near-contact gunshot wound. Soot is short-
lived evidence and its presence surrounding a wound should
always be documented. (Photo contributor: William S.
Smock, MD.)
Soot and Bullet Wipe. Soot is the carbonaceous residue from the burning of
gunpowder. Soot is associated with close-range wounds, 6 inches or less. Bullet wipe
is residue and/or lead from the surface of the bullet that is transferred to clothing or
skin. Bullet wipe can be seen at any range of fire. Clothing should be collected and
packaged in separate paper bags for submission to the crime laboratory. (Photo
contributor: William S. Smock, MD.)
High-Velocity Gunshot Wound. A perforating high-velocity gunshot wound to a lower
extremity. The gaping exit wound resulted from the transfer of energy from the
projectile to the tibia. The impact propelled multiple bony fragments through the skin.
(Photo contributor: William S. Smock, MD.)
EVIDENCES SHOWING THAT THE
GUNSHOT WOUNDS MAY BE SUICIDAL
• Shot fired in a closed locked room, or open uninhabited
place.
• Death open near the place victim was found
• Shot fired with the muzzle of the gun in contact with the
part of body involved
• Location of entrance wound accessible part of body
• Direction of fire is compatible with the trajectory of bullet
• Personal history may reveal social, economic, business or
marital problem which cannot be solve.
• Gunpowder presence in the hand of the victim
• Entrance wound usually does not contain clothing
• Fingerprints of victim on the butt, shot usually solitary
• No disturbance in the place of death , us. With suicide note
• Russian roulette = unfortunate victim has no
predetermined desire of self-destruction

EVIDENCES THAT GSW IS HOMICIDAL

• site of wound of entrance has no point of

election
• fire is made when the victim is at some
distance
• signs of struggle or defense wounds
• disturbance in the surroundings
• wounding firearm usually not found in the
scene of the crime
• testimony of witness
 EVIDENCES TO SHOW THAT GSW IS
ACCIDENTAL

= Usually one shot

= No special area of body involved
= Consideration on the testimony of the assailant
and determination as to whether it is possible by
knowing the relative position of the victim
= Testimony of the witness
 POINTS TO BE CONSIDERED AND INCLUDED
IN THE REPORT OF THE PHYSICIAN

= Complete description of the wound of

entrance and exit
= Location of the wound; part of body involved,
distance of wound from midline, distance of
wound from heel or buttock.
= Direction and length of the bullet track
= Organs or tissues involved in its course
= Location of the missile, if lodged in the body
= Diagram, photograph, sketch or drawing
showing the location and number of wounds.
QUESTIONS THAT A PHYSICIAN IS EXPECTED
TO ANSWER IN COURT;

= COULD WOUND THE WOUND BE INFLICTED BY

THE WEAPON PRESENTED TO HIM?
= AT WHAT RANGE WAS IT FIRED?
= WHAT WAS THE DIRECTION OF THE FIRE?
= IS IT SELF-INFLICTED?
= ARE THERE SIGNS OF STRUGGLE?
= DID THE VICTIM DIE INSTANTANEOUSLY?
= IS IT POSSIBLE FOR THE VICTIM TO FIRE OR
RESIST THE ATTACK AFTE THE INJURY WAS
SUSTAINED?
= WHERE WAS THE POSTION OF THE ASSAILANT
AND THE VICTIM WHEN THE SHOT WAS FIRED?
The caliber may be inferred from the
diameter of the wound of entrance.
Determination of the length of survival of the victim:
• nature of the GSW
• organs involved
• presence or absence of infection
• amount of blood loss
• physical condition of the patient

Capacity of a victim to perform volitional acts – depends upon the area

of the body involved, involvement of vital organs and the resistance of
the victim.

DETERMINATION AS TO THE LENGTH OF TIME A FIREARM HAD BEEN

FIRED
• odor of the gas inside the barrel
• chemical changes inside the barrel
• evidences that may be deduced from the wound
DETERMINING WHETHER THE WOUNDING WEAPON
IS AN AUTOMATIC PISTOL OR A REVOLVER
Location of the empty shells – revolver the empty shells are
found in the cylindrical magazine chamber after the fire
Nature of the spent shell – automatic firearm = bullet is copper
jacketed
Nature of the base of the cartridge or spent shell = base of a
revolver has a wider diameter than that of the cylindrical body
to keep the cartridge stay in the magazine chamber.

It may be possible for a person who is accustomed to the

sounds of firearms of different calibers to identify the firearm
by the sound produced.

It is not possible to determine the direction of the shot by

determining the direction of the sound except when the flash
or the person firing the shot is seen at the time the shot was
fired.
 GSW may not be a near fire or
may not appear to be near fire:
• When a device is set up to hold the firearm and
to enable it to be discharged at a long range by
the victim.
• When the GSW of entrance does not show
characteristics of a near shot because the
clothing are interposed between the victim and
the firearm.
• When the examining physician failed to
distinguish between a near or far shot wound
• When the product of a near shot has been
washed out of the wound.
 X-ray
• Facilitate the location and extraction of
the wound
• Reveals fragmentation and its location
• Shows bone involvement like fracture
• Reveal trajectory of the bullet
• Shows effect of the bullet wound, like
hemorrhage, escape of air, laceration
SHOTGUN WOUNDS

Is a shoulder fired firearm having a barrel that is

smooth-bored and is intended for the firing of a
changed compound of one or more balls or
pellets.

Measure the distance between the two farthest

shot(pellets) in inches and subtract one, the
number obtained will give the muzzle-target
distance in yards.
• Determination of the presence of
gunpowder and primer components:
Importance:
• Determination of the distance of the gun muzzle
from the victim’s body when fired. Usually not more
than 24 inches when fired.
• Determining whether a person has fired a firearm. –
dorsum of the hand
= metallic residues, burning and unburned
gunpowder
= in suicide found in the palm
Procedures in determining
the presence of gunpowder:
1. Gross examination use of hand
lens
– Fine black powder – not conclusive
2. Microscopic examination
3. Chemical test:
Tests for the Presence of Powder residues
• On the skin – Dorsum of the hand or Wound of
entrance

• Dermal nitrate test ( Paraffin test,

Diphenylamine test, Lung’s test ,Gonzales’
test)
= Melted paraffin heated at 150 degrees fahrenheit –
Lung’s reagent
= Small particles with nitrate or nitrite > blue reaction
= Not conclusive: fertilizers, cosmetics, cigarettes,
urine
= Negative is not conclusive: thorough washing
2. On clothings Walker’s test ( C-acid test,
H-acid test)

= Glossy photographic paper fixed in

hyposolution for 20 min to
• Remove the silver salts and washed for 45
min. and dries.
 Tests for the presence of Primer Components –
metallic primer residues like barium, antimony,
and lead.
1. Harrison and Gilroy test :Cotton swab moistened with 0.1 molar HCl to
gather the primer component.
= Reagent sodium rhodisonate yields red color with the primer
components.
= Add 1.5 HCl to the red area> blue-violet or pink in lead or barium
= lacks specificity, sensitivity

2. Neutron Activation Analysis (NAA)

= Sample obtained by paraffin or by washing with dilute acid
= Extremely sensitive, even with small quantity

3. Flameless Atomic Absorption Spectroscopy (FAAS)

4. Use of Scanning electron microscope with a Linked X-ray analyzer

Thanks for listening…..
Thanks for listening…
OTHER CAUSES OF DEATH

ANTONIO ROQUE R. PARADELA, M.D., FPCS, LlB

Vicente Sotto Memorial Medical Center
Objectives:
The student must be able to know the medico legal
implications and distinguish the different causes and factors
affecting the effects of some forms of stimulus producing
death or physical injuries due to:
a. Explosion, Powder propelled substance.
b. Deviation from normal temperature, lightning and
electricity.
c. Change in the atmospheric pressure.
d. Interference with the process of respiration or reduced
oxygen supply to blood and tissues; asphyxiation,
drowning.
e. Automobile crush, Athletic sports.
THERMAL INJURIES

• Caused by appreciable deviation from

normal temperature
• Produce cellular and tissue changes.
• Thermal death: primarily caused by
thermal injuries
• Exposure to extreme cold→ Frostbite
• Exposure to high temperature→ Burning
or Scalding
Death or Injury from Cold

• Cold
→ vascular spasm
→ anemia of skin surface
→ vascular dilatation with paralysis and
increased capillary permeability

• Prolonged exposure→ necrosis or

gangrene
Death or Injury from Heat

Effects of heat in the body may be

local at the place of its application or
general when the whole body is
affected
Effects of Cold
Classifications of
Heat Injury
General or Systemic Effect

Heat Cramps Heat Exhaustion Heat Stroke

*Is the involuntary spasmodic *Due to a heart failure *This occurs among those
painful muscle contractions due to primarily caused by working in illventilated
dehydration and excessive loss of
heat and precipitated by places with dry and high
chlorides by sweating among
laborers working in rooms with high muscular exertion temperatures or due to a
temperature and with profused direct exposure to
sweating and warm clothing
the sun
Symptoms
Heat Cramps
Symptoms
Heat Exhaustion
Symptoms
Heat Stroke
 Injuries produced by the application to the body by
liquids at or near boiling point, or in its gaseous state
SCALD (HOT LIQUID)
Characteristics of
Scalds
THERMAL BURNS (DRY HEAT)
Caused by heat or chemical substances like fire,
Characteristics of Burns radiant heat, solid substances, friction, electricity.

Lesion varies
- Singeing of the hair and carbon deposits
- Without any demarcation line

THERMAL BURNS (DRY HEAT)

- Burning of clothings
- Death by burning - ID victim, det. ante-
mortem or postmortem burns
Burn Effect: Factors

Heat applied
Exposure duration
Surface extent
Body part involved
Age
Gender
depth
Infection
 Causes of Death in Burns and Scalds

Immediate Fatal Result Delayed Fatal Result

• Death from shock
• Exhaustion.
• Death from concomitant • Dehydration with hemoconcentration.
physical injuries with burns. • Secondary shock.
• Hypothermia.
• Death from suffocation. • Complications:
• Septicemia.
• Pneumonia.
• Nephritis
• Inflammation of serous cavities and internal organs.
• Changes in the blood due to heat
Is Burning the Cause of Death?
Is Burning the Cause of Death?
Is Burning the Cause of Death?

• Proof that death is due to burning:

a. Presence of vital reaction at the heated areas.
b. Presence of carboxyhemoglobin in the blood.
c. Presence of carbon particles in the tracheo-bronchial lumina.

The physician must determine whether:

1. The lesions due to burning are by themselves sufficient to cause death

2. There are evidences of other lesions which may account for the death.
 Investigation of Death in a Conflagration

• Examination of the burnt body should be directed to obtain the

following information:
1. Identity
2. Whether the person was alive in the fire
3. Cause of death
4. Information indicating possible cause of fire

Medico-legal Aspect of Burns and Scalds

Revised Penal Code considers killing of a person by means of fire as Murder.
(Art 248)
 CHEMICAL BURNS (CORROSIVE BURNS)

• Extensive destructions of the tissue

• Healing is quite slow → may require
plastic surgery
• May be followed by Keloid scars
 DEATH OR PHYSICAL INJURY BY
LIGHTNING
POINTS TO BE CONSIDERED IN MAKING A DIAGNOSIS
OF DEATH FROM LIGHTNING
• History of thunderstorm that took place in the locality
• Evidence of effects of lightning are found in the vicinity
• Metallic articles are fused and magnetized
• Fusion of glass materials due to severe heat
• Absence of wound and other injuries indicating suicidal or
homicidal death
• Skin often shows arborescent markings due to superficial
erythema which disappear in a day or two if the person lives
• Burns may be present, but may be limited to the the part under
the pieces of metals such as/watch, knife or bunch of keys
Effects of Lightning
in the Human Body
Postmortem Findings of Lightning
in the Body

Investigation of death due to lightning is NOT by

itself a medico-legal interest
DEATH OR PHYSICAL
INJURY FROM ELECTRICITY
• Main cause of death in electricity is shock.
• Voltage is NOT only the factor causing the injury.
• Amperage or intensity of the electrical current is
the principal factor.
• Ordinary domestic line is from 100-250 V.
• 300 V may be similar to lightning stroke
Factors that affect the conductivity of body
Increase Conductivity Decrease Conductivity
• Moist skin, wet floor, • Dryness of skin, dryness of
barefoot and proximity of floor, presence of rubber
metals boots or shoes
Factors which influence the effect of electrical shock
Personal Idiosyncrasy Density of Current
Disease Resistance of Body
Anticipation of Shock Nature of Current
Sleep Earthing
Electrical voltage or tension Duration of Contact
Amperage or intensity Kind of Electrodes
Point of Entry
Metallization
• Feature in electrical injury
wherein the metal of the
conductor is volatilized and
particles are driven into the
epidermis.
• If the conductor is iron, it is
usually yellow-brown; copper
salts will yield a blue mark
 NATURE OF ELECTRICAL BURNS

Sometimes called electrical

necrosis, electric marks or Medico Legal Aspect Symptoms
current markings. Death by electrocution Surface of the body is
Skin is puckered with gray color is mostly accidental. cold and moistened
and traversed by They are rarely suicidal Breath is stertorous
deep impressions arranged at or homicidal
Pulse is rapid, filiform
right angle and irregular
Marks are painless and show no Pupils are dilated and
vital reaction insensitive
Pale face
DEATH OR PHYSICAL INJURIES DUE TO
CHANGE
OF ATMOSPHERIC PRESSURE (BAROTRAUMA)
• 760 mmHg is the normal
atmospheric pressure

• Goes deep in water =increase of

atmospheric pressure

• Ascends=decrease of
atmospheric pressure
INCREASE OF ATMOSPHERIC PRESSURE
(HYPERBARISM)
• Observed underwater

• Pressure increases as the body of water goes

deeper

• Longer under pressure and deeper, greater gas

saturation,
greater length of time for decompression
EFFECTS OF
INCREASE ATMOSPHERIC PRESSURE

• Nitrogen narcosis
• Pulmonary Edema
• Rupture of blood vessels and
hemorrhage
• Bulging of eardrum inward
and perforation of tympanic
membrane
Diver suffer from:

• Cerebral anoxia
• Muscular cramp
• Physical injury
• Injuries caused by aquatic animals
• Effects of changes of atmospheric
pressure in preexisting
hypertension or coronary affection
During ascent:

• If rapid, suffer from effects of

sudden release of gases from
body fluid
• Interstitial emphysema
• Pneumothorax and
pulmonary emboli
• “Bends”
Post-mortem findings
If death immediate
• SQ emphysema
• Generalized visceral If death after lapse of several
congestion days
• Presence of gas bubbles
• Extravascular bubbles • Degeneration and softening of
white matter of spinal cord
• Hemorrhage in adipose • Fat necrosis of liver
tissue like mesentery • Osteonecrosis
and omentum
 AIRCRAFT INJURIES AND FATALITIES
Causes of Injuries and Fatalities in Aircraft:

During the Flight:

During the Crash:
• Altitude- Hypobarism (Decompression)
• Fracture of the tibia and fibula
• Speed - Spatial disorientation & windblast • Fracture of the femur
• Toxins - Asphyxia • Upper half of the chest
• Temperature • Cranio-facial injuries
At 25,000 feet, 40 degrees below zero -> Death • Rupture of the heart or aorta
due to Frostbite or freezing of the body
• Pre-existing disease: Coronary disease or
hypertension
 HELICOPTER
• Most accidents are due to: structural failure, engine failure ,control
failure
• Other causes (unseen obstacles): fire, weather, error of judgement
• Because of the low speed, accidents do not take place during take off
or landing but during flight
• Injuries: Head and spinal cord
• Crash injuries:
Laceration of the heart due to extreme compression of the chest
Bursting of the heart due to hydrostatic pressure (paper bag pressure)
DEATH BY ASPHYXIA
 General term applied to all forms of violent death which
results primarily from 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

• Anoxic death - failure of the arterial blood to become normally

saturated with oxygen
• Anemic anoxic death- due to a decreased capacity of blood to carry
oxygen
• Stagnant Anoxic Death - brought about by the failure of circulation
• Histotoxic anoxic death - failure of cellular oxidative process.
Cyanide and alcohol are common agents responsible
 Phases of Asphyxial Death:
1. Dyspneic phase - symptoms due to lack of oxygen.
Breathing becomes rapid and deep

2. Convulsive phase - stimulation of the cns by carbon dioxide.

Cyanosis becomes more pronounced and eyes becomes staring
and pupils are dilated

3. Apneic phase - due to paralysis of the respiratory center of the

brain. The breathing shallow and gasping, the rate becomes
slower till death, the heart later fails
 Classification of Asphyxia

1. Hanging
2. Strangulations 3. Suffocation
a. Strangulation by ligature
4. Asphyxia by submersion or drowning
b. Manual strangulation or throttling
5. Asphyxia by pressure on the chest
c. Special forms of strangulations (Traumatic crush asphyxia)
i. Palmar strangulation
6. Asphyxia by irrespirable gases
ii. Garroting
iii. Mugging or yoking
iv. Compression of the neck with stick
ASPHYXIA BY HANGING

• Form of violent death

brought about by
suspension of the body by
a ligature that encircles the
neck

• Victim may be sitting or

lying with face downward
 MECHANISM OF HANGING:
• Ligature around the neck -> fastened to an elevated object ->
suspension of the body -> weight causes the noose to tighten - >
pressure on neck ->

1. constricts air passage -> asphyxia

2. compression on nerves & blood vessels -> cerebral anoxia

• Pressure above larynx = Tongue protrusion

• Pressure below larynx = Tongue is kept
 CLASSIFICATION

• Location of Ligature and Knot

a. Typical b. Atyipical

• Amount of Constricting Force

a. Complete b. Partial

• Symmetry
a. Symmetrical b. Asymmetrical
LIGATURE OF HANGING
 ASPHYXIA BY
HANGING
PRIOR RESCUE
AFTER TIMELY RESCUE
-Gradual loss of sensibilities
-Sensation of constriction of the neck - Whistling sensation inside the ear
-Loss of consciousness and muscular power - Watering of the eyes
-Numbness of the legs and clonic convulsion - Difficulty of breathing and
-Sensation of ringing inside the ear swallowing
-Sensation of flash of light before the eyes - Sensation of numbness of both
-Face becomes red with eyes prominent and feeling legs
of heat in the head
- ALL SYMPTOMS may last for 12
days after rescue
 CAUSE OF DEATH
BY HANGING
CAUSE: MECHANISM
- Simple asphyxia
- Blocking the air passage
- Brain damage
- Congestion of venous blood vessel in
- Syncope the brain
- Spinal cord injury - Lack of arterial blood in the brain due
to pressure on the carotid arteries,
pressure on vagus and carotid sinus
injury
 ASPHYXIA BY HANGING

Time required in the Treatment Differential Diagnosis

process of Death
Time is influenced by: 1. Induce the natural act 1. Fold markings on the neck of
1. Severity of the of respiration an obese individual
Constricting Force 2. Stimulate the heart to 2. Marks of tight neckwear
2. Point of Application of renew action if it
ceases to beat
Ligature
3. Maintain the natural
3. Other factors
body temperature
POST-MORTEM FINDINGS IN DEATH BY HANGING
General External Appearance
a. Neck elongated and stretched with the head inclined on the side opposite
the knot or noose
b. Lips livid or blue
c. Urination or defecation due to the loss of power of sphincter muscles.
d. Eyes closed or partially opened with pupils usually dilated on one side and
small on the other side (facies sympathetic)
e. Saliva dribbled from the mouth with froth
POST-MORTEM FINDINGS IN DEATH BY HANGING
General External Appearance
f. Hands are clenched firmly and purple colored fingernails
g. Lividity or pallor of the face with swelling and protrusion of the tongue
h. Post mortem lividity with ecchymosis are mostly marked at the legs
i. State of erection or semi erection of the penis with seminal fluid in the
urethral meatus
 POST-MORTEM FINDINGS IN DEATH BY HANGING
Internal Findings

a. Engorgement of the lungs

b. Venous system contains dark-colored fluid blood.
c. Kidneys are congested.
d. Blood vessels of the brain is generally congested.
e. Sub-pleural, sub-pericardial punction hemorrhages
f. Right side of the heart and the big blood vessels connected with it
are distended with blood
 POST-MORTEM FINDINGS IN DEATH BY HANGING
Findings on the Neck

a. Neck is flexed opposite the side where the knot is located.

b. Fracture of the hyoid bone or tracheal rings.
c. The lining membrane of the blood vessels may be lacerated.
d. Ecchymosis of the neck depends upon the width and softness of the ligature.
e. Ecchymosis of the neck depends upon the width and softness of the ligature.
f. The skin at the site of the ligature is hard with red line of congestion and
hemorrhage in some points.
g.There may be rapture of the underlying blood vessels, muscles and other soft
tissue
Determination whether hanging
is Ante Mortem or Post Mortem
• The principal criterion is the vital reaction

• Findings that show that hanging is Ante Mortem:

1. Redness or ecchymosis at site of ligature
2. Ecchymosis of the pharynx & epiglottis
3. Line of redness or rupture of the intima of the carotid artery
4. Subplural , subepicardial punctiform hemorrhages
 Determination whether hanging is accidental,
homicidal or suicidal

• Evidence that support hanging as homicidal

1. Nature of windows & doors - whether entrance was forcibly opened
or
have been used as an escape by the offender in homicide case
2. Presence of signs of struggle - furniture & beddings may be disturbed
when there is a previous struggle
3. Presence of stains, bodily injuries in the body of the victim
4. Presence of defense wounds in the body of the victim
5. Evidence that support hanging as homicidal
 Asphyxia by
Strangulation
Strangulation of Ligature
- It is produced by compression of Cause of Death:
the neck by means of ligature
which is tightened by a force - Asphyxia due to occlusion of windpipe
other than the weight of the - Coma due to arrest of cerebral
body
circulation
- Evidences of struggle or marks - Shock or syncope
of violence suggest that - Inhibition of respiratory center due to
homicide is the most common pressure on vagus & sympathetic nerves
motive for strangulation by
ligature.
 Asphyxia by Strangulation
• Homicidal manual strangulation is the most common
• Suicide throttling is impossible
• Manual Strangulation or Throttling
• This is a form of asphyxial death whereby the constricting
force in the neck is the hand
• Manners of Death in Manual Strangling
1. The air passage may be blocked & death is due to asphyxia
2. The pressure of the neck may cause compression of blood
vessels
& disturbs blood supply to the brain
3. The nerves of the neck may be traumatized
 Special forms of Strangulation

• Palmar Strangulation : The palm of the hand of the offender is

pressed in front of the neck without employing the fingers
• Garroting : A ligature, a metal collar or a bowstring is placed around
the neck & tightened at the back
• Mugging (Strangle Hold): This form of strangulation with the
assailant standing at the back & the forearm is applied in front of teh
neck
• Compression of the Neck with a Stick : The victim may be forced to
place his back behind a post
ASPHYXIA BY SUFFOCATION

-Is exclusion of air from the

lungs by closure of air
openings or obstruction of
the air passageway from the
external openings to the air
sacs.
ASPHYXIA BY SUBMERSION OR DROWNING
• 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.
• Average time required for death is 2 to 5 minutes
• Within 24 hours, the body floats
• Where drowning took place, wearing apparel,
wearing apparel, age, sex and body built
COMPRESSION ASPHYXIA( TRAUMATIC OR CRUSH
ASPHYXIA)

Is a form of asphyxia
whereby the free exchange
of air in the lungs is
prevented by the immobility
of the chest and abdomen
due to external pressure or
crush injury.
 ASPHYXIA BY BREATHING
IRRESPIRABLE GASES
CARBON CARBON HYDROGEN HYDROGEN
MO N O X I D E DIOXIDE SULFIDE CYANIDE

- "Silent Killer" From respiration “Sweetish taste One of the most

toxic and rapid
- CO + Hgb =CarboxHgb Cause of death: odor: rotten egg acting gases
Asphyxia due to Dilute solution
- Accidental or
deficiency of oxygen causes irritation
Suicidal death supply to the brain SULFUR
DIOXIDE
Employed as a disinfectant, as a
bleaching agent, a powerful
reducing agent
Essential characteristics of a substance to
be considered as a War gas:
• Must be a substance heavier than air
• Capable of spreading rapidly on the area
• Capable of producing effect even in low concentration
• May be a true gas, smoke, volatilized liquid, or finely divided solid
• Can be manufactured in big quantity in a relatively cheap price
• Must be a stable substance or not easily made non-toxic by rapid
chemical reaction
• Can be stored for an ample length of time and does not react
freely with the container
Classification based on the
Physiological action of War Gases:
DEATH OR PHYSICAL INJURIES DUE TO
AUTOMOTIVE CRASH OR ACCIDENT

A. FACTORS RESPONSIBLE FOR

PASSENGER AND DRIVER INJURY

1. Displacement of the occupants within

the vehicle with Impact against
structures
2. Ejection
3. Distribution of the passengers in the
compartment resulting in direct impact
injuries
Injuries and Death on the Driver and Passenger
B. Front Impact Crash

1. Driver - Injuries include:

- Laceration of the scalp, face or neck

- Skull fractures
- Laceration and fractures of lower
extremities,chest, neck or facial injuries

2. Front Seat Passengers

3. Rear Seat Occupants

Injuries and Death on the Driver and Passenger
C. Side Impact Crash

• May occur when a vehicle strikes the side of another

vehicle or when a vehicle skids sideways into another
fixed object

Injuries are more severe because...

• Side of the car is less rigid

• Less crushable components to absorb impact
• Windows in the side are not laminated and will
shatter into large pieces
Injuries and Death on the Driver and Passenger
D. Rear Impact Crash

• May occur following change of lane in an

express way or crash at the rear of a
parked vehicle the head is
hyperextended and quickly
hyperflexed during this crash, this is
known as“acceleration-deceleration
injury” or “whiplash"
Injuries and Death on the Driver and Passenger
E. Roll Over Crash (Turn-turtle Impact)

• The occupants may be

pinned,crushed or may be thrown
away and fall on the ground

• The passengers usually do not

sustain severe injuries
 Injuries and Death on the Driver and Passenger
F. Ejection
- Primary impact of the vehicle may forcibly open the unlocked door
- May increase further the injury sustained by the occupant

G. Means Employed to Minimize Injury to Driver and Passenger

- Cars are designed to be less hostile to the person, to prevent intruding
into thepassenger
compartment
- Parts of the car made of metal absorb energy thus, dissipating force
- Use of restaraints such as lap and shoulder belt and airbags
Injuries and Death on the Driver and Passenger
• H. Suicidal Crush
• Usually a single vehicle and single occupant crash

I. Homicide by Motor Vehicle

• Usually on account of negligence, rarely intentional
• May be simulated to cover up victim of violent death
PRIMARY IMPACT SECONDARY IMPACT
- First violent contact between the - Subsequent impact of the pedestrian to
pedestrian and the motor vehicle
the ground after the first impact
Severity depends on: - Accounts for the multiple abrasions and
Position of the victim when impact contusions on the body of the pedestrian -
occurred victim
- Speed of the moving vehicle
- Amount of bodily support (clothing,
apparel victim was wearing) - Severity depends on:
Force of the ground impact
- Bumper fracture - fracture of leg bones Nature of the road
as a consequence of the Part of the body involved
primary impact
RUN OVER INJURIES

- If primary impact is above the center of gravity - body's

tendency is to fall on the ground with car wheel passing over
the body

- Pedestrian may be run over by moving vehicle during initial

impact or thereafter

- The following may be seen on autopsy:

Crash fracture
Skin or tire marks
Rupture of organs
Internal hemorrhage
 HIT AND RUN INJURIES
Usually happens:
• When driver is drunk or high
• At night time
• An isolated road with no eyewitnesses or
someone who could note the identity of the vehicle

• The suspected car may be examined for presence of

blood stains, hair, or clothing of the victim to compare
with one of the victim
• If car has been damaged as result of impact
- must investigate motor shops
• Eyewitnesses may be able to take note of plate number
- check LTO for identity of vehicle
EVIDENCES IN VEHICULAR CRUSH
From the scene of the crime
• Area of the road where the collision took place & the point of
collision.
Photographs and sketches must betaken
• Skid marks on the road
• Condition & position of the victim(pedestrian or occupants)
• Condition of vehicles and structures involved
• Any Blood, paint stains, any pieces of clothing that may be found.
• Narrations of witnesses
 EVIDENCES IN VEHICULAR CRUSH

FROM THE DRIVER From the victim in Vehicle-Pedestrian

Collision

• Fitness to drive • Crush Injury

• Alcohol drunkness • Tire thread marks
• Injuries due to • Abrasion marks
second collision • Paint marks
• Blood, Hair or clothings of victim
• Physical defects of the victim
• Inebriation of the victim
 Purposes of Autopsy in Vehicular
Accidents

1. Give opinion as to the position in the vehicle or pattern of injuries

correlated to the point of contact with the vehicle
2. Determine whether death occurred as a result of the crash and not
due to natural disease poisoning, GSW, etc. prior to the crash
3. In cases when >1 member of the family died, examiner can form an
opinion as to who from the among them survived the longest
4. Size of the monetary reward in a civil suit may depend on the nature
and extent of the injuries suffered.
 Motorcycle Crash Injuries
Common Injuries in Motorcycle Crashes
1. Traumatic brain injuries (TBI)
2. Spinal cord injuries
3. Lower-extremity injuries
4. Internal injuries
5. Fractures
6. Road rash

• High Speed
• Lose control
• Head and legs - most common injuries
• Protective apparel - helmet, leather boot,
leather jakcet, thick pants, gloves
Death or Physical
Injuries due to
Athletic Sports
Aspects of Sport Development
Delayed Consequence of Brain Damage
• Known as punch-drunkenness or traumatic or pugilistic
encephalopathy
• Slurred speech, slow clumsy movement, unsteadiness of gait,
tremor, progressive dementia, poor tolerance to alcohol, symptoms
of progressive ventricular dilatation
• May also present with diabetes insipidus and hypothermia
Postmortem Findings

Death after intracranial hemorrhage

1. Generalized edema & compression of the brain

2. Petechial hemorrhage in the white matter
3. Compression of the brainstem
4. Small areas of contusion on the brain surface
5. Capillary congestion with endothelial swelling
6. Swollen and poorly stained axons
7. Astrocytes appear swollen
8. Nerve cells show chromatolysis and vacuolated
cytoplasm
Postmortem Findings

Death after chronic Sequelae

1. Abnormality in the septum pellucidum
2. Cerebellar scarring
3. Small areas of scarring in the cerebellar
tonsil & medulla oblongata
4. Reduction of the brain weight
5. Dilated lateral ventricle w/ thinning of the
corpus callosum
6. Loss of pigmented nerve cells in the
substantia nigra
Boxing TO MINIMIZE INJURIES
- Use effective gum shielding
- Use heavier / well-padded gloves
- Use of preliminary binding of handswith cotton or
ZnO adhesive plaster
- "knocked out" = stop from fighting,thoroughly
examined with an ECG,and suspend license to
participate
- Space between matches = not less than a month
- Blow on genital region = foul
- Stimulants = prohibited
Wrestling
Common injuries
Cervical Spine Injury
Knee Injury
Shoulder Joint / Rotator Cuff Injuries
Facial Injuries and Mat Burns
Abdominal Hemorrhage

TO MINIMIZE INJUIRES
Medical examination before combat
Shaven, hair shorten, no grease orlubricant on the body
Pulling, blows w/ the first, and kicking
= forbidden
Fall on the head or bleeding from the nose
= 5-minutes rest
Thanks for listening!!!
CHILD ABUSE
and
SEX CRIMES
ANTONIO ROQUE R. PARADELA,M.D.,FPCS, LLB
VICENTE SOTTO MEMORIAL MEDICAL CENTER
Objectives:
The student must be able to recognize a physically and
mental injuries or maltreated child and other battered
victims
a. Child and welfare code.
b. Classification of child abuse, causes and inflication.
c. Social reaction to child abuse and neglect.
d. Familiarization of REPUBLIC ACT 7610 and Violence
against Women and Children.
 CHILD ABUSE OR NEGLECTED CHILD
• Physical and mental injury or maltreatment of a child by a person
who's responsible for the child's welfare
• Victim is of tender age, usually less than 3 y.o.

• CAUSES:
1. Unwanted child
2. Abusive parent
3.Child as a center of a triangle
4.Child may be a hindrance to the
socio-economic activities of the parents.
CLASSIFICATION
OF CHILD ABUSERS
• Intermittent Child Abuser: Parents who periodically batter a child
with periods of proper care between battering
• One-time Child Abuser: Parents who manhandle their children for
a time and never repeat the act
• Constant Child Abuser : Parents who actually hates his or her child
and callously and deliberately beats and miscares for it
• Ignorant Abuser: Parents "mean" well, but their attempts at rearing
their children result in a permanent injury or death of their children
MEDICAL EVIDENCE TENDING
TO SHOW INJURIES TO ABUSE
• Skin imprints from forcefully striking objects
• Multiple bruises and/or scars
• Multiple small burns or emersion burn levels
• Multiple fresh healing fractures
• Trauma to the mouth, nose, ears and eyes
• In case of sexual abuse, injuries to the genitalia, peri-rectal and peri-
vaginal
• In case of child neglect, signs of malnourishment, poor hygiene,
• infection, poor growth and development
FACTS TO BE CONSIDERED TO SUSPECT
THAT A CHILD IS A VICTIM OF ABUSE
• Child is emotional, fearful and with a vague history of injury
• Parents present a vague and defensive detail of the child's "illness"
or "injury"
• Too many previous unexplained signs of injuries
• Extended delay in seeking medical cure
• Poor growth and development of the child
SOCIAL REACTION
TO CHILD ABUSE AND NEGLECT
1. REPORT OF MALTREATED OR ABUSED CHILD
• ART. 166, CHILD AND YOUTH WELFARE CODE (P.D. 603)
All hospitals, clinics and other institutions as well as private physicians providing
treatment shall, within 48 hours from knowledge of the case, report in writing to the city
or provincial fiscal or to the Local Council for the Protection of Children or to the nearest
unit of the DSWD (Ministry of Social Service and Development)
• ART. 167, CHILD AND YOUTH WELFARE CODE — FREEDOM FROM
LIABILITY OF THE REPORTING PERSON OR INSTITUTION
Persons, organizations, physicians, nurses, hospitals, clinics and other entities which shall
in good faith report cases of child abuse, neglect, maltreatment or abandonment or
exposure to moral danger shall be free from any civil or criminal liability arising therefrom
2. THE COURT MAY DEPRIVE PARENTS OF THEIR
AUTHORITY OVER THE CHILD OR ADOPT OTHER
MEASURES OR THE WELFARE OF THE CHILD
• ART. 332, CIVIL CODE:
The court may deprive the parents of their authority or suspend the
exercise of the same.

The judge may:

• Warn parents or counsel them;
• Order medical and psychiatric treatment for the child and/or parents;
order the child to be in a protective supervision in a welfare home.
• ALTHOUGH THE PARENTS HAVE THE RIGHT TO CUSTODY OF THEIR
CHILDREN, THE CHILDREN ALSO HAVE THE RIGHT TO LIVE.

3. ESTABLISHMENT OF PUBLIC AND PRIVATE WELFARE INSTITUTIONS

FOR THE CARE OF ABUSED, NEGLECTED, ABANDONED, INFIRMED, OR
OTHER CONDITIONS WHICH REQUIRE AID, SUPPORT, OR TREATMENT.
4. ABUSE, NEGLECT, OR ABANDONMENT OF CHILDREN IS
MADE A CRIMINAL ACT OR OMISSION:
a. If the child dies, then the offender is guilty of parricide: Art. 246,
Revised Penal Code - Parricide
b. If the child did not die but was a victim with physical injuries, the
offender can be charged with frustrated parricide or physical injuries.
c. If the child is abandoned or neglected, the offender can be charged
with abandonment of minors:
(1) Art. 276, Revised Penal Code - Abandoning a minor:
• Abandon a child under 7 years of age: arresto mayor and a fine of < 500 pesos.
• If death results from abandonment: prision correccional in its medium and
maximum periods.
• If life is in danger only: prision correccional in its minimum and medium periods.

(2) Art. 277, Revised Penal Code - Abandonment of minor by person

entrusted with his custody; indifference of parents:
• The person assigned to rear a minor delivers the said minor to public institution
or other person without the consent of the one who entrusted the child.
• Penalty: arresto mayor and a fine of < 500 pesos
Virginity
• A condition of a female who has not experienced sexual intercourse
• And whose genetalia have not been altered by carnal connection
• Virtuous female- if her body is pure and if she has never had any
sexual intercourse with another, though her mind and heart is
impure.
• A woman is presumed to be virgin if she is unmarried and of good
reputation.
Virginity
1.Moral Virginity — The state of not knowing the nature of sexual life
and not having experienced sexual relation.
2. Physical Virginity — A woman is conscious of the nature of the sexual
life but has not experienced sexual intercourse; may be True Physical
Virginity or False Physical Virginity.
3. Demi-Virginity — A condition of a woman who permits any form of
sexual liberties while abstain from rupturing the hymen by sexual act.
4. "Virgo Intacta" — 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.
DEFLORATION
• is the laceration or rupture of the hymen
as a result of sexual intercourse

PARTS EXAMINED:
• Condition of vulva
• Fourchette
• Vaginal Canal
• Hymen
CONDITION OF VULVA
• LABIA MAY GAPE EXPOSING THE INTROITUS

CONSIDERATIONS
• Females may have inherently gaping labia
• Others may preserve the coaptated labia even with previous sexual
act
FOURCHETTE
• RETRACTED, LOSS OF NORMAL V-SHAPE

OTHER CAUSES OF RETRACTION

• Ballet dancing
• Separation of thighs
• Tree climbing
• Cycling
• Horse riding
• Insertion of foreign body
VAGINAL CANAL
DIMINUTION OF THE SHARPNESS, OBLITERATION OF VAGINAL
RUGOSITIES AND LAXITY OF VAGINAL WALL

PREDISPOSING CAUSES OF VULVOVAGINAL INJURIES

• Recent vaginal surgery

• Virginity
• Excessive active involvement of the
• Prepuberty female partner
• Genital disproportion • Multiple sexual act among sex deviates
• Unprepared or un aroused female or multiple consort
• Position during the sexual act • Renewed sexual activity after prolonged
abstinence
• Brutality of the male partner • Post-menopause
. • Uterine retroversion
HYMEN
LACERATED DURING SEXUAL ACT
OTHER CAUSES OF LACERATION MEDICAL EXAMINATION

• Passage of clotted blood during menstruation. General Condition

• Ulceration due to disease Original Shape of the orifice
• Jumping or running
• Falling on hard and sharp object Note the following if lacerated
• Medical instrumentation • Degree of laceration
• Local medication • Location
• Self-scratching due to irritation • Duration
• Masturbation • Complications
• Insertion of foreign bodies
• Previous operation
PHYSIOLOGIC CONSIDERATION:
A. During Sexual Excitement:
1. Local changes: 2. Systematic effects:

• In the male, stimulation will cause • An increase in the pulse rate;

erection of the penis due to active • Marked increased in blood pressure;
dilatation of the arteries through the
nervus origentis. • An increase of peripheral flow of
blood;
• In the female, sexual stimulation will
cause tumescence of the clitoris, • Tomescence (engorgement of blood);
vestibule and labia minora. There is • Increased respiration;
spontaneous vulvar lubrication.
• A decrease in bleeding during arousal;
• A decrease in sensory perception
PHYSIOLOGIC CONSIDERATION:
B. During orgasm:
• In the male, orgasm is the sensation resulting from the contraction of
the smooth muscles of the genitalia and the striated muscles of the
pelvic floor coinciding with ejaculation.
• In the female, during orgasm, there is contraction of the smooth
muscles of the uterus and rhythmic contraction of the vaginal
sphincter, the ischiocavernosus and the pelvic floor musculature.
DEATH RELATED TO SEXUAL ACT
1. Death of the Male Partner:
a. Death from natural cause
b. Death may be due to the defensive act of the woman-victim
2. Death of the Female Partner: usually accidental and not on account
of a natural disease
3. Death of Both Partners:
a. Almost simultaneous death - CO poisoning
b. Homicide - suicide pact
SEX CRIMES
Criminological Characteristics:
1. It is one of the ancient and universal crimes 9. Pardon, forgiveness or marriage between the
2. A close physical contact between the offender and the victim will extinguish the
criminal liability of the offender
offender and the victim
10. A seasonal variation in the frequency of
3. A crime committed by one sex against the
opposite sex commission
11. The severity of punishment does not deter its
4. Sex is an inborn instinct
commission
5. Do not belong to the so called conventional
crimes 12. Occasional consequence (pregnancy) becomes
a legal problem
6. Are committed but not reported; if reported,
13. If the offender is of past middle age, usually
not investigated; if investigated, not
the victims are children
prosecuted
7. It is a crime committed in strict privacy 14. The psychic trauma suffered by the victims of
sex crimes varies with the moral standard of the
8. More frequent among the lower ocio- victim
economic class
RAPE
COMMITTED BY HAVING A CARNAL KNOWLEDGE OF THE
WOMAN UNDER ANY OF THE FOLLOWING:

• BY USING FORCE OR INTIIMIIDATIION

• WHEN THE WOMAN IS DEPRIVED OF THE REASON OR OTHERWIISE
UNCONSCIOUS
• WHEN THE WOMAN IS UNDER 12 Y/O EVEN THOUGH NEITHER OF THE
CIRCUMSTANCES ABOVE SHALL BE PRESENT

• PUNISHMENT: RECLUSION PERPETUA

ELEMENTS OF THE CRIIME OF RAPE:
• OFFENDER: MAN; HAD A CARNAL KNOWLEDGE OF THE WOMAN
• VICTIM:WOMAN

THE CARNAL RELATION MUST BE MADE UNDER ANY OF THE

FOLLOWING:
• USE OF FORCE OR INTIMIDATION
• WOMAN:: DEPRIVED OF HER REASON OR MADE UNCONSCIOUS
• THE WOMAN-VICTIM:: < 12 Y/O
CARNAL KNOWLEDGE
ACT OF THE MAN IN HAVING SEXUAL BODILY CONNECTION TO A WOMAN SLIGHTEST PENETRATION
IN THE SEXUAL ORGAN OF THE FEMALE BY SEXUAL ORGAN OF THE MALE

• RAPE COMMITTED BY EMPLOYMENT OF INTIMIDATION

• RAPE COMMITTED BY DEPRIVING THE VICTIM OF HER REASON OR
OTHERWISE MADE UNCONSCIOUS
• DEPRIVAL OF REASON: COMMITTED TO INSANE OR MENTALLY
DEFICIENT WOMAN, UNDER THE INFLUENCE OF ALCOHOL ,ETC.
• WOMAN IS UNCONSCIOUS OR UNDER 12 YEARS OLD
 EVIDENCE FROM THE EXAMINATION OF ALLEGED EVIDENCE FROM COMPANION OF
VICTIM: OFFENDER THE VICTIM
• DETAILED HISTORY OF RAPE • PHYSICAL DEVELOPMENT, • HISTORY OF THE INCIDENCE,
• CONDITION OF CLOTHING, • MENTAL CONDITION AND EXAMINATION OF CLOTHING
• PHYSICAL AND MENTAL STRENGTH, PHYSICAL • DETERMINE IF HE/SHE IS AN
• DEVELOPMENT, SIGNS OF INJURIES, ACCOMPLICE; MENTAL
VIOLENCE • PUBIC HAIR, GENITAL CONDITION, PHYSICAL
• EXAMINATION OF GENITALIA, INFECTIONS CONDITION POWER AND EMOTIONAL
BREAST OF SEX ORGANS, STATE
• GAIT, FACIAL EXPRESSION, • POTENCY OF THE
• BODILY AND MENTAL OFFENDER
ATTITUDE
EXAMINATION FOR SEMINAL
FLUID AND SPERMATOZOA
The following specimens may be examined for seminal fluid
and spermatozoa:

• Wearing apparel of the victim and of the alleged accused.

• Vaginal smear from the victim.
• Stains on the body of the victim and of the accused .
• Stains found at the site of the commission of the offense .
 EXAMINATION FOR SEMINAL FLUID AND
SPERMATOZOA
• Gross examination
• Micro-Chemical examinations: Florence test, Berberio's test - specific for
spermatic fluid, Puramen reaction, Acid phosphatase test - The semen
produces a very high acid phosphatase activity as compared with other
body fluids (saliva, perspiration, urine, etc.) and common vegetable and
fruit juice stains.
• Microscopic examinations : Hematoxylin & Eosin stain,
Dr. Hankin's method ,Ganguli's method
• Biological examinations: Seminal grouping, Precipitin Test (Biological test of
Farnum): to determine whether the semen is of human origin or not.
OTHER CRIMES AGAINST CHASTITY
• Seduction
• Acts of Lasciviousness
• Abduction
• Adultery
• Concubinage
SEDUCTION The act of a man enticing women to have unlawful
intercourse with him by means of persuasion, solicitation, promises, bribes or
other means without employment of force.
ART. 337. QUALIFIED SEDUCTION
Ordinary qualified seduction
• The offended party must be a virgin
• The offended party must be over 12 but under 18 years of age
• There must be sexual intercourse between the offender and the
offended party
• The sexual act was done through abuse of authority or
confidence
Incestuous qualified seduction
• sexual act between the offender and the offended party
• blood relation between the offender and the offended party
ART. 338. SIMPLE SEDUCTION
• The offended party is over 12 but less than 18 years of age
• The offended party must be single or a widow of good
reputation
• There must be sexual intercourse done by the offender
with her
• The sexual act was committed by means of deceit
ACTS OF LASCIVIOUSNESS Acts which tend to
excite lust, conduct which is wanton, lewd, voluptuous or lewd emotion.

ART. 336. ACTS OF LASCIVIOUSNESS

• The offender commits any acts of lasciviousness
• The lascivious act is done under any of the ff:
a. By using force or intimidation
b. By depriving her of her reasons or otherwise unconscious
• When the woman is <12 years old
• The offended party must be a person of either sex
ART. 339. ACTS OF LASCIVIOUSNESS WITH
THE CONSENT OF THE OFFENDED PARTY
1. The offender commits acts of lasciviousness
2. The offended woman must be over 12 but under 18 years
of age, except when the victim is the sister or descendant of
the offender;
3. The offender commits the act by abuse of authority,
confidence, relationship or deceit;
4. The victim must be a woman, virgin, single, or widow of
good reputation, except when she is the sister or
descendant of the offender where virginity is not required.
ABDUCTION Carrying away of a woman by an abductor with
lewd design which is the intent of the abductor to have sexual intercourse
with the woman abducted.
ART. 342. FORCIBLE ABDUCTION
1. The victim abducted is a woman
2. The abduction is against her will
3. The abduction is with lewd design

ART. 343. CONSENTED ABDUCTION

1. The offended party must be a virgin
2. The offended party must be over 12 but under 18 years old
3. The carrying away of the offended party is with her consent; and
4. The taking away must be with lewd design.
 ADULTERY AND CONCUBINAGE

ART. 333. WHO ARE GUILTY OF ADULTERY

1. The woman is married
2. She has had sexual intercourse with a man not her husband; and
3. The man with whom she had sexual intercourse knows her to be
married even if the marriage has subsequently been declared void.
ART. 334. CONCUBINAGE
1. Keeping a mistress in the conjugal dwelling;
2. Having sexual intercourse, under scandalous circumstances, with a
woman not his wife; or
3. Cohabiting with her in any other place.
PROSTITUTION Prostitutes-women,who for money or profit,
habitually indulge in sexual intercourse or lascivious conduct

MEDICO-LEGAL
REQUIREMENTS REASONS ASPECTS
• 1. She habitually 1. Physiological and 1. Prostitution is one of the
indulges in sexual psychological traits venues in spreading
intercourse or
lascivious acts 2. Economic factors venereal and other
diseases
• 2. When the 3. Home and 2. Evidences may be
habitual sexual neighborhood
intercourse or gathered to prove sexual or
lascivious act is 4. Influence of lascivious acts
done for money or contraceptives
profit
PROSTITUTION
PERSONNEL TYPES OF
TYPES OF PROSTITUTES ASSOCIATED PROSTITUTION HOUSE
1. Call girl-receives 1. Madam/Mama-san-general 1. Disorder house-employs
telephone calls, makes manager of prostitution den only 4 to 8 girls
meeting arrangements 2.Procurer-charged with 2. Furnished room house
2. Hustler getting girls to work as operated
3. Door knocker- prostitutes by experienced
newcomer, frequents 3. Transporter-takes madams, has 2 to 3 girls and
small hotels and also rooms for rent
prostitutes from town to town
furnished rooms 4. Pimp/Bugao-one who gets
3. Call house-merely a place
where a telephone is
4. Factory Girl-works in customers, earns by maintained by a madam
regular house of percentage
prostitution
ABUSE AGAINST CHASTITY
WAYS OF COMMITTING
1. By soliciting or making immoral or indecent advances
to a woman interested in matters pending before the
offending officer for decision or with respect to which he
is required to submit a report to, or consult with a
superior officer
2. By soliciting or making immoral or indecent advances
to a woman under the offender’s custody
3. By soliciting or making immoral or indecent advances
to the wife, daughter or relatives with the same degree
by affinity of any person in custody of the offending
warden or officer
SEXUAL ABNORMALITIES
: AS TO CHOICE OF SEXUAL PARTNER
1.Heterosexual-sexual desire towards the opposite sex
2. Homosexual-sexual desire towards the same sex
3. Infantosexual-sexual desire towards an immature person
4. Bestosexual-sexual desire towards animals
5.Autosexual-a form of “selfabuse” or “solitary vice”
6. Gerontophilia-sexual desire with an elder person
7. Necrophilia-erotic desire or actual sexual intercourse with
a corpse
8. Incest-blood relationship
SEXUAL ABNORMALITIES
• AS TO INSTINCTUAL STRENGTH OF SEXUAL URGE
1. Over sex
2. Under sex (sexual frigidity)
• AS TO MODE OF SEXUAL EXPRESSION
1. Oralism
2. Sado-masochism
3. Fetishism
• AS TO PART OF THE BODY
1. Sodomy-anus
2. Uranism
3. Frottage
4. Partialism
Objectives:
The student should know the legal importance and establlish
the existence of pregnancy and deliver
a. Be familiar with the medical evidence of pregnancy by
laboratory test.
b. Show proof of delivery antemortem and postmortem.
Legal Importance of the Study of
Pregnancy
• Pregnancy is a ground for the suspension of the
execution of the death sentence in a woman.
● A conceived child is capable of receiving
donation.
● A conceived child may exercise civil rights.
● Concealment of the woman that she is pregnant
by another man at the time of marriage is a ground
for annulment of marriage.
Instances why some women claim pregnancy even if
none exist
1. Ground for suspension of the death sentence in a woman
2. Lawful plea in mitigation when charged with theft
3. Ground for widow’s larger claim
4. Claim for the posthumous child
5. For black-mailing purposes or inducing a man to marry her

Instances why some women deny the existence of pregnancy

1. When there is no ground for them to become pregnant
2. Defense when accused of infanticide or abortion
3. Marriage inducement
Signs of Pregnancy in the Dead
1.) Presence of Ovum or Fetus:
• Examination of the uterine content will reveal the product of
conception together with the placenta, amniotic fluid and membrane.
2.) Findings on the Uterus itself:
• There is thickening, an increase in size and capacity of the uterus.
The mark of placental attachment may be seen.
3.) Corpus Luteum
• May be well developed and attains a certain size, however, it may
gradually retrogress, but is usually developed at the time of delivery.
The changes in the corpus luteum may also be found in fibroid
tumors or other pathological conditions and even in cases of
congestion.
Duration of Pregnancy
• Average duration is 270 to 280 days from the last onset of the
last menstruation.
• There is no means of determining it with certainty.
• There is no synchrony between coitus and fertilization

Abnormally Prolonged Gestation

• Sex cases which has been accepted as authentic in which the
calculated period of gestation lay between 311 and 336 days,
the weights of the infant ranging from 12-¾ to 13-¼ pounds.
• In all cases where gestation much over 300 days is alleged,
confirmatory evidence should be expected in the exceptional
weight and size of the child.
In Period of Gestation Compatible with Viability of Child

• A child born at 180 days of gestation may live. A child may be

born alive before this period, but it is not viable or capable of
living.
• A fetus of 3-4 months development may exhibit signs of life,
movements of the limbs, etc. but cannot continue to live, owing
to the want of development of the breathing muscles and
breathing center.
• Most 6 months old infants die immediately or within a few days
of birth: occasionally one has been reared.
Methods of Estimating the Date of Expected Delivery

1.) From the date of the 1st day of the last menstruation, add 7 days
and count 3 months backward.
2.) Count forward 9 calendar months from the date of the first day of
the last menstruation and add 1 week.
3.) Count 40 weeks or ten lunar months from the date of the first day
of the last menstruation.
4.) Determination of the level of the fundus of the uterus.
5.) MacDonald Method - Measure the distance from the symphysis
pubis up to the fundus of the uterus in centimeters divided by 3.5
gives the age in month of gestation.
6.) Date of the quickening : It is customary to count ahead 24 weeks in
multi gravidas and 22 weeks in primigravidas from the date of the
quickening.
- This has been found not to be reliable.
Proofs of Previous Pregnancy
• Laxity of the abdominal wall
• Presence of striae of pregnancy on the abdominal
wall
• Perineum is lax with a scar if there was previous
laceration. Fourchette is markedly retracted
• Vestige only of the hymen is present
• Breast is lax with enlarged nipples
• Vaginal examination shows previous laceration of
the cervix
• SUPERFECUNDATION, SUPERFOETATION,
PSEUDOCYESIS or SPURIOUS PREGNANCY
Diagnosis of Fetal Death
• Repeated examinations of the uterus show that the size remains
stationary even after a lapse of a number of weeks and months
• Endocrine test for pregnancy is negative on more than one
occasion
• Cessation of fetal movement after they have been felt
• Absence of fetal heart sounds after repeated and prolonged
examination
• Palpation of softened macerated fetal head with bones freely
movable on each other and the scalp hanging over a loose sac
• Breasts cease to be enlarged and become soft and flabby
● May a Woman Who Is Pregnant Be Unconscious of Her Condition?
• It may happen in rare instances. A woman who has dismissed in her
mind the possibility of being pregnant may grow stouter or may
entertain the possibility that the enlargement of the abdomen is due
to some internal pathology or disease.
● Is It Possible for a Child to be Born Without Human Form?
• Following the principles of heredity, no child can be born without
human form. Monstrosities and other forms of abnormalities of a
child does not divorce from the child the human form.
● Can Impregnation Occur When the Woman Is Unconscious?
• This has been proven in many cases. A woman may be under the
influence of narcotics, anesthesia, alcohol or other knock-out drugs
during the sexual intercourse which resulted in pregnancy.
● When Does Menstruation Commence?
• In the Philippines - used to commence at the age of· twelve to
fourteen. In colder countries - may be established at the age of
fourteen to sixteen.
● When Does Menstruation Cease?
• The average age when menstruation ceases is forty-five. There are
records in literature wherein women menstruate at the age of
seventy-three. The cessation of menstruation is also called
climacterium or menopause.
● What Is The Earliest Age When Pregnancy Is Possible?
• As long as the woman is menstruating, she has also the potential
capability of being pregnant. Some women have preconscious sexual
development.
 Methods of Delivery:
DELIVERY ● Natural Route
Importance: ○ Spontaneous
• Legitimacy ○ Surgical Intervention
○ Instrumentation
• Abortion
● Surgical Route
• Infanticide ○ Abdominal CS section
• Concealment of birth ○ Vaginal CS section
• In slander or libel ○ Post-mortem CS section
Signs of Recent Delivery
• Languid look, with pulse and • Laxity of the perineum with
temperature slightly increase possible tear
• Peculiar odor • Vaginal canal is lax with possible
• Changes in the breast lacerations
• Flaccidity of the abdominal wall • Cervix on the uterus is flabby,
patulous and may be torn
• Linea Albicantes present in the
abdominal wall • Presence of lochial discharge
• Presence of Linea Nigra • Evidence of placenta, umbilical
cord and new-born child
• Uterus is enlarged and palpable
• Positive Pregnancy Slide Test
Signs of Remote Delivery in the Living
Post Mortem Findings in a woman who died
Recently after delivery
1. Findings in the uterus 3. Findings in the other organs
• Laceration of the cervix • Hydremia of blood
• Enlarged and flabby uterus • Slight anemia
• Bloody and rugged inner surface • Hypertrophy of the milk glands
• Dark color sloughy and gangrenous
sinuses 4. Pathology accountable for the cause
• Increase thickness of uterine wall • Eclampsia
• Endometritis, peritonitis, etc cardiac,
2. Findings in the ovary renal, pulmonary affection
• Presence of corpus luteum • Rupture of uterus
• Severe loss of blood
ABORTION, BIRTH & INFANTICIDE

• Abortion :as the expulsion of the contents of a gravid

uterus anytime before full term while others consider it
as the forcible expulsion of the product of conception
anytime before the age of viabiiity.

• Viability : is the point at which the fetus is "potentially

able to live outside the mother's womb", albeit with
respiratory aid. Later on, as when it is capable of
meaningful life outside the mother's womb
In the legal viewpoint, Abortion:
• The willful killing of the fetus in the uterus, or violent
expulsion of the fetus from the maternal womb and which
results to the death of the fetus.
• As long as the fetus dies as a result of violence used or of
the drug administered, the crime of abortion exists, even if
the fetus is full term.

The principal elements of the crime:

1. That the expulsion of the product of conception is induced.
2. That the fetus dies either as an effect of the violence used,
drug administered or the fetus was expelled before the term of its
viability.
An embryo at 6-8 weeks, as seen at a clinic in
Montgomery, Alabama.
Anti-abortion activists say this is a human,
while doctors and scientists show it is cells
before they have grown.
CLINICAL TYPES OF ABORTION

Missed Abortion :
• An ovum destroyed by hemorrhage into the choriospace,
usually before the fourth month of pregnancy.
• The hemorrhage takes place from maternal sinuses into
the decidua.
• Usually followed by the death with maceration or
absorption of the product of the conception.
CLINICAL TYPES OF ABORTION
Threatened Abortion:
• Hemorrhage without dilatation of the internal os.
• Hemorrhage in early stage of pregnancy may be due to
causes other than a threatened abortion e.g., ectopic
pregnancy, cervical polyp, extensive erosion of the
cervix, et

Complete Abortion
• The whole product of conception is expelled
CLINICAL TYPES OF ABORTION

Inevitable Abortion
• Hemorrhage with dilatation of the internal os and
presence of rhythmical pain.
• It may end by spontaneous expulsion of the
product of conception or may require medical
intervention.
• Hemorrhage and infection are the potential
complications.
CLINICAL TYPES OF ABORTION
Incomplete Abortion
• Hemorrhage without dilatation of the internal os.
• Hemorrhage in early stage of pregnancy may be
due to causes other thana threatened abortion
e.g., ectopic pregnancy, cervical polyp, extensive
erosion of the cervix, etc.
Causes of Abortion
• Death of the fetus:
• Congenital abnormality
• Poisoning by minerals (Lead)
• Disease of the decidua, chorion, placenta, amnion
• Abnormality of the uterus
• Emotional condition: Fright, grief and anger
• Abortifacient drugs: Ergot, purgatives
• Trauma - Direct or indirect
• Hormonal deficiency
• Acute specific fever and high temperature
 Kinds of abortion
Spontaneous or Natural Abortion: Abortion which occurs
without any form of inducement or intervention.

Induced Abortion:
• Abortion which will not take place had it not been for
some form of inducement or intervention.
• Induced abortion may be:
a. Therapeutic Abortion
• Purposely done to preserve the life of the mother
b. Criminal Abortion
• Done without any therapeutic indication but with
criminal intent
• Punishable by law
HOW ABORTION IS PROCURED OR
INDUCED
1. General Violence
• Includes Intentional violence, as exerting strong physical efforts
on strenuous and exhaustive exercises
2. Means of Local Violence
• This is usually resorted to when general violence and the use of
drugs fail to give the desired result.
• May be applied by the pregnant woman herself, physician,
midwife, or parents.
3. Use of Drugs
How abortion is procured or induced
3.Drugs commonly used for abortion
Direct action to uterus
• Emmenagogues- increase menstrual flow maybe due to its
direct effect on the uterus or its indirect effect which increases
bodily tone.

Types of Emmenagogues
a. Direct Emmenagogues
• Act directly on uterus or on nervous system in close relation to it.
• Ergot, Potassium permanganate

b. Indirect Emmenagogues
• Promote and build the health of the person
• Tonic- iron, arsenic, strychnine
• Hematinics- iron, copper, liver extracts
• Purgative- magnesium sulfate and castor oil
How abortion is procured or induced
3. Drugs commonly used for abortion
ii. Direct action to uterus

• Ecbolics - cause death or expulsion of the product of conception by

stimulation of the uterine muscles . E.g. Ergot, Quinine, Pituitary extract,
Lead and Mercury

Drugs acting reflexly through the genito-urinary tract:

• Produce irritation of GUT and reflexly incite uterine contraction.
• Large dosage may cause severe inflammatory changes in the kidney and
may cause uremia.
• Diuretics may also cause mild reflex contraction of the uterus : e.g. Oil of
Pennyroyal, Oil of Tamsy, and Oil of Turpentine
• 3. Drugs commonly used for abortion

Drugs acting reflexly through the gastrointestinal tract

• May cause uterine contraction due to its reflex action.
• e.g. Castor oil, Magnesium sulfate, Croton oil, Gamboge, Aloes,
Elatrium
Drugs having poisonous effects in the whole body
• Manner of action is not localized in certain tissues/organs but in
the whole body.
• To this group are the animal, vegetable and mineral irritant
poisons.
4. By Surgical Intervention
Application or use of instrument by gynecologist or surgeon
a. Dilatation and Curettage
b. Surgical abdominal route (hysterolaparotomy)

5. Modern methods of procuring of inducing abortion

a. Amniocentesis - Intrauterine injection of hypertonic saline or glucose
solution (20% saline or 50% glucose). Needle is inserted in the abdominal
wall or vaginal route. Method is applied when pregnancy is beyond 2
months. Expulsion of uterine content usually occur 24-48 hrs after injection.
b. Vacuum suction (aka menstrual regulation) may be applied through the
cervix. The suction apparatus will create a negative pressure of 0.4-0.6 kg
per cm sufficient to detach and break up the products of conception.
Procedure applied 12-14 weeks of pregnancy.
Medical evidences of abortion
Medical Evidences of Abortion in the Living:
A. Presence of external signs of violence in the form of
contusions, abrasions, hematoma, open wounds of whatever
form if induced by general violence. If violence is applied locally
in the generative tract, injuries of whatever form may be seen.
B. Examination of the Generative tract:
1. Appearance of the external genitalia and vagina may show
laceration, contusion, abrasions and other marks of
instrumentation
2. Examine the external os for softness, tear, and discharge
3. Note the size of the uterus, its consistency, and location
C. Examination of the instrument used for the presence of blood,
placental tissue or fetal parts.

D. History-note state of health before abortion. Inquire motive and

history of having ingested or injected with abortives.

E. Signs of previous pregnancy:

1. Condition of the breasts
2. Laxity of the abdominal wall
3. Paleness of integument
4. General body weakness
5. Presence of characteristic lochial discharge and odor
6. Palpability of the uterus and laceration of the cervix and perineum
F. Examination of the expelled product of conception
1. Blood examination for maternity and paternity
2. Marks of instrumentation
3. Signs of physical violence
4. Proof of viability or non viability of the fetus
5. Presence of abortives and other toxic materials in the fetal blood
6. Presence or absence of malformation
7. Completeness of placenta
8. Other identifying marks

G. Laboratory test for pregnancy

H. Testimony of the physician who completed the abortion or of
other persons who witnessed the criminal act.
Medical evidences of abortion in the dead
The following may be observed in autopsy:
A. Evidence of instrumentation - punctured wounds in placenta,
remnants of placenta inside, presence of perforation of uterus
B. Examination of the stomach and its contents - abortifacent
drugs and other irritants may be found inside stomach. It is
advisable to subject whole stomach and contents for chemical
examination
C. Examination of the kidneys and other organs for irritants -
kidneys, liver, spleen must be subjected to qualitative and
quantitative chemical examination for presence of irritant poisons
The following may be observed in autopsy:
D. Examination of uterine contents- remnant of the product of
conception for the ff:
1. Infection
2. Stage of pregnancy
3. Other complication of abortion
E. Biological test
1. Paternity test
2. Test for pregnancy
F. Examination of some untoward effects of abortion:
1. Infection, toxemia, or bacteremia
2. Embolism
3. Fistulae formation
4. Pelvic adhesions
Therapeutic abortion is an abortion which tlie law allows
under some specific justifications.

Art. 11, No. 4, Revised Penal Code

• Any person who, in order to avoid an evil or injury, does an act which causes
damage to another, provided that the following requisites are present:
• That the evil sought to be avoided actually exists
• That the injury feared be greater than that done to avoid It
• That there be no other practical and less harmful means of preventing it
• In the performance of an abortion, two lives are involved, namely, the life of the
mother and the life of the fetus. One life must be sacrificed to save the life of
another in case of therapeutic abortion.
• If both lives can be saved in accordance with the present state of. medical
science, then there is no justification to such abortion, . hence the physician must
be criminally -liable.
• A physician in performing a therapeutic abortion is doing an act to save the life or
to preserve the .health of the mother. In so doing, . damage is done to the
conceived child. The child is deprived of its future existence.
Grounds for therapeutic abortion
The following conditions have been considered by some authorities to be a
justifiable ground· for therapeutic abortion:
• Cardio - vascular conditions as congestive heart failure, auricular
fibrillations, repeated hemoptysis, paroxysmal tachycardia.
• Renal conditions as chronic nephritis, previous eclampsia, p-yelitis,
tuberculosis.
• Pulmonary· conditions as advanced tuberculosis.
• Blood condition as severe anemia
• Gynecological conditions as refractory chorea gravidarum
• Organic nervous conditions as psychosis
• Miscellaneous conditions. as diabetes, exophthalmic goiter
• Hereditary conditions as insanity
Safeguards to be observed by physician in
performing therapeutic abortion
• The lawful abortion must be performed by a licensed physician or surgeon.
• Abortion in order to be justifiable must be performed to save the life or to
preserve the health of the mother. But modern advancement of medical
science has reduced the number of diseases which will endanger life and
health if pregnancy is allowed to progress to full term. A physician must
exercise due diligence in considering a disease or a combination of
diseases or conditions as grounds for the therapeutic abortion.
• Abortion must be performed openly in a hospital to avoid suspicion that it
was done for some cause other than to save the life of the mother.
• It is advisable to have the opinion of other competent physicians as to the
justifiability of such therapeutic abortion. The opinion of one might be
influenced by prejudice and misjudgment.
• Enlightened and expressed consent must be obtained from the woman
herself if she has no impediment to give consent. It is advisable to have
also the consent of the husband, inasmuch as abortion will affect marital
relationship.
Reasons why it is difficult to prosecute
physicians committing the crime of abortion
• The crime is performed clandestinely by an intelligent being who is
fully aware of his criminal act
• The physician has several medical reasons to justify his act. There is
no hard and fast rule in medicine. He may claim that there is medical
justification to such abortion because the woman is suffering from a
disease which might imperil her life if pregnancy. will be allowed to
progress to full term.
• In most cases, the products of conception removed which may be
utilized as corpus delicti in the crime is lost
• The pregnant woman herself is in connivance with the physician and
it is quite difficult. to let her testify truthfully as to the actual
happening. She, herself, is in pari delicto to the crime of criminal
abortion.
• Medical society seems to have a lukewarm attitude in helping the
state prosecute the abortionist
Pros and cons – restrictive abortion law
Reasons for Liberal Abortion Law
• A strict anti-abortion law is violative of the right of privacy of a
person. The right of privacy means the right of-the individual to
the possession and control of his own person free from all
restraints or interference of others. A woman should have the
right to decide whether or not to bear children and that this right
includes the right to have an abortion
Modern advances in medical diagnostic procedures
• Can determine whether a developing fetus inside the uterus is
suffering from physical abnormalities.
• Allowing such product of conception to reach full term will cause
sufferings on the part of the parents and an overburdened
social welfare institution of the government. er.
Pros and cons – restrictive abortion law
Reason Justifying Restrictive Abortion Law:
• From the moment of conception life begins to start and destruction of
the growing product of conception will be contrary to the law of
mankind.
• This is in line with the philosophy that God created man and only
God cari destroy it

Reasons for Liberal Abortion Law:

• Where abortion is illegal, it favors the rich people. In the Philippines,
the draconian and restrictive abortion law has been accompanied in
the recent years by non-prosecution, either of the woman or of the
abortionists
• Statistics has shown that children born as a consequence of denied
abortion to terminate unwanted pregnancy ere mentally and
physically impaired.
Religious consideration of abortion
• As a general rule, all induced abortion are considered
sinful, illicit and against the tenets of the Catholic Church
even it sanctioned by law. The principal basis is that every
human being, even the child in the mother's womb, has the
right of existence directly from God and that no human
being has the right to destroy it.
• A conceived child has the right of existence as that of the
mother.
• However; the Catholic Church classified abortion into two
main categories for the purpose of determining whether it
may be allowable or not:
Direct Abortion
• Deliberate expulsion of the product of conception. This is never
permitted by the Catholic Church even if the purpose is to save
the life of the mother
Indirect Abortion
• When the expulsion of the product of conception is not the
primary objective of an operation to save the life of the mother,
but merely incidental or unavoidable to an operation.
• Among the Jews, destruction of the fetus for the purpose of
saving the life of the mother is not only permissible but
obligatory. To the Protestants, abortion is generally considered
sinful.
BIRTH delivery of a child with or without
separation from the mother
• Legal importance of the study of Birth:
• Birth determines personality
Article 40 Civil Code
• Birth determines personality; but the conceived child shall be
considered born for all purposes that are favorable to it, provided it
be born later with the conditions specified in the following article.
Article 41, Civil Code
• Fetus is considered born if it is alive at the time it is completely
delivered from the mother's womb
• If the fetus had an intrauterine life of less than seven months, it is not
deemed born if it dies within twenty-four hours after its complete
delivery from the maternal womb.
Article 760, Civil Code : Revocation of donation
• Every donation inter vivos, made by a person having no children
or descendants, legitimate or legitimated by subsequent marriage,
or illegitimate, may be revoked or reduced as provided in the next
article, by the happening of any of these events:
(1) If the donor, after the donation, should have legitimate or
legitimated or illegitimate children, even though they be
posthumous;
Proof of live-birth must first be shown before the death of the child
by the prosecution in case of infanticide

Article 255 RPC (Infanticide)

Penalty provided for parricide and for murder shall be imposed to
anyone who shall kill any child less than three days old.
STILLBIRTH when child has not breathed or has not
shown any sign of life after being completely born
• Immaturity Local disease of generative organ
• Congenital diseases / malformation • Syphilis
• Intra-placental hemorrhage
• General debilitating diseases • Extensive infarction
1. Acute specific infection • Ablatio placenta
2. Acute liver disease • Kind of the cord
3. Kidney disease • Placenta previa
4. Toxemia
5. Septicemia Accidents in the delivery
• Disproportion of birth canal
• Violence (deliberate or accidental • Injudicious forcep application
at birth)
 LIVE-BIRTH

• "In live birth the Presence of Respiration are

child after birth • Proof of Heart Action indicated by:
exhibited clear signs and Circulation:
of vitality and • Presence of fetal heart a. Arching of chest
viability is not sound when newborn is
necessary" examined with stet.
b. Fall of the level of the
• "To have a child • Movement of the Child diaphragm (test is not
acquire personality and Crying:
conclusive, but merely
distinct as that of the • First instinct of child corroborative)
mother, there must after birth is
be proof of life after restlessness and crying Before birth: diaphragm is at
complete separation 4th/5th rib → reaches to
from the mother's 6th/7th rib at respiration
womb"
c. Expansion of lungs
 c. Expansion of lungs
Appearance of lungs if Appearance of lungs before
respiration has taken place respiration has taken place
• Lungs fill thoracic cavity and is • Found at the back of the
overlapping the heart and thoracic cavity behind heart and
thymus gland thymus gland
• Surface covered with mosaic of • Small, smooth, uniform dark
expanded air vesicles (marble blue-red color, with sharp
appearance) edges, looks like a piece of liver
• On pressure, they crepitate • Do not crepitate when squeezed
• Voluminous, with rounded between finger and thumb
edges and pink mottled color • On section they appear solid
• On section they exude froth and exude blood
Hydrostatic Test (Fodere’s Hydrostatic Test (Fodere’s Test)
Test; Static Test) Procedure of the Test
1. Remove the entire-lungs from
• A test to determine whether the thoracic cavity and immerse them
respiration took place on a in water en bloc
newborn child before death • If it floats- (+) the child has
• Based on the principle that breathed;
the specific gravity of the • If it sinks- (-) breathing has not
lungs becomes less as a taken place
result of:
• introduction of air in the air 2. The lung is cut in small pieces and
passages and air sacs again placed in water
• If it floats- air has entered into the
air sacs
Hydrostatic Test
• Value of the test : Is not conclusive that respiration took place when it is
positive (when lung floats) or negative (when lungs did not float)

Fallacies of the Hydrostatic Test

• Unexpanded lung may float if the child is subjected to artificial
respiration or if gases due to putrefaction are present, even if the child is
born dead
• The child may have respired or breathed before it is completely born if the
head is at the external os, or if the head protrudes on the outlet in head
presentation, but dead at birth
• The child may have breathed, but the lungs may not float on account of
disease (atelectasis), or from imperfect respiration, or on absolute
persistency of fetal condition
• The child may utter audible cry while inside the uterus or in the vagina.
• In cases of vagitus uterinus, the child is usually born dead but the lungs
are perfectly expanded
Naturally expanded lung : the level of the diaphragm reached
the level of the 6th or 7th rib,
Artificially expanded lung : may reach only the 5th rib

To differentiate whether the floating of the lungs is due to

putrefaction; note the color, consistency and condition of
the bubbles
• Putrefaction: the lung is green, soft with bubbles at edges
• Naturally expanded: bright vermillion in color, mottled
appearance, bright-red alternating with bluish patches with air
cells on surface in groups of four
When is Hydrostatic Test Not
Necessary
• When the fetus is born less than 180 days of
intrauterine life is a monster which is not capable of
living a separate existence shows signs of
intrauterine maceration umbilical cord is separated
and the umbilicus is cicatrized stomach on
dissection contains coagulated or half coagulated
milk as a result of digestion
 when child has not breathed or has not shown any sign
LIVEBIRTH of life after being completely born

• Proof of live birth are:

Examination of the Stomach and Intestine
• It contains only mucous, but after respiration, the stomach will
contain mucous, air bubbles and saliva.
Changes in the Middle Ear
• the middle ear of a child before birth is filled with gela- tinuous,
embryonic connective tissue. This disappears after the birth of the
child.
Condition of the skin
• The skin of a newly born infant is bright red in color. This gradually
changed to a lighter one. In 2 to 4 days, it darkens · to brick-red, but
may be yellow due to physiological jaundice.
LIVEBIRTH
• Marks of violence : Violence applied to a child while living will
show some degree of vital rxns but such rxn will not be seen in
cases of still-birth
• Changes in the umbilical cord: Pulsation seen or felt in the
cord indicates livebirth. In 12 to 24 hours it dries and slowly
becomes shrivelled in 3 to 5 days and the cord separates with
cicatrization of the wound
• Condition of the Heart and Blood vessels
• Ductus arteriosus closes within 3 days. Ductus venosus also
closes within 3 days after birth. The foramen ovale may close
on the second or third month.
LIVEBIRTH
Proof of Live-Birth can be If born alive, how long did
deduced in the following: the child survive?
• Well-developed signs of
breathing
• Changes in skin
• Presence of air or food in the
• Presence of caput
stomach
succedaneum
• Changes having taken place
• Changes in the umbilical cord
in·the region of the umbilicus
• Changes in circulation
 Signs of Maturity of the Child
1. Length of the fetus- 50 centimeters
2. Weight- 3.0 kilos
3. Lanugo hair almost disappeared
4. Limbs and body plump
5. Face lost its wrinkles.
6. Skin covered with vernix caseosa
7. Head covered with hair about 2 inches long
8. Nails project from the fingers but the toe-nails reach only to the end
9. One or both testes are in the scrotum, or labia have close the vulva
10. Lower end of femur may show center of ossification about 0.6 cm
in diameter
INFANTICIDE It is the killing of a child less than three days old

Art. 255, Revised Penal Code,

lnfanticide
• If the killing was done by the parents,
grandparents or other direct ascendants,
or either of them, the penalty to be
imposed is the same as that of parricide
(Art. 246)
• If the killing was done by any other
person, the penalty is the same as that of
murder. (Art. 248)
• If the crime be committed by the mother of the
child for the purpose of concealing her
dishonor, she shall suffer the penalty of
prision correccional in its medium and
maximum period

• If said crime be committed by the maternal

grandparents or either of them, the penalty
shall be prision mayor.
PROBLEMS
• Why is the crime of infanticide applied
only to the killing of less than a three-
day-old infant rather than within the
first year of the life of the child?

• Can the crime of infanticide be

committed on someone who is not yet
a person as contemplated by law?
• During the process of delivery when the head and neck
of the child are already out of the birth canal, the child
was deliberately put to death before expulsion of the
other parts of the body.
• The child was not yet capable of independent existence
inasmuch as placental circulation was still maintained.
Ideally it is feticide, but it is not a crime in the
Philippines. Can it be considered infanticide?
• If the fetus has an intrauterine life of less than seven
months, it is not deemed born if it dies within twenty four
hours after its complete delivery from the maternal
womb (Art. 41 Civil Code).
Motives for Committing Infanticide

• To conceal dishonor
• Increased financial burden
• Desired number of children has
already been attained
• Congenital abnormality of child
• Mental abnormality of parent
• Belief that the child will bring bad luck
Criminological Characteristics
• Most often committed by the mother
• Almost always committed in the home
• Crime scene shows no manifest disturbance
• Trauma applied is minimal
• Newly born child found dead was born dead

Types of Evidences
• child was born alive
• child was deliberately killed
• child killed was less than three days old
OMISSION OR NEGLECT

• Umbilical cord is not ligated after it is cut; fatal hemorrhage

• Depriving the child of necessary clothings; exposure of the
child to heat and cold may cause the death
• Failure to take the necessary help of a midwife or a skilled
physician
• Deliberately starved to death; stomach and intestine
examined for presence of food
• Failure to remove the child from the mother's discharge;
suffocation
COMISSION
• Physical injuries
• Pressed into some soft tissues like a bed-sheet or a pillow;
suffocation
• Strangulation
• Disposed of in a sewerage disposal; deeper body of water
with weight attached
• Poisoning with household products; warrants examination of
the gastro-intestinal tract for irritation by toxicologist
• Burning; may be simultaneous with dwelling place
• Exposed to direct sunshine or may be placed in a basin of
cold water until death
POSTMORTEM FINDINGS
• Skin surfaces- show marks of physical violence
• Mouth and upper portion of the alimentary tract-
signs of irritation due to poisoning laceration of the
upper portion of air passage with deformity of the
trachea and larynx
• Lungs- show petechial hemorrhages, emphysema, or
signs of drowning fracture of the bones, laceration of the
internal organs, cerebral hemorrhages in poisoning, the
organs must be preserved and sent to a competent
toxicologist for proper analysis
Thanks for Listening…

• TO GOD BE THE GLORY!

PATERNITY AND FILIATION

ANTONIO ROQUE R. PARADELA,M.D., FPCS, LLB

VICENTE SOTTO MEMORIAL MEDICAL CENTER
Legal importance of determining of paternity and filiation
a. Determine when a child is legitimate or not and different
kinds of children.
b. Know the medical and non-medical evidence of paternity
and filation.
c. Be familiar with the medical, legal and moral procedures
of non-conventional methods or procreation.
• PATERNITY - civil status of the father with
respect to the child begotten by him
• FILIATION - civil status of the child in relation to
its mother or father

Legal Importance of Determining Paternity and

Filiation
• For succession : legitimate child > illegitimate
• For enforcement of Naturalization and
Immigration laws : “Ipso facto” Philippines
citizenship to their minor children of naturalized
citizens
 Kinds of Children
A. Legitimate Children
• Proper
• Legitimated children
• Adopted

B. Illegitimate Children
Natural
• Proper
• By presumption
• By legal fiction
Spurious children
• Adulterous
• Incestuous
• Manceres
• Sacrilegious
 A. 1. LEGITIMATE CHILDREN
(PROPER)
• Born in lawful wedlock or within 300 days after the dissolution of marriage
Requisites of presumption
• Valid marriage
• Born before 180 days following marriage and within 300 days after
dissolution
• No physical impossibility within 120 days of 300 days after dissolution

Physical impossibility
• Impotence of husband
• Living separately
• Serious illness of husband
 A. 1. LEGITIMATE CHILDREN
(PROPER)
Example
• Mark, who is Anne’s husband, died. 230 days after his death, a
child was born.
→ presumed to be legitimate child of Mark

Civil Code Article 258

• Child born within 180 days following marriage is prima facie
presumed to be legitimate

Child presumed legitimate in these cases:

• Husband knew of pregnancy before marriage;
• Consented to putting of surname on record of birth
of the child
• Recognized child as his own
• Prima facie: presumption is true unless proven contrary
Civil Code Article 256
• Child shall be presumed legitimate, although the mother
may have declared against its legitimacy or may have
been sentenced as an adulteress
Reasons for this provision
• Child’s status must not be left at mercy or passion of
parents
• Husband may connive with wife and declare child as
illegitimate
• Child must not be punished by wrongful acts of parents

Presumption of illegitimacy based on ethnic reasons:

• Child is prima facie presumed to be illegitimate if:
• It appears highly improbable, for ethnic reasons, that the
child, is that of the husband.
• Wife commits adultery at the time of the conception, with
no physical impossibility of access between her and her
husband
Presumption of illegitimacy based on
ethnic reasons:
Example:
• Don and Mela, both white, are legally married.
• During the period of conception for the child, the wife had an illicit relation with
Tyron, a African-American.

• The child born has dark skin, wiry and curly hair and with thick lips. There is no
ancestor in Don and Mela who is African-American. The child is prima facie
presumed illegitimate.
Presumption of legitimacy if the widow
marries within 300 days following the
death of the husband:

These rules shall govern:

• A child born before 180 days
• disputably presumed to be conceived during the former
marriage

• A child born after 180 days

• prima facie presumed to have been conceived during
subsequent marriage.
Marriage of women within 300 days following death of
husband, annulment or other forms of marital dissolution
• No marriage license shall be issued to a widow till after three hundred
days following the death of her husband
Premature marriages:
• A widow who shall marry within 301days from the date of the death of her
husband shall be punished by arresto mayor and fine not exceeding 500
pesos.
• If she shall marry before the expiration of the period of 301 days after the
legal separation.
• The purpose of the provisions is to prevent disputed paternity of the child
born after the subsequent marriage.
• However, where deceased husband was proven to be impotent or sterile,
the widow who contracted a premature marriage was not held criminally
liable.
Duty of a woman after annulment of marriage when she
becomes a widow and pregnant

She shall notify former husbands or his heirs of the fact that she
is pregnant
• Within 30 days from time she became aware of pregnancy
• Husband or his heirs may prevent simulation of birth
Same obligations
• Widow left pregnant
• Wife pregnant by her legally separated husband
Simulation of births, substitution of one child
for another and concealment or abandonment
of a legitimate child

• Punished by prison mayor and fine of not

exceeding 1,000 pesos
• Any person with intent to cause child to lose
civil status
• Any physician or surgeon or public officer in
cooperation
• Addition of temporary special disqualification
• Usurpation of Civil Status
• Penalty of prison mayor
• Imposed upon any person whom shall do so for defrauding
the offended party or his heirs
• Otherwise, prison correccional in medium and maximum
periods

• Child born after 300 days following dissolution of marriage or

separation of spouse
• No presumption of legitimacy or illegitimacy
• Whoever alleges legitimacy or illegitimacy of such child must
prove allegation
 A. 2. LEGITIMATED CHILDREN

Legitimation
• process by which a child born out of lawful wedlock (illegitimate) are by
fiction of law considered legitimate by subsequent valid marriage of
parents
Natural children (proper)
• Born outside lawful wedlock of parents who, at the time of conception of
the former, were not disqualified by any impediment to marry each other
Requisites for legitimation of natural child (proper):
• Child must be natural
• Child must be acknowledged by both parents before marriage
• There must be subsequent marriage of the parents
 A. 2. LEGITIMATED CHILDREN

Example
• Mart and Beatrice are both single and are of age.
There are no other impediments for them to marry
one another. Although unmarried, they had a child.
The child is considered to be natural.

• If child is acknowledged by both parents to be their

own, child becomes an acknowledged natural child
• If the parents subsequently marries , child becomes
a legitimated child
A. 3. ADOPTED CHILDREN

• Adoption, defined as the act or proceeding by which

relations of paternity and filiation are recognized as legally
existing between persons not so related by nature.

Persons who may be adopted:

• The natural child, by the natural father or mother;
• Other illegitimate children, by the father or mother;
• A step-child, by the step-father or step-mother (Art. 338,
Civil Code); and
• Any person, even if of age, provided the adopter is sixteen
years older (Art. 337, Civil Code)
Persons who cannot be adopted:
• A married person, without the written consent of the other
spouse;
• An alien with whose government the Republic of the
Philippines has broken diplomatic relations; and
• A person who has already been adopted (Art. 339, Civil
Code).

Persons who may adopt:

• Every person of age, who is in full possession of his civil
rights. (Art. 334, Civil Code)
Persons who cannot adopt:
• Those who have legitimate, legitimated, acknowledged natural
children or natural children by legal fiction;
• The guardian, with respect to the ward, before the final approval
of his accounts;
• A married person, without the consent of the other spouse;
• Non-resident aliens,
• Resident aliens with whose government the Republic of the
Philippines has broken diplomatic relations; and
• Any person who has been convicted of a crime involving moral
turpitude, when the penalty imposed was six months'
imprisonment or more (Art. 335, Civil Code).
 B. ILLEGITIMATE CHILDREN
Natural Children
Natural Children (Proper)
• Born outside wedlock of parents who, at the time of the conception of the
former were not disqualified by any impediment to marry each other (Art. 269,
Civil Code)

Natural Children by Legal Fiction

• Children born of void marriages or those born of voidable marriages after the
decree of annulment

Natural Children by Presumption

• Children acknowledged by the father or the mother separately if the
acknowledging parent was legally competent to contract marriage at the time
of conception
 B. ILLEGITIMATE CHILDREN
Spurious Children
Adulterous Children
• Children conceived in an act of adultery or
concubinage

Sacrilegious Children
• Children born of parents who have been ordained in sacris

Incestuous Children
• Children born by parents who are legally incapable of contracting valid
marriage because of their blood relationship as marriage between
brothers and sisters, father and daughter, etc.

Manceres
• Children conceived by prostitutes
 Civil Liability of Persons Guilty of Crimes Against Chastity:

Art. 345, Revised Penal Code:

Persons guilty of rape, seduction or abduction shall also be sentenced:
• To indemnify the offended woman.
• To acknowledge the offspring, unless the law should prevent him from so doing.
• In every case to support the offspring.

Evidence of Paternity and Filiation

Medical Evidences
• Parental Likeness , Blood Grouping Test
• Evidences from the Mother , Evidences from the Father

Non-Medical Evidences
• Record of birth in the Civil Registrar, or by an authentic
document or a final judgement
• Continuous possession of the status of a legitimate child
• Any other evidences allowed by the Rules of Court and
special laws.
Non-Conventional Modes of
Procreation
A. ARTIFICIAL INSEMINATION
• a medical procedure by which the semen is introduced into
the vagina by means other than copulation for the purpose
of procreation.

Source of Semen:
• A.I.H. - sperm Comes from the husband.
• A.I.D - sperm comes from a donor other than the husband
• A.I.H.D - donor semen comes from the husband and a third party donor.
 A. ARTIFICIAL INSEMINATION
Medical Indications:
1. For A.I.H.:
• Deposition of the husband's semen within the vagina by coitus is
prevented because of anatomic or psychological difficulties on the part of
either husband or wife;
• Infertility due to poor motility, paucity or otherwise defective sperm cells or
too small a volume of the ejaculant.

2. For A. J.D. or A.I.H.D.:

• Absolute male sterility (Azoospermia)
• Oligospermia - <10-15 million sperm per cc. of semen
with infertility of long duration
• Hereditary diseases in the husband
• Rh blood incompatibility
3. Selection of Donor of Semen:
• Proper screening of the donor (genetic defects)
• Blood type must be compatible with A.B.O. and Rh genotype of the
wife.
• Ensure that the identity of the donor is not known to the parents and
vice versa.
• Complete physical examination with standard test for syphilis and
gonorrhea is obtained one week before the seminal fluid is collected.
 Precautions to be Observed by the Physician in
Performing Artificial Insemination

• Make certain the procedure is medically indicated for the couple

• Establish that the couple is emotionally stable and psychologically suited
for this type of parenthood
• Use all reasonable precautions in selecting the donor to exclude donor
with potential transmissible undesirable traits, features and details.
• The physician must maintain confidentiality except by court order
• Must use freshly donated blood sperm or frozen semen that has been
prepared and stored accordingly and with the source properly identified
• The procedure must be performed by the physician in accordance with the
currently accepted techniques
• Full and valid consents and releases should be obtained in writing from all
parties involved, and each consent must be an “informed consent,”
STATUS OF CHILD BORN BY ARTIFICIAL INSEMINATION

In A.I.H. (sperm from husband)

• there is no doubt that the child is a legitimate child of the husband

In A.I.D. (sperm from donor)

• with the consent of the husband
• → child must be considered legitimate
• Even if the child is considered illegitimate, the child can be adopted by him, making
the child's status legitimate.
• without the consent or if it is against the will of the husband
• → child considered as illegitimate

Did the wife commit adultery?

• Adultery is committed by "having sexual intercourse with a man not her husband"
• There is no sexual intercourse in artificial insemination
• therefore no such crime is committed by the wife.
 CONSENT ON A.I.D.
• Consent and release for any future claim must be obtained by
the physician from all parties in writing.
• The consent of the wife necessary to avoid being held liable for
an assault.
• The consent of the husband necessary to avoid the wife being
charged with adultery, or toward the question of legitimacy of
the child, issues of divorce, separation or inheritance.
• The consent and release of the donor should be obtained for the
unrestricted use of the semen supplied and he should also
certify in writing that he will make no effort to ascertain the
identity of the couple involved.
• If the donor is married, the consent of the wife must also be
obtained to the giving of semen because her marital interest
may be affected by the donation.
 Basis of Legality of In Vitro
Fertilization
• The constitution provides that "No person shall be deprived of life, liberty,
or property without due process of law, nor shall any person be denied
the equal protection of the laws." (14th amendment of U.S. and Article IV,
Sec. 1, Philippines).

• From the term "liberty" emanates the right of privacy.

Other implications of the right of privacy which may be the basis of legality
of in vitro fertilization:
• Right of procreation
• Right of marital privacy
• Right to decide whether to bear or beget
• Right of self-determination
 Problems in In Vitro Fertilization:
The probability that the child to be born will be defective:
Some of the probable causes of the birth of a defective child may be:
• Administration of hormone to the prospective source of ovum:
• Mechanical manipulation of the oocyte and embryo
• Mistake in the "screening process' or selection of the best ovum for
fertilization.
• Defective donors (sperm and ovum)
A physician need not fear too much of the possible liability on account of a
defective child because:
• Plaintiff will find difficulty in proving negligence
• Prospective parents are normally briefed of the potential risks of the
procedure
• In vitro fertilization is still in the experimental stage and has yet to evolve
• The plaintiff is required to meet the difficult task of proving negligence
 2. Problem of a Surrogate Mother
• Reasons why a surrogate mother may be necessary:

Necessity:
• The genetic mother is unable to carry the child to term
• The genetic mother may believe that she is too old to
safely carry a child to term
• The genetic mother may possess deleterious genetic
traits
• Couple is unable to adopt a child

Convenience:
• A woman may not want to interrupt her career during
pregnancy
2. Problem of a Surrogate Mother
Motivation of a woman to become a surrogate mother:
• Altruistic motive
• Material consideration

Problems that may arise in the agreement:

• Surrogate other decided to abort the child
• Surrogate mother may decide to keep the child after birth
• Genetic parents may decide to abort the child
• The parents refused to take the child
• Other legal parameters

Potential solutions:
• By contract - specific mentioning of rights and duties of each party
• By legislation - court is bound to enforce the legislation.
Marital Union, Impotency,
& Sterility

ANTONIO ROQUE R. PARADELA,M.D., FPCS, LLB

VICENTE SOTTO MEMORIAL MEDICAL CENTER
WHAT IS MARRIAGE? ART. 52, CIVIL CODE
• No marriages shall be solemnized unless all these requisites
are complied with:
1. Legal capacity of the contracting parties
2. Their consent, freely given
3. Authority of the person performing the marriage
4. A marriage license, except in a marriage of exceptional
character
• Any male of the age sixteen years or upwards, and any
female of the age of fourteen years or upwards may contract
marriage
Males less than 20 yrs and/or females less
than 18 yrs of age:

• Exhibit to the local civil registrar, the consent

to their marriage, of their father, mother or
guardian, or persons having legal charge of
them, in the order mentioned.
• Such consent shall be in writing, under oath
taken
• Males above 20 but under 25 yrs and/or
females above 18 but under 23 yrs of age:

• Obliged to ask their parents or guardian for advice

upon the intended marriage
• If they do not obtain such advice, or if it is
unfavorable, the marriage shall not take place till
after three months following the completion of the
publication of the application for marriage license
• A physician may be required to determine the
ages of contracting parties whenever the
question of validity of marriage is at issue

Analysis of peculiarities connected with age:

• Growth of the pubic hair
• Presence of the third molar
• Development of the breast
• Height
• Character
• Educational attainment of the person
Incestuous Marriages
• These marriages are void from their performance,
whether the relationship between the parties be
legitimate or illegitimate
(1) Between ascendants and descendants of any degree;
(2) Between brothers and sisters, whether of the full or
half blood;
(3) Between collateral relatives by blood within the fourth
civil degree.
Marriages that are void from the
beginning:
• Between stepfathers and stepdaughters, and
stepmothers and stepsons;
• Between the adopting father or mother and the
adopted, between the latter and the surviving
spouse of the former, and between the former and
the surviving spouse of the latter;
• Between the legitimate children of the adopter and
the adopted
 As to Marital Relation
Art 109, Civil Code
• Husband and wife are obliged to live together, observe
mutual respect and fidelity, and render mutual help and
support

Art 110, Civil Code

• Husband shall fix the residence of the family
• Court can exempt wife from living w the husband if he
should live abroad unless in the service of the Republic
Art 111, Civil Code
• Husband is responsible for the support of the wife and the
rest of the family
• In case of separation of property, by stipulation in marriage
settlements, the husband and wife shall contribute
proportionately to the family expenses

Art 112, Civil Code

• Husband is the administrator of the conjugal property, unless
there is a stipulation in the marriage settlements conferring
the administrator upon the wife.
 Causes of Sexual Dissatisfaction
After Marital Union
1. Fear of consequence of repeated abortion
2. Fear of unwanted pregnancy.
3. Faulty contraceptive methods. There is inadequate opportunity for
orgasm.
4. Dyspareunia (Vaginisimus, or improper sex technique).
5. Fear of coitus.
6. Emotional frustration due to fertility.
7. Ignorance of the reproductive process and genital anatomy.
8. Aversion to coitus (frigidity).
9. No sex desire (low basal metabolic rate found).
Causes of Sexual Dissatisfaction
After Marital Union
10. Anatomic cause of dissatisfaction in coitus:
a. Tight resistant septate hymen.
b. Size and location of the clitoris.
c. Extreme obesity .of either husband or wife.
d. Infantile genital development.
e. Pelvic abnormality, e.g., parametritis, torn perineum.
11. Disparity in age.
12. Venereal disease.
13. Masturbation preferred to coitus.
14. Infidelity.
Reasons Why Patients Requested
Contraceptive Advice
1. Recent childbirth
2. Desire to space offspring
3. Desired number of offspring
4. Medical condition of wife does not warrant pregnancy
5. Mental illness or emotional disturbance of husband and wife
6. Economic conditions
a. Unemployment of husband
b. Wife sole or co-wage earner
c. Support or dependants
d. Desire to complete education or professional training
7. Dissatisfaction of either or both partners w method ofcontraception
8. Failure of other methods used
Causes of Non-consummation
of the Sexual Act
1. Septate hymen
2. Tight thick hymen
3. Fear of pain or inability to stand pain
4. Ignorance of genital anatomy
5. Ignorance of sex technique
6. Fear of pregnancy
7. Sense of shame regarding genitals and coitus
Complaints After Marital Union
1. Male sex inadequacy
2. Prolonged debilitating disease of one partner
3. Anxiety over economic security
4. Manual clitoral stimulation preferred
5. Too frequent pregnancy
6. Lack of privacy
7. husband ‘s preference to perversion
8. Cultural aesthetic inequalities
9. Faulty attitude of husband and wife toward normal
intimacies
 Contraceptive methods
General Contraceptive Methods
• Condom , Coitus interruptus , Abstinence , Lactation . Safe period

Male Contraceptive Methods

• Condoms w jelly, suppository or douche , Coitus interruptus w douche

Female Methods of Contraception

• Douche alone with condom, with coitus interruptus, with pessary, or with
diaphragm
• Vaginal diaphragm , Cervical type pessary , Stem pessary
• Jelly alone/w diaphragm/w cervical type pessary/w condom
• Suppository w douche
 AS TO ANNULMENT OF MARRIAGE
Art 85 Civil Code

A marriage may be annulled for any of the following causes

• ● That the party in whose behalf it is sought to have the marriage
annulled was between the ages of 16 and 20 years, if male, or
between the ages of 14 and 18 years, if female, and the marriage
was solemnized without the consent of the parent, guardian or
person having authority over the party
• ○ UNLESS after attaining the ages of 20 or 18 years, as the case
may be, such party freely cohabited with the other and both lived
together as husband and wife;
A marriage may be annulled for any of the
following causes

• ● Either party was of unsound mind

• ○ UNLESS such party, after coming to reason, freely cohabited
with the other as husband ·or wife;
• ● That the consent of either party was obtained by fraud
• ○ UNLESS, such party afterwards, with full ·knowledge of the
facts constituting the fraud, freely cohabited with the other as
her husband or his wife, as the case maybe; .
• ● That either party was, at the time of marriage, physically
incapable of entering into the married state, and such
incapacity continues, and appears to be incurable.
AS TO ANNULMENT OF MARRIAGE
Art 86 Civil Code
• Any of the following circumstances shall constitute fraud referred to
in number 4 of the preceding article:
● Concealment by wife of the fact that at the time of the marriage, she
was pregnant by a man other than her husband.

Medico-legal interest
• A physician may be requested to determine the ages of
the contracting parties, if the ground for the annulment of
marriage is age.
He may be required to examine the mentality of the party to
determine whether she or he could have been of unsound
mind at the time of the celebration of marriage.
 AS TO LEGAL SEPARATION
Art. 97 Civil Code
• A petition for legal separation may be filed:
(1) For adultery on the part of the wife and for concubinage
on the part of the husband as defined in the Penal Code;
or,
(2) An attempt by one spouse against the life of the other
Art. 333 RPC Who are guilty of Adultery ? Adultery
is committed by
○ by any married woman who shall have sexual intercourse with a man not her
husband AND
○ by the man who has carnal knowledge of her, knowing her to be married, even if
the marriage be subsequently declared void.
● Adultery shall be punished by prision correccional in its medium and maximum
periods.
● If the person guilty of adultery committed this offense while being abandoned
without justification by the offended spouse, the penalty next lower in degree than
that provided in the next preceding paragraph shall be imposed.
AS TO SEPARATION
Art. 334 RPC Concubinage

• Any husband who shall keep a mistress in the

conjugal dwelling, or,
• Shall have sexual intercourse, under scandalous
circumstances, with a woman who is not his wife, or
• Shall cohabit with her in any other place, shall be
punished by prision correccional in its minimum and
medium periods.
● The concubine shall suffer the penalty of destierro.
 Impotence
• It is the physical incapacity of either sex to allow or grant to the
other legitimate sexual gratification.

A. Legal Importance of Impotence: Impotence, if proven, will

overthrow presumption of legitimacy

Art. 255, Civil Code:

• Children born after 180 days following celebration of marriage AND before 300
days following its dissolution shall be presumed LEGITIMATE.
• Against this presumption, no evidence shall be admitted other than that of
physical impossibility of husband’s having access to his wife within first 120
days of the 300 days preceding the child’s birth.
B. Impotence may be ground for annulment of a marriage
• Art. 85, Civil Code:
• Marriage may be annulled for any of the following causes
existing at the time of marriage:
• (6) That either party was, at the time of marriage, was
physically incapable of entering into the married state,
and such incapacity continues, and appears to be
incurable.

C. Impotency may be a defense in rape :

• An accused of the crime of rape may claim of his inability
to commit the crime on account of his impotency.
Requires medical evidence to support allegation.
 Legal Importance of Impotence
D. Impotency may be a cause to the development of abnormal
sexual behavior :
• May resort to uranism, cunnilingus, homosexuality or other
lasciviscious acts to satisfy sexual partner.

E. Impotency may be the cause for development of suicidal

tendency:
• A person who is not in a capacity to give gratification to the
sexual partner may consider himself to be “biologically dead”.
He may resort to self -destruction.
Causes of Impotence
A. General or Functional, not connected directly to
sexual organs
• Age ○ As long as male as there is erection in the male, he is considered
potent.
• Illness ○ Diseases attended by general debility may temporarily remove the
sexual power on the part of the male.
• Emotion ○ Some females manifest vaginismus due to pain on contact or fear
of pain. ○ In males, emotion may lead to temporary impotence.
• Hormonal dysfunction may also lead to temporary or permanent impotence.
B. Local or Organic, in direct connection to sexual organs
CONGENITAL DEFECTS
• MALES: Non - development of the penis , maldevelopment of the penis ,
Penis adherent to the scrotum, Duplex organ
• FEMALES: Absence of vagina, Vagina ill - developed, e.g. may be too small,
Vagina occluded by intrauterine disease
DISEASE OR ACCIDENT
• MALES : Penis ○ Acute diseases of the penis ○ Chronic diseases ○
Complete amputation
: Testis ○ Removal of the testis ○ Sexual abuse
• FEMALES : Vaginal Ulceration, Disease of the vulva , Obstruction of the
vaginal canal due to tumor, cyst or fibroid
What is sterility?
• It is the loss of power of procreation and is absolutely
independent of whether or not impotence is present.
• A person may be: ● Sterile but not impotent ● Impotent
but not sterile

Causes of Sterility
A. General or Functional, not connected directly to sexual organs
• Before puberty there is no spermatozoa in the seminal fluid, hence
sterile, but as age increases, fertility also increases.
B. Local Causes of Sterility
• CONGENITAL CONDITIONS
 Causes of Sterility

A. General or Functional, not connected directly to sexual organs

• Before puberty there is no spermatozoa in the seminal fluid,
hence sterile, but as age increases, fertility also increases.

B. Local Causes of Sterility

• CONGENITAL CONDITIONS
• MALES : Absence or nondevelopment of testicle, Absence or
nondevelopment of penis , Maldevelopment of the testicle ,
Misplacement of the testicle , Malformation of the penis, as in
epispadias or hypospadias
• FEMALES : Absence or maldevelopment of the ovary, Absence
or maldevelopment of the uterus , Absence of the vagina
• ACQUIRED CONDITIONS

• MALES : Complete amputation of the penis ,

Excision of the testicle , Diseases of the testicle ,
Atrophy of the testicle
• FEMALES : Excision of the ovaries , Diseases of the
ovary , Occlusion of the vagina from diseases,
Diseases of the vagina , Occlusion of the Fallopian
Tubes
 Methods of Sterilization
• Male
1. The source of sperm production can be eliminated
by removing both testicle (Orchiectomy).
2. The tubular passage (vas deferens) through which
the sperm are transported from the testicle to the
urethra where they combined with the seminal fluid
elaborated by the prostate gland to form the ejaculant,
can be divided and the cut ends tied (vasectomy); thus
newly produced sperm cannot join the ejaculantand
the ability of the male to fertilize the female is lost.
•Female
1. The source of eggs (ovary) can be removed
(oophorectomy).
2. The tubular appendages of the uterus (Fallopian tube)
through which the eggs enter the uterine cavity where
fertilization takes place, can be divided and the cut ends
tied (Tubal ligation or salpingectomy), preventing newly
produced eggs from reaching the uterus for fertilization.
3. The uterus (womb) itself can be removed (hysterectomy)
, thereby eliminating the site of fertilization and pregnancy.
• Thanks for listening….

• To God be the Glory!

INSANITY, ALCOHOLISM
AND POISONING

ANTONIO ROQUE R. PARADELA,M.D.,LLB

VICENTE SOTTO MEMORIAL MEDICAL CENTER
INSANITY
The student must know the different conditions producing
disturbances of mentality
a. Legal importance of insanity and criminal responsibility.
b. Manifestations of Mental disorder
WHAT IS INSANITY?
• Sociological viewpoint:persistent inability through mental causes
to adapt oneself to the environment.
• Medical viewpoint: prolonged departure of individual from his
natural mental state due to bodily diseases.
• Legal viewpoint: relation of a person and the particular act which
is the subject of judicial investigation.

• Commonly used to be synonymous with lunacy, madness,

unsoundness of mind, mental derangement, mental disorder, or
mental aberration or alienation.
LEGAL IMPORTANCE OF INSANITY
In the Civil Code:
• A restriction on the capacity of a natural person to act
• Modifies or limits the capacity of a natural person to act
• Ground for the annulment of marriage
• A testator must be of sound mind at the time of execution of a
will
• A witness to a will must be of sound mind
• Insanity of the testator is a ground for disallowance of a will
• An insane cannot give consent to a contract
• The guardian or the insane himself, if there is no parent or
guardian, shall be held liable for damages due to his insanity
LEGAL IMPORTANCE
In the Revised Penal Code:
• Insanity exempts a person from criminal liability
• A person who becomes insane after final sentence:
• Suspension of the execution and service of the
penalties in case of insanity.

In the Rules of Court:

• A guardian on the person of insane must be appointed
• An insane cannot be a witness in court
MANIFESTATIONS OF MENTAL DISORDERS
DISORDER OF COGNITION
DISORDER IN PERCEPTION:
1. Illusion
2. Hallucination
Visual: Seeing things although not present
Auditory: Hearing voice in absolute silence
Olfactory: False perception of smell
Gustatory: False perception of taste
Tactile: False perception of touch,
Kinesthetic: False perception of movement
Hypnagogic : False sensory perception occurring mid-way between
falling asleep and being awake
Lilliputian – Perception of object as reduced in its size
DISORDER OF MEMORY
Dementia
• Acute Dementia (Schizophrenia)

• Dementia Paralytica (GeneralSenile Dementia

Toxic Dementia
• Paralysis of the Insane)
• Dementia Praecox

Amnesia (Loss of memory)

• Anterograde Amnesia — Loss of memory of recent
event.
• Retrograde Amnesia — Loss of memory of past events
and observed in trauma of the head.
DISORDER OF CONTENT OF THOUGHT

Delusion
• Delusion of Grandeur Nihilistic Delusion
• Delusion of Persecution Delusion of Poverty
• Delusion of Reference
Hypochondriacal Delusion
• Delusion of Self-accusation
Delusion of Depression
• Delusion of Infidelity
Delusion of Negation

Obsession
Thought and impulse which continually occur in the person's mind despite all
his attempts to keep them out.
DISORDER OF TREND OF THOUGHT
• Mania : A state of excitement accompanied by exaltation or a
feeling of well-being which is out of harmony with the
surrounding circumstances of the patient.

• Melancholia : Intense feeling of depression and misery which is

unwarranted by his physical condition and external environment

• Manic-Depressive Psychosis ("Folie circulaire") : In between

attacks of mania and depression is a period of cessation of
symptoms of psychosis known as lucid interval. Any person who
committed a criminal act during lucid interval is criminally liable.
DISORDER OF EMOTION
EXALTATION PHOBIA DEPRESSION APATHY

Fear of Specific Objects:

Sharp objects: Belonophobia
Fear of Place:
Robbers: Harpaophobia
School: Scholionophobia
Trees: Dendrophobia
Churches: Ecclasiophobia

Fear of Specific Situations: Crowds: Ochlophobia

Marriage: Gamophobia
Fear of Illness or Death:
Sexual intercourse: Coitophobia
Illness: Nosemaphobia
Pregnancy: Maieusiophobia
Snakes: Ophidiophobia
Childbirth: Tocophobia
Infirmity: Apirophobia
DISORDER OF VOLITION/COALITION

• IMPULSION or IMPULSE (Compulsion) : Sudden and irresistible

force compelling a person to the conscious performance of some
action without motive or forethought

SOME TYPES OF IMPULSION

• Pyromania
• Kleptomania
• Mutilomania
Homicidal Impulse
• Dipsomania
Sex Impulse
Suicidal Impulse
INSANITY & CRIMINAL
RESPONSIBILITY
FUNDAMENTAL PRINCIPLES IN CRIMINAL RESPONSIBILITY
• A SANE MAN IS ASSUMED TO BE WHOLLY RESPONSIBLE FOR THE
CONSEQUENCE OF HIS CRIMINAL ACT
• A PERSON WHO COMMITS A CRIMINAL ACT IS PRESUMED TO BE SANE.
• THE CRIME IS ALWAYS CONSIDERED TO BE AN AFFAIR OF THE MIND AS
WELL AS THE BODY AND TO MAKE AN ACT OF OMISSION A CRIME
• A CRIMINAL ACT (ACTUS REUS) + A CRIMINAL MIND (MENS REA)
• “Actus facit reum nisi mens sit rea”
• (There cannot be a guilty act unless there is a guilty mind)
MENTAL ILLNESS MAY BE AN
EXEMPTING
CIRCUMSTANCE TO CRIMINAL
LIABILITY
ART. 12, REVISED PENAL CODE
THE FOLLOWING ARE EXEMPT FROM CRIMINAL LIABILITY:
• AN IMBECILE OR AN INSANE PERSON, UNLESS THE LATTER HAS ACTED
DURING A LUCID INTERVAL
• IMBECILE OR AN INSANE PERSON HAS COMMITTED AN ACT WHICH LAW
DEFINES AS FELONY (DELITO), THE COURT SHALL ORDER HIS CONFINEMENT IN
ONE OF THE HOSPITALS OR ASYLUMS ESTABLISHED FOR PERSONS THUS
AFFLICTED
MENTAL ILLNESS MAY BE A MITIGATING
CIRCUMSTANCE TO CRIMINAL LIABILITY
ART. 13, REVISED PENAL CODE
• THAT THE OFFENDER IS DEAD AND DUMB, BLIND OR OTHERWISE SUFFERING FROM PHYSICAL
DEFECT WHICH THUS RESTRICTS HIS MEANS OF ACTION, DEFENSE OR COMMUNICATION WITH
HIS FELLOW BEINGS
• SUCH ILLNESS OF THE OFFENDER AS WOULD DIMINISH THE EXERCISE OF THE WILL-POWER OF
THE OFFENDER WITHOUT, HOWEVER, DEPRIVING HIM OF CONSCIOUSNESS OF HIS ACTS
EARLIER TEST FOR INSANITY
• "WILD BEAST RULE“A person who is totally deprived of his
understanding and memory and knows no more than an infant, brute
or wild beast of what he is doing

• DELUSION RULE : a person is not responsible for his act if he is

suffering from delusion although he knows his act is wrong

LATER TEST FOR INSANITY

• A defense on the ground of insanity can be established if it
can be proven that at the time of committing the act:
(1) The accused was laboring under such defect of reason or
from a disease of the mind as not to know the nature and
quality of the act he was doing, or
(2) If he did know, he did not know that what he was doing
was wrong.
(a) That the accused was suffering from the disease of the mind

(b) It must be proven that the accused did not know the nature
and quality of the act he was doing. A person who, on account of
mental disease, did not know the nature and quality of his act
does not have criminal intent (mens rea)

(c) If the accused knew the nature and quality of the act, then it
must be proven that he did not know that what he was doing was
wrong.
LATER TEST FOR INSANITY
• "IRRESISTABLE IMPULSE RULE“ : A
person is considered insane when
mental disease has rendered him incapable of restraining
himself, although he understands what he is doing and knows it
is wrong.
• "DURHAM RULE“ : The accused is not criminally responsible if his act
was the product of mental disease or mental defect.
• The determination of criminal responsibility is based on the
answer to two questions:
(1) Is the defendant suffering from a mental disease or defect?
(2) If so, was his crime a product of mental disease or defect?

"CURRENS RULE“ : In order to make the accused not responsible for

his act it must be proven that at the time of committing the
prohibited act the defendant, as a result of mental disease or
defect, lacked substantial capacity to conform his conduct to the
requirements of the law which he has allegedly violated. ·
"AMERICAN LAW INSTITUTE RULE“
• In 1955, The American Law Institute with the
support of the American Bar Association,
formulated the following rule of criminal
responsibility:
(1) A person is riot responsible for his criminal
conduct if at the time of such conduct as a result o f
mental disease or defect he lacks essential capacity
to appreciate the criminality of his conduct or to
conform his conduct to the requirements of the law;
(2) The term "mental disease or defect" does not
include an abnormality manifested only by repeated
criminal or otherwise anti-social conduct.
MENTAL DEFICIENCY
METHODS OF ESTIMATING MENTAL CAPACITY

Intelligence tests (performance tests,

verbal tests and mixed tests)
• Diagnose the degree of
mental retardation
• Studying the relationship of
intellectual degree and
personality problems
• As a means to understand
personality dimensions

Intelligence Quotient test

WAYS TO HOSPITALIZE AN INSANE PERSON
Judicial Methods
1. By the Director of Health through a petition
• Venue: Court of First Instance
• Served on: the person; the in-charge; or his relatives
• Judgment: for public/his welfare when relatives cannot take
proper custody
Discharge when:
• Temporarily/permanently cured
• can be released without danger
2. By the court upon knowledge that the insane person
committed a felony
Extrajudicial Methods
Voluntary [at times of lucidity] : Alone, or with assistance
Involuntary [police power/ordinance] : By his immediate
relatives, the peace officer, or persons concerned with public
welfare
MALINGERING
• Is the act of feigning or simulating a disease or injury with ostentation,
exaggeration, and inconsistency

CAUSES OF MALINGERING
• To avoid military or naval training
• To avoid court summons
• As a defense to criminal prosecution
• To increase civil liability
• To promulgate sympathy
TYPES OF MALINGERING
• “Feigned or fictitious” malingering : This is when
malingering is built up out of pure imagination and does not
have a slight basis of fact. The disease/injury which the person
claims to be suffering from does not exist at all. Eg. A person
may act as if he is completely blind when, in fact, both of his
eyes are normal.

• “Factitious” malingering : This is a type of malingering in

which something exists as a fact but is exaggerated to depict a
more serious disability or injury, or an exaggeration of the true
complaint. In this case, the person is suffering from an injury or
disease, but he may exaggerate or amplify the severity of the
complaint or the nature of the injury or disease.
WAYS TO DETERMINE MALINGERING
GENERAL PROCEDURE
• Observation of the subject during his unguarded moments
• Complete history and physical examination
• Application of general anesthesia
• Application of sudden unexpected minimal amount of electrical stimulus

SPECIFIC PROCEDURE
1.Feigning Blindness
2. Feigning Deafness
3. Feigning Insanity
OTHER CONDITIONS : Manifesting or
Simulating Disturbance of Mentality
SOMNAMBULISM : An abornmal mental condition whereby the
person performing the act is asleep
• Might be too concentrated on an idea or certain thoughts that he
executes it while in the state of sleep
• May commit the crime of murder, infanticide, or parricide while
under the influence of the fit
• Has no recollection of the events that occured during sleep
SEMISOMNOLENCE : Person is half asleep or in a condition between
sleep and waking
• May be suddenly aroused and may unconsciously commit a
criminal act like murder, infatidice, or parricide during this state of
confusion
• Acts done in this state do not show manifestations to justify
insanity
HYPNOTISM/MESMERISM : A person is made unconcious by the
suggestive influence of the hypnotist
• May commit a crime while under the influence which he may not
be capable of doing in a normal state
• A person cannot be hypnotized against his will
• Hypnotism as a defense to a criminal act is not accepted with
favor in court

DELIRIUM : A state of confusion of the mind characterized by

incoherent speech, hallucinations, illusions, delusions,
restlessness, and purposeless motions
• When under the state of delirium, person may commit a crime
• May be exempted from criminal liability although there is no
jurisprudence in the issue yet
ALCOHOLISM
To know if a person is a habitual drunkard, is a potential
troublemaker.
a. Causes of alcoholism and provisions of law regarding
alcoholism
b. Absorption and distribution of alcohol and its effect on the
special senses.
c. Signs and symptoms in relation to blood alcohol level.
d. Physical and chemical test to determine drunkness.
e. Social implication.
 ALCOHOLISM
Ethyl alcohol : Colorless, transparent, volatile liquid ·
with aromatic odor and boiling point at 78°C
• Formed out of the fermentation and isolated by distillation
• Used as solvents, antiseptic and beverage
• Alcoholic beverages are primarily a mixture of water and
ethyl alcohol with small amount of other substances →
called "congeners"
○ Consist of organic acids and esters or even other types of
alcohol
○ Imparts the so called "odor of alcohol" among drinkers
and tasted
• Drunkard : person who habitually takes or uses any
intoxicating alcoholic liquor and
• ● while under the influence of such, or in consequence of the
effect thereof, is either dangerous to himself and to others,
or
• ● is a cause of harm or serious annoyance to his family or
his affair, or ordinary proper conduct
• Habitual drunkard : one who excessively uses intoxicating
drink. Habit should be actual and confirmed, but
• ● it is not necessary that it be continuous or of daily
occurrence.
• ● It lessens individual resistance to evil thought and
undermines will power, making its victim a potential evil doer
PROVISIONS OF THE LAW REGARDING ALCOHOLISM
1. Intoxication is an alternative circumstance to criminal liability
Art. 15, Revised Penal Code:
• Alternative circumstances are those which must be taken into consideration
as aggravating or mitigating according to the nature and effects of the
crime and the other conditions attending its commission.
• When the offender has committed a felony in a state of intoxication,
consider:
1. Mitigating:
a. If intoxication is not habitual; or
b. If intoxication is not subsequent to the plan to commit the felony ·
2. Aggravating:
a. If intoxication is habitual; or
b. If .intoxication is subsequent to the plan to commit the felony.
● They are the relationship, intoxication, and the degree of instruction and
education of the offender. ·
PROVISIONS OF THE LAW REGARDING ALCOHOLISM
2. Public scandal committed by a person while drunk is punishable
Art. 155, Revised Penal Code - Alarms & Scandals:
• The penalty of arresto menor or fine not exceeding 200
pesos may be imposed upon:
• ○ Any person who while intoxicated or otherwise, shall
cause any disturbance or scandal in public places.

3. Contracts agreed to a in a state of drunkenness are

voidable:
Art. 1328, Civil Code:
• ● Contracts entered into during a lucid interval are valid.
• ● Contracts·agreed to in a state of drunkenness or
during a hypnotic spell are voidable
PROVISIONS OF THE LAW REGARDING ALCOHOLISM
4. The law penalizing manufacture of liquor w/o license is valid
Art. 264, Civil Code - Administering injurious substances or
beverages:
• The penalties established in the next preceding article (arresto mayor in
its maximum period to prision correccional in its minimum period) ·shall
be·applicable in the respective cases to any person who, without intent
to kill, shall inflict upon another any serious physical injury, by knowingly
administering to him any injurious substances or .beverages or by taking
advantage of his weakness of mind. And credulity.
5. The state may prevent some people from drinking highly spirited
wine Act 1639
• Prohibits any native of the Philippine Islands, who is a member of the
non-Christian tribes to buy, receive, have in possession, or drink any
intoxicating liquor other than the native wine or liquor which the tribe has
been accustomed to take
 Absorption of alcohol
• Immediately absorbed in the walls of the stomach and
duodenum, does not require digestion
● Maximum period of absorption: 30-60 mins after
intake
● Rate depends on:
Concentration & total The higher percentage taken, the greater volume alcohol per unit
quantity taken time. Greater volume consumed will enhance absorption
Nature of food in Fatty food makes absorption slower (compared to sugar and
stomach and intestine other carbs and proteins
Diseased condition of SLOW: Achlorhydria, gastric atony, chronic gastritis
stomach & intestine RAPID: Subtotal gastrectomy, gastro-enterostomy - cause early
intoxication
Length of time and Warm drinks dilate gastric capillaries = more absorption
permeability
Concentration Optimum concentration between 10-20% is rapidly absorbed
Volume of Gastric content Presence of sufficient amount of food and water delays
Distribution of alcohol
• Distributed in proportion to water contents
● High water content = highest concentration ○ Blood, urine,
brain, liver, kidney
● Low water content = lowest concentration ○ Fat, bone
Pharmacologic effects:
Acuity diminished, comparable to wearing dark sunglasses
at night
● Diminution of peripheral vision (tunnel vision)
● Blood alcohol: 100-200mg ○ Impaired ocular coordinator
○ Diplopia develops
Smell is depressed ● Malodorous substances may be
undetected
Taste: Decreased, all food taste good when drunk
Blunting of judgement - one of the first mental functions affected
• ○ Leads to automobile accidents, poor business decisions, gambling
losses, fights, injuries
● Attention deteriorates ● Motor skills impaired = reaction time prolonged
● Blunted ability to hear ● Disturbed memory recall
● Blunted and lowered moral standards
● Increase desire for sex, impaired performance, prolonged ejaculation
• Others:
1. Dilatation of blood vessels
2. ↑ pulse rate
3. Weaker cardiac systole = cardiac dilation
4. Direct irritation effect on stomach and intestines
5. Depression of liver function (↓ hepatic O2 and glycogen storage)
6. ↓ BP
SSX in relation to blood alcohol level:
10mg% Pleasant clearing of the head
20mg% Physical feeling of well-being
50mg% Feels on top of the world - ↑ self confidence, ↓ inhibitions,
diminution of attention, judgment, and control
100mg% Intoxicated, “under the influence”, mental confusion,
incompetency, drowsiness, emotional instability, ↓ inhibitions, loss of
critical judgment, impaired memory and comprehension

150mg% All are intoxicated, deterioration in acts or judgment

150-300 mg% Lose muscle coordination, disorientation, mental confusion, dizziness,
sensory disturbances, ↓ sense of pain, slurred speech,
exaggerated emotions

300mg% Stuporous, uncoordinated, lose sphincter control, apathy,

general inertia, ↓ response to stimuli, impaired consciousness
400mg% Anesthetic level, death above this
Symptomatic changes following ingestion:
Stage of excitement
• Few minutes after drink has been absorbed and has
reached CNS
• Feeling of well being and slight excitation
• Actions, speech, and emotions are less strained
• Self confidence, blunting of self criticism, self
consciousness, self-control
• “Stimulant” - erroneously
• Doesn’t stimulate but “inhibits the inhibition”
Stage of incoordination or confusion
• CNS control of body gradually diminishes
• Blunting of perceptive mechanism
• Muscle coordination lost
• Nausea, vomiting, confusion, cardiac and respiratory
symptoms appear

Stage of narcosis or coma

• Deep sleep
• Only respond to strong stimuli
• Pupils are dilated
• Breathing is slow and stertorous
• Reflex is abolished
• Death - paralysis of cardiac and respiratory center
Degree of intoxication:
1. Slight Inebriation
○ Face flushing, exaggerated mood, can control behavior
2. Moderate Inebriation
○ Talkative, argumentative, over-confident. Slight mental impairment,
difficulty of articulation, loss of coordination. Flushed face, eyeballs
congested. Reckless, motor incoordination. “Under the influence”
3. Drunk
○ Confused, irregular behavior, uncontrolled movement. Thick and
uncoordinated speech
4. Very Drunk, “dead drunk”
○ Confused, disoriented, speech difficulty, marked motor
incoordination, impossible to walk
5. Coma
○ Stuporous or comatose
Diagnostic points of drunkenness
1. Alcoholic smell of the breath or of the vomitus
2. Dry furred tongue or with excessive salivation
3. Irregular behavior
4. Congestion of conjunctiva
5. Hesitancy or thickness of speech with impaired
articulation
6. Tremor or error of coordination and orientation
7. Examination of the blood and the urine shows
presence of alcohol
8. History of having taken alcoholic beverages
PHYSICAL TESTS TO DETERMINE
DRUNKENNESS
Romberg’s test
○ If not drunk: not sway
○ If drunk: sway/not stable
● Heel to toe
● Sit comfortably in a desk and get samples of handwriting
● Bend down and pick up small object from the floor
● Walk straight forward and walk back
CONDITIONS SIMULATING ALCOHOLIC
INTOXICATION
• Severe head injuries
• Metabolic disorders
• Neurological conditions associated with dysarthria, ataxia,
tremor, drowsiness
• Effect of a drug e.g. insulin, barbiturates, antihistamine,
morphine
• Certain pre-existing psychological disorder
• Prodromata of cerebrovascular emergencies
• High fever
• Exposure to carbon monoxide in sufficient concentration to
give significant anoxemia
RELATION OF BLOOD ALCOHOL LEVEL TO
THE
DEGREE OF INTOXICATION
>0.05% Not considered intoxicated
0.01-0.15% Possibly under the influence of alcohol
0.1% - 0.15% More rise to the presumption that the person is drunk
0.2% Staggering
0.5% Coma
Factors responsible for the tolerance
and susceptibility to alcohol
• Tolerance to Alcohol
○ Consumption tolerance- lesser percentage of blood alcohol as compared with
another person who is not used to it when given the same quantity. Habituated
drinkers eliminate faster than non-habituated drinkers.
○ Constitutional tolerance - increase in threshold due to adaptation from habitual
drinking.

• Susceptibility to alcohol - factors rendering susceptibility

○ Extreme cold or fatigue
○ Pre-existing post-conclusional state
○ Chronic cerebrovascular state - HPN, adv. Cerebral arteriosclerosis
○ Cerebral depression caused by drugs e.g Barbiturates
○ Neurological disorders like disseminated sclerosis and intracranial tumors
○ Psychological disorders
Causes of Death in Alcoholics
1. Acute Alcoholic intoxication.
2. Hidden trauma
3. Unexpected aspiration of food (“cafe Coronary”)
4. Poisoning by congemer or contaminants in Alcoholic Beverages
5. Diseases associated with/or as a complication of Alcoholism

Pathological Drunkenness - A condition wherein a small amount of

alcohol intake may be sufficient to make a person drunk on account
of an existing pathological condition of the body.
Punch Drunkenness - not a condition of drunkenness. It may be
observed among professional boxers who may have developed a
peculiar physical and mental condition on account of repeated
trauma on the head.
 Analysis of:
Blood - most widely accepted way to determine concentration
• - direct method of estimation although subject may refuse extraction
Breath - Alcohol concentration determined indirectly by making a quantitative
determination of alcohol in respired air
• Basis of analysis
● Constant ratio between bloodstream and alveolar air alcohol concentration
● Percentage of blood alcohol = Gms. Of Alcohol in breath x 2Gms. of Carbon dioxide x 100
Saliva, Perspiration, and Spinal Fluid - Although it may be done, it is seldom done
Urine - Has not gained widespread use due to variability
Body Tissue - Method applicable in death cases
- Examination of the brain is reliable
Other bloody organs like liver, spleen, and kidney may also be used
Objectives of alcohol examination
• For screening Apparatus:
- Determine whether alcohol is present in the sample
- Can be blood, urine, saliva, vitreous humor, stomach content or respired
air

• Criteria:
- Must be simple for an ordinary layman to perform the job
- Must be portable for results to be available the shortest time possible
- May be placed in a mobile laboratory for screening of motor vehicular
drivers

Examples with mode of detection and indicator response

• Alcolyzer = Chromate salt in acid, Color Change:
Orange-Yellow to Green
• Alco-sensor = Fuel Cell , Light Pass: Warn or Fail
Methods used in alcohol detection
1. Chemical Method
a. Sample is distilled allowed to react with a known quantity of oxides (usually
chromate)
• i. Alcohol can be measured by determining the amount of chromate not reacted to
alcohol
2. Enzymatic Method
a. Purified alcohol and coenzyme Nicotinamide Adenine Dinucleutide (NAD) is
allowed to react
• i. Alcohol is oxidized to aldehyde, this is then measured either
1. Colorimetrically
2. Spectrophotometrically
b. The dipstick method is based on this principle
3. Gas Chromatographic Method
• a. Specimen may be purified first or injected directly to the apparatus
4. Infrared Absorption Method
• a. Alcohol presents as vapor absorbs specific wavelengths of infrared
i. Measured by detecting the decrease in the intensity of infrared energy as it passes
through the cell
Societal reaction to the problems of Alcoholism:
Promotion of Laws and Regulations
■ Manufacturing of liquor only to a certain percentage of alcohol
■ Restricting the time and place of drinking and availability of liquor
■ Subjecting drivers at random to an alcohol screening test
○ If found positive, followed by a quantitative determination
○ If blood alcohol exceeds prescribed tolerable limit, driver can be arrested

Indoctrination Methods
■ May employed to encourage moderation or abstinence ● Education in schools and churches
Institutional-organization Approach
■ Introduces substitute form of tension relief
■ Subsequent removal of the tension cause
■ Diverting attention to something else

Various therapeutic approaches under the concept that an alcoholic is a patient

• ● Therapy - combining medicine with psychiatry,
psychology, social case work and alcoholic anonymous
• ● Pastoral counseling - in churches
• ● Halfway houses - bridging the gap between the penal
institution and the community
Objectives: POISONING
The student must be knowledgeable on the medico legal
aspect of poisoning
a. Definition and classification of poisons.
b. Effects of poison, sites of action, signs and symptoms.
c. Laws on poison and other poisonous substance.
 POISONING
POISON
• capable of destroying life either by chemical action on the issues
of the living body, or by physiological action by absorption into
the living system.
• applied or administered with the intention to kill or to do harm →
the essential element in law.
• QUANTITY does not affect CULPABILITY, nor is the law concerned
with the quantity in which the substance acts
NOT advisable to confine toxicological analysis to the stomach and
contents because:

• The GIT is only one of the means of entry of poison into the body.
• Even if the poison was taken orally, after a significant period of
time (4-6 hours) has elapsed from ingestion to death, the poison
might have passed out of the stomach and could no longer be
present.
• If there are possible toxic substances in the gastric content
analysis, it is possible that the said poison could have been
introduced post-mortem to conceal the real cause of death.
• Except in cases of poisoning by strong corrosive agent, there must
be a demonstration of absorption of the poisonous agent →
presence of the toxic materials in other organs or parts of the
body.
SITE OF ACTION OF POISONS

LOCAL The poison may act on the: skin , mucous membrane , any part of the body
ACTION where it is applied Example: Sulfuric acid

REMOTE The poison may act remotely: By the production of shock.

ACTION Example: Poisoning by strong acid

By absorption into the blood & being carried to the organs they affect.
Example: Morphine-absorbed by the blood → carried to the brain and depresses it.

By transmission through the nerves of local parts affected going to the nerve centers
and then reflected to the organs on which they act.

BOTH LOCAL The poison may act at the site of application and in some distant place.
& REMOTE Example: Carbolic acid is an irritant·to the alimentary tract and also toxic when
absorbed.
Site of Remote Actions of the Different
Poisons
Failure to detect poison may be due to:

• Possible elimination of poison.

• Materials examined may not contain the poison
• Procedure applied is not sensitive or specific enough for the
quantity of poison used.
• The poison may have already been transformed into another
state/composition in the body.
To confirm suspicion of a case of
poisoning
Obtain information from:
• The victim
• Members of the family
• Police or other peace officers
• Obtain samples of the vomitus, urine, and other bodily
discharges for analysis
• Observe the patient as to other developments of the symptoms
and progress of condition.
• Request a fellow physician to assist and observe the patient if
necessary.
TREATMENT
1. Evacuation of Stomach
• Stomach Tube Long rubber tube Introduce fluid to prevent tube
contact with the stomach wall
• Fluid is withdrawn and introduced repeatedly until traces of
poison are removed
• C/I: Corrosives Danger or tear or laceration of stomach wall

Emetics
• Zinc Sulfate 30g
• Ipecacuanha 20-30g in (2) 6 drachms of wine
• Mustard & Water = one tbsp in 1 tumbler of water
• Salt & Water
• Apomorphine - 1/10g hypodermically
II. Neutralization of poison that remains in the stomach

Direct Chemical Reaction

• Acids & Alkali
• Physiochemical Reaction
• Common salt → Silver nitrate
• Starch → Iodine

Physical Reaction
Formation of insoluble compound → prevent absorption
• Tannic acid → Strychnine
• Albumin → Mercuric chloride
Mixture for when poison is unknown
• Powdered charcoal - 2 parts
• Magnesium - 1 part
• Tannic acid - 1 part

Mixture in poisonings of Arsenic, Zinc salts, Digitalis, Ordinary

acids, Mercury salts, Morphine & Strychnine
• Sat sol of iron sulfate - 100 parts
• Calcined magnesium - 88 parts
• Animal charcoal - 40 parts
• Water - 100 parts
III. Physiological Antidotes
• Strychnine –Respiration
• Amyl Nitrate & Na Nitrate -BV Constriction
• Digitalis -Cardiac depression
• Morphine, Bromides or barbiturates –Stimulants

IV. Keep the patient alive by general measures, while his organs of elimination
are getting rid of the poison.
• Treat any urgent and dangerous symptoms

V. Eliminating poison
• Purgatives, Sudorifics & Diuretics
• Sweating through -hot bath, warm packing and
injection with apomorphine
SYMPTOMATIC TREATMENTS
• Morphine = pain
• Glucose = restore depleted Glycogen
• Adrenaline, Demulcents (Oil, starch, albumin & water) =
delayed stomach absorption
• Stimulants, Artificial Respiration, Inhalation of o2 and CO2,
Application of heat on skin
SUGGESTED AUTOPSY SPECIMENS AND QUANTITIES TO BE
SUBMITTED FOR TOXICOLOGICAL EXAM
SUGGESTED AUTOPSY SPECIMENS AND QUANTITIES TO BE SUBMITTED
FOR TOXICOLOGICAL EXAM
SUGGESTED AUTOPSY SPECIMENS AND QUANTITIES TO BE SUBMITTED
FOR TOXICOLOGICAL EXAM
CHEMICAL ANALYSIS

• Beyond the scope of a physician

• Done by expert analyst, chemist or
toxicologist
CLASSIFICATION OF POISONS
Manner of action and effect in the body
CLASSIFICATION OF POISONS
CLASSIFICATION OF POISONS
II. Chemical Standpoint
CLASSIFICATION OF POISONS

Miscellaneous Poisons
• Food poisoning
• Poisonous plants
• Poisonous animals and their poisons
• Biological products
• Ground glass
FOOD POISONING
• State if ill-health resulting from food with abnormal or
noxious content
Food cause disease by:
• Lack or excess
• Unbalance proportion of proper constituents
• Absence of certain constituents
• Idiosyncracy
• Most common in GIT
• Presence of abnormal constituents
• Food inherently poisonous as fungi, horseradish, water
hemlock
BACTERIAL FOOD POISONING
Non-specific Origin
• Sometimes called Ptomaine Poisoning
• Probably caused by degradation products of the protein molecules
occurring in the decomposition of food when they have reached an
advanced stage

Specific Origin
By infection with Salmonella group
Symptoms:
1. Vomiting and nausea
2. Abdominal pain
3. Prostration
4. Collapse with cold sweating
5. Rigor with pain at the back and limbs
6. Headaches and dizziness
POST MORTEM EXAMINATION
• Congestion of mucous membrane of stomach and
intestine
• Petechial hemorrhages of the visceral organs
• Cloudy swelling of the kidney
• Congestion of the liver and spleen
• Isolation of specific organism
BOTULISM
• Specific infection in which symptoms arise from
ingestion of very potent exotoxin of anaerobic
Clostridium botulinum
• Usually due to ingestion of food stored, prepared
unsatisfactory conditions, and when food are eaten
without cooking
Laws on Poisons and Other Poisonous
Substances in the Philippines
Revised Administrative Code
Sec. 755 Provisions Relative to Dispensing of Violent Poisons
• Every person who dispenses, sells, or delivers any of the following
violent poisons, to wit, arsenic, arsenical solutions, phosphorus,
corrosive sublimate, cyanide of potassium or other cyanide, atropine,
cocaine, morphine, strychnine, or any of their salts, and all other
poisonous vegetable alkaloids or any of their salts, hydrocyanic acid,
or prussic acid, oil of bitter almonds containing hydrocyanic or prussic
acid, oil of mirbane (nitro-benzene), opium and its preparations,
except paregoric and such others as contain less than four hundred
and fifty milligrams of opium per one hundred cubic centimeters (two
grains to the ounce),
• shall make or cause to be made in a book kept for the purpose of
recording the sale of such poisons an entry stating the date of each
sale and the name and address of the purchaser, the name and
quantity of the poison sold, and the purpose for which it was claimed
to be purchased, before delivering it to the purchaser.
Revised Administrative Code
Sec. 755 Provisions Relative to Dispensing of Violent Poisons

• He shall not deliver any such poison to any person without satisfying himself
that such person is aware of its poisonous character, and that the poison is to
be used for a legitimate purpose, and he shall affix to every box, bottle, or
other package containing any dangerous or poisonous drug, a label of red
paper upon which shall be printed in large black letters the word "poison"
and a vignette representing a skull and bones, before delivering it to any
person. Books kept for the purpose of recording the sale of poisons shall be
open at all times to the inspection of the Board of Pharmaceutical Examiners,
and of health officers or officers of the law, and every such book shall be
preserved for at least five years after the last entry in it has been made.

Revised Administrative Code

Sec. 757 Receptacle for Poisonous Drugs

• The poisonous drugs specified in the two next preceding sections shall be
kept in a cabinet to be provided in every pharmacy carrying such drugs in
stock for the retail trade; and the same shall be kept securely locked when
not in use.
Revised Administrative Code
Sec. 756 Provisions Relative to Dispensing of Less Violent Poisons

• He shall not deliver any such poison to any person without satisfying himself
that such person is aware of its poisonous character, and that the poison is to
be used for a legitimate purpose,
• and he shall affix to every box, bottle, or other package containing any
dangerous or poisonous drug, a label of red paper upon which shall be
printed in large black letters the word "poison" and a vignette representing a
skull and bones, before delivering it to any person.
• Books kept for the purpose of recording the sale of poisons shall be open at
all times to the inspection of the Board of Pharmaceutical Examiners, and of
health officers or officers of the law, and every such book shall be preserved
for at least five years after the last entry in it has been made.
REPUBLIC ACT NO. 6969
Toxic Substances and Hazardous and Nuclear Wastes
Control Act of 1990

• Scope. — This Act shall cover the importation, manufacture,

processing, handling, storage, transportation, sale, distribution, use
and disposal of all unregulated chemical substances and mixtures in
the Philippines, including the entry, even in transit, as well as the
keeping or storage and disposal of hazardous and nuclear wastes
into the country for whatever purpose.
POSTMORTEM FINDINGS
POSTMORTEM FINDINGS
Hydrochloric Acid
POSTMORTEM FINDINGS
Hydrochloric Acid
POSTMORTEM FINDINGS
Nitric Acid
• Lesions produced are similar to HCl except that the cutaneous stains
are distinctly yellow
POSTMORTEM FINDINGS
Caustic Alkali (KOH, NaOH)
POSTMORTEM FINDINGS
Caustic Alkali (KOH, NaOH)
POSTMORTEM FINDINGS
Caustic Alkali (KOH, NaOH)
POSTMORTEM FINDINGS
Ammonia
POSTMORTEM FINDINGS
Ammonia
POSTMORTEM FINDINGS
Phenol and its derivatives
POSTMORTEM FINDINGS
Phenol and its derivatives
POSTMORTEM FINDINGS
Phenol and its derivatives
POSTMORTEM FINDINGS
Mercury (Perchloride and Nitrate Salts)
POSTMORTEM FINDINGS
Mercury (Perchloride and Nitrate Salts)
POSTMORTEM FINDINGS
Lead (Chronic Poisoning)
POSTMORTEM FINDINGS
Lead (Chronic Poisoning)
POSTMORTEM FINDINGS
Lead (Chronic Poisoning)
POSTMORTEM FINDINGS
Phosphorous (Rat-poisoning, fireworks, match stick)
POSTMORTEM FINDINGS
Phosphorous (Rat-poisoning, fireworks, match stick)
POSTMORTEM FINDINGS Hydrocyanic
Acid
POSTMORTEM FINDINGS Hydrocyanic Acid
 REFERENCES

• Solis, P. (1987). Legal Medicine.

• officialgazette.gov.ph. 2021 [cited 2021 Aug 27]. Available from:

https://www.officialgazette.gov.ph/1990/10/26/republic-act-no-6969
TO GOD BE THE GLORY…
• Thanks for listening…
BASIC PRINCIPLES OF PHILIPPINE
CRIMINAL LAW

ANTONIO ROQUE R. PARADELA,M.D., LLB

VICENTE SOTTO MEMORIAL MEDICAL CENTER
CRIMINAL OR PENAL LAW
• Defined as that branch or division of law which defines crimes, treats of
their nature and provides for their punishment.

• The Philippine criminal law is embodied in the REVISED PENAL CODE and in
the penal provision of other statutes.
• The Revised Penal Code took effect on January 1, 1932.
(Art. 1) It consists principally of three parts, namely:
(a) Principles affecting criminal liability (Arts. 1-20)
(b) Provisions on penalties including criminal and civil liability (Arts. 21-113)
(c) Felonies defined under different title (Art. 114-367)
Characteristics of Penal Laws:
(1) It must be general:
• The penal law must apply to all person within a territory, irrespective of
sex, race, nationality, and other personal circumstances; with certain
exceptions.
(2) It must be territorial:
• As a general rule, penal laws are enforceable within the territorial
jurisdiction of a state. It is inherent upon a state to promulgate such laws
which it thinks best for its self-preservation.
(3) It is prospective:
• No person can be penalized for a crime which is not punishable at the time
of commission.
APPLICATION OF THE PROVISIONS OF THE
REVISED PENAL CODE:
• this Code shall be enforced not only within the Philippine Archipelago,
including its atmosphere, its interior waters and maritime zone, but also
outside its jurisdiction against those who:
1. Should commit an offense while on a Philippine ship or airship.
2. Should forge or counterfeit any coin or currency note of the Philippine
Islands or obligations and securities issued by the Government of the
Philippine Islands.
3. Should be liable for acts connected with the introduction into this
Islands of the obligations and securities mentioned in the preceding number.
4. While being public officers or employees, should commit an offense in the
exercise of their functions; or
5. Should commit any of the crimes against national security and law of
nations, defined in Title One of Book Two of this Code. (Art. 2).
Exceptions to the Rule that the Penal Laws
are Strictly Territorial:
I. Provisions of treaties and Laws of -preferential application:
• The Philippines accepted the principles of international law as a part of the law of the land.
The generally accepted principles of International Law must prevail over the existing municipal
laws in case of conflict between the two laws.
1. Provision of Treaty: The Philippine-United States Base Agreement:
2. Operation of International Law (Exterritoriality):
• The right of exterritoriality is the right to be exempted from local jurisdiction granted to
citizen or subjects of another state by operation of International Law.
• Exterritoriality embraced the following immunities and privileges of diplomats and members of
the suite:
a. Exemption from criminal and civil jurisdiction.
b. Immunity of domicile and diplomatic premises from local jurisdiction (franchise de l'hotel).
• The diplomatic envoy and his residence is considered to be an extension of the territory and
person of the country wherein he is a citizen of.
II. Statutory Exceptions:
• Article 2 of the Revised Penal Code mentioned specific instances wherein
the provision may also be applied.
1. Should commit an offense while on a Philippine ship or airship.
• This is based on the theory that the vessel or airship of local registry is an
extension of the territory of the Philippines.
• If the offense is committed within the Philippine maritime zone on board
foreign ships, the following are the theories as to jurisdiction:
a. French Rule — If the crime is committed on board a foreign vessel in
Philippine water, it should not be prosecuted in our local court, except when
the offense affects the peace, security and safety of the Philippines. This
theory emphasizes nationality.
b. English Rule — If a crime is committed on board a foreign vessel in
Philippine water, the case is triable in our local court, except when it merely
affects internal discipline and management of the vessel.
2. Should forge or counterfeit any coin or currency not of the Philippine
Islands or obligations and securities issued by the government of the
Philippine Islands.
3. Should be liable for acts connected with the introduction into this
Islands of the obligations and securities mentioned in the preceding
number.
4. While being public officers or employees, should commit an offense
in the exercise of their function; or
5. Should commit any of the crimes against national security and laws
of national.
• The reason for this is to safeguard the State from acts of treason and
espionage based upon the inherent right of a state to self-defense.
DEFINITION OF FELONIES:

Acts and omissions punishable by law are felonies (delitos).

• Felonies are committed not only by means of deceit (dolo) but also by
means of fault (culpa).
• There is deceit when the act is performed with deliberate intent; and
there is fault when the wrongful act results from imprudence,
negligence, lack of foresight, or lack of skill. (Art. 3).
Elements of a Felony:
1. There must be an act or omission:
• By act is meant the positive action on the part of a person doing a thing
which he must not lawfully do, while omission is failure of a person to do a
thing which he is legally obliged to do.
2. Such act or omission must be done voluntarily:
• There must be free and voluntary act or omission on the part of the person
committing the felony. If the act or omission is done due to the compulsion
of an irresistible force or due to an impulse of an uncontrollable fear or an
equal or greater injury, then the person is exempted from criminal liability.
3. Such act or omission must be punishable by law at the time of the
commission:
• No felony shall be punishable by any penalty not prescribed by law prior to
its commission. (Art. 21).
• Penal laws shall have a retroactive effect in so far as they favor the person
guilty of a felony, who is not habitual criminal, although at the time of the
publication of such laws a final sentence has been pronounced and the
convict is serving; the same.
CRIMINAL INTENT:
• As a general |rule, intent is necessary in a felony, for an act does not make a person a criminal
unless he possesses a criminal mind.
• Requisites of Criminal Intent:
1. There must be freedom of the person committing the felony:
• There is no freedom to act in the following instances:
a. Any person who acts under the compulsion of an irresistible force. (No. 5, Art. 12).
b. Any person who acts under the impulse of an uncontrollable fear or an equal or greater
injury. (No. 4, Art. 12).
2. There must be intelligence on the part of the person committing the felony:
• In the following instances a person is exempted from criminal liability because of the lack of
intelligence:
a. An imbecile or an insane, unless the latter has acted during a lucid interval. (No. 1, Art. 12).
b. Persons under nine years of age.
c. A person over nine years of age and under fifteen, unless he has acted with discernment
(No. 3, Art. 12).
• For crimes defined under the Revised Penal Code, criminal intent is necessary, however in
other statutory crimes, the intent is immaterial, provided that the prohibited act is
committed.
CRIMINAL LIABILITY:
• Criminal liability shall be incurred:
1. By any person committing a felony (delito) although the wrongful act
done be different from that which he intended.
2. By any person performing an act which would be an offense against
persons or property, were it not for the inherent impossibility of it
accomplishment or on account of the employment of inadequate or
ineffectual means. (Art. 4).
• This includes the impossible crimes. Although the wrongful act was
made with evil intent, it does not produce the desired injury on
account of either of the following:
1* Inherent impossibility of accomplishing it.
2. Employment of inadequate or ineffectual means.
• There is inherent impossibility of accomplishing the felony, when the
very nature of the act, it is impossible to consummate it.
Example:—Stabbing a person with intent to kill who has been long long
dead.
• Employment of inadequate or ineffectual means implies that the
offended performs an act which is not capable of producing the
desired effect.
• Example: — When a person tries to kill another by putting arsenic in
the drinking water when in fact it is table salt
• The provision only refers to acts which would have been an offense
against persons or property. It does not refer to other crimes
described in the Revised Penal Code.
• The penalty imposed in the commission of the impossible crimes
depends upon the social danger and the degree of criminality of the
offender and shall impose upon him the penalty of arresto mayor or a
fine ranging from 200 to 500 pesos (Art. 59).
I. By any person committing a felony (delito) although the wrongful act
done be different from that which he intended:
• A person is responsible for all the natural and logical consequences of
his felonious act even if the wrongful act done is different from that
which he intended to commit.
• The following requisites must concur before a person can be held
responsible for the felony if the wrongful act done is different from
that one intended:
1. That a felony was committed.
2. That the wrongful act done to the aggrieved party is a direct and
natural consequence of the crime committed by the offender.
Exceptions:
• Exceptions:
1. When the injury suffered by the offended party is due to some causes or
accident foreign to the facts constituting the felony.
• Example: — If the offender inflicted slight physical injuries to the offended, and
later the offended died of heart failure.
• The offender cannot be liable for homicide or murder but only for slight physical
injuries.
2. When the injury suffered by the offended party is due to his inexcusable
negligence or deliberate misconduct.
• Example: — If the offended party received slight physical injuries from the
offender and later the offended party deliberately contaminated the wounds
which later become serious, the offender is only liable for slight physical injuries.
3. When the injury suffered by the offended party is due to the lack of skill, lack of
foresight, or gross carelessness or negligence of a third person.
• Example: — If the offender inflicted less serious physical injuries to the offended
and due to the gross negligence of the attending physician, the offended died,
the offender is only liable for less serious physical injuries.
II. By any person performing an act which would be an offense against
persons or property, where it not for the inherent impossibility of its
accomplishment or on account of the employment of inadequate or
ineffectual means (Par. 2, Art. 4).
STAGES OF EXECUTION OF A CRIME:
• Consummated, as well as those which are frustrated and attempted,
are punishable.
• A felony is consummated when all the elements necessary for its
execution and accomplishment are present; and it is frustrated when
the offender performs all the acts of execution which would produce
a felony as a consequence but which, nevertheless, do not produce it
by reason of causes independent of the will of the perpetrator.
• There is an attempt when the offender commences the commission
of a felony directly by overacts, and does not perform all the acts of
execution which should produce the felony by reason of some causes
or accident other than his own spontaneous desistance. (Art. 6).
1. Attempted crime:
• In attempted felony, the offender never goes beyond the subjective phase of the
crime. The following are the requisites:
a. The offender commences directly or by overt acts the execution of the crime.
b. The external acts must have direct connection with the crime.
• Overt act means the act which followed by another act will commit the felony.
c. The offender fails to perform all the acts of execution by reason or cause other
than his spontaneous desistance.
• In attempted felony, the offender fails to perform all the acts of execution of the
crime due to external interventions or causes.
• If the offender desisted later because of fear or remorse, there would be no
attempted felony and such act is not punishable by law.
• The reason of the law for exempting him from any criminal liability is to reward
him for having been at the verge of a crime, heed to the call of his conscience and
return to the path of righteousness. (Guevarra)
• Example: The offender with intent to kill tried to aim his gun against another
person, but fortunately the gun was grabbed by another.
2. Frustrated Crime:
• There is frustrated felony when the offender has performed all the
acts of execution which will produce the felony, but it did not produce
the crime because of some causes independent of the will of the
offender. The subjective phase of the crime is complete but fails to
realize the objective phase for reason independent of the will of the
offender.
• The subjective phase of the crime begins from the moment the
offender thought of committing the felony or from the
commencement of the overt acts to the last act of the offender to
produce the desired effect. The objective phase starts beyond the last
act of the offender up to the time the desired effect has been
produced.
Requisites:
a. The offender has done all the acts of execution which would produce
the felony.
b. The desired effect was not produced by reason or causes independent
of the will of the offender.
If the desired felony was not produced because of the voluntary will of the
perpetrator, then there is no frustrated crime.
Example: The offender with intent to kill stabbed a person in the abdomen
and because of the timely intervention by a surgeon, the offended did not
die.
3. Consummated Crime:
There is consummated crime when the offender has done all of the
acts of execution necessary for a felony and the desired result as a
direct and natural consequence of which was produced.
The crime is complete in its subjective and objective phase.
Example: An offender stabbed treacherously another person with
intent to kill and as a result of which the victim died. The offender may
be charged for consummated murder.
PERSONS CRIMINALLY LIABLE:
1. Principals:
The following are considered principals:
a. Those who take a direct part in the execution of the act (Principal by
direct participation);
b. Those who directly force or induce others to commit it (Principal by
inducement);
c. Those who cooperate in the commission of the offense by another
act without^ which it would not have been accomplished (Principal by
cooperation). (Art. 17)
2. Accomplices:
• Accomplices are those persons who, not having included in Article 17
(Principals), cooperate in the execution of the offense by previous or
simultaneous acts. (Art. 18).
• The presence of an accomplice although necessary is not
indispensable. The accomplice in order to be criminally liable must
have a common criminal purpose with the principal. The accomplice
must have the intention to help morally or materially in the
commission of the crime.
3. Accessories:
• Accessories are those who, having knowledge of the commission of the
crime, and without having participated therein, either as principals or
accomplices, take part subsequent to its commission in any of the following
manners:
a. By profiting themselves or assisting the offenders to profit by the effect of
the crime.
b. By concealing or destroying the body of the crime, or the effects or
instruments thereof, in order to prevent its discovery.
c. By harboring, concealing, or assisting in the escape of the principal of the
crime, provided the accessory acts with abuse of his public functions or
whenever the author of the crime is guilty of treason, parricide, murder, or
an attempt to take the life of the Chief Executive, or is known to be
habitually guilty of some other crimes. (Art. 19).
• The penalty prescribed by law for the commission of a felony shall be
imposed upon the principals in the commission of the felony.
• Whenever the law prescribes a penalty for a felony in general terms, it shall
be understood as applicable to the consummated felony. (Art. 46).
 CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY:
I. Justifying Circumstances:
• A person who acted by virtue of a justifying circumstance does not commit a
crime in the eye of the law. In as much as no crime is committed then it follows
that there is no criminal. The person is exempted from criminal and civil liability.
The following do not incur any criminal liability:
1. Anyone who acts in defense of his person or rights, provided that the following
circumstances concur:
First. Unlawful aggression;
Second. Reasonable necessity of the means employed to prevent or repel it;
Third. Lack of sufficient provocation on the part of the person defending
himself.
2. Anyone who acts in defense of the person or rights of his spouse,
ascendants, descendants, or legitimate, natural or adopted brothers or
sisters, or of his relatives by affinity in the same degrees, and those by
consanguinity within the fourth civil degree, provided that the first and
second requisites prescribed in the next preceding circumstance are
present, and the further requisite, in case the provocation was given by
the person attacked, that the one making defense had no part therein.

3. Anyone who acts in defense of the person or right of a stranger,

provided that the first and second requisites mentioned in the first
circumstance of this article are present and that the person defending
be not induced by revenge, resentment, or other civil motive.
4. Any person who, in order to avoid an evil or injury, does an act which
causes damage to another, provided that the following requisites are
present:
First. That the evil sought to be avoided actually exists;
Second. That the injury feared be greater than that done to avoid it;
Third.- That there be no other practical and less harmful means of
preventing it.
5. Any person who acts in the fulfillment of a duty or in the lawful
exercise of a right or office.
6. Any person who acts in obedience to an order issued by a superior
for some lawful purposes. (Art. 11).
II. Exempting Circumstances:
• There is a crime committed but there is no criminal on account of the absence of free will and voluntariness
to act. The offender although exempted from the criminal liability may be civilly liable for his felonious act.
• Circumstances which exempt from Criminal Liability:
1. An imbecile or an insane person, unless the latter has acted during , a lucid interval.
• When the imbecile or an insane person has committed an act which the law defines as a felony (delito), the
court shall order his confinement in one of the hospitals or asylums established for persons thus afflicted,
where he shall not be permitted to leave without first obtaining the permission of the* same court.
2. A person under nine years of age.
3. A person over nine years of age and under fifteen unless he has acted with discernment, in which case, such
minor shall be proceeded against in accordance with the provision of article 80 of this Code.
• When such minor is adjudged to be criminally irresponsible, the court, in conformity with the provisions of
this and the preceding paragraph, shall commit him to the care and custody of his family who shall be
charged with his surveillance and education; otherwise, he shall be committed to the care of some
institution or person mentioned in said article 80.
4. Any person who, while performing a lawful act with due care, causes an injury by mere accident without
fault or intention of causing it.
5. Any person who acts under the compulsion of an irresistible force.
6. Any person who acts under the impulse of an uncontrollable fear of an equal or greater injury.
7. Any person who fails to perform an act required by law, when prevented by some lawful or insuperable
cause. (Art. 12).
III. Mitigating Circumstances:
• These are circumstances which lessen the penalty. The penalty may
be the minimum within a degree provided there are no aggravating
circumstances to off-set them or the penalty will be lowered one or
two degrees from that one prescribed by law.
• Kinds of Mitigating Circumstances:
1. Privileged mitigating circumstances:
This kind of mitigating circumstances cannot be off-set by aggravating
circumstances. It lowers the penalty one or two degrees.
2. Ordinary mitigating circumstances:
• This can be off-set by the aggravating circumstances and lower only
the penalty to the minimum period within a degree. (Padilla).
Circumstances which Mitigate Criminal Liability:
1. Those mentioned in the preceding chapter, when all the requisites
necessary to justify the act or to exempt from criminal liability in the
respective cases are not attendant.
2. That the offender is under eighteen years of age or over seventy
years. In the case of the minor, he shall be proceeded against in
accordance with the provisions of Art. 80.
3. That the offender had no intention to commit so grave a wrong as
that committed.
4. That sufficient provocation or threat on the part of the offended
party immediately preceded the act.
5. That the act was committed in the immediate vindication of a grave
offense to the one committing the felony (delito), his spouse,
ascendants, descendants, legitimate, natural or adopted brothers or
sisters, or relatives by affinity within the same degrees.
6. That of having acted upon an impulse so powerful as naturally to
have produced passion or obfuscation.
7. That the offender had voluntarily surrendered himself to a person in
authority or his agents, or that he had voluntarily confessed his guilt
before the court prior to the presentation of the evidence for the
prosecution.
8. That the offender is deaf and dumb, blind or otherwise suffering
some physical defect which thus restricts his means of action, defense,
or communication with his fellow beings.
9. Such illness of the offender as would diminish the exercise of the
will-power of the offender without however depriving him of
consciousness of his acts.
10. And, finally, any other circumstance of a similar nature and
analogous to those above mentioned. (Art. 13).
IV. Aggravating Circumstances:
• Aggravating circumstances increase the penalty or qualify a crime to a
graver one. The basis is the moral perversion of the offender is dangerous
to the state and justify longer confinement.

• Kinds of Aggravating Circumstances:

1. Generic — Those aggravating circumstances that may be applied to all
crimes. Example: recidivism, night time.
2. Specific — Those that may only be applied to a particular crime.
Example: Cruelty can only be applied to crime against person.
3. Qualifying — These are aggravating circumstances that change the nature
of the crime. Example: Treachery qualifies homicide to murder.
4. Inherent — Those that are considered to be a party of the crime itself.
Example: Breaking of the wall in robbery. (Padilla).
Circumstances Which Aggravate Criminal Liability:
1. That advantage be taken by the offender of his public position.
2. That the crime be committed in contempt of or with insult to the
public authorities.
3. That the act he committed with insult or in disregard of the respect
due the offended party on account of his rank, age, or Bex or that it be
committed in the dwelling of the offended party, if the latter has not
given provocation.
4. That the act be committed with abuse of confidence or obvious
ungratefulness.
5. That the crime be committed in the palace of the Chief Executive, or
in his presence, or where public authorities are engaged in the
discharge of their duties, or in place dedicated to religious worship.
6. That the crime be committed in the night time or in an uninhabited place, or by a
band, whenever such circumstances may facilitate the commission of the offense.
7. That the crime be committed on the occasion of a conflagration, shipwreck,
earthquake, epidemic, or other calamity or misfortune.
8. That the crime be committed with the aid of armed men or persons who insure
or afford impunity.
9. That the accused is a recidivist.
• A recidivist is one who, at the time of his trial for one crime, shall have been
previously convicted final judgment of another crime embraced in the same title
of this Code.
10. That the offender has been previously punished for an offense to which the law
attaches an equal or greater penalty or for two or more crimes to which it attaches
a lighter penalty.
11. That the crime be committed in consideration of a price, reward, or promise.
12. That the crime be committed by means of inundation, fire, poison explosion,
stranding of a vessel or intentional damage, thereto, derailment of a locomotive, or
by the use of any other artifice involving great waste and ruin.
13. That the act be committed with evident premeditation.
14. That craft, fraud, or disguise be employed.
15. That advantage be taken of superior strength, or means be employed to
weaken the defense.
16. That the act be committed with treachery (alevosia). There is treachery when
the offender commits any of the crimes against the person, employing means,
methods, or form in the execution thereof which tend directly and specially to
insure its execution, without risk to himself arising from the defense which the
offended party might make.
17. That means be employed or circumstances brought about which add ignominy
to the natural effects of the act.
18. That the crime be committed after an unlawful entry. There is an unlawful entry
when the entrance is effected by a way not intended for the purpose.
19. That as a means to the commission of a crime a wall, roof, floor, door, or
window be broken.
20. That the crime be committed with the aid of persons under fifteen years of age
or by means of motor vehicles, airships, or other similar means.
21. That the wrong done in the commission of the crime be deliberately
augmented by causing other wrong not necessary for its commission (Art. 14,
Revised Penal Code).
V. Alternative Circumstances:
• Alternative circumstances are those which must be taken into
consideration as aggravating or mitigating according to the nature and
effects of the crime and the other conditions attending its commission.
• They are the relationship, intoxication and the degree of instruction and
education of the offender.
• The alternative circumstance of relationship shall be taken into
consideration when the offended party is the spouse, ascendant,
descendant, legitimate, natural, or adopted brother or sister, or relative by
affinity in the same degrees of the offender.
• The intoxication of the offender shall be taken into consideration as a
mitigating circumstance when the offender has committed a felony in the
state of intoxication, if the same is not habitual or subsequent to the plan
to commit said felony; but when the intoxication is habitual or intentional
it shall be considered as an aggravating circumstance. (Art. 15).
PENALTIES:
• No felony shall be punishable by any penalty not prescribed by law
prior to its commission (Art. 21). Penal laws shall have a retroactive
effect in so far as they favor the person guilty of a felony, who is not a
habitual criminal, as this term is defined in rule 5 of article 62 of this
code, although at the time of the publication of such laws of final
sentence has been pronounced and the convict is serving the same.
(Art. 22).
• For purposes of this article, a person shall be deemed to be habitual
delinquent, if within a period of ten years from the date of his release
or last conviction of the crimes of serious or less serious physical
injuries, robo, hurto, estafa, or falsification, he is found guilty of any
of said crimes a third time or offender. (Rule 5, Art. 62).
Theories Justifying Penalties:
1. As a preventive measure of the State: The state is obliged to punish
the criminals to prevent or suppress the danger to the State and to the
public arising from the criminal acts of the offender.
2. As a measure of self-defense: The State has the right to punish the
wrong-doer to protect society from the threat and wrong inflicted by
the criminal.
3. To reform the criminal: It is the prime duty of the State to correct or
reform the criminals.
4. For exemplarity: The wrong-doer is punished to be made as an
example to discourage others committing crimes.
5. To do justice: The criminals are punished by the State as an act of
retributive justice, a vindication of absolute right and moral law
violated by the criminal.
Classification of Penalties:
I. Principal Penalties:
1. Capital punishment: death
2. Afflictive penalties:
• Reclusion perpetua
• Reclusion temporal
• Perpetual or temporary absolute disqualification
• Perpetual or temporary special disqualification
• Prision mayor
3. Correctional penalties:
• Prision correccional
• Arresto mayor
• Suspension
• Destierro
4. Light penalties:
• Arresto menor
• Public censure
5. Penalties common to the three preceding classes:
• Fine, and Bond to keep the peace.
II. Accessory Penalties:
1. Perpetual or temporary absolute disqualification
2. Perpetual or temporary special disqualification
3. Suspension from public office, the right to vote and to be voted for,
the profession or calling.
4. Civil interdiction
5. Indemnification
6. Forfeiture or confiscation of instruments and proceeds of the offense
7. Payment of costs. (Art. 25)
Duration of Penalties:
1. Reclusion perpetua:
• Any person sentenced to any of the perpetual penalties shall be pardoned
after undergoing the penalty for thirty years, unless such person by reason
of his conduct or some other serious cause shall be considered by the Chief
Executive as unworthy of pardon. (Art. 27)
2. Reclusion temporal:
• The penalty of reclusion temporal shall be from twelve years and one day
to twenty years. (Art. 27)
3. Prision mayor and temporary disqualification:
The duration of the penalties of prision mayor and temporary
disqualification shall be from six years and one day to twelve yean except
when the penalty of disqualification imposed as an accessory penalty, in
which case its duration shall be that of the principal penalty. (Art. 27>
4. Prision correccional, suspension and destierro:
• The duration of the penalties of prision correccional, suspension and
destierro shall be from six months and one day to six years, except when
suspension is imposed as an accessory penalty; in which case, its duration
shall be that of the principal penalty. (Art. 27)
5. Arresto Mayor:
• The duration of the penalty of arresto mayor Bhall be from one month and
one day to six months. (Art. 27)
6. Arresto Menor:
• The duration of the penalty of arresto menor shall be from one day to
thirty days. (Art. 27)
7. Bond to keep the peace:
• The bond to keep the peace shall be required to cover such period of time
as the court may determine. (Art. 27)
• Effects of the Penalties:
1. Perpetual or temporary absolute disqualification:
a. The deprivation of the public offices and employments which the
offender may have held, even if conferred by popular election.
b. The deprivation of the right to vote in any election for any popular
elective office or to be elected to such office.
c. The disqualification for the offices or public employment and for the
exercise of any of the rights mentioned.
In case of temporary disqualification, such disqualification as is
comprised in paragraphs 2 and 3 of this article shall last during the
term of the sentence.
d. The loss of all rights to retirement pay or other pension for any office
formerly held. (Art. 30)
2. Perpetual or temporary special disqualification:
a. The deprivation of the office, employment, profession or calling
affected.
b. The disqualification for holding similar offices or employments either
perpetually or during the term of the sentence, according to the extent
of such disqualification. (Art. 31)
3. Suspension from any public office, profession or calling, or right of
suffrage:
• The suspension from public office, profession or calling, and the
exercise of suffrage shall disqualify the offender from holding Buch
office or exercising such profession or calling or right of suffrage
during the term of the sentence.
• The person suspended from holding public office shall not hold
another having similar functions during the period of his suspension.
(Art. 33)
4. Civil Interdiction:
• Civil interdiction shall deprive the offender during; the time of his
sentence of {he rights of parental authority, or guardianship, either as
to the person or property of any ward, of marital authority, of the
right to manage his property and of the right to dispose of such
property by any act or any conveyance inter vivos. (Art 34)
5. Bond to keep the peace:
• It shall be the duty of any person sentenced to give bond to keep the peace, to
present two sufficient sureties who shall undertake that such person will not
commit the offense sought to be prevented, and that in case such offense be
committed they will pay the amount determined by the court in its judgment, or
otherwise to deposit such amount in the office of the clerk of the court, to
guarantee said undertaking.
• The court shall determine, according to its discretion, the period of duration of
the bond.
• Should the person sentenced fail to give the bond as required he shall be
detained for a period which shall in no case exceed six months, if he shall have
been prosecuted for a grave or less grave felony, and shall not exceed thirty days
for a light felony. (Art. 35)
6. Destierro:
• Any person sentenced to destierro shall not be permitted to enter the place or
places designated in the sentence, nor within the radius therein specified, which
shall not be more than 250 and less than 25 kilometers from the place
designated. (Art 87)
EFFECT OF PARDON:
• A pardon shall not work the restoration of the right to hold public
office, or the right of suffrage, unless such rights be expressly
restored by the terms of the pardon.
• A pardon shall in no case exempt the culprit from the payment of the
civil indemnity imposed upon him by the sentence. (Art. 36)
DIVISION OF THE DEGREE OF PENALTY INTO
PERIODS:
• Each degree of penalty is further subdivided into three periods,
namely: maximum, medium, and minimum periods, except the
indivisible penalties, like death. As to what period within a degree
shall be imposed upon a convict depends upon the mitigating and
aggravating circumstances present which must offset one another.
DEFINITION OF COMPLEX CRIME:

• When a single act constitutes two or more grave felonies, or when an

offense is a necessary means for committing the other, the penalty
for the most serious crime shall be imposed, and the same to be
applied in its maximum period (Art. 48)
CONSPIRACY AND PROPOSAL TO COMMIT
FELONY:
• Conspiracy and proposal to commit felony are punishable only in
cases in which the law specially provides a penalty therefor.
• A consipracy exists when two or more person come to an agreement
concerning the commission of a felony and decide to commit it
• There is proposal when the person who has decided to commit a
felony proposes its execution to some other person or persons. (Art.
8)
EXTINCTIONS OF CRIMINAL LIABILITY:
I. Total Extinction:
1. By the death of the convict, as to the personal penalties; and as to pecuniary
penalties, liability therefore is extinguished only when death of the offender
occurs before final judgment.
2- By service of the sentence.
3. By amnesty, which completely extinguishes the penalty and all its effects.
4. By absolute pardon.
5. By prescription of the crime.
6. By prescription of the offense.
7. By the marriage of the offended woman, as provided in article 344 of this
Code. (Art. 89)
EXTINCTIONS OF CRIMINAL LIABILITY:

II. Partial Extinction:

1. By conditional pardon.
2. By commutation of the sentence.
3. For good conduct' allowances which the culprit may earn while he is
serving his sentence. (Art. 94)
4. Special time allowance for loyalty (Art. 98)
5. Preventive imprisonment.
Thanks for listening…..God bless you.