Professional Documents
Culture Documents
GENERAL CONSIDERATION
^EGALM^DIClNllis a branch of medicine which deals with the
application of medical knowledge to the purposes of law and in the
administration of justice. It is the application of basic and clinical,
medical and paramedical sciences to elucidate legal matters.
Originally the terms legal medicine, forensic medicine and medical
jurisprudence are synonymous and in common practice are used
interchangeably. This concept prevailed among countries under the
Anglo-American influence.
The concept and practice of legal medicine in the Philippines is
of Spanish origin. In modern times, especially in continental European countries, legal medicine has a similar meaning as the term
forensic medicine, although, strictly speaking, legal medicine is
primarily the application of medicine to legal eases while forensic
medicine concerns with the application of medical science to elucidate legal problems. On the other hand, .medical jurisprudence
(j'uris-law, prudentia-knowledge) denotes knowledge"of lawT in relation to the practice of medicine. 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.
According to the Rules of Court (Sec. 5, Rule 138) Medical
Jurisprudence is one of the subjects in the law course before admission to the bar examination. This is based on the original concept
but actually it must be the study of legal medicine as it was the
intention and practice in the past.
v Scope of Legal Medicine:
The scope of legal medicine is quite broad and encompassing. It
is the application of medical and paramedical sciences as demanded
by law and administration of justice. The knowledge of the nature
and extent of wounds has been acquired in surgery, abortion in
gynecology, sudden death and effects of trauma in pathology, etc.
aside from having knowledge of the basic medical sciences, like
anatomy, physiology, biochemistry, physics and other allied sciences.
^Nature of the Study of Legal Medicine:
A knowlege of legal medicine means the ability to acquire facts,
the power to arrange those facts in their logical order, and to draw a
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LEGAL MEDICINE
GENERAL CONSIDERATION
LEGAL MEDICINE
5. Jurisprudence:
It is a practical science which investigates the nature, origin,
development and functions of law. It is a science of giving a wise
interpretation of the law and making just application of them to
all cases as they arise.
Judicial decisions applying or interpreting the laws shall form a
part of the Philippine jurisprudence. The decisions contemplated
are those rendered by the Supreme Court which is the final arbiter
on legal issues. However, the decisions of the Court of Appeals
may serve as precedent for inferior courts on points of facts.
Principle of Stare Decisis:
A principle that, when the court has once laid down a principle of
law or intepretation as applied to a certain state of facts, it will
adhere to and apply to all future cases where the facts are substantially the same.
The principle is one of policy, grounded on the theory that
security and certainty require that accepted and established legal
principles, under which right may accrue, be recognized and followed, though later found to be not legally sound, but whether
previous holding of court shall be adhered to, modified or overruled is within the court's discretion under the circumstance of the
case before it (Black's Law Dictionary, 4th ed.).
Branches of Law Where Legal Medicine may be Applied:
1. Civil Law Civil law is a 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 (Sanchez Roman).
Our civil laws are scientifically and systematically compiled in
the Civil Code of the Philippines (Republic Act No. 386).
In civil law, knowledge of legal medicine may be useful on the
following:
a. The determination and termination of civil personality (Art. 40
and 41),
b. The limitation or restriction of a natural person's capacity to
act (Art. 23 and 39);
c. The marriage and legal separation (Book I, Title III & IV);
d. The paternity and filiation
^Book I, Title VIII); and
e. The testimentary capacity of a person making a will (Book III,
Title IV).
GENERAL CONSIDERATION
LEGAL MEDICINE
GENERAL CONSIDERATION
LEGAL MEDICINE
The Code of Hammurabi, the oldest code of law (2200 B.C.)
included legislation on adultery, rape, divorce, incest, abortion and
violence.
Hippocrates (460-355 B.C.) in Greece discussed the lethality
of wounds. Aristotle (384-322 B.C.) fixed animation of fetus at
the 40th day after conception.
About 300 B.C. the Chinese materia medica gave information
on poison including aconite, arsenic and opium. Hashish was said
to have been used as a narcotic in surgery about 200 B.C.
That bodies of all women dying during confinement should
immediately be opened in order to save the child's life was promulgated during the reign of Numa Pompilius in Rome (600
B.C.).
The first "police surgeon" or forensic pathologist was Antistius. Julius Caesar (100-44 B.C.) was murdered and his body was
exposed in the forum and Antistius performed the autopsy. He
found out that Julius Caesar suffered from twenty-three wounds
and only one penetrated the chest cavity through the space between the first and second ribs.
Justinian (483-565 A.D.), in his Digest, made mention that a
physician is not an ordinary witness and that a physician gives
judgment rather than testimony. This led to the recognition of
expert witness in court.
The first textbook in legal medicine was included in the Constitute Criminalis Carolina which was promulgated in 1532 during
the reign of Emperor Charles V in Germany.
Pope Innocent III (1209) issued an edict providing for the
appointment of doctors to the courts for the determination of the
nature of wounds.
Pope Gregory IX, in 1234, caused the preparation of Nova
Compilatio Decretalium which concerned medical evidence, marriage, nullity, impotence, delivery, caesarian section, legitimacy,
sexual offenses, crime against persons and witchcraft.
In the 14th century, Pope John XXII expressed the need of
experts in the ecclesiastical courts, in the diagnosis of leprosy and
many medico-legal documents.
In China, the Hsi Yuan Lu (Instructions to Coroner) was published. It is a five volume book dealing with inquest, criminal
abortion, infanticide, signs of death, assault, suicide, hanging,
strangling, drowning, burning, poisoning and antidotes, and
examination of the dead.
GENERAL CONSIDERATION
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idents of the same, medico-legal duties of the "Medico Titulares"
of the Spanish regime. The Philippine Legislature maintained the
pre-existing medico-legal system in full force in the Administrative
Code.
In 1908, the Philippine Medical School incorporated the teaching of Legal Medicine, one hour a week to the fifth year medical
students.
In 1919, the University of the Philippines created the Department of Legal Medicine and Ethics with the head having the salary
of 4,000.00 pesos per annum, half-time basis, with Dr. Sixto de
los Angeles as the chief.
On January 10, 1922, the head of the Department of Legal
Medicine and Ethics became the Chief of the Medico-Legal Department of the Philippine General Hospital without pay.
On March 10, 1922,-the Philippine Legislature enacted Act. No.
1043 which became incorporated in the Administrative Code as
Section 2465 and provided that the Department of Legal Medicine,
University of -the Philippines, became a branch of the Department
of Justice.
On December 10, 1937, Commonwealth Act. No. 181 was
passed creating the Division of Investigation under the Department
of Justice. The Medico-Legal Section was made as an integral part
of the Division with Dr. Gregorio T. Lantin as the chief.
On March 3, 1939, the Department of Legal Medicine of the
College of Medicine, University of the Philippines was abolished
and its functions were transferred to the Medico-Legal Section of
the Division of Investigation under the Department of Justice.
On July 4, 1942, President Jose P. Laurel consolidated by
executive order all the different law-enforcing agencies and created
the Bureau of Investigation on July 8,1944.
In 1945 immediately after liberation of the City of Manila, the
Provost Marshal of the United States Army created the Criminal
Investigation Laboratory with the Office of the Medical Examiner
as an integral part and with Dr. Mariano Lara as Chief Medical
Examiner.
On June 28, 1945, the Division of Investigation, under the
Department of Justice was reactivated.
On June 19, 1947, Republic Act. No. 157 creating the Bureau
of Investigation was passed. The Bureau of Investigation was
created by virtue of an executive order of the President of the
Philippines. Under the bureau, a Medico-Legal Division was created
with Dr. Enrique V. de los Santos as the Chief.
GENERAL CONSIDERATION
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of witnesses, records, documents, concrete objects, etc., for the purpose of inducing belief in the minds of the court as to their contenti o n (Black's Law Dictionary, 4th ed.).
If the means employed to prove a fact is medical in nature then it
becomes a medical evidence.
Same rules in all cases The rules of evidence shall be the same in
all courts and on all trials and hearings, whether civil or criminal
(Sec. 2, Rule 128, Rules of Court).
Admissibility of evidence Evidence is admissible when it is
relevant to the issue and is not excluded by these rules (Sec. 3, Rule
128, Rules of Court).
It is considered relevant when it has the tendency to prove any
matter of fact. It is something which by the process of logic, an
inference may be made as to the existence or non-existence of a fact
at issue.
Relevancy of evidence (collateral matters) Evidence must have
such a relation to the fact in issue as to induce belief in its existence
or non-existence; therefore, collateral matters shall not be allowed,
except when they tend in any reasonable degree to establish the
probability or improbability of the fact at issue (Sec. 4, Rule 130,
Rules of Court).
Collateral matters are those different from those or do not correspond with the matters in issue.
Types of Medical Evidence:
. /I. Autoptic or Real Evidence:
This is an evidence made known or addressed to the senses of the
court. It is not limited to that which is known through the sense
of vision but is extended to what the sense of hearing, taste, smell
and touch is perceived.
Sec. 1, Rule 130, Rules of Court View of an object Whenever an object has such a relation to the fact in issue as to afford
reasonable ground of belief respecting the latter, such object may
be exhibited to or viewed by the court, or its existence, situation,
condition, or character proved by witnesses, as the court in its
discretion may determine.
The court may require the physician to present the skeleton of
the victim of a criminal act exhumed and examined for the judge
to see the presence and degree of the ante-mortem fracture.
Limitations to the Presentation of Autoptic Evidence:
a. Indecency and Impropriety Presentation of an evidence may
be necessary to serve the best interest of justice but the notion
of decency and delicacy may cause inhibition of its presentation.
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LEGAL MEDICINE
Sec. 21(c), Rule 130, Rules of Court Privileged communication A person authorized to practice medicine, surgery or
obstetrics cannot in a civil case, without the consent of the
patient, be examined as to any information which he may have
acquired in attending such patient in a professional capacity,
which information was necessary to enable him to act in that
capacity, and which would blacken the character of the patient.
A medical witness can only testify on matters derived by his
own perception. Hearsay informations are as a rule not admissible in court. Hearsay evidences are those not proceeding
from the personal knowledge of the witness but from mere
repetition of what he has heard others say. It is a, "second
hand" evidence which rest mainly on the veffdty and competence of its source.
Sec. 30, Rule 130, Rules of Court Testimony generally
confined to personal knowledge A witness can testify only
to those facts which he knows of his own knowledge; that is,
which are derived from his own perception, except as otherwise provided in these ruje:
One of the exceptions to the non-admissibility of hearsay
evidence is dying declaration. The declaration of a dying person
under the consciousness of his impending death as regards
circumstance regarding his impending death is admissible in
spite of the fact that it is a hearsay, it is made so because of
necessity and it is trustworthy.
Exceptions to the hearsay rule. Sec. 31, Rule 130, Dying
declaration The declaration of a dying person, made under a
consciousness of an impending death, may be received in a
criminal case wherein his death is the subject of inquiry, as
evidence of the cause and surrounding circumstances of such
death.
Physicians are frequent recipients of dying declaration in the
medical clinics and emergency rooms of hospitals. To be admissible it must be shown that the declarant was conscious of
his impending death, that the declaration must be with regards
to his impending death; that the declarant was in full possession
of his mental faculties when he made the declaration; and that
such evidence is presented in court in a case of homicide,
murder or parricide wherein the declarant was the victim,
b. Expert Witness:
A physician on account of his training and experience can
give his opinion on a set of medical facts. He can deduce or
GENERAL CONSIDERATION
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GENERAL CONSIDERATION
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e. There must be a title and legend to tell what it is and the meaning of certain marks indicated therein.
3. Description This is putting into words the person or thing to be
preserved. Describing a thing requires keen observation and a
good power of attention, perception, intelligence and experience.
It must cause a vivid impression on the mind of the reader, a true
picture of the thing described.
The following are the minimum standard requirements which
must be satisfied in the description of the person or thing to make
it complete:
a. Skin Lesion kind, measurement, other descriptive information of the lesion itself, location, orientation.
b. Penetrating Wound (Punctured, Stab or Gunshot) kind,
shape, other information from the wound itself, location,
orientation, direction, other structures involved, complications
and foreign elements that may be present.
c. Hymenal laceration location, degree, duration, complication.
d. Person those requirement in portrait parle (see p. 53 supra).
4. Manikin Method In a miniature model of a scene or of a human
body indicating marks of the various aspects of the things to be
preserved. An anatomical model or statuette may be used and
injuries are indicated with their appropriate legends. Although it
may not indicate the full detail of the lesion, it is quite impressive
to the viewer as to the nature and severity of the trauma.
5. Preservation in the Mind of the Witness A person who perceived
something relevant for proper adjudication of a case may be a
witness in court if he has the power to transmit to others what he
perceived. He would just have to make a recital of his collection.
Principal drawbacks of preserving evidence in the mind of the
witness:
a. The capacity of a person to remember time, place and event
may be destroyed or modified by the length of time, age of the
witness, confusion with other evidences, trauma or disease,
thereby making the recollection not reliable.
b. The preservation is co-terminus with the life of the witness. If
the witness dies, then the evidence is lost.
c. Human mind can easily be subjected to too many extraneous
factors that may cause distortion of the truth. Other persons
./may influence a witness to serve the interest of another or state
untruthful facts to justify an end.
6. Special Methods Special way of treating certain type of evidence
may be necessary. Preservation may be essential from the time it
GENERAL CONSIDERATION
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Chapter II
^'fjECEPTION DETECTION
The knowledge of the truth is an essential requirement for the
administration of criminal justice. The success or failure in making
decisions may rest solely on the ability to evaluate the truth or
falsity of the statement given by the suspect or witness. The task
for its determination initially lies on the hand of the investigator.
Modern scientific methods have been devised utilizing knowledge
of physiology, psychology, pharmacology, toxicology, etc. in determining whether a subject is telling the truth or not. Although the
scientific methods of deception detection have not yet attained
legal recognition to have their results admissible as an evidence in
court, they have been considered very useful as aids in criminal
investigation.
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DECEPTION DETECTION
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LEGAL MEDICINE
Examples of relevant questions are "Did you shoot to
death Mr. "X''? "Did you take the ring, wrist watch, and
wallet of Mr. "X" after his death? "
c. Control questions These are questions which are unrelated
to the matter under investigation but are of similar nature
although less serious as compared to those relevant questions
under investigation.
If someone is being investigated for murder by shooting,
the control questions may be "Have you ever used or fired
a gun? ", "Do you have a gun? ", "Have you killed someone
with a gun? ", etc.
DECEPTION DETECTION
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DECEPTION DETECTION
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LEGAL MEDICINE
Inasmuch as the test requires the subject to answer the questions either by "yes" or "no", it infers the use of intelligence and
attention or other mental faculties which is self-incriminatory.
Therefore, a person cannot be compelled to be subjected to the
test.
DECEPTION DETECTION
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1. Procedure:
a. The examiner meets the requesting party to determine the
specific purpose of the examination and to begin formulation of relevant questions.
b. A pre-test interview is conducted with the subject to help
him or her feel at ease with the examiner, to provide an
opportunity to specify matters, to eliminate outside issues,
and to review questions that will be asked.
c. An oral test of about 12 to 15 "yes* or "no" questions is
given which is recorded on a tape recorder. The questions
are a mixture of relevant and irrelevant questions.
d. Immediately following the test or at a later time, the tape is
processed through the Psychological Stress Evaluator for
analysis of the answers.
e. If stress is indicated, the subject is given opportunity to
provide additional clarification. A retest is given to verify
correction and clarification (Legal Medicine 1980, Cyril
Wecht, ed. p. 58).
2. Advantages of Psychological Stress Evaluator over the Lie
Detector Machine:
a. It does not require the attachment of sensors to the person
being tested.
b. The testing situation need not be carefully controlled to
eliminate outside distraction; and
c. Normal body movement is not restricted.
/ II. USE OF DRUGS THAT "INHIBIT THE INHIBITOR"
A. Administration of Truth Serum:
The term "truth serum" is a misnomer. The procedure does not
make someone tell the truth and the thing administered is not a
serum but is actually a drug.
In the test, hyoscine hydrobromide is given hypodermically in
repeated doses until a state of delirium is induced. When the
proper point is reached, the questioning begins and the subject
feels a compulsion to answer the questions truthfully. He forgets
his alibi which he may have built up to cover his guilt. He may
give details of his acts or may even implicate others.
j The drug acts as depressant on the nervous system. Clinical
evidence indicates that various segments of the brain particularly
the cortex and diencephalon are selectively depressed in the
reversed order of their evolutionary development.
The use of drugs for the purpose is not without the element of
danger and should not be attempted except by a physician who
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DECEPTION DETECTION
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III. HYPNOSIS
Hypnosis is the alteration of consciousness ^nd concentration in
which the subject manifests a heightened of suggestibility while
awareness is maintained.
Not all persons are susceptible to hypnotic induction. Subjects
who are compulsive-depressive type, strong-willed like lawyers,
accountants, physicians and other professionals are usually nonhypnotizable.
Reasons Why Deception Detection Obtained Through Hypnosis Is
Not Admissible in Court:
1. It lacks the general scientific acceptance of the reliability of
hypnosis per se in ascertaining the truth from falsity;
2. The fear that the trier of fact will give uncritical and absolute
reliability to a scientific device without consideration of its flaw
in ascertaining veracity.
3. The possibility that the hypnotized subject will deliberately
fabricate;
4. The prospect that the state of heightened suggestibility in which
the hypnotized subject is suspended will produce distortion of the
fact rather than the truth; and
5. The state of the mind, skill and professionalism of the examiner
are too subjective to permit admissibility of the expert testimony
(Am. J. of Trial Advocacy, 1981, p. 603).
Confession while under hypnotic spell is not admissible as
evidence because such "psychiatric treatment" is involuntary and
mentally coersive (Leyra v. Demro, 347 U.S. 556, 74 S. Ct. 716,
98, 948 (1954).
Although hypnosis may not yield admissible evidence it may be
of some use during investigation as a discovery procedure.
IV.^SERVATION
A good criminal investigator must be a keen observer and a good
psychologist. A subject under stress on account of the stimulation of
the sympathetic nervous system may exhibit changes which may be
used as a potential clue of deception. And since just one or a combination of the following signs and symptoms is not conclusive or a
reliable proof of guilt of the subject, their presence infers further
investigation to ascertain the truth of the impression.
Physiological and Psychological Signs and Symptoms of Guilt:
1. Sweating Sweating accompanied with a flushed face indicate
anger, embarrassment or extreme nervousness. Sweating with a
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V. SCIENTIFIC INTERROGATION
Interrogation is the questioning of a person suspected of having
committed an offense or of persons who are reluctant to make a full
disclosure of information in his possession which is pertinent to the
investigation. It may be done on a suspect or a witness.
DECEPTION DETECTION
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DECEPTION DETECTION
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shall have the right to remain silent and to counsel, and be informed
of such right. No force, violence, threat, intimidation, or any other
means which vitiates the free will shall be used against him. Any
confession obtained in violation of this section shall be inadmissible
in evidence.
In compliance with the above provision of the constitution and
the decision of the U.S. Supreme Court, in Miranda v. Arizona, 384
U.S. 436 (1966) safeguards were established for the interrogation of
suspected (accused) person. If a person is to be interrogated, he
must first be warned and advised that:
a. He has the right to remain silent;
b. Anything he says can be used against him in court of law;
c. He has the right to consult with an attorney and to have the
attorney present during the questioning; and
d. If he cannot afford an attorney, one will be appointed for him
prior to any questioning if he so desires.
After such warning and in order to secure a waiver, the following
questions should be asked. An affirmative answer to each question
constitutes a waiver to the rights:
a. Do you understand each of these rights I have explained to
you?
b. Having these rights in mind, do you wish to talk to us now?
Some Techniques of Interrogation:
The choices of methods of questioning depend on the personal
and psychological evaluation of the subject by the interrogator, the
nature of the crime under investigation, previous criminal record, and
the social and educational background of the subject.
1. Emotional appeal The interrogator must create a mood that is
conducive to confession. He may be sympathetic and friendly to
the subject. The subject may be willing to disclose more information if he is treated in a kind spirit.
2. Mutt and Jeff technique In this technique there must be at least
two investigators with opposite character; one (Mutt) who is
arrogant and relentless who knows the subject to be guilty and
will not waste time in the interrogation, and the other (Jeff) who
is friendly, sympathetic and kind. When Mutt is not present Jeff
will advice the subject to make a quick decision and plea for
cooperation.
3. Bluff on split-pair technique This is applicable where there are
two or more persons who allegedly participated in the commission
of a crime. All of them are interrogated separately and the results
of their individual statements are not known to one another.
While one of them is under interrogation, the interrogator may
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claim that the subject was implicated by the author and that there
is no use for him to deny participation.
4. Stern approach The questions must oe answered clearly, and the
interrogator utilizes harsh language. Immediate response from the
subject is demanded.
5. The subject is given the opportunity to make a lengthy, timeconsuming narration. There may be a moment when the subject
becomes confused and desists from making further statement for
fear of contradicting his previous statement.
Basis of the Investigator's Inference that the Subject is Not Telling
the Truth:
1. The subject's statement have many improbabilities and gaps on
its substantial parts.
2. The subject's statements are inconsistent with the material facts.
3. The subject's statements are incoherent, conflicting with one
another.
VI. CONFESSION
Confession is an expressed acknowledgment by the accused in
a criminal case of the truth of his guilt as to the crime charged, or of
some essentials thereof.
Confession is different from admission, although admission includes, as one of its species, confession. Confession is a statement of
guilt while admission is usually a statement of fact by the accused
which does not directly involve an acknowledgement of guilt of the
accused.
The defendant stated in the preliminary investigation that he
had inflicted upon the deceased the wounds -in question. It was
held that such statement was not a confession of guilt but only an
admission, inasmuch as the defendant might have inflicted the
wound in self-defense (U.S. v. Team, 23 Phil. 64).
An admission by one accused of rape that he had carnal intercourse with the complaining witness at the time and place mentioned in the information is not a confession of guilt of the crime
charged unless he further admits that he cohabited with the
woman without her consent, or by the use of force or threat
(U.S. v. Flores, 26 Phil. 262).
Kinds of Confession:
1. Extra-judicial Confession:
This is a confession made outside of the court prior to the
trial of the case.
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DECEPTION DETECTION
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Preamble
It is the privilege of the medical doctor to practice medicine in
the service of humanity, to preserve and restore bodily and mental
health without distinction as to persons, to comfort and ease the
suffering of his or her patients. The utmost respect for human life is
to be maintained even under threat, and no use made of any medical
knowledge contrary to the laws of humanity.
For the purpose of this Declaration torture is defined as the
deliberate, systematic or wanton infliction of physical or mental
suffering by one or more persons acting alone or on the orders of
any authority, to force another person to yield information, to make
a confession, or for any other reason.
Declaration
1. The doctor shall not countenance, condone or participate in the
practice of torture or other forms of cruel inhuman or degrading
procedures, whatever the offense of which the victim of such
procedures is suspected, accused or guilty, and whatever the
victim's beliefs for motives, and all the situations, including
armed conflict and civil strife.
2. The doctor shall not provide any premises, instruments, substances
or knowledge to facilitate the practice of torture or other forms
of cruel, inhuman or degrading treatment or to diminish the
ability of the victim to resist such treatment.
3. The doctor shall not be present during any procedure during
which torture or other forms of cruel, inhuman or degrading
treatment is used or threatened.
4. A doctor must have complete clinical independence in deciding
upon the care for a person for whom he or she is medically responsible.
The doctor's fundamental role is to alleviate the distress of his
or her fellow men, and no motive whether personal, collective
or political shall prevail against his higher purpose.
5. Where a prisoner refuses nourishment and is considered by the
doctor as capable of forming an unimpaired and rational judgment
concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the
capacity of the prisoner to form such a judgement should be
confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the
doctor to the prisoner.
6. The World Medical Association will support, and should encourage
the international community, the national medical associations
and fellow doctors, to support the doctor and his or her family in
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LEGAL MEDICINE
Chapter III
MEI31G0-LEGAL ASPECTS OF IDENTIFICATION
- identification is the determination of
or thing.
t h e i n d i v i d u a l i t y nt
ajTimn
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LEGAL MEDICINE
3. The longer the interval between the death and the examination
of the remains for purposes of identification, the greater is the
need for experts in establishing identity. The process of taking
fingerprints and its examination under a magnifying lens requires
the services of an expert. When putrefaction has set in, the external bodily marks useful in identification might be destroyed
so that it is necessary to resort to an anatomical or a structural
examination of the body which requires knowledge of medicine'
and dentistry.
4. Inasmuch as the object to be identified is highly perishable, it is
necessary for the team to act in the shortest possible time specially in cases of mass disaster.
5. There is no rigid rule to be observed in the procedure of identification of persons.
Methods of Identification:
l.By comparison Identification criteria recovered during investigation are compared with records available in the file, or postmortem finding are compared with ante-mortem records.
Examples:
a. Latent fingerprints recovered from the crime scene are compared with the fingerprints on file of an investigating agency.
b. Dental findings on the skeletal remains are compared with the
dental record of the person in possession of the dentist.
2. By exclusion If two or more persons have to be identified and
all but one is not yet identified, then the one whose identity has
not been established may be known by the process of elimination.
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IDENTIFICATION OF PERSONS
The bases of human identification may be classified as:
X- Those which laymen used to prove identity No special training
or skill is required of the identifier and nc instrument or procedure is demanded.
2 JPhose which are based on scientific knowledge Identification is
made by trained men, well-seasoned by experience and observation, and primarily based on comparison or exclusion.
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LEGAL MEDICINE
c. Gait A person, on account of disease or some inborn traits,
may show a characteristic manner of walking.
(1) Ataxic gait A gait in which the foot is raised high, thrown
forward and brought down suddenly is seen in persons
suffering from tabes dorsalis.
(2) Cerebellar gait A gait associated with staggering movement is seen in cerebellar diseases.
(3) Cow's gait A swaying movement due to knock-knee.
(4) Paretic gait Gait in which the steps are short, the feet are
dragged and the legs are held more or less widely apart.
(5) Spastic gait A gait in which the legs are held together and
move in a stiff manner and the toes dragged.
(6) Festinating gait Involuntary movement in short accelerating steps.
(7) Frog gait A hopping gait resulting from infantile paralysis.
(8) Waddling gait Exaggerated alternation of lateral trunk
movement similar to the movement of the duck.
In the normal process of walking the rear portion of the
heel is placed on the ground. This is subsequently followed by
the other parts of the heel and the sole of the foot is pressed on
the ground. The toes are the last to be pressed followed by the
lifting of the foot making another step forward. The pressure at
the rear portion of the heel and in the region of the toes is the
most forceful, hence the impression is the most.
During the process of running the foot marks are less distinct because of the slipping of the foot and the sand or soil
thrown into the marks by the pressure of the tip of the toes.
Gait Patterns:
A scientific investigation of the gait pattern may be useful
for purposes of identification and investigation of the crime
scene. Gait pattern is the series of foot marks by a person
walking or running. Examination of the gait includes the
direction line, gait line, foot angle, principal angle and the
length and breadth of the steps.
45
at..
Gait pattern. A: direction line; B: gait line; C: foot line; D: foot angles;
E: principal angle; F: length of step; G: breadth of step.
46
LEGAL MEDICINE
e. Hands and feet Size, shape and abnormalities of the hands
and feet may be the bases of identification. Some persons have
supernumerary fingers or toes far apart with bony prominence.
Some fingers or toes are with split nails.
Foot or hand marks found in the investigation of the crime
scene may be:
(1) Foot or hand impression This develops when the foot or
hand is pressed on mouldable materials like mud, clay,
cement mixture, or other semi-solid mass. The impression
can be preserved by making a cast of it with plaster of Paris.
(2) Footprint or handprint This is a footmark or handmark
on a hard base contaminated or smeared with foreign
matters like dust, flour, blood, etc.
Base up
47
Base down
Triangular face
48
LEGAL MEDICINE
_1,
Tattoo marks
so
l e g a l medicine
Importance of Tattoo Mark:
a. It may help in the identification of the person. The image
inscribed may reflect the name, date of birth, language spoken,
religion, name of spouse, etc.
b. It may indicate memorable events in his life.
c. It may indicate the social stratum to which the person belongs.
Generally, tattooing is practiced by the members of the lower
economic class.
d. Lately, the presence of tattoo implies previous commitment
in prison or membership in a criminal gang.
Factors Responsible for the Permanency of Tattoo:
a. Whether the punctures are superficial or deep to reach the true
skin;
b. Nature and solubility of the pigment used. Ordinary pen ink
disappears in a short time while carbon introduced to the true
skin layer is usually permanent. Soluble pigments easily disappear and may be seen in the lymph glands.
LEGAL MEDICINE
52
"a.~Sotfy Mrasuromentii
sitting height.
- Height^
b. Measurement of the head Length and breadth of head, bizygouiatkal diameter, and length of the right ear.
"of the left foot, length of
the left middle and left little fingers, and length of left arm and
hand from the elbow to the tip of the oustretched middle
finger.
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55
6. Identification records on file at the police department, immigration bureau, hospitals, etc.
7. Identification photograph.
LIGHT AS A FACTOR IN IDENTIFICATION
1. Clearest moonlight or starlight:
Experiments have shown that the best known person cannot be
recognized by the clearest moonlight at a distance greater than 16
to 17 yards and by starlight any further than 10 to 13 yards.
a. Broad daylight:
A person can hardly recognized another person at a distance
farther than one hundred yards if the person has never been
seen before, but persons who are almost strangers may be
recognized at a distance of twenty-five yards.
b. Flash of firearm:
Although by experiment, letters of two inches high can be
read with the aid of the flash of a caliber .22 firearm at a
distance of two feet it is hardly possible for a witness to see the
assailant in case of a hold-up or a murder because:
(1) Usually the assailant is hidden.
(2) The assault is unexpected and the attention of the person or
witness is at its minimum.
c. The flash of lighting produces sufficient light for the identification of an individual provided that the person's eye is focused towards the individual he wishes to identify during the
flash.
d. In case of artificial light, the identity is relative to the kind and
intensity of the light. Experiments may be made for every
particular artificial light concerned.
/ JH. SCIENTIFIC METHODS OF IDENTIFICATION
Aspects o t Identification Requiring Scientific Knowledge:
^printing
^jS^Denfal Identification
.^^Handwriting .
Dudentification of Skeleton
E<^5etefmination of Sex .
F/f5e^0rfmnation of Age ,
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LEGAL MEDICINE
A. FINGERPRINTING
Dactyloscopy is the art of identification by comparison of fingerprints. It is the study and utilization of fingerprints.
f W > L f g A t ^ p e e r t of IOETWIC^TiON
57
A Fingerprint
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58
a. Visible print Impression made by chance and is visible without previous treatment. Impression made by the fingers smeared
with some colored substances, like black ink, vegetable juice,
may be visible immediately after impression.
b. Plastic print Impression made by chance by pressing the
finger tips on melted paraffin, putty, resin, cellophane, plastic
tape, butter, soap, etc.
c. Latent print Prints which are not visible after impression but
made visible by the addition of some substances. Latent prints
develop because the fingers are always covered with colorless
residue of oil and perspiration which when pressed on smooth
and non-absorbent material will cause the production of the
prints.
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Four Primary Types of Fingerprint
> Whorl
4 Composite
d. Twin loop There are at least two loops opening at the different sides.
e. Accidentals There are no rules that can be made in this pattern. They are rare and often with more than two deltas.
/Poroscopy (Locard's method of identification):
Examination of the ridges of the hands and fingers reveal to be
studded with minute pores which are the openings of ducts or sweat
glands. These pores are permanent as the ridges are and differ in
number and shape in a given area in each person. Poroscopy, as a
means of identification, is applied when only a part of the fingerprint is available for proper means of identification.
Can fingerprints be effaced?
John Dillinger, a notorious gangster and a police character attempted to erase his fingerprints by burning them with acid, but as
time went by, the ridges were again restored to its "natural" feature.
The acid he applied temporarily destroyed the epidermis of the
bulbs of his fingers.
As long as the dermis of the bulbs of the finger is not completely
destroyed, the fingerprints will always remain unchanged and indestructible.
61
The role of the teeth iri human identification is important for the
following reasons:
1. The possibility of two persons to have the same dentition is quite
remote. An adult has 32 teeth and each tooth has five surfaces.
Some of the teeth may be missing, carious, with filling materials,
and with abnormality in shape and other peculiarities. This will
lead to several combinations with almost infinite in number of
dental characteristics.
2. The enamel of the teeth is the hardest substance of the human
body. It may outlast all other tissues during putrefaction or
physical destruction.
3. After death, the greater the degree of tissue destruction, the
greater is the importance of dental characteristics as a means of
identification.
4. The more recent the ante-mortem records of the person to be
identified, the more reliable is the comparative or exclusionary
mode of identification that can be done.
In order to make an accurate dental record available for purposes
of comparison with that of the person to be identified, Presidential
Decree No. 1575 was promulgated, requiring practitioners of dentistry to keep records of their patients. It provides the following:
"Whereas, the identification of persons is a necessary factor in
solving crimes and in settling disputes such as claims for damages,
insurance, and inheritance;
_
Whereas, in these cases where the identification of persons
cannot be established through the regular means, identification
through dentition has been proven to be necessary and effective;
Whereas, however, records of dentition of persons are often
not available due to the lack of systematic recording of dental
practitioners of the dental history of their patients.
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NOW, THEREFORE, I, FERDINAND E. MARCOS, President
of the Philippines, by virtue of the powers vested in me by the
Constitution, do hereby order and decree the following:
Distal
morphology, configuration
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64
Dental Chart
X
RF
AM
S
CG
Caries
Indicated for Extraction
Retained Root Fragment
Amalgam Filling
Silicate Filling
Gold Crown
AB
P
- Bridge Abutment
Pontic
Gold Clasp
Gl
- Gold Inlay
M
- Missing due to Extraction
U N - Unerupted
6 6
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in dispute, respecting the mental sanity of the signer; and the opinion
of an intimate acquaintance respecting the mental sanity of a person,
the reason for the opinion being given, may be received as evidence.
In order for an ordinary witness to be qualified to express his
opinion, it must be shown that he has some familiarity with the
handwriting of the person in a way recognized by law.
Some Practical Uses of Handwriting Examination:
(^Financial crimes (bogus checks, cr'xlit card fraud, embezzlement).
/fjDeath investigation (suicide notes, hotel registration cards, letter
af explanation),
obberies (pawnshop notes, cashing of stolen checks),
idnapping with ransom (demand note, threatening letter).
'Anonymous threatening letters.
Falsification of documents (deeds of conveyance, receipts).
A
<A Graphology is the study of handwriting for the purpose of determining the writer's personality, character and aptitude. It is a
pseudo-science and merely explains the characteristics of the handwriting reflecting the character, weakness, personal idiosyncracies,
mannerisms and ambition of the writer. It must not be confused
with bibliotics.
Handwriting is a complex interaction of nerves, memory and
muscular movement. It is influenced by several factors and may be
changed or modified during the life-span of a person.
Writing is a conscious act, but on account of a repeated act it
becomes habitual and unconscious. The writer concentrates more
on the subject-matter of the writing than on the way the letter are
formed which make up the writing.
.Worry, anxiety, anger, fegling of insecurity, age, and drunkenness
may cause variation of a person's handwriting.
~
k Movements in Writing:
1. Finger movement The letters are made entirely by the action of
the thumb, the pointing and middle fingers. Such is found among
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does not flow into the fibers and spread in the same way
as fluid ink does.
(2) Fountain pen The lines are more or less round but
when pressure is increased there is separation of the nib
which is easily detected. There is evenness in the flow
of ink.
(3) Steel pen There is unevenness in the flow of ink and
leaves a scratchy appearance.
(4) Pencil Lead of pencils is compose of graphite and
clay with kaolin as binder. Soft pencils have greater
proportion of graphite while hard ones have relatively
more clay. Cheap quality pencils have frequently gritty
impurities which scratch the paper, while high-grade
pencils are free from such grit.
Paper:
(1) Color Color can be well appreciated with a good light.
Dirt, stain or fading condition may not show the true
color of the paper.
(2) Surface appearance It may be smooth or rough. The
surface may be damaged or wrinkled.
(3) Watermarks - Exposure of the paper to a strong light may
reveal the watermarks of the manufacturer or the type of
paper.
(4) Weight and thickness The thickness may be measured
by means of the paper micrometer. Papers are designated
in weight which is in turn related to the thickness of the
sheet.
Ink:
(1) Iron gallotannate ink Commonly used in "blue-black"
ink and still the basis of the greatest number of commercial ink. The changes in the paper may provide some
indications of the age of the writing.
(2) It may be a solution of a single or a mixture of dyes.
This is a common constituent of "washable" inks.
(3) Logwood ink Made of logwood extract with salts of
iron, copper, or chromium.
(4) Carbon ink It is a fine suspension in water of carbon
with stabilizing agent. India ink is an example of this
type of ink.
(5) Ballpoint ink A thick suspension of dye in a liquid
which is usually a drying oil (Crime Investigation, Physical Evidence and the Police Laboratory by Paul L. Kirk,
p. 446).
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4. Very unlikely to produce facsimile signatures in size, arrangement and proportion of parts.
5. The writing is not rhythmic, but made up of disconnected unskilled movement impulses which are not likely to be related in
an exactly identical way.
6. Tremor or involuntary trembling is seen due to inability to
control the pen in motion because of not being familiar with and
self-conscious to the process of writing.
7. Formation and angle of letters are irregular and definitely show
lack of knowledge of size and proportion.
8. Same speed is utilized from beginning to end and seldom is the
pen raised to get a new adjustment.
9. Illiterate pencil-writing is usually produced with much pressure
and may show the habit of wetting the pencil lead frequently.
10. In anonymous writing, illiteracy is indicated by faulty arrangement of words, lines, paragraphs and pages.
11. Combination of script forms and Roman capitals, or pen or
pencil printing, containing freak forms, abbreviations or punctuation marks are individual creations.
Handwriting Characteristics of Old Aged Persons:
X^Due to lack of muscular control, the handwriting will not usually
show fine lines continuously but the strokes are mostly rough
and made with considerable pressure.
2^With the presence of tremor, the changes of direction are numerous and omission of parts of letters of strokes are common.
Z. The concluding parts are often made with a nervous haste and
carelessness and they may be much distorted.
A\ Even with much tremor, the handwriting will usually show free
connecting and terminal strokes made by the momentum of the
hand.
J Often shows very uneven alignment and may disregard entirely a
line near which they are written.
-o. Usually shows an unusual and erratic departure from its intended
movement, particularly in the downward strokes.
"7. There is a loss of individual departure from its intended movement, particularly in the downward strokes.
,-8TThere is a loss of individual rhythm as indicated by malformation
and irregularity of speed in the writing of small letters.
Disguised Writing:
Disguised writing is the deliberate attempt on the part of the
writer to alter his writing habit by endeavoring to invent a new writing
style or by imitating the writing of another person.
73
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76
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77
Stature-bone length
coefficient(s)
Centimeters
Inches
69.089
81.688
73.570
80.405
69.294
71.429
66.544
66.400
64.505
27.200
32.161
28.965
31.655
27.281
28.112
26.198
26.142
25.396
56.006
22.050
61.412
72.572
64.977
73.502
65.213
55.729
59.259
60.344
57.600
24.178
28.572
25.581
28.938
25.674
21.941
23.330
23.757
22.677
57.495
22.636
Male
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(k)
2.238 (femur)
2.392 (tibia)
2.970 (humerus)
3.650 (radius)
1.255 (femur + tibia)
1.728 (humerus + radius)
1.422 (femur) + 1.062 (tibia)
1.789 (humerus) + 1.841 (radius)
1.928 (femur) + 0.568 (humerus)
1.442 (femur) + 0.931 (tibia)
+ 0.083 (humerus)
+ 0.480 (radius)
Female
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(k)
2.317 (femur)
2.533 (tibia)
3.144 (humerus)
3.876 (radius)
1.233 (femur + tibia)
1.984 (humerus + radius)
1.657 (femur) + 0.879 (tibia)
2.164 (humerus) + 1.525 (radius)
2.009 (femur) + 0.566 (humerus)
1.644 (femur) + 0.764 (tibia)
+ 0.126 (humerus)
+ 0.296 (radius)
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352
358
364
370
376
382
388
436
443
450
457
464
471
478
159.5
161.2
163.0
165.0
167.0
169.2
171.5
313
318
324
329
334
339
344
226
230
234
238
242
246
250
243
247
251
254
258
261
264
Coefficients for smaller bone lengths than given above.
x4.88 x4.85 x3.87
x5.41 x7.44 x7.00
Coefficients for greater bone lengths than given above.
x4.52 x4.42 x3.58
x4.98
x7.00 x6.49
MANOUVRIER'S STATURE TABLE FOR MALES
Fibula Tibia Femur Cadaver Humerus Radius Ulna
Length
Mm. Mm. Mm.
Cm.
Mm.
Mm. Mm.
153.0
295
318
319
392
213
227
323
324
398
155.2
298
216
231
328
330
404
157.0
302
219
235
333
335
410
159.0
306
222
239
338
340
416
160.5
309
225
243
344
346
422
162.5
313
229
246
349
351
428
'232
249
163.4
316
353
357
434
164.4
320
236
253
358
362
440
165.4
324
239
257
363
368
446
166.6
328
243
260
368
373
453
167.7
332
246
263
373
460
336
249
266
378
168.6
378
383
467
169.7
340
252
270
383
389
475
344
255
273
171.6
388
394
482
173.0
348
258
276
393
400
490
175.4
352
261
280
398
405
497
176.7
356
264
283
403
410
504
178.5
360
267
287
408
415
512
181.2
364
270
290
413
420
519
183.0
368
273
293
Coefficient for smaller bone lengths than given above.
x4.82 x4.80 X3.92
...
x5.25 x7.11 x6.66
Coefficients for greater bone lengths than given above.
x4.37 x4.32 x3.53
. ..
x4.93 x6.70 x6.26
(From: Medical Jurisprudence by Gordon, Turner and Price, 3rd ed.,
pp. 354-355.)
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82
n n
f T
2. Pelvis:
Pelvic Index =
Anteroposterior diamete^
Transverse diameter
Below 85 Platypellic Semato Caucasian
86 95 Dolicopellic Malayan
Above 95 Mesopellic Negroes
x
1 Q Q
n n
1 0 0
83
,
.
..
,
Pubis length x 100
b. Ischium-pubis Index = =
:
Ischium length
Caucasians (200 cases): <90=Male; 90-95=Sex?; > 95= Female
Negroes (100 cases): < 84= Male; 84-88=Sex? ; > 88= Female.
(GradwohVs Legal Medicine by Camps, Lucas & Robinson,
3rded.,p. 112).
3. Extremities:
,
,
Length of the lower leg
.. _
a. Crural Index = 7 *
. ..
x 100
Length of the upper leg
95 98 Semato-Caucasian
98 102 Mongolian and Malayan
,, _
Length of humerus + length of radius x 100
b. IntermembralIndex = 7 7
. . . . .
Length of femur + Length of tibia
(Modi p. 22)
Indian 67.27
European - 70.4
Negroes 70.3
,t j
Length of humerus
c. Humero-femoral Index = -=
..
x 100
Length of femur
T
rt
Mongolian
Square
inclined
Small
4. Upper
Extremity
Small
Small
5. Lower
Extremity
Normal
Small
1. Skull
2. Forehead
3. Face
Negro
Narrow and elongated
Small and compressed
Malar bones and jaw
projecting; teeth set
obliquely
Long in proportion to
body; forearm large in
proportion to arm;
hand small
Leg6 large in proportion to thighs; feet
wide and flat, heelbones projecting backwards.
AGE:
Aside from the size of the bones and dental examination, the age
of the person to whom the skeleton belongs may be determined by:
LEGAL MEDICINE
84
CO
85
18-20 yean
The head of the femur should have joined diaphysis; the epiphysis of long bones of the hand and
foot should have united to the diaphyses; the basiocciput should be fused with the basisphenoid.
20 years
The epiphyses of the fibula should be united to the
diaphysis. Distal radius unites.
22 years
The inner (secondary) epiphysis of the clavicle fuses.
25 years
The crest of the ilium and the articular facts of the
ribs should be united, if all the epiphysis have
united, the person is above 25 years of age.
(A Simplified Textbook of Medical Jurisprudence & Toxicology by
C.K. Parikh, p. 40).
3. Dental Identification (supra p. 61).,
4. Obliteration of cranial sutures (see illustration).
4U-50
20-3Q
MOLAR
root calcification
more important
than eruption
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LEGAL MEDICINE
87
above,
^AA^H
3. Marriage or the union of a man and a woman:
Any male of the age of sixteen years or more, and any female
at the age of fourteen years or more, not under any of the impediments mentioned in articles 80 to 84, may contract marriage
(Art. 54, Civil Code).
4. Rights granted by law are different io different sexes:
Majority commences upon the attainment of the age of twentyone years (Art. 402, Civil Code).
Notwithstanding the provisions of the preceding article, a
daughter above twenty-one but below twenty-three years of age
cannot leave the parental home without the consent of the father
or mother in whose company she lives, except to become a wife,
or when she exercises a profession or calling, or when the father
or mother has contracted a subsequent marriage (Art. 403, Civil
Code).
5. There are certain crimes wherein a specific sex can only be the
offender or victim:
a. In rape (Art. 335, Revised Penal Code), seduction (Art. 337 &
338, Revised Penal Code), abduction (Art. 342 & 343, Revised
Penal Code) or abuse against chastity (Art. 245, Revised Penal
Code) a woman is the victim.
b. In case of prostitution, the offender must be a woman:
For purposes of this article, women who, for money or
profit, habitually indulge in sexual intercourse or lascivious
conduct, are deemed to be prostitutes (Art. 202, No. 5, Revised
Penal Code).
c. In adultery the offender is a married woman and in concubinage
the offender is a husband.
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Genital test:
The presence of penis indicates a male, its absence and the
presence of a vaginal opening, indicates a female. We may look
for the testes in the scrotum and if they are absent we must not
conclude that the individual is not a male. They may be in the
abdomen or inguinal canal undescended.
3. Gonadal test:
Presence of testes in male and ovary in female. This will involve exploration of the abdomen and in some cases a histological examination of the gonad to see whether its microscopic
structure is characteristically ovarian or testicular.
4. Chromosomal test:
f^-^t*
*~W-cT
Shortly after the war, Barr noticed that there was a difference
between cells derived from men and women suitably stained and
examined under the microscope. The nucleus of the cells is a
densely staining area in the cell itself and Barr noticed that there
was a small part of nucleus which stained deeply than the rest
in woman's cells but not in cells from men. He observed this in
white cells from the blood and cells obtained by scraping the
mucous membrane of the mouth. This is called Barr bodies.
(Medico-Legal Journal, Part 3, Vol. 40, p. 79).
Problems in Sex Determination:
Sex determination may be possible and can scientifically be
distinguished on account of the biological structure differences;
however, in the following instances there will be no way to determine the sex:
1. Gonadal agenesis Sex organs (testes or ovaries) have never developed.
2. True hermaphrodism A state of bisexuality. The gonads of both
sexes are present which may be separated or combined as ovotestis.
<fc Evidences of Sex:
1. Presumptive evidences:
(a) General features and contour of the face.
cK^Presence or absence of hair in some parts of the body.
@ Length of the scalp hair. Generally, the female has long hair in
the scalp than that of the male.
(ji/Clothes and other wearing apparel, but not in a transvestite.
Transvestism is a form of sexual deviation characterized by
an overwhelming desire to assume the attire and be accepted as
a member of the opposite sex.
f eJ Figure Females have prominent pelvis, while those of the
males are slender.
have the gonadal tissue of one sex and the behavior of the
opposite sex,
g} Voice and manner of speech.
The Important Distinguishing Presumptive Characters between the
Two Sexes are as follows:
Female
Male
a. Hips are broader in relaShoulders are broader than
tion to shoulders.
hips.
b. Generally smaller build.
Larger build.
c. Breasts developed.
Generally not developed,
very rarely and may be
developed in cases like
gynaecomazia.
d. Adam's apple (Thyroid
Adam's apple prominent.
cartilage) not prominent.
e. Striae present on breasts,
e. Striae absent.
abdomen and buttocks in
ladies who have borne
children.
f. Pubic hair straight and
Pubic hair thick, curved
upward extending up to
stop short above the monsumbilicus.
veneris.
g. Hair absent on face, abdog Hair present on chest and
face moustaches, beard,
men and chest.
etc.
h. Female skull is smaller
h Male skull is longer, heavier
and of thick bones.
lighter, and has thin bones
and smooth,
i- Trunk abdominal segment
i Trunk abdominal segment
smaller.
larger.
j . Thighs conical.
j Thighs cylindrical.
(From: Handbook of Forensic Medicine and Toxicology by Dr. P. V.
Chadha, IVth ed., p. 68).
2. Highly probable evidences of sex:
(a^Possession of vagina, uterus and accessories in female, and penis
, in male.
( j p Presence of developed and large breasts in female.
c. Muscular development and distribution of fat in the body.
3. Conclusive evidence:
( paJi Presence of ovary in female and testis in males.
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94
6th month
7th month
9th month
1 Oth month
12th month
18th month
2nd year
6th year
7th year
8th year
9th year
10th year
11th year
11th-12th year
17th-18th year or at
any period later
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{2) When a child was born out of lawful wedlock and the
mother claimed someone to be the father but he vehemently denied it.
(3]T In a claim for support or right of succession of the alleged
illegitimate child,
b. Disputed maternity may arise:
fflTTn case of allegation of jnterchange of children in a hospital
or nursery home, either accidentally or deliberately.
(2ffn cases of wayward or stray children being claimed by two
or more women.
(-SfFor ownership of dead fetus or newly born child found in
street trash.
tSC'vrcumstantial or corroborative evidence against or in favor of the
perpetrator of a crime:
Example:
"A" was found dead with a deep stab wound on the chest. "B"
was found with a kitchen knife in his hand stained with blood.
Examination of the weapon showed that the stain was blood of
human origin and belonging to the same group as that of the
deceased "A". With such result of the examination, the investigating
authorities have a very strong presumption that " B " was the one
who committed the crime.
^Determination of the cause of death:
The amount of blood or blood stains found in the scene of the
crime or found inside the body of the deceased outside the blood
vessels may imply that the cause of death of the person is hemorrhage.
^Determination of the direction of^ escape of the victim or the
assailant:
The shape of the blood or blood stains will give the investigator an idea on the direction of the source of blood. Usually,
in small drops, the tapering end of the blood spot is towards the
direction of the moving source of blood.
^Determination of the approximate time the crime was committed:
Although there are variations as to the color and soluble
changes as to regards the age of the stain, we can only say that
when there is too much change, it is not very recent.
^Determination of the place of commission of the crime.
^Determination of the presence of certain diseases.
Problems to be Answered in the Examination of Blood:
-tTDetermine whether the stain is due to blood.
Aril due to blood, determine whether it is of human origin or not.
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99
MICROSCOPIC EXAMINATIONS:
Saline extract of the stain is examined under the microscope.
Note the presence of red blood cells, leucocytes, epithelial cells and
microorganisms. The presence of red blood cells will conclusively
show that the stain is blood. By microscopic examination, we can
differentiate the origin or the part of the body it came from. Menstrual blood will show abundance of vaginal epithelial cells and Doederlein's bacilli.
MICRO-CHEMICAL TESTS:
1. Hemochromogen crystal or Tokayama test:
A fragment of the suspected material is placed on a slide glass and
a drop of hemochromogen reagent is added. A cover glass is
placed on top and heated gradually for a time, then examined
under the microscope. Crystals varying from salmon color to
dark brown and pink and which are irregular rhomboids or in
clusters, may be seen. This test is positive to any substance
containing hemoglobin.
Hemochromogen solution:
Sodium hydroxide (10%)
3 cc.
Pyridine
3 cc.
Glucose (saturated solution).. .3 cc.
Distilled water
7 cc.
Hemochromogen crystals
hemin crystal*
100
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101
102
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103
will make the red blood cells suspension remain even. But if
suspended in the serum of another group, the red blood cells
clump with one another and this is called agglutination. The red
blood cells contain agglutinogens and the serum contains agglutinins.
Procedure of the test:
Two methods may be utilized and both should be employed
in the examination:
a. Detection of agglutinins
b. Detection of agglutinogens
a. Detection of agglutinins:
A saline extract is made on the stain. The solution is then
mixed on a slide glass with A, B, and O cell suspensions. The
results should be examined after agitation for several hours until
a decisive reading is possible.
b. Detection of agglutinogens:
Agglutinogens cannot be detected in dried stains since the
red blood cells lose this power on drying, but the presence may
be shown by their ability to absorb agglutinins A and B and
their power to inhibit the action of the sera containing these
agglutinins from the test sera. When these are subsequently
tested against known test corpuscles, the absorption which has
taken place will become apparent. Corresponding absorption
will result if only agglutinogen A' or B is present in the stain.
The portion of stained material should be mixed with Group
O serum. (Medical Jurisprudence and Toxicology by Glaister,
8th ed., p. 308).
Value of the test:
It may solve disputed parentage (paternity or maternity). A
positive result is not conclusive that the one in question is the
offspring, but a negative result is conclusive that he is not the child
of the alleged parents.
Inheritance Patterns of ABO Blood Groups:
Group of
Group of
Exclusion
Parents
Children
Cases
OxO
A, B, AB
O
Ox A
O.A
B, AB
OxB
0,B
A, AB
Ax A
O, A
B, AB
AxB
O, A, B, AB
BxB
O, B
A, AB
O x AB
A, B
0 , AB
A x AB
A, B, AB
0
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104
O
A, B, AB
O
A, B, AB
Inheritance of MN type
Possible Children
Parents
MxM
M
M, MN
MxMN
MN
MxN
M, N, MN
MN x MN
MN, N
MN x N
N
NxN
Grouping is true not only with blood but also with other fluids
of the body like saliva, vaginal secretion, seminal fluid, milk, urine
and others.
Age of the Blood Stains:
When blood is exposed to the atmosphere or some other influences, its hemoglobin is converted to meth-hemoglobin 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 hours. Blood of one week old and that
of six weeks may not present a difference in physical and chemical
properties.
Differential Characteristics of Blood from Different Sources:
1. Arterial Blood:
a. Bright scarlet in color.
b. Leaves the blood vessel with pressure.
c. High oxygen contents.
2. Venous Blood:
a. Dark red in color.
b. Does not spill far from the wound.
c. Low oxygen content.
3. Menstrual Blood:
a. Does not clot.
b. Acidic in reaction owing to mixture with vaginal mucous.
c. On microscopic examination, there are vaginal epithelial cells.
d. Contains large number of Deoderlein's bacillus.
4. Man's or Woman's Blood:
There is no method differentiating a man's blood from a woman's blood. Probably, the presence of sex hormone in female
blood may be a point of differentiation.
5. Child's Blood:
a. At birth, it is thin and soft compared with that of adult.
b. Red blood cells are nucleated and exhibit greater fragility.
c. Red blood cells count more than in adult.
Bx AB
ABx AB
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The fibers have typical large cavities which are not uniform but
vary with the degree of contraction of the walls of the fibers
which are lignified.
The ends are blunt.
The fibers are stained red with phloroglucin and yellow with
aniline sulphate, also with iodine and sulfuric acid.
6. Wool Fibers:
These fibers can easily be distinguished from vegetable fibers
since the former show an outer layer of flattened cells and imbricated margins.
The interiors are composed of fibrous tissues but sometimes
the medulla is present.
They do not dissolve in a solution composed of copper sulphate,
sodium carbonate and ammonia.
Stain is yellow with iodine and sulfuric acid and also with
picric acid.
Do not dissolve in sulfuric acid.
Smell of singeing on burning.
7. Silk Fibers:
Manufactured silk is almost structureless, microscopically.
Fibers stain is brown with iodine and sulfuric acid and yellow
with picric acid.
They dissolve slowly in a mixture of copper sulphate, sodium
carbonate and ammonia.
8. Linen Fibers:
Fibers are straight and tapering to a point.
Cortical area shows transverse lines which frequently intersects,
simulating a jointed appearance.
The medullary region shows a thin dense line.
They do not dissolve in concentrated sulfuric acid.
If placed in 1% alcoholic solution of fuchsin and then in a
solution of ammonium hydroxide, they assume a bright red
color (Medical Jurisprudence and Toxicology by Glaister, 8th ed
P. 110).
The Vegetable and Animal Fibers may be Differentiated as Follows:
1. Ignition test:
a. Animal fibers
107
Animal
Medulla
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108
Cortex
Looks like a thick muff.
Pigments in the form of fine
grains.
Cuticle
Thin scales not protruding, covering one another to about
4/5.
109
Chimpanzee
Constantly present.
Small but slightly
larger than human's or gorilla's.
Human
Very frequently absent.
Small size, slightly
smaller than gorilla's or chimpanzee's.
Granules less coarse,
peripheral, near
cuticular margins.
Cuticular margins,
extremely regular.
Granular
cortical Centrally placed.
pigment, central
around medulla.
Cuticular
margins Less regular than in
regular, but less
human hair.
tnan in human
hair.
(From: Recent Advances in Forensic Medicine by Sydney Smith
& Giaister,p. 109).
Other Points in the Identification of Hair:
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Chapter IV ^
MEDICOLEGAL ASPECTS OF DEATH
Importance of Death Determination: f P ^ * ^
yThe civil personality of a natural person is extinguished by death:
The civil personality is extinguished by death. The effect of
death upon the 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:
Succession is a mode of acquisition by virtue of which the
property, rights and obligations to the extent of the value of the
inheritance of a person are transmitted through his death to
another or others either by will or by operation of law (Art. 774,
Civil Code).
3<The death of a partner is one of the causes of dissolution of
partnership agreement:
Dissolution (of a partnership) is caused. . . (5) by the death of
any partner;. . (Art. 1830, Civil Code).
4\77ie death of either the principal or agent is a mode of extinguishment of agency:
Agency is extinguished. . . (3) By death, civil interdiction,
insanity or insolvency of the principal or of the agent. . . (Art.
1919, Civil Code).
f/The criminal liability of a person is extinguished by death:
How criminal liability is totally extinguished Criminal liability
is totally extinguished:
1. By death of the convict, as to the personal penalties; and as
to pecuniary penalties, liability therefore is extinguished
only when the death of the offender occurs before judgment.
(Art. 89, Revised Penal Code).
The civil case for claims which does not survive is dismissed upon
death of the defendant:
When the action is for recovery of money, debt or interest
thereon, and the defendant dies before the final judgment in the
court of the First Instance, it shall be dismissed to be prosecuted
in the manner especially provided by these rules (Rule 3, Sec. 21,
Rules of Court).
Ill
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113
114
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f A. KINDS OF DEATH ^ j j ^
)MATIC DEATH OR CLINICAL DEATH:
This is the state of the body in which there is ^complete, persistent and continuous cessation of the vital functions of the
brain, heart and lungs which maintain life and health^ It occurs
the moment a physician or the other members of the family
declare a person has expired, and some of the early signs of
death are present. It is hardly possible to determine the exact
time of death.
Immediately after death the face and lips become pale, the
muscles become flaccid, the sphincters are relax, the lower jaw
tends to drop, the eyelids remain open, pupils dilate and the
skin losses its elasticity. The body fluid tends to gravitate to the
mostf dependent portions of the body and the body heat gradually
assiimes the temperature of the surroundings.
(OLECULAR OR CELLULAR DEATH:
After cessation of the vital functions of the body there is still
^animal life among individual cells. This is evidence by the presence of/excitability of muscles and^ciliary movements and other
functions of individual cells.
About three to six hours later, there is death of individual cells.
This is known as molecular or cellular death. Its exact occurrence
cannot be definitely ascertained because its time of appearance is
influenced by several factors. Previous state of health, infection,
climatic condition, cellular nutrition, etc. influence its occurrence.
^APPARENT DEATH" OR "STATE OF SUSPENDED ANIMATION":
This condition is not really death but merely aCtransient loss of
consciousness or temporary cessation of the vital functions of the
body on account of disease, external stimulus or other forms of
influence.^ It may arise especially in hysteria, uremia, catalepsy
and electric shock.
It may be induced voluntarily as has been cited by foreign
authors (Col. Townshend who could be able to pass into a state
of pulselessness for half an hour). Involuntary suspension is
shown in still-birth. A newly born child may remain at the state
of suspended animation and may die unless prompt action is
taken. A person who has been rescued from drowning may
appear dead but life is maintained after continuous resuscitation.
It is important to determine the condition of suspended animation to prevent premature burial. There are records of cases
wherein a person was pronounced dead, placed in a coffin and
117
later angrily rise from it and walk unaided. The relative has sent
death notice and placed wreaths near his coffin (Daily Mail
England, 1948).
ji B. SIGNS OF DEATHS
^XC^
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119
CESSATION OF RESPIRATION:
Like heart action, cessation of respiration in order to be considered as a sign of death must be continuous and persistent. A
person can hold his breath for a period not longer than 3-1/2
minutes. In case of electrical shock, respiration may cease for
sometime but may be restored by continuous artificial respiration.
In the following conditions there may be suspension of respiration without death ensuing.
a. In a purely voluntary act, as in divers, swimmers, etc. but it
cannot be longer than two minutes.
b. In some peculiar condition of respiration, like Cheyne-Stokes
respiration, but the apneic interval cannot be longer than
fifteen to twenty seconds;
c. In cases of apparent drowning;
d. Newly-born infants may not breathe for a time after birth and
may commence only after stimulation or spontaneously later.
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i r|
122
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123
124
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S ^ HMANGES
AN
IN THE SKIN:
The following are the changes undergone by the skin after death:
a. The skin may be observed to be-pale and vgaxy-looking due to
the absence of circulation. Areas of the skin specially the most
dependent portions will develop livid discoloration on account
of the gravitation of blood.
bsLoss of Elasticity of the Skin:
Normally when the body surface is compressed, it readily
returns to normal shape. After death, application of pressure
to the skin surface will make the surface flattened. Application of pressure with the finger tip will produce fitting impression like one observed in edema.
Post-mortem Contact Flattening On account of the loss
of elasticity of the skin and of the post-mortem flaccidity of
muscles, the body becomes flattened over areas which are in
contact with the surface it rests. This is observed at the region
of the shoulder blades, buttocks and calves if death occurs
while lying on his back. Certain degree of pressure may be
applied on the face immediately after death and may be mistaken for traumatic deformity.
c. ppacity of the Skin:
Exposure of the hand of a living person to translucent
light will allow the red color of circulation to be seen underneath the skin. The skin of a dead person is opaque due to the
absence of circulation.
d. Effect of the Application of Heat:
Application of melted sealing wax on the breast of a dead
person will not produce blister or inflammatory reaction on
the skin. In the living, an inflammatory edema will develop
about the wax.
6. CHANGES IN AND ABOUT THE EYE:
a. Loss of Corneal Reflex:
The cornea is not capable of making any reaction to whatever intensity of light stimulus. However, absence of corneal
reflex may also be found in a living person the following conditions:
(1) General anesthesia.
(2) Apoplexy.
(3) Uremia.
(4) Epilepsy.
(5) Narcotic Poisoning.
(6) Local Anesthesia.
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126
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127
This stage usually lasts about three to six hours after death.
In warm places, the average duration is only one hour and fiftyone minutes (Mackenzie cited by Modi, p. 122).
Chemically, the reaction of the muscle is alkaline and the
normal constituents of the individual muscle proteins are the
same as in life.
b. Stage of Post-mortem Rigidity, or Cadaveric Rigidity, or Death
Stiffening, or "Death Struggle of Muscles" or rigor mortis:
Three to six hours after death the muscles gradually stiffen.
It usually starts at the muscles of the neck and lower jaw and
spreads downwards to the chest, arms, and lower limbs. Usually
the whole body becomes stiff after twelve hours. All the
muscles are involved both voluntary and involuntary. In the
heart, rigor mortis may be mistaken for cardiac hypertrophy.
Chemically, there is an increase of lactic acid and phosphoric
content of the muscle. The reaction becomes acidic. There is
no definite explanation as to how such contraction of muscles
occurs although it has been proven that there is coagulation of
the plasma protein.
In the medico-legal view point, post-mortem rigidity may be
utilized to approximate the length of time the body has been
dead. In temperate countries it usually appears three to six
hours after death, but in warmer countries it may develop
earlier.
In temperate countries, rigor mortis may last for two or
three days but in tropical countries the usual duration is
twenty-four to forty-eight hours during cold weather and
eighteen to thirty-six hours during summer. When rigor mortis
sets in early, it passes off quickly and vice versa.
Factors Influencing the Time of Onset of Rigor Mortis:
(1) Internal Factors:
(a) State of the Muscles:
Rigor mortis appears late and the duration is longer
in cases where the muscles have been healthy and at
rest before death, It has been observed that in the
following deaths, the onset of rigor mortis is hastened:
i. Animal having been hunted to death.
ii. Prolonged convulsion and lingering illness.
iii. Death from typhoid fever, typhus, cholera and
phthisis.
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(b) Age:
Rigor mortis has early onset in the aged and new-born.
The onset is delayed in good health and good muscular
development.
(c) Integrity of the Nerves:
Section of the nerve will delay onset of rigor mortis
as shown in paralyzed muscles.
(2) External Factors:
(a) Temperature:
The development of rigor mortis is accelerated by
high temperature but a temperature above 75C will
produce heat stiffening.
(b) Moisture:
Rigor mortis commences rapidly but the duration is
short in moist air.
/
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capable of restoration
to its original form as
soon as the distorting
force has ceased to act.
(3) In reaction to litmus, it
is either neutral or slightly alkaline, and any reduction in this alkalinity is very speedily
removed.
(4) If the contraction be
overcome by mechanical force, the muscles
though they may remain for a time uncontracted, possess still
their inherent power
of contraction; they
may then keep the limb
fixed in a new position
or allow a return to
the old position.
(From: Taylor's Principles and Practice of Medical Jurisprudence, 11th ed.. Vol I, p. 179).
c. Stage of Secondary Flaccidity or Secondary Relaxation:
After the disappearance of rigor mortis, the muscle becomes
soft and flaccid. It does not respond to mechanical or electrical
stimulus. This is due to the dissolution of the muscle proteins
which have previously been coagulated during the period of
rigor mortis.
This body while at the stage of rigor mortis, if stretched or
flexed to become soft, will no longer be rigid. This condition
f the muscles is not secondary flaccidity.
CHANGES IN THE BLOOD:
a. Coagulation of the Blood:
The stasis of the blood due to the cessation of circulation
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S o f t i n
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poisoning, it is bright pink. Exposure of the dead body to cold
or hot may cause post-mortem lividity to be bright-red in
color.
The lividity usually appears three to six hours after death
and the condition increases until the blood coagulates. The
time of its formation is accelerated in cases of death due to
cholera, uremia and typhus fever. Twelve hours after death,
the post-mortem lividity is already fully developed. It also
involved internal organs.
Physical Characteristics of Post-mortem Lividity:
(1) It occurs in the most extensive areas of the most dependent
portions of the body.
(2) It only involves the superficial layer of the skin.
(3) It does not appear elevated from the rest of the skin.
(4) The Color is uniform but the color may become greenish
at the start of decomposition.
(5) There is no injury of the skin.
Kinds of Post-mortem (Cadaveric) Lividity:
Hypostatic Lividity:
The blood merely gravitates into the most dependent
portions of the body but still inside the blood vessels and
still fluid in form. Any change of position of the body
leads to the formation of the lividity in another place.
This occurs during the early stage of its formation.
This appears during the later stage of its formation
when the blood has coagulated inside the blood vessels
or has diffused into the tissues of the body. Any change
of position will not change the location of the lividity.
Importance of Cadaveric Lividity:
(1) It is one of the signs of death.
(2) It may determine whether the position of the body has
been changed after its appearance in the body.
(3) The color of the lividity may indicate the cause of death.
Example: a. In asphyxia, the lividity is dark.
b. In carbon monoxide poisoning, the lividity
is bright pink.
Hemorrhage, anemia less marked.
Hydrocyanic acid bright red.
Phosphorus dark brown.
Potassium chlorate, Potassium bichromate
chocolate or coffee brown.
133
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(From: Taylor's Principles and Practice of Medical Jurisprudence, 11th ed. 1949, Vol I, p. 175-176.
Internal Hypostasis in Visceral Organs:
Post-mortem lividity also occurs in the internal organs. The
principal organs affected are the lungs, loops of the intestine
and brain. It may in some instances be mistaken for disease.
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136
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137
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Decomposition in water with bloating of the whole body, blackening of the face and
attitude of the extremities at the time of recovery.
139
140
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141
142
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143
144
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Decomposition - Soft tissues of the chest and head have disappeared while
those of the abdomen and extremities are mummified.
145
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146
c. Arms.
d. Abdomen.
e. Legs.
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weight and erosion of the epiphysis. Flat bones disintegrate
faster than round bones. The degree of ossification is also a
factor in the bone destruction.
Death in the sea with post-mortem erosion of the face due to the activities
of the fishes and other aquatic animals.
149
Kinds of Mummification:
(1) Natural Mummification;
When a person is buried in hot, arid, sandy soil, there will
be insufficient moisture for the growth and multiplication
of putrefactive bacteria. The body will become dehydrated
and mummified which is caused by the forces of nature.
(2) Artificial Mummification:
The principles involved in artificial mummuification are:
(a) Acceleration of the evaporation of the tissue fluid of
the body before the actual onset of decomposition.
(b) Addition of some body preservatives to inhibit decomposition and to allow evaporation of fluid. This is made
by treatment of the body with arsenic, formalin, resinous or tarry materials.
b. Saponification or Adipocere Formation:
This is a condition wherein the fatty tissues of the body are
transformed to soft brownish-white substance known as adipocere. The layer of subcutaneous tissue is the frequent site of
its formation. It occurs naturally in the visceral organs and
even in non-fatty tissues of the body like the muscles.
Adipocere is a waxy material, rancid or moldy in odor,
floats in water, and dissolves in ether and alcohol. With diluted
solution of copper sulfate, it gives a light greenish-blue color. It
is inflammable and burns with a faint yellow flame. When
distilled it produces a dense oily vapor.
Some Theories on the Formation of Adipocere:
(1) The fats of the body split into glycerol and fatty acids.
The fatty acids combine with calcium, magnesium, potassium, sodium, and ammonium salts to form an insoluble
soap. These ester of fatty acid somehow delay body decomposition and make the body surface greasy to touch.
(2) There is gradual hydrogenation of pre-existing fat in the
body like olein to higher fatty acids. Hydrogenation
causes remarkable swelling and stiffening of the fats. The
new hydrogenated fat is quite stable but on exposure to
air becomes yellow, hard and brittle.
Factors Influencing Adipocere Formation in Earth Burial:
(1) State of Health Before Death:
Adipocere formation depends primarily on the presence
of fat in the body of the deceased. It is difficult for adi-
LEGAL MEDICINE
pocere to develop in the state of extreme emaciation.
Areas of the body where fat is abundant develop adipocere
recognizable through the naked eye rapidly as compared
with the other areas. The amount of water in the surroundings is not very essential to the phenomena. Water of the
body may be drawn from the muscles and internal organs.
(2) Time Interval between Death and Burial:
Generally, the longer the space of time interval between
death and burial, the greater is the degree of adipocere
formation. This is further accelerated when the body is
subjected to autopsy. Exposure of the internal organs
to external elements promotes enzymatic and bacterial
actions in the process of hydrolysis and glycerol formation.
(3) Effect of the Coffin:
The coffin has air space and if crudely made, it may
allow water to come in contact with the body surface
thereby enhancing hyrolysis of fat. If water has been freely
admitted, colliquative putrefaction will develop for a
longer time thus making adipocere formation scanty.
(4) Presence of Clothings and Other Coverings of the Body:
Adipocere formation is found to be more advanced
under clothings or other body coverings, especially if the
clothings are tight.
(5) Type of Soil:
Dry soil is conducive to mummification. Sufficiently
moist soil accelerates adipocere formation.
(6) Access of Air to the Body After Burial:
The disturbance of a body in the grave shortly after
burial or before the formation of adipocere prolongs its
formation.
(7) Mass Grave:
There is more tendency for adipocere formation when
several bodies are located in a grave because of the abundance of moisture.
Maceration:
This is the softening of the tissues when in a fluid medium
in the absence of putrefactive microorganism which is frequently observed in the death of the fetus en utero.
When the fetus dies en utero, provided that the death of the
fetus is not due to attempted abortion or rupture of the membrane, the child is enclosed by the membrane in sterile con-
151
dition. Putrefaction does not take place and the fetus becomes
soft. The softening of the body may be due to the action of
the autolytic and proteolytic enzymes and ferments. /
The appearance of the fetus is typical. The hody is discolored either reddish or greenish with the skin peeling off and
the arms flaccid and frail. As maceration advances, there is
brownish-red discoloration of the skin. There may be blister
formation and the odor is somewhat rancid. For a definite and
appreciable degree of maceration to take place, it requires about
twenty-four hours.
DURATION OF DEATH
In the determination as to how long a person has been dead from
the condition of the cadaver and other external evidences, the
following points must be taken into consideration:
1. Presence of Rigor Mortis:
In warm countries like the Philippines, rigor mortis sets in
from 2 to 3 hours after the death. It is fully developed in the
body after 12 hours. It may last from 18 hours to 36 hours
and its disappearance is concomitant with the onset of putrefaction.
2. Presence of Post-mortem Lividity:
Post-mortem lividity usually develops 3 to 6 hours after
death. It first appears as a small petechia-like red spots which
later coalesce with each other to involve bigger areas in the
most dependent portions of the body depending upon the
position assumed at the time of death.
3. Onset of Decomposition:
In the Philippines like other tropical countries, decomposition is early and the average time is 24 to 48 hours after death.
It is manifested by the presence of watery, foul-smelling froth
coming out of the nostrils and mouth, softness of the body and
presence of crepitation when pressure is applied on the skin.
4. Stage of Decomposition:
The approximate time of death may be inferred from the
degree of decomposition, although it must be made with extreme
caution. There are several factors which modify putrefaction of
the body. For the stage of decomposition and the approximate
time after death, see tabulations (supra p. 143).
5. Entomology of the Cadaver:
In order to approximate the time of death by the use of the
flies present in the cadaver, it is necessary to know the life cycle
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of the flies. The common flies undergo larval, pupal and adult
stages. The usual time for the egg to be hatched into larva is
24 hours so that by the. mere fact that there are maggots in the
cadaver, one can conclude that death has occurred more than
24 hours.
6. Stage of Digestion of Food in the Stomach:
It takes normally 3 to 4 hours for the stomach to evacuate its
contents after a meal. The approximate time of death may be
deduced from the amount of food in the stomach in relation to
his last meal. This determination is dependent upon the amount
of food taken and the degree of tonicity of the stomach.
The extent of the gastric emptying and the progression of the
meal in the gastro-intestinal tract can be useful in estimating the
time of death. However, the position and condition of the decedent's last meal is influenced by the following factors:
a. Size of the Last Meal The stomach usually starts to empty
within ten minutes after the first mouthful has entered. A
light meal leaves the stomach within 1-1/2 to 2 hours after
being eaten. A medium-sized meal will require 3 to 4 hours.
A heavy meal is entirely expelled into duodenum in 4 to 6
hours.
b. Kind of Meal Liquid move more rapidly than semi-solid and
the latter more rapidly than solids.
c. Personal Variation Psychogenic pylorospasm can prevent
departure of the meal from a stomach for several hours, contrariwise, a hypermotile stomach may enhance entry of food into
the duodenum.
d. Other Factors:
(1) Kinds of Food Eaten Vegetables may require more time
for gastric digestion. The less fragmentation of the food
will require more time to stay in the stomach. The absence or insufficiency of pepsin and other digestive ferments will delay the food in the stomach. Absence or
insufficiency of the gastric hydrochloric acid content
and lesser amount of liquid consumed with solid food
will likewise delay gastric evacuation.
The head of the meal ordinarily reaches the distal ileum and
cecum between 6 and 8 hours after eating.
The conclusion may be of value in the estimation of death if
one is familiar with the decedent's eating habit and meal time,
quantity of the last meal and the interval between the last two
meals.
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155
F. PRESUMPTION OF SURVIVORSHIP
Sec. 5(jj), Rule 131, Rules of Court:
When two persons perish in the same calamity, such as wreck,
battle, or conflagration, and it is not shown who died first, there
are no particular circumstances from which it can be inferred, the
survivorship is presumed from the probabilities resulting from the
strength and age of the sexes, according to the following:
1. If both were under the age of fifteen years, the older is presumed to have survived;
2. If both were above the age of sixty, the younger is presumed
to have survived;
3. If one is under fifteen and the other above sixty, the former
is presumed to have survived;
4. If both be over fifteen and under sixty, and the sexes be different, the male is presumed to have survived; if the sexes be the
same, then the older;
5. If one be under fifteen or over sixty, and the other between
those ages, the latter is presumed to have survived.
Art. 43, Civil Code:
If there is a doubt, as between two or more persons who are called
to succeed each other, as to which of them died first, whoever
alleges the death of one prior to the other, shall prove the same; in
the absence of proof, it is presumed that they died at the same time
and there shall be no transmission of rights from one to the other.
Chapter V
MEDICO-LEGAL INVESTIGATION OF DEATH
An inquest officer is an official of the state charged with the duty
of inquiring into certain matters. In a medico-legal investigation,
an inquest officer is the one charged with the duty of investigating
the manner and cause of death of a person. He is authorized to
summon witnesses and direct any person to perform or assist in the
investigation when necessary.
The following officials of the government are authorized to make
death investigations:
1. The Provincial and City Fiscals:
Sec. 983, Revised Aministrative Code:
The district health officer, upon the request of any provincial fiscal of a province within his district, or of any judge of
a Court of the First Instance (now Regional Trial Court), or of
any justice of the peace (now, Municipal Trial Court), shall conduct in person, when practicable, investigations in cases of death
where there is suspicion that death was caused by the unlawful act
or omission of any person, and shall make such other investigations as may be required in the proper administration of
justice.
Sec. 38, Rep. Act 409 as amended by Rep. Act. 1934 (Revised
Charter of the City of Manila):
The City Fiscal shall also cause to be investigated the cause of
sudden deaths which have not been satisfactorily explained and
when there is suspicion that the cause arose from the unlawful
acts or omissions of other person, or from foul play, and, in
general, victims of violence, sex crimes, accidents, self-inflicted
injuries, intoxications, drug addiction, states of malingering and
mental disorders, which occur within the jurisdiction of the
City of Manila, and the examination of evidences and telltale
marks of crimes. For that purpose, he may cause autopsies to
be made and shall be entitled to demand and receive for purposes of the office of the medical examiner, or the criminal
investigation laboratory of the Manila Police Department, or
subject to the rules and conditions previously established by
the Secretary of Justice, the aid of the medico-legal section
of the National Bureau of Investigation. If in case the fiscal
156
157
158
LEGAL MEDICINE
159
6. Solicitor General:
Sec. 95 (b) P.D. 856 (Code of Sanitation of the Philippines)
Autopsies shall be performed in the following cases:
3
4. Whenever the Solicitor General, provincial or city fiscal
as authorized by existing laws, shall deem it necessary to
disinter and take possession of remains for examination to
determine the cause of death.
Stages of Medico-Legal Investigation:
1. Crime Scene Investigation (Investigation of the place of commission of the crime).
2. Autopsy (Investigation of the body of the victim).
1. CRIME SCENE INVESTIGATION:
The crime scene is the place where the essential ingredients of
the criminal act took place. It includes the setting of the crime
and also the adjoining places of entry and exit of both offender
and victim.
Not all crimes have a well-defined scene, like estafa, malversation, continuing crimes, etc. However, where medical evidence
may be present, like murder, homicide, physical injuries, sex
crime, crime scene is almost invariably present.
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D. WHEEL METHOD
E. ZONE METHOD
161
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LEGAL MEDICINE
163
164
LEGAL MEDICINE
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LEGAL MEDICINE
(1) Medical examiner of the City of Manila (See Sec. 34 and
38 of Rep. Act 409 as amended by Rep. Act. 1934).
(2) Medical staff of the National Bureau of Investigation
which is composed of those assigned in the central office
in Manila under the Medico-Legal Section and those
assigned in the regional offices of the Bureau in accordance with the administrative plantilla implementing
Rep. Act. 157.
(3) Medico-Legal officers of the Philippine Constabulary
assigned in the Philippine Constabulary Crime Laboratory
(PCCL) and those assigned in different regional commands.
Insofar as medico-legal investigation of criminal cases
occurring within the jurisdiction of the City of Manila is
concerned, there are two officers qualified to make the
investigation:
(a) The medical examiners of the Manila Police Department; and
(b) The Medico-Legal Officers of the National Bureau of
Investigation.
The Medical examiner or medico-legal officer "may
investigate cases of sudden deaths, which have not
been satisfactorily explained and when there is
suspicion that the case arose from unlawful acts or
omissions of other persons, or from foul play, and in
general victims of violence, sex crimes, accidents,
self-inflicted injuries, intoxication, drug addiction,. .
." (Sec. 38, Act. 409 as amended by Rep. Act. 1934).
c. Members of the medical staff of accredited hospitals.
e. Conclusion
f. Minor or
non-pathological
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LEGAL MEDICINE
PROCEDURE OF AUTOPSY
169
ized autopsy. The liability was made on the nurse who unfortunately was not made as one of the defendants (Schwalb
v. Connely, 179p. 2d 667, Colo.).
The award for damages for wrongful autopsy is not on account
of the mutilation of the deceased body but for the injury to the
feelings and mental suffering of the living because of the illegal
act.
After the death of the husband and without the consent of
the wife, an autopsy was performed on the body of the deceased. The widow filed a suit for unlawful autopsy and failure
to replace the brain, heart and organs. The court held that
there is no justification for the autopsy and dismemberment
and have injured the feelings of the widow. The sum of $1,000
was awarded as reasonable damages (Gould v. State of New
York, 181 Misc. 884, 46 N. Y.S. 2d 313).
6. A dead body must riot be embalmed before the autopsy. The
embalming fluid may render the tissue and blood unfit for toxicological analyses. The embalming may alter the gross appearance
of the tissues or may result to a wide variety of artifacts that tend to
destroy or obscure evidence. An embalmer who applied embalming
fluid on a dead body which in its very nature is a victim of violence is liable for his wrongful act.
7. The body must be autopsied in the same condition when found
at the crime scene. A delay in its performance may fail or modify
the possible findings thereby not serving the best interest of
justice.
Precautions to be Observed in Making Medico-Legal Post-mortem
Examination:
1. The physician must have all the necessary permit or authorization to perform such an examination. Such permit must be
issued by the inquest officer. The absence of such authorization
may hold the physician civilly and criminally liable.
2. The physician must have a detaUed'liistory of the previous symptoms and condition of deceased to be used as his guide in the
post-mortem examination.
3. The true^fuentity of the deceased must be ascertained. If no one
claims the body, a complete date to reveal his identity must be
taken.
4. Examination must be made in a Well-lighted place and it is advisable that no unauthorized person should be present.
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171
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LEGAL MEDICINE
3. Weight:
Increased
Diminished
4. Color:
Grayish-red
Slaty-black
Bluish-red
Light-brownish
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LEGAL MEDICINE
External Examination
Large Intestine
Rectum
External Examination
Cut Surface
175
Gall Bladder
LEGAL MEDICINE
176
Cardio-Vascular System:
Aorta
Veins
Neck Organs:
Remove the larynx, pharynx and tongue including the tonsils.
The condition of the lymph glands, obstruction and edema of the
glottis, foreign body and materials in the larynx and trachea, condition of the thyroid gland, and condition of the tongue and tonsils
should be noted.
Head:
The scalp is incised from the mastoid process of one side passing
the vertex to the mastoid process on the opposite side. The flaps
are turned down to the back and to the front. Note the presence
of hemorrhage, bruise, hematoma and fracture of the skull. Open
the skull by sawing at the forehead above the eyebrow to the region
of the upper portion of the ear and another vertically a little behind
the vertex and meeting the horizontal cut at the region of the upper
portion of the ear. Remove the flap of bone and note the condition
of the meninges. Remove the brain after cutting it from its attachment and the tentorium cerebelli. Examine the brain for pathological condition, hemorrhage, laceration, softening, and the base and
side of the cranial box for hemorrhage and fracture. Make several
incisions on the brain and study the injury or disease.
Examination of the Extremities:
There is no technical incision for the extremities. Just open what
is deemed necessary and appropriate for the occasion.
Weight and Measure of the Organs Removed:
The specimen which are collected for further study must be placed
in clean jars and brought to the laboratory are:
LjOrgans for toxicological examination.
2. Slices of organs for histopathologic^ study.
(For a more detailed examination of post-mortem examination,
consult any textbook on pathology.)
AVERAGE MEASUREMENT OF INDIVIDUAL
ORGANS
HEART:
Weight of heart
Male
300 gms.
Both
Female
250 gms.
177
1 to 162
8-8.5
10.4 cms.
12.0 cms.
7.7 cms.
8.9 cms.
8.0 cms.
28.8 cms.
1.1 1.4 cms.
0.5 0.7 cms.
SPLEEN:
Weight of spleen
Measurement
PANCREAS:
Weight of pancreas
Measurement
90 120 gms.
23.0 x 4.5 x 2.8 cms.
LIVER:
Weight
Measurement
Length from right to left
Width of right lobe
Vertical diameter of right lobe
Vertical diameter of left lobe
KIDNEYS:
Male
Weight
Measurement
Thickness of:
Cortex
Medulla
Relation to body weight
Relation to weight of heart
OVARY:
Weight
BRAIN:
Weight
Female
4.6 cms.
1 3 cms.
1:200
1:1.1
7.0 gms.
1,358 gms.
1,234 gms.
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LEGAL MEDICINE
ADRENALS:
Weight
Measurement
WEIGHT OF THYMUS:
Newborn
I - 55 years
j
6 - l10
O years
j
I I - 115
5 3years
20 years
16 - 20
j
253years
21 - 25
353years
26 - 35
453years
36 - 45
553years
46 - 55
653years
56 - 65
6 6 - 775
5 3years
Mistakes in Autopsies:
1. Error or omission in the collection of evidence for identification:
a. Failure to make frontal, oblique and profile photographs of the
face;
b. Failure to have fingerprints made;
c. Failure to have a complete dental examination performed.
2. Errors or omission in the collection of evidence required for
establishing the time of death:
a. Failure to report the rectal temperature of the body;
b. Failure to observe changes that may occur in the intensity and
distribution of rigor mortis before, during and after autopsy.
c. Failure to observe the ingredients of the last meal and its
location in the alimentary tract.
3. Errors or omission in the collection of evidence required for other
medico-legal examination:
a. Failure to collect specimens of blood and brain for determination of the contents of alcohol and barbiturates;
b. Failure to determine the blood group of the dead person if
death by violence was associated with external bleeding;
c. Failure to collect nail scrapings and samples of hair if there is
reasonable chance that death resulted from assault.
d. Failure to search for seminal fluid if there is a reasonable
chance that the fatal injuries occurred incident to a sexual
crime;
e. Failure to examine clothings, skin and the superficial portion
of the bullet tract for residue of powder, and the failure to
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LEGAL MEDICINE
181
Chapter VI
182
CAUSES OF DEATH
183
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LEGAL MEDICINE
CAUSES OF DEATH
185
186
LEGAL MEDICINE
intervention of the felonious acts of another person, no one can
be held responsible for the death.
"Sudden death" is the termination of life which comes
quickly under circumstances when its arrival is not expected.
It may be due to natural or violent cause. Heart diseases and
cerebral apoplexy are the most common causes of deaths due to
natural causes, while poisoning, asphyxia and severe trauma are
frequent causes of violent death.
The natural death may or may not be associated with violence. Although the history and external findings may show
that death is due to natural cause, a complete autopsy must be
made to determine exactly the cause of death and exclude the
possibility of violent cause.
If signs of violence are associated with the natural cause of
death, the physician must be able to answer the following
questions:
Did the Person Die of a Natural Cause and were the Physical
Injuries Inflicted Immediately After Death ?
If violence was applied on a dead person, the person inflicting
the physical injuries cannot be guilty of murder, homicide or
parricide. The act is considered to be an impossible crime and
is penalized as such. In order that it may be considered an
impossible crime, the person inflicting the physical injuries must
have no knowledge that the victim is already dead at the time of
infliction.
Criminal liability shall be incurred by any person who performs an act which would be an offense against persons and
property, were it not for the inherent impossibility of its accomplishment. . . (Art. 4, No. 2, Revised Penal Code). The
court having in mind the social danger and the degree of criminality shown by the offender shall impose upon him the
penalty of arresto mayor or a fine ranging from 200 to 500
pesos. (Art. 59, Revised Penal Code).
"A" has a grudge and wanted to kill "B". One night "A"
entered the bedroom of "B", and without knowing that "B"
died of heart failure an hour ago, inflicted several stab wounds
on " B " "A" cannot be held liable for murder because it is an
impossible crime. " B " was already dead when the stab wounds
were inflicted. However, the law still imposes penalty for such
act depending upon the degree of criminality and social danger
of the offender (Art. 59, Revised Penal Code).
CAUSES OF DEATH
187
LEGAL MEDICINE
disease. After the slapping, " B " died of heart failure. "A"
cannot be held responsible for the death of "B". He can
only be held for slight physical injury brought about by the
slapping.
The defendant struck a boy with the back of his hand on
the mouth. Although the mouth was bleeding, he was able
to work. A few days later, he developed fever and died. The
court believed that the fever which caused the death was not
the direct consequence of the injury inflicted. It was not
denied that malaria fever was prevalent in the locality, so it
was quite probable that the death was due to a natural cause.
The defendant was acquitted (U.S. v. Palaton, 49 Phil. 117).
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. If the physical injuries is not the
proximate- cause of death of the victim, then the offender cannot be held liable for such death. Proximate cause is that cause,
which in natural and continuous sequence, unbroken by an
efficient intervening cause, produces injury or death, and without which the result would not have occurred.
So in natural death with concomitant physical injuries, it is
necessary for the physician to determine whether the physical
injuries would accelerate the death, or the injuries itself developed independently and produced the death or that the person
died absolutely of a natural cause.
A physician must determine for the interest of justice with
absolute care at autopsy and laboratory examination the real
cause of death. Opinion evidence must be given with caution
and must be made after a thorough deliberation of the facts
and other findings.
The Following are Deaths Due to Natural Cause:
(1) Affection of the central nervous system:
(a) Cerebral Apoplexy:
The sudden loss of consciousness followed by paralysis or death due to hemorrhage from thrombosis or
embolism in the cerebral vessels.
i. Cerebral Hemorrhage:
This is brought about by the breaking or rupture
of the blood vessels inside the cranial cavity.
ii. Cerebral Embolism:
This is the blocking of the cerebral blood vessels
by bolus or matters in the circulation.
CAUSES OF DEATH
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LEGAL MEDICINE
(4) Affection of the Gastro-Intestinal Tract:
(a) Ruptured peptic ulcer.
(b) Acute intestinal obstruction.
(5) Affections of the Genito-Urinary Tract:
(a) Acute strangulated hernia.
(b) Ruptured tubal pregnancy.
(c) Ovarian cyst with twisted pedicle.
(6) Affection of the Glands:
(a) Status thymico-lymphaticus:
This is a condition associated with the enlargement
of the thymus and hyperplasia of the lymphoid tissues
in general.
(b) Acute Hemorrhagic Pancreatitis:
An acute inflammation of the pancreas accompanied
with hemorrhages and in some cases suppuration and
gangrene.
(7) Sudden Death in Young Children:
(a) Bronchitis.
(b) Congestion of the lungs.
(c) Acute broncho-pneumonia.
(d) Acute gastro-enteritis.
(e) Convulsion.
, (f) Spasm of the larynx.
Violent Death:
Violent deaths are those due to injuries inflicted in the body
by some forms of outside force. The physical injury must be
the proximate cause of death.
The death of the victim is presumed to be natural consequence of the physical injuries inflicted, when the following
facts are established:
(1) That the victim at the time the physical injuries were inflicted was in normal health.
(2) That the death may be expected from physical injuries
inflicted.
(3) That death ensued within a reasonable time (People v.
Datu Baginda, C.A. 44 O.G. 2287).
Classification of Trauma or Injuries:
(1) Physical injury Trauma sustained thru the use of physical
force.
(2) Thermal injury Injury caused by heat or cold.
(3) Electrical injury Injury due to electrical energy.
CAUSES OF DEATH
191
LEGAL MEDICINE
Elements of the Provision:
(a) A person is performing a lawful act.
(b) He performed it with due care.
(c) He caused injury to another by mere accident.
(d) He is without fault and with no intention of causing it.
Example:
A patient died a few minutes after the administration of
penicillin by injection. The physician took the history from
the patient as to the presence of allergic diseases, made the
necessary tests and took other necessary precautions to
prevent any untoward reaction. The physician cannot be
held liable for the death of the patient because it is purely
accidental.
A driver who, while driving his automobile on the proper
side of the road at a moderate speed and with due diligence,
suddenly and unexpectedly sees a man in front of his
vehicle coming from the sidewalk and crossing the street
without any warning that he would do so, but because it is
not physically possible to avoid hitting him, the said driver
runs over the man. He is not criminally liable, it being a
mere accident (U.S. v. Tayongtong, 21 Phil. 476, cited by
L. Reyes).
The accused was a driver of a loaded truck. While driving
at a curve the front tire exploded and as a consequence of
which the truck fell in a ditch and pinned one of the passengers. The tire, engine, brake and wheel were in good
condition before the incident. HELD: There being no
proof of excessive speed, the accident under consideration
caused by the blow-out of the tire cannot give rise to
liability of the driver (People v. Hatton (C.A.) 49 O.G.
1866).
The accused while hunting saw wild chickens and fired a
shot. He heard a human being cry and found that the
victim was hit. There was no evidence of the intention of
the accused to kill the deceased. HELD: If life is taken by
misfortune while the actor is in the performance of a lawful
act executed with due care and without intention of doing
harm, there is no criminal liability (U.S. v. Tanedo, 15
Phtf 196).
(2yNegligent Death:
Death due to reckless imprudence, negligence, lack of
skill or lack of foresight.'
CAUSES OF DEATH
193
LEGAL MEDICINE
the penalty of arresto mayor in its medium and maximum
periods shall be imposed.
Acts Punishable in Giving Assistance to Suicide:
(a) The offender assisted in the commission of suicide of
another which was consummated.
(b) The offender gave assistance in the commission of
suicide to the extent of d6ing the killing himself which
is consummated.
(c) The offender assisted another in the commission of
suicide which is not consummated.
(4fParricidal Death (Killing of One's Relative):
Art. 246, Revised Penal Code:
Parricide:
Any person who shall kill his father, mother, or child,
whether legitimate or illegitimate, or any of his ascendants
or descendants, or his spouse, shall be guilty of parricide
and be punished by the penalty of reclusion perpetua
to death.
Requisites of the Crime:
(a) A person was killed by the offender.
(b) The person killed was the father, mother, or child,
whether legitimate or illegitimate in relation with the
offender, or other legitimate ascendants, or descendants
or spouse of the offender.
The father, mother or child killed must either be legitimate or illegitimate to make it parricide, so that the
killing of one's illegitimate father is parricide.
But, insofar as with the other ascendants or descendants or spouse, it must be legitimate to make it parricide.
Thus, the killing of a common-law wife or one's illegitimate
grandfather is not parricide.
A moro who has three wives and killed the last married
to him cannot be guilty of parricide (People v. Subano,
73 Phil. 692).
A stranger who cooperated and took part in the commission of the crime of parricide is not guilty of parricide
but only of homicide or murder as the case may be
J (People v. Patricio, 46 Phil. 875).
(Sr) Infanticidal Death (Killing of a child less than three days
old):
Art. 265, Revised Penal Code:
CAUSES OF DEATH
195
Infanticide:
The penalty provided for parricide in article 246 and for
murder in article 248 shall be imposed upon any person
who shall kill any child less than three days of age.
If the crime penalized in this article be committed by the
mother of the child for the purpose of concealing for
dishonor, she shall suffer the penalty of prision correccional
in its medium and maximum periods, and if said crime be
committed for the same purpose by the maternal grandparents or either of them, the penalty shall be prision
mayor.
Requisites of the Crime:
(a) A person was killed.
(b) The person killed was a child less than three days old.
The penalty to be imposed depends upon the killer of
the child. If the killer is the father, mother or any of the
legitimate ascendants, the penalty corresponding to parricide shall be imposed. If the killing is made by any other
persons, the penalty for murder shall be imposed.
There is no medical explanation why three days is made
to distinguish infanticide from murder and parricide.
Concealment of the dishonor is not an element of the
crime but only mitigates penalty. So that if the mother or
the maternal grandparents killed the child to conceal the
dishonor the penalty for parricide is not imposed but only
that jone provided in the second paragraph of Art. 255.
(6TMurder:
Art. 248, Revised Penal Code:
Murder:
Any person who, not falling within the provisions of
article 246 shall kill another, shall be guilty of murder and
shall be punished by reclusion temporal in its maximum
period of death, if committed with any of the following
circumstances:
1. With treachery, taking advantage of superior strength,
with the aid of armed men, or employing means to
weaken the defense or of means or persons to insure
or afford impunity.
2. In consideration of a price, reward or promise.
3. By means of inundation, fire, poison, explosion,
shipwreck, stranding of a vessel, derailment or assault
LEGAL MEDICINE
upon a street car or locomotive, fall of an airship, by
means of motor vehicles, or with the use of any other
means involving great waste and ruin;
4. On occasion of any of calamities enumerated in the
preceding paragraph, or of an earthquake, eruption of
a volcano, destructive cyclone, epidemic, or any other
public calamity;
5. With evident premeditation;
6. With cruelty, by deliberately inhumanly augmenting
the suffering of the victim, or outraging or scoffing at
his person or corpse.
Requisites for the Crime of Murder:
(a) The offender killed the victim;
(b) The killing is attended by any of the qualifying circumstances mentioned;
(c) There was the intent of the offender to kill the victim;
(d) The killing is not parricide or infanticide.
Whenever the killing is attended by more than one of
the qualifying circumstances mentioned, only one of them
will make the killing, murder and the rest will be considered
as generic aggravating circumstances.
The presence of several wounds inflicted by the offender prove murder because there is cruelty if the victim is
alive, or scoffing or outraging at the corpse if inflicted after
death.
The presence of gunshot wound of entrance at the back
as a general rule qualifies act to murder because there was
treachery, i There is treachery when the offender commits
any of the crimes against person, employing means, or
method, or form in its execution thereof which tend directly or specially to insure its execution, without risk to
himself arising from the defense which the offended party
may make (Art. 14, Par. 16, Revised Penal Code).
Death:
Art. 249, Revised Penal Code:
Homicide:
Any person who, not falling within the provisions of
article 246 shall kill another without the attendance of any
of the circumstances enumerated in the next preceding
article, shall be deemed guilty of homicide and be punished
by reclusion temporal.
(7-Hlomicidal
CAUSES OF DEATH
197
LEGAL MEDICINE
198
CAUSES OF DEATH
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LEGAL MEDICINE
Gauges of Death from Asphyxia:
(1) Diseases of the respiratory system, as pneumonia, acute
bronchitis, bronchitis in infancy, rupture of the blood
vessels in pulmonary tuberculosis with cavitation.
(2) Impaction of foreign bodies in the larynx.
(3) Compression of the larynx.
(4) Pressure on the respiratory tract due to tumor, or intracranial hemorrhage.
(5) Strangulation, suffocation, hanging, drowning, inhalation
or irritant gases.
(6) Refraction of the atmosphere.
(7) Causes operating in the nervous system:
(a) Paralysis of the respiratory muscles or respiratory
center from injury or disease or action of poison.
(b) Fixation of the respiratory muscles from over stimulation of the spinal cord as in strychnine poisoning.
(8) Causes operating from the lung or pulmonary circulation:
(a) Pleurisy with effusion.
(b) Emphysema.
(c) Pulmonary embolism.
(d) Pulmonary thrombosis.
Symptoms of Asphyxia:
(1) Stage of Increasing Dyspnea :
This stage usually lasts from 1/2 to 1 minute:
(a) Increased rate and depth of respiration, leading to
difficulty of breathing (dyspnea).
(b) Exaggerated movement of inspiratory muscles soon
replaced by exaggerated expiration.
(c) Rise of blood pressure, consequently the heart beat
becomes quicker and more forcible.
(d) Person becomes bluish and consciousness is lost.
(e) Pupils are contracted.
(2) Stage of Expiratory Convulsion:
(a) This stage lasts for about a minute:
i. Marked expiratory effort.
ii. Convulsive movement of the limbs accompanied by
expiratory effort.
iii. Blood pressure gradually lowers owing to the failure
of the heart due to lack of oxygen.
CAUSES OF DEATH
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LEGAL MEDICINE
(e) Ingested alcohol.
Symptoms of Coma:
(1) Person unconscious.
(2) Breathing is stertorous.
(3) Pulse is full but intermittent.
(4) Cold, clammy perspiration.
(5) Imperfect perception of sensory impression.
(6) Delirium.
(7) Relaxation of all sphincter muscles.
(8) Accumulation of mucous in the respiratory passages.
Post-mortem Findings:
The findings in coma are the same as in asphyxia, and
addition, there is congestion of the brain and the spinal cord.
Chapter VII
^S^ECIAL DEATHS
1. JUDICIAL DEATH:
Modern methods in the execution of death sentences have
abandoned inhuman, cruel and barbarous means. Executions by
garroting, decapitation by means of the guillotine and by drowning
which were common during the medieval days are no longer
practiced. The statutes of all countries state the legal procedure
for the execution of death penalties. The constitution, like that
of the Philippines, imposes certain limitations to the law-making
body as to the method to be established.
Art. Ill, Sec. 1, Par. 19, of the Philippine Constitution provides
that "cruel and unusual punishment shall not be inflicted." The
wait for the provision of the new constitution punishment prohibited must not only be cruel but also unusual or vice versa.
Banishment may be unusual but not cruel and therefore valid.
Death penalty is not cruel and unusual whether it be by hanging,
shooting, or electrocution (Legarda v. Valdez, 1 Phil 146).
Punishments are cruel when they involved torture or a lingering
death, but the punishment of death is not cruel because it is not
barbarous and inhuman.
The purpose of the guaranty by the constitution is to eliminate
many inhuman and uncivilized punishments formerly known,
the infliction of which tend to barbarize present civilization
(McElvaine v. Brush, 142 U.S. 155).
Death Penalty:
1. Arguments in Favor of the Death Penalty:
( 1 ) It is the only method of eliminating the hopeless enemy
of society Escape from prison, commutation of sentence
and pardon are ways that criminals, helped by their friends,
escaped life imprisonment.
( 2 ) It deters potential criminals as no other form of punishment does.
(3) Its brutalizing effect is an unproven assumption. It is
contended that if capital punishment is properly carried
out, instead of brutalizing society, it satisfies the sense of
justice and provides social satisfaction and a sense of protection.
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(4) It is the only means whereby society is relieved of the
support for those who continually war upon it. Society
will be relieved of- expenses of maintaining the irreformable
criminals who prey upon it.
(5) It is a positive selective agency to wipe out the stock of
irreformable criminals Killing the hopeless criminals will
eliminate some of the degenerated stock of society.
SPECIAL DEATHS
205
If the convict does not die after a few minutes that the current
was put on, it is necessary to apply another current until he is
pronounced dead by the physician. The law states that the
penalty is death by electrocution so that the convict must be
put to death. It is the duty of the administrator of the penitentiary to mitigate as much as possible the sufferings of the
convict in the execution of death sentence.
Art. 81, Revised Penal Code When and how the death
penalty is to be executed. The death sentence shall be executed with preference to any other and shall consist in putting
the person under sentence to death by electrocution.
The
death sentence shall be executed under the authority of the
Director of Prisons, endeavoring so far as possible to mitigate
the sufferings of the person under sentence during electrocution as well as during the proceedings prior to the execution.
If the person under sentence so desire, he shall be anesthesized at the moment of the electrocution.
Art. 82, Revised Penal Code Notification and execution of
the sentence and assistance to the culprit. The court shall
designate a working day for the execution, but not the hour
thereof, and such designation shall not be communicated to
the offender before sunrise of said day, and the execution shall
not take place until after the expiration of at least eight hours
following the notification, but before sunset.
During the
interval between notification and the execution, the culprit
shall, in so far as possible, be furnished with assistance as he
may request in order to be attended in his last moments by
priests or ministers of the religion he professes and to consult
lawyers, as well as in order to make a will and confer with
members of his family or persons in charge of the management
of his business, of the administration of his property, or of the
care of his descendants.
Art. 83, Revised Penal Code Suspension of the execution
of the death sentence. The death sentence shall not be inflicted upon a woman within the three years next following
the date of the sentence or while she is pregnant not upon any
person over seventy years of age. In this last case, the death
sentence shall be commuted to reclusion perpetua with the
accessory penalties provided in article 40.
Art. 84, Revised Penal Code Place of execution and persons who may witness the same. The execution shall take place
in the penitentiary of Bilibid in a space closed to public view
and shall be witnessed only by the priests assisting the offender
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and by his lawyers and by his relatives, not exceeding six, if
he so request, by the physician and the necessary personnel
of the penal establishment, and by such persons as the Director
of Prisons may authorize.
Death by electrocution is the only method recognized by
our civil law. There is a growing sentiment to remove capital
punishment although it is a means to discourage future wrongdoers.
Death may be due to shock; respiratory failure due to bulbar
paralysis or asphyxia;and due to prolong and violent convulsion.
2. Death by Hanging:
The convict is made to stand in an elevated collapsible flatform with a black hood on the head, a noose made of rope
around the neck and the other end of which is fixed in an elevated
structure above the head. Without the knowledge of the convict, the flatform suddenly collapses which causes the sudden
suspension of the body and tightening of the noose around the
neck. Death may be due to asphyxia or injury of the cervical
portion of the spinal cord.
In the Philippines, this method of death execution is only
allowed on death penalties imposed by military tribunals or
court marshals.
It is considered to be the most gruesome
means of death and is imposed primarily to those who have
been found guilty of very grave offenses.
In the Philippines, death penalty that are imposed by the civil
court must only be by electrocution. Hanging is not recognized as
a means of executing death sentence, although the decision of the
military tribunals may impose death by hanging.
The following are the causes of death in judicial hanging:
a.
b.
c.
d.
e.
f.
3. Death by Musketry:
The convict is made to face a firing squad and is put to death
by a volley of fire. The convict may be facing or with his back
towards the firing squad.
SPECIAL DEATHS
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SPECIAL DEATHS
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LEGAL MEDICINE
c. If the suicide with the assistance of the physician is not
consummated, the penalty of arresto mayor (1 month and
1 day to 6 months) in its medium and maximum period shall
be imposed; and
3.
SPECIAL DEATHS
211
3. SUICIDE:
Suicide or self-destruction is usually the unfortunate consequence of mental illness and social disorganization.
Societal
reaction to suicide varies in different jurisdiction. Some consider
suicide a crime (Maryland, N e w Jersey, North Carolina, Oklahoma,
South Dakota); others impose no penalty for suicide but suicide
attempts are considered felonies or misdemeanors and could result
to jail sentences.
In criminal statistics there is under-reporting of suicide cases
because of the following reasons:
1. Even if the facts are clear to support suicide, the strong opposition of the family, the physician, attorney and friends may
cause a certification that it is accidental, because they are not
only bereaved but also stigmatized. The legal and moral implications of suicidal death prevent certification of such manner
of death. If insured may deprive the beneficiary from receiving
the full value of the policy, the usual religious rites may not be
accorded the deceased, and other benefits provided by law
which the heirs are entitled may not be received.
2. There is a lack of generally accepted standards for determining death by suicide. To make death suicidal, it must
be the direct, conscious, intentional act of self-destruction.
Subconscious or sub intended acts which directly or indirectly
cause or hasten death is not considered to be suicide.
No
single finding in the investigation of death is an absolute criterion
of suicide.
Suicide rarely occurs during the pre-addescent age. The incidence increase with the age but more in the elderly. There is
more incidence in male than in female. Most victims have experienced depression of long duration prior to dying.
Suicide occurs in almost every conceivable location but a vast
majority of cases occur at home. It may occur in other places
like hotel, automobile, jails, hospitals and mental institutions.
The bodies of victims may be found in rivers, lakes, open fields.
The scene of death is orderly.
Psychological Classification of Suicide:
1. First degree deliberate, planned, premeditated, self-murder.
2. Second degree impulsive, unplanned, under great provocation
or mitigating circumstances.
3. Third degree sometimes called "accidental" suicide. This
occurs when a person puts his or her life into jeopardy by
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voluntary self-injury, but where we infer that the intention
to die was relatively low because the method of self-injury was
relatively harmless, or because provisions for rescue were made.
The person was "unlucky" actually to die.
SPECIAL DEATHS
213
Death b y itarvation
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Types of Starvation:
1. Acute starvation is when the necessary food has been suddenly
and completely withheld from a person.
2. Chronic starvation is when there is a gradual or deficient supply
of food.
Causes of Starvation:
1. Suicidal:
a. People deprived of liberty or prisoners may go in a "hunger
strike" to create sympathy.
b. Mistaken belief that people can live without food for a prolonged period.
c. Excessive desire to lose weight.
d. Lunatics during depressive state.
e. As an expression of political dissent.
2. Homicidal:
a. Deliberate deprival of food for helpless illegitimate children,
feeble-minded and old persons.
b. Punishment or act of revenge by deliberate incarceration in
an enclosed place without food m water.
3. Accidental:
a. Scarcity of food or water during famines or draught.
b. Shipwreck, entombment of miners caused by landslides, marooned sailors, or fall in a pit.
Length of Survival:
The human body without food loses l/24th of its weight daily,
and a loss of 40% of the weight results to death.
The length of survival depends upon the presence or absence of
water. Without food and water, a person cannot survive more than
10 days, but with water a person may survive without food for 50
to 60 days.
Factors that Influence the Length of Survival:
a. Age Children suffer earlier from the effects of starvation
than old aged people. A child demand more food for growth
and development. Assimilation and utilization of food elements
is slowed and weakened in old age.
b. Condition of the body During starvation, fat stored up in the
body is the one utilized to maintain life. It is but natural that
a healthy person with more fat deposit can resist more deprival
of food.
SPECIAL DEATHS
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Post-mortem Findings:
1. External Findings:
a. Body greatly emaciated and emitting a peculiar offensive odor.
b. The eyes are dry, red and open with the eyeballs sunkened.
c. The skin is dry, shrivelled and sometimes with secondary skin
infection.
d. Bed sores may be present.
2. Internal Findings:
a. The muscles are pale, soft, wasted with the subcutaneous fat
almost completely disappeared.
b. There is a general reduction in the size and weight of all organs,
except the brain.
c. The brain is pale and soft, while meningeal vessels are congested
and frequently, there is a serous effusion in the ventricle.
d. The heart is small, with flabby and pale muscles and generally
empty chambers (brown atrophy).
e. The lungs are edematous with hypostatic congestion.
f. The stomach is small, contracted and empty with the mucous
membrane less stained with bile.
g. The intestine is thin, empty, with its thin and translucent wall
and with the disappearance of the mucosal folds.
h. There may be superficial or extensive ulceration of the colon as
in ulcerative colitis.
i. The liver, spleen, kidneys and pancreas are small and shrunken.
Microscopically, the liver shows necrosis of the central zone.
The liver damage was due to protein deficiency.
j. The gall bladder is distended with bile while the urinary bladder
is empty.
k. There is demineralization of bones and in pregnant women, it
may produce osteomalacia.
1. Findings are refenable to concomitant disease which may
develop on account of the diminished resistance.
Effects of Chronic Starvation:
Incomplete withdrawal of food to the body may cause a different
effect. The person will manifest symptoms referrable to the food
deficiency.
1. Deprivation of protein in the diet reduces the amount of protein
in the serum and edema, anemia, leucopenia and weakened
cardiac function develop.
SPECIAL DEATHS
217
Chapter VIII
DISPOSAL OF THE DEAD BODY
Sec. 1103, Revised Administrative Code:
Persons Charged with Duty of Burial:
The immediate duty of burying the body of a deceased person,
regardless of the ultimate liability for the expense thereof, shall
devolve upon the persons hereinbelow specified:
(a) If the deceased was a married man or woman, the duty of
burial shall devolve upon the surviving spouse if he or she
possesses sufficient means to pay the necessary expenses.
( b ) If the deceased was an unmarried man or woman, or a child,
and left any kin, the duty of burial shall devolve upon the
nearest kin of the deceased, if they be adults and within the
Philippines and in possession of sufficient means to defray the
necessary expenses.
(c) If the deceased left no spouse or kindred possessed of sufficient means to defray the necessary expenses, as provided in
the two foregoing subsection, the duty of burial shall devolve
upon the municipal authorities.
Any person upon whom the duty of burying a dead body is imposed by law shall perform such duty within forty-eight hours after
death, having ability to do so.
Sec. 1104, Revised Administrative Code:
Right of Custody to body:
A n y person charged by law with the duty 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; and, in case of death
due to or accompanied by a dangerous communicable disease, such
body shall until buried remain in the custody of the local board of
health or local health officer, or if there be no such, then in the
custody of the municipal council.
C O N C E P T O F POSSESSION:
The right of custody over a dead body means possession. Possession means the holding of a thing or enjoyment of a right. The
possession of a thing means two things: either in the concept of
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220
executor of the will, and claimed the body for burial, which he
intended should be in a Protestant cemetery. This was resisted
by the widow who contended that her husband should be buried
in a cemetery of the church he had joined recently. The court
maintained the son's claim holding that, as executor, he had a right
to have the body for the purpose of burial. The wife was prevented from interfering with that right (Cited by Meridith).
METHODS OF DISPOSAL OF THE D E A D B O D Y :
1. Embalming:
Embalming is the artificial way of preserving the body after
death by injecting 6 to 8 quarts of antiseptic solutions of formalin,
perchloride of mercury or arsenic, which is carried into the common carotid and the femoral arteries. Usually, alcohol is added
to minimize the strong odor of the chemical and glycerine to
lessen the evaporation of water from the tissues of the body. If
the preservation of the body is for a longer time, the abdominal
and thoractic viscera are removed, washed and soaked in strong
antiseptic solution before they are returned. The skin is painted
with vaseline or covered with plaster of Paris to prevent too much
evaporation.
2. Burial or Inhumation:
a. The body must be buried within forty-eight hours after death:
Sec. 1092, Revised Administrative Code:
Time within which body shall be buried:
Except when required for the purposes of legal investigation
or when specifically authorized by the local health authorities, no
unembalmed body shall remain unhurried longer than fortyeight hours after death; and after the lapse of such period the
permit for burial, interment, or cremation of any such body
shall be void and a new permit must be obtained.
When it has been certified or is known that any person died
of, or with a dangerous communicable disease, the body of such
person shall be buried within twelve hours after death, unless
otherwise directed by the local board of health or other health
authority.
The dead body must be buried within forty-eight hours after
death except:
( 1 ) When it is still a subject matter of legal investigation;
( 2 ) When it is specifically authorized by the local health authorities that the body may be buried more than 48 hours
after death;
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(3) The municipal mayor, if there is no local health officer and
no physician in attendance;
(4) The municipal secretary, in the absence of the mayor;
( 5 ) Any councilor.
The order in the enumeration is exclusive and successive.
The presence of the preceding person will exclude the
succeeding person in the enumeration.
Inasmuch as almost all municipalities of the Philippines
have municipal health officers; the municipal mayor,
secretary and any of the councilors are practically inhibited
to sign the death certificate.
It appears unusual and contrary to the intent and purpose
of the death certificate when persons not qualified to know
the cause of death, are authorized by law to sign it.
This provision of the Administrative Code was promulgated during the time when physicians were quite
scarce.
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bodies of persons dying of a dangerous communicable disease
shall be buried or cremated.
Sec. 91 ( h ) , P.D. 856 Code of Sanitation:
When the cause of death is a dangerous communicable
disease, the remains shall be buried within 12 hours after death.
They shall not be taken to any place of public assembly. Only
the adult members of the family pf the deceased may be permitted to attend the funeral.
Sec. 1091, Revised Administrative Code:
Burial permit (Death Certificate) must be presented before
burial:
No sexton, superintendent, or other person having charge of
a burial ground or cemetery shall assist in, assent to or allow
any interment, disinterment or cremation to be made until a
permit from the municipal secretary, authorizing the same, has
been presented.
Placing of body in overground tomb:
Sec. 1099, Revised Administrative Code:
Exhibition of permit to sexton:
The placing of the body of any deceased person in an unsealed overground tomb is prohibited, unless the coffin, or
casket containing the remains shall be permanently sealed.
The provision shall not apply to tombs and vaults which are
strictly receiving vaults for bodies or remains awaiting final
disposition, nor to embalmed bodies awaiting final disposition.
The depth of the grave must be at least 1-1/2 meters:
Sec. 1100, Revised Administrative Code:
Depth of grave:
A grave shall be dug, when practicable, to a depth of one and
one-half meters and after the implacement of the body shall be
well and firmly filled.
Sec. 91 ( c ) , P.D. 856 Code of Sanitation:
Graves where remains are buried shall be at least one and onehalf (1-1/2) meters deep and filled well and firmly.
The Law Penalizes Desecration of Burial Premises:
Sec. 2695, Revised Administrative Code:
Desecration of burial premises:
Any person who wantonly or maliciously defaces, breaks, or
destroys any tomb, ornament, or gravestone erected to any
deceased person, or any momento or memorial, or any plant,
tree or shrub pertaining to places of burial of a dead body, or
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227
to
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LEGAL MEDICINE
232
Death:
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LEGAL MEDICINE
or to remove from
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LEGAL MEDICINE
Sec. 92 (b & c), ( P . D . 856) Code of Sanitation Disinterment
requirements:
a
b. Permission to disinter remains of persons who died of
dangerous communicable diseases may be granted after
burial period of five ( 5 ) years.
c. Disinterment of remains covered in paragraphs "a" and " b "
of this Section may be permitted within a shorter time than
that prescribed in special cases, subject to the approval of
the Regional Director concerned or his duly authorized
representative.
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LEGAL MEDICINE
c. A written request for exhumation of the body of the deceased
must be sent to the Ministry of Health or the Regional Director
concerned, mentioning among other things:
(1) Name of the deceased.
(2) Place of exhumation.
( 3 ) Date and time of exhumation.
( 4 ) Duration of interment.
( 5 ) Purpose of exhumation.
The Ministry of Health aside from issuing the necessary
permit together with the conditions to be complied with, will
inform the local health officer concerned to assist the physician
to perform the exhumation to see to it that public health will
not be prejudiced.
d. During actual exhumation, the grave must be properly identified by the person who was present when the body was
interred.
e. During the process of disinterment care and diligence must be
observed to avoid destruction, deformity, contamination or
such other effects that will prevent the realization of its objectives.
f. After opening the coffin, the body must be viewed by any or
more persons who can identify the deceased. The names of the
person who identified the grave, who viewed and identified the
deceased must be included in the report. The exhuming physician must describe the coffin, wearing apparel and condition of
the body.
g. Actual autopsy and adoption of the procedure is needed to
accomplish the purpose of the exhumation.
h. Disinfection of the body and all the areas involved must be
carried out with the assistance of the local health officer and
return of the body to the burial place.
What must be Included in the Exhumation Report:
a. The name of the deceased and the personal circumstances (age,
sex, civil status, address, occupation, etc.).
b. The purpose(s) of exhumation;
c. The name, address and designation of the requesting party;
d. The date, time and place of exhumation;
e. The description of the burial place;
f. The name and address of person(s) who identified the burial
place;
g. The condition of the body and coffin (if there is) after disinterment.
239
h. The name and address of the person(s) who identified the body
of the deceased;
i. The post-mortem examination and accomplishment of the
pnrpose(s) of the exhumation;
j. The conclusion(s) based on the findings and result of the
examination;
k. Remarks (if any); and
1. The signature and designation of the physician.
Some Problems in Exhumation:
a. Identity of the deceased:
The exhumed buried deceased might not be subject-matter
of exhumation especially when the burial ground is a cemetery.
Mass burial of "salvaging" victims or disaster victims may cause
serious problem to the physician. There must be a meticulous and
time consuming attempt of the exhuming physician to establish
identity in order that his report may be of some value in the
investigative or judicial proceedings.
b. Refusal of the next-of-kin to give consent or to cooperate in the
exhumation-autopsy:
This situation is frequently observed when the next-of-kin
has a strong possibility to be involved in the investigation.
The proper remedy to this situation is to petition the court
to issue an order to exhume the body stating the specific
reasons why exhumation-autopsy will serve the best interest
of justice.
Chapter IX
MEDICO-LEGAL ASPECTS OF
PHYSICAL INJURIES
Physical injury is the effect of some forms of stimulus on the body.
The effect may only be apparent when* the stimulus applied is
insufficient to cause injury and the body resistance is great. It may
be real when the effect is visible.
The effect of the application of stimulus may be immediate or
may be delayed. A thrust to the body of a sharp pointed and sharp
edged instrument will lead to the immediate production of a stab
wound, while a hit by a blunt object may cause the delayed production of a contusion.
^ C a u s e s of Physicial Injuries:
A^Thysical Violence
J
Br Heat or Cold
J
Or Electrical Energy
A
ECChemical Energy
\
E. Radiation by Radio-Active Substances
V F Change of Atmospheric Pressure (Barotrauma)
G. Infection
A. PHYSICAL INJURIES BROUGHT ABOUT
BY PHYSICAL VIOLENCE
The effect of the^apphcation of physical violence on a person is
the production ofTwojund: )
f\
A wound is the solution of the natural continuity of any tissue of
the living body. It is the disruption of the anatomic integrity of a
tissue of the body. In several occasions, the word physical injury is
used interchangeably with wound. However, the effect of the physical violence may not always result to the production of wound, but
the wound is always the effect of physical violence.
Physics of Wound Production:
Wound = Kinetic energy X time X area X "other factors"
MV
Kinetic Energy =
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M=Mass
V=Velocity
LEGAL MEDICINE
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LEGAL MEDICINE
Incised ( d e f e n s e ) w o u n d
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LEGAL MEDICINE
(5) Trauma inflicted on the female genitalia to induce abortion or promotes hemorrhage and creates an anemia.
( 6 ) Subcutaneous injection of fecal matters to promote
abscess formation.
( 7 ) Pricking of acne eruption to lead to a severe facial disfigurement.
( 8 ) Subcutaneous injection of air to create a condition of
emphysema.
( 9 ) Nail-biting (onychophagia) which may lead to maceration
of the skin and an infection.
(10) Grinding of the teeth (bruxism) is frequently seen in the
mentally retarded and can lead to abnormal tooth wear, a
bilateral hypertrophy of the masseter and a pain on
chewing.
(11) Pressure on the subcutaneous tissue by a tightly applied
cord or belt around the body:
(a) Tribal customs of metal band around the heck or a
leg by some African tribes may cause a permanent
disfigurement.
( b ) Use of shoes made of metal by Chinese women.
(12) Pulling of the body hair (Trichotillomania).
(Forensic Medicine A Study in Trauma & Environmental
Hazards by Tedeschi, Eckert & Tedeschi, Vol. 1, p. 496).
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249
( 3 ) Assaulting ( A r t . 263); or
( 4 ) Administering injurious substances (Art. 264) without the intent to kill.
It may be committed through a simple negligence or imprudence.
The main purpose of dividing the provision into four paragraphs
is to graduate the penalties depending upon the nature and character of the wound inflicted and their consequences on the
person of the victim.
In paragraph one, the injured person became insane, imbecile,
impotent, or blind.
Insanity has not been defined or qualified by the article.
Imbecility infers that the injured person must be of the preadolescent age and that on account of the physical injuries inflicted there is an arrest of mental development.
Impotency is the inability to grant to the partner sexual gratification.
Blindness must be total or involvement of both eyes. If only
one eye became blind, then the physical injury will fall in paragraph 2 of Article 263.
In paragraph two, the following nature and character of the
wound or consequences of the injuries inflicted must be present:
a. Loss of the use of speech or the power to hear or to smell, or
loss of an eye, a hand, a foot, an arm, or a leg;
b. Loss of the use of any such member; or
c. Becomes incapacitated for the work in which he was therefore
habitually engaged.
There must be a total loss of hearing capacity. If the loss of
power to hear is only in one ear, it is a serious physical injury
under paragraph 3, article 263 (People v. Hernandez, 94 Phil. 49).
Insofar as loss of a hand is concerned, the prosecution must
prove by clear and conclusive evidence that the offended party
actually cannot make use of his hand and that such impairment is
permanent (People v. Reli. C.A. 53 O.G. 5695).
In paragraph three, the following physical injuries or their consequences are included:
a. Deformity;
b. Loss of any other member of his body;
c. Loss the use thereof; or
d. Becomes ill or incapacitated for the performance of the work
in which he was habitually engaged for more than 90 days, as
a consequence of the physical injuries inflicted.
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Deformity is a condition of physical ugliness. It must be permanent and conspicuous. The loss of the front teeth, the development of a pigmented scar on the face, or loss of the pinna of the
ear are considered deformities. However, the development of a
scar in covered plots of the body may not be considered deformity
because it is not conspicuous and visible.
"The loss of any other part of his body" means loss of the parts
of the body not mentioned in paragraph 2, Art. -263.
Incapacity means the inability of the injured person to perform,
or engage on a work or vocation before he sustained injury.
In paragraph four, the injured person becomes ill or incapacitated
for labor for more than thirty days and impliedly less than 90
days.
It is noteworthy to mention that in paragraphs 3 and 4 of
article 263 there is no mention of periods of medical attendance
but merely incapacity.
Administering Injurious Substances or Beverages:
Art. 264, Revised Penal Code:
The penalties established by the next preceding article 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 advantages of his weakness of mind or credulity.
Elements of the crime:
a. The offender inflicted upon another person any serious physical
injury.
b. The infliction of physical injury was done knowing that the
substance or beverage administered is injurious or took advantage
of the victim's weakness or credulity; and
c. There was no intent to kill on the part of the offender.
If the offender does not know that the substance administered is
injurious, he cannot be held liable under the above provision.
The throwing of acid on the face of someone does not fall within
the provision because what the provision contemplates is administering or taking in the injurious substance or beverages (U.S. Chiong
Songco, 18 Phil. 459).
The provision does not contemplate of slight or less serious
physical injuries which is the consequence of injurious substances
or beverages, but results only in serious physical injuries.
If the administration of injurious substances or beverages is
intentional, the crime committed is frustrated murder. Treachery is.
251
LEGAL MEDICINE
Obligation Imposed on Physicians W h o have Treated Persons Suffering From Serious and Less Serious Physical Injuries:
P R E S I D E N T I A L D E C R E E N O . 169
W H E R E A S , Pursuant to Proclamation N o . 1081, dated September
21, 1972 and N o . 1104, dated January 17, 1973, martial law has
been declared throughout the Philippines to, among other goals,
restore and maintain peace and order;
W H E R E A S , for the attainment of the aforesaid goal, and to enable
the law-enforcement agencies to keep track of all violent crimes,
conduct timely investigation thereon and effect the immediate arrest
of the perpetrators thereof, it is necessary that all persons treating
physical injuries resulting from any form of violence be required to
report such fact to said agencies;
W H E R E A S , while some of the victims of violent crimes, or those
who may have sustained physical injuries in the act of committing
or as a result of the commission of a crime submit themselves for
medical treatment in hospitals, medical clinics, sanitariums, or
other medical establishments or to medical practitioners, they do
not report their injuries to the law-enforcement agencies for one
reason or another;
N O W , T H E R E F O R E , I, F E R D I N A N D E. M A R C O S , pursuant to
Proclamation N o . 1081, dated September 21, 1972 and N o . 1104,
dated January 17, 1973 and in my capacity as Commander-in-Chief
of all the Armed Forces of the Philippines, do hereby order and
decree that:
1. The attending physician of any hospital, medical clinic, sanitarium or other medical establishments, or any medical practitioner, who has treated any person for serious or less serious
physical injuries as those injuries are defined in Articles 262,
263, 264 and 265 of the Revised Penal Code shall report the
fact of such treatment personally or by the fastest means of
communication to the nearest Philippine Constabulary unit
without delay: provided, that no fee shall be charged for the
transmission of such report thru government communication
facilities; and
2. The report called for in this Decree shall indicate when practicable the name, age, address and nearest of kin of the patient;
the nature and probable cause of the injury; the approximate
time and date when, and the place where the injury was sustained; time, date and nature of treatment; and the physical
diagnosis and/or disposition of the patient.
253
254
LEGAL MEDICINE
2. Physical injuries which did not prevent the offended party from
engaging in his habitual work or which did not require medical
attendance.
If the victim merely suffered from small contusion or superficial
abrasion which does not require medical attendance or incapacity,
this falls in the paragraph of slight physical injury.
3. Ill-treatment of another by deed without causing any injury.
A slight slap on the face or holding tightly the arm of the victim
which did not even develop redness of the skin may be a form of
ill-treatment.
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 (People v. Penesa, 81 Phil. 398;
People v. Amarao et al., C.A. 36 O.G. 3462).
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 (3rd paragraph).
Physical Injuries Inflicted in a Tumultuous Affray:
Art. 252, Revised Penal Code:
When in a tumultuous affray as referred to in the preceding article,
only serious physical injuries are inflicted upon the participants
thereof and the person responsible therefor cannot be identified, all
those who appear to have used violence upon the person of the
offended party shall suffer the penalty next lower in degree than that
provided for the physical injuries so inflicted.
When the physical injuries inflicted are of a less serious nature
than the person responsible therefor cannot be identified, all those
who appear to have used any violence upon the person of the offended party shall be punished by arresto from five to fifteen days.
Elements of the Crime:
a. There is a tumultuous affray;
b. Participant(s) suffered from serious physical injuries;
c. The person(s) who inflicted such serious physical injuries
cannot be identified; and
d. All those who appear to have used violence upon the person
of the offended party shall be penalized by arresto from five to
fifteen days.
/ T Y P E OF WOUNDS (Medical Classification):
\/Closed Wound There is nojareach of continuity of the skin or
mucous membrane.
255
CLOSED WOUNDS:
Petecbjaej_^___
This is a circumscribed extravasation of blood in the subcutaneous
tissue or underneath the mucous membrane. The cause of passage of
blood from the capillaries may be due to the increase intra-capillary
pressure or increased permeability of the vessel. The hemorrhage
may be small or pinhead sized but several petechiae may coalesce to
form a bigger hemorrhagic area. Mosquito or other insect bites may
cause the formation of circumscribed hemorrhages.
Petechiae is not always a product of trauma. Petechial hemorrhage may be a post-mortem finding in asphyxial death, coronary
occlusion and blood diseases. It may also develop post-mortem in
death by hanging.
There is gravitation of blood into the most
dependent part of the body which eventually leads to the rupture of
over-distended capillaries specially seen at the region of the leg.
Contusion:
Contusion 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.
256
LEGAL MEDICINE
The size of the contusion is usually greater than the size of the
object causing it. The location of the contusion may not always
indicate the site of the application of force. For instance, a blow
on the forehead may cause black-eye or contusion around the tissues
of the eye-ball, or a kick on the leg may cause appearance of contusion at the region of the ankle on account of the gravitation of the
effusion, between muscles and fascia.
On the medico-legal viewpoint, a contusion as indicated by its
external pattern may correspond to the shape of the object or
weapon used to produce it; its extent may suggest the possible degree
257
Contusion
and
Post-mortem
Hypostasis
LEGAL MEDICINE
258
(a) In contusion the effused blood are accumulated in the interstices of the tissue underneath the skin, while in hematoma
blood accumulates in a newly formed cavity underneath the
skin.
( b ) In contusion, the skin shows no elevation and if ever elevated, the elevation is slight and is on account of inflammatory
changes, while in hematoma the skin is always elevated.
(c) In contusion, puncture or aspiration with syringe of the
lesion no blood can be obtained, while in hematoma, aspiration will show presence of blood and subsequent depression of the elevated lesion.
Abscess, gangrene, hypertrophy, fibroid thickening and even
malignancy are potential complications of hematoma.
/Musculo-Skeletal Injuries:
(1) Sprain Partial or complete disruption in the continuity of a
muscular or ligamentous support of a joint. It is usually caused
by a blow, kick or torsion force.
(2) Dislocation Displacement of the articular surface of bones
entering into the formation of a joint.
( 3 ) Fracture Solution of continuity of bone resulting from violence or some existing pathology.
(a) Close or Simple Fracture Fracture wherein there is no
break in continuity of the overlying skin or where the external air has no point of access to the site of injury.
259
/Internal Hemorrhage:
Rupture of blood vessel which may cause hemorrhage may be due
to the following:
(a> Traumatic intracranial hemorrhage.
(b)- Rupture of parenchymatous organs.
(c)-Laceration of other parts of the body.
Cerebral Concussion (Commotio Cerebri):
Cerebral concussion is 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.
Cerebral concussion is much more 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.
s^Signs and Symptoms:
(a) Unconsciousness which is more or less complete.
( b ) Muscles are relaxed and flaccid.
(c) Eyelids are closed and the conjunctivae are insensitive.
(d) Surface of the body is pale, cold and clammy.
(e) Respiration is slow, shallow and sighing.
( f ) Pulse is rapid, weak, faltering and scarcely perceptible to the
fingers.
(g) Temperature is subnormal.
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Abrasions
Characteristics of Abrasion:
a. ft develops at the precise point of impact of the force causing it.
b. Grossly or with the aid of a hand lens the injury consists of
parallel linear injuries which are in line with the direction of the
rub or friction causing it.
c. It may exhibit the pattern of the wounding material.
261
\MOA
Confluent:
An abrasion where the linear marks on the skin are almost
indistinguishable on account of the severity of friction and
roughness o the object.
d. Multiple:
Several abrasions of varying sizes and shapes may be found in
different parts of the body.
Types of Abrasions:
a. Scratch:
This is caused by ajsharp-pointed object which slides across
the skin, like a pin, thorn or fingernail. The injury is always
parallel to the direction of slide.
The commencement and
termination are well defined and the depth depends on the
pressure applied. The fingernail scratch may be broad at the
point of commencement and may terminate with a tailing.
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LEGAL MEDICINE
b. Graze:
These are usually caused by forcible contact with rough,
hard objects resulting to irregular removal of the skin surface.
The nature of the injury is dependent upon the degree of roughness of the object and the amount of pressure in the course of
the sliding. The course will be indicated by a clean commencement and tags on the end.
c. Impact or Imprint Abrasion (Patterned
Abrasion, "Abrasion A La Signature"):
Abrasion,
Stamping
,, ^
263
Differential Diagnosis:
a. Dermal Erosion A gradual breakdown or very shallow
ulceration of the skin which involves only the epidermis and
heals withour scarring. It may appear in spots and with no
previous history of friction or sliding.
b. Marks of Insects and Fishes Bites The skin injury is irregular
with no vital reaction and usually found on angles of the mouth,
margins of nose, eyelids and forehead.
c. Excoriation of the Skin by Excreta This condition is only
found among infants and the skin lesion heals when the cause is
removed. There is no apparent history of rubbing trauma on
the affected area.
d. Pressure Sore Usually found at the back at the region of bony
prominence.
History of long standing illness, bed ridden
condition although pressure sore may start as a previous area of
abrasion.
^Distinction Between Ante-mortem from Post-mortem Abrasions:
Point of
Distinction
Ante-mortem
Abrasion
Post-mortem
Abrasion
Color
Location
Any area.
Vital
reaction
264
LEGAL MEDICINE
Hacked wound. The injury is quite severe, edges may or may not
be contused depending on the nature of the edge of the instrument used.
Characteristics of Incised Wound:
a. Edges are cleanboth extremities are sharp, except in
areas where the skin is loose or folded at the time of infliction.
b. The wound is straight and may be shelving if inflicted with the
wounding instrument applied with an acute angle to the surface
of the body involved.
c. Usually the wound is shallow near the extremities and deeper
at the middle portion. However, this finding may be modified
by the shape of the wounding instrument and part of the body
involved.
d. Because the blood vessels involved are clean-cut, profuse hemorrhage is invariably a feature.
e. Gaping is usually present due to the retraction of the edges but
Its presence and degree of retraction depends on the direction
of the incised wound with the line of cleavage (Langer's line).
f. If the incised wound is located in parts of the body covered
with clothes, the clothing itself will show clean-cut of its
texture.
g. In the absence of complication and/or when there is deeper
involvement present, healing is relatively fast and the scar may
not or may develop conspicuously.
h. Incised wound caused by broken edge of glass may be irregular
and may appear like a punctured or stab wound. Fragments of the
glass may be removed from the incised wound. Examination
with the aid of a magnifying lens is necessary to determine the
presence and removal of particles of flakes of glasses in the
wound.
Changes that occur in an Incised Wound:
After 12 hours
Edges are swollen; adherent with blood and
with leucocyte infiltration.
After 24 hours
Proliferation of the vascular endothelium
and connective-tissue cells.
After 36-48 hours Capillary network complete; fibrolasts running at right angles to the vessels.
After 3-5 days
Vessels show thickening and obliteration.
(From: Gradwohl's Legal Medicine by F.E. Camps ed., 3rd ed.,
p. 272).
265
M u l t i p l e Incised w o u n d s ( H o m i c i d a l ) .
LEGAL MEDICINE
266
Homicidal
Usually horizontal below
tho "Adam's'apple.
Position
of the
body
Wounding
weapon
Weapon is jjbsent.
Blood
distribution
Motive
May be present.
267
Always absent,
Stab Wound:
Stab wound is produced by the penetration of a sharp-pointed
and sharp edged instrument, like a^knjfe, saber, dagger, scissors. It
may involve the skin or mucous surface. IftRe sharp edgTportion
of the wounding instrument is the first to come in contact with
the skin, the wound produced is an incised wound, but if the
sharp-pointed portion first come in contact, then the wound is a
stab wound. As a general rule, like an incised wound, the edges
are cleanzcut, regular and distinct.
The surface length of a stab wound may reflect the width of
the wounding instrument. It may be smaller when the wound is
not so deep inasmuch as it is only caused by the penetration of
the tapering portion of the pointed instrument. It may be made
wider if the withdrawal is not on the same direction as when it
was introduced or the stabbing is accompanied by a slashing movement.
In the latter case the presence of an abrasion from the
extremity of the skin defect is in line with direction of the slashing
movement.
268
LEGAL MEDICINE
M u l t i p l e stab w o u n d s
following must be
269
LEGAL MEDICINE
270
S t a b w o u n d w i t h intestinal herniation.
271
272
LEGAL MEDICINE
27 3
continuity may only extend deeper to the stronger layer like that
of the galea aponeuritica in case of scalp injury.
Characteristics:
a. The shape and size of the injury do not correspond to the
wounding instrument.
b. The tear on the skin is rugged with extremities irregular and
ill-defined.
c. The injury developed is at the site where the blunt force is
applied.
d. The borders of the wound are contused and swollen.
e. It is usually developed on the areas of the body where the bone
is superficially located, like the scalp, malar region of the face,
front part of the leg, dorsum of the foot, etc.
f. Examination with the aid of the hand lens shows bridging tissue
joining the edges and hair bulbs intact.
g. Bleeding is not extensive because the blood vessels are not
severed evenly.
h. Healing process is delayed and has more tendency to develop
scar.
Classification of Lacerated Wounds
a. Splitting caused by crushing of the skin between two hard
objects. This is best seen in laceration of the scalp caused by a
hit of a blunt instrument, cut eyebrow of boxer and laceration
of the chin of motorcyclist.
b. 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.
c. Grinding compression The weight and the grinding movement
may cause separation of the skin with the underlying tissues.
d. Tearing This may be produced by a semi-sharp-edged instrument which causes irregular edges on the wound, like
hatchet and choppers.
Lacerated wounds may involve deeper tissues like laceration of
the muscles and fracture of bones depending upon the degree of
force applied in causing it.
It may be homicidal or accidental but rarely it is suicidal.
An insane person may hit his head on a concrete wall but when
loss of consciousness develops he will not be able to continue
further his act of self-destruction.
LEGAL MEDICINE
274
Lacerated Wound
Healing is faster.
Avulsion of the skin at the forehead with e x p o s u r e of the fractured skull and
part of the brain.
275
1. Mechanical stretching or dilatation The presence of a mechanical device on the edges to prevent coaptation will cause separation.
The presence of a canula in tracheostomy, drain (rubber or gauze)
in an incised abscess, or a retractor during a surgical operation are
examples of this type of gaping.
2. Loss of tissue Separation of the edges of a wound may be on
account of loss of tissue bridging them. The loss of tissue may be
due to:
a. Destruction by pressure, infection, cell lysis, burning or chemical reaction.
b. Avulsion or physical or mechanical stretching resulting to
separation of a portion of the tissue.
c. Trimming of the edges. Debridment of the skin which came in
contact with the bullet at the gunshot wound of entrance and
the removal of necrotic material in an infected wound may
cause separation of the edges.
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 or cleavage of the skin and their linear representation on the
skin is called Langer's line. These lines of cleavage are different in
different parts of the body.
If an incised wound or stab wound was inflicted wherein the
long axis of the wound is parallel or on the same direction as the
cleavage line of the part of the body involved, the wound will
appear narrow or slit-like because the edges of the wound will not
be subjected to the lateral pull of the severed connective tissue
fibers.
If the long axis of the wound is perpendicular to or with an
angle with the lines of cleavage, the tendency of the borders of
the wound is to separate on account of the retraction of the
severed fibers.
Practical Ways of Determining How Much of the Skin Surface is
Involved in an Injury or Disease:
The skin serves as a mechanical protection to the body. It is
punctuated with sensory nerve endings for pain, temperature and
touch. It also acts as a thermo-regulator, storage of water, excretor of sweat and also an organ for absorption.
The determination of how much skin involvement is important
in the mode of treatment and prognosis. Such determination may
276
LEGAL MEDICINE
Line of cleavage
Langer's line
B o d y surface
LEGAL MEDICINE
278
9%
9%
18%
18%
9%
9%
1%
Total
Factors Responsible for the Severity of Wounds:
9%
18%
18%
18%
18%
18%
1%
100%
1. Hemorrhage:
a. Hemorrhage may influence the severity of wound by:
( 1 ) Loss of blood incompatible with life:
Blood constitutes about 1/20 of the body weight of an
adult. By volume, an average size adult has 5 to 6 quarts
of blood (one quart is 946 c c ) . A loss of one tenth of its
volume may not cause any significant clinical change. A
loss of one quart may cause fainting even if the subject is
lying down.
But a loss of 1/3 to 2/5 of the circulating
blood may result to irreversible hypovolemic shock and may
be fatal.
The volume of blood lost may be related to the rate or
space of time a certain volume of blood has been shed.
The blood loss may be massive but if it occurred for a long
period of time, the hemopoietic organs may be able to
replace it thereby preventing the development of any
untoward effects.
Males can stand more lost of blood than females. Hypertension may cause excessive and rapid bleeding from an
arterial wound.
Persons suffering from hemophilia and
other clotting disorders and those being treated by anticoagulants can cause prolonged bleeding.
( 2 ) Hemorrhage may result in ah increase in pressure in or on
the vital organs to affect the normal function:
Intracranial hemorrhage may cause compression of the
vital centers of the brain. Hemopericardium (pericardial
279
LEGAL MEDICINE
280
o- ^
e. Toxin-:
j-fr
( 1 ) Snake Venom Snake bite is characterized as two punctured wounds at the center of the reddened affected area.
The venom is injected through its fangs which is connected
to the poison gland.
281
282
LEGAL MEDICINE
283
LEGAL MEDICINE
284
Hemorrhage:
It is the bleeding which occurs immediately after the traumatic injury of the blood vessel.
b. Secondary Hemorrhage:
This occurs not immediately after the infliction of the
injury but sometime thereafter on or near the injured area.
3. Infection:
Infection is the appearance, growth and development of microorganisms at the site of injury:
How Injury or Trauma Acquires Infections:
a. From the instrument or substance which produces the injury.
b. From the organs involved in the trauma applied. A bullet
wound may involve the intestine and causes its contents to spill
out in the peritoneal cavity causing peritonitis.
c. As an indirect effect of the injury which creates a local area of
diminished resistance causing the invasion and multiplication
of microorganisms.
d. Injury may depress the general vitality, especially among the
aged and the young children and makes the patient succumb to
terminal disease.
e. Deliberate introduction of microorganisms at the site of injury.
4. Embolism:
This is a condition in which foreign matters are introduced in
the blood stream causing sudden block to the blood flow in the
finer arterioles and capillaries.
285
286
LEGAL MEDICINE
Vascularity
Age of the Person
Degree of Rest or Immobilization
Nature of the Injury
287
Chapter X
MEDICO-LEGAL INVESTIGATION OF WOUNDS:
The following rules must always be observed by the physician in
the examination of wounds:
1. All injuries must be described, however small for it may be important later.
2. The description of the wounds must be comprehensive, and if
possible a sketch or photograph must be taken.
3. The examination must not be influenced by 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:
a. Examination of the place where the crime was committed.
b. Examination of the clothings, stains, cuts, hair and other
foreign bodies that can be found in the scene of the crime.
c. Investigation of those persons who may be the witnesses to the
incident or those who could give light to the case.
d. Examination of the wounding instrument.
e. Photography, sketching, or accurate description of the scene of
the crime for purposes of preservation.
2. Examinations of the
Wounded Body:
290
LEGAL MEDICINE
there may be superficial tentative cuts (hesitation cuts). Lacerated wound may show contusion of the neighboring skin.
e. Extent of the Wound:
Extensive injury may show marked degree of force applied in
the production of the wound. In homicidal cut-throat cases, it
is generally deeper than in cases of suicide. Homicidal wounds
are extensive and numerous.
f. Direction of the Wound:
The direction of the wound is material in the determination
of the relative position of the victim and the offender when
such wound has been inflicted. The direction of the incised
wound of the anterior aspect of the neck may differentiate
whether it is homicidal or suicidal.
g. Number of Wounds:
Several wounds found in different parts of the body are
generally indicative of murder or homicide.
h. Conditions of the Locality:
(1) Degree of hemorrhage.
(2) Evidence of struggle.
(3) Information as to the position of the body
(4) Presence of letter or suicide note.
(5) Condition of the weapon.
Determination Whether the Wounds were Inflicted During Life or
After Death:
In the determination whether the wounds were inflicted during
life or after death, the following factors must be taken into consideration:
1. Hemorrhage:
As a general rule, hemorrhage is more profuse when the wound
was inflicted during the lifetime of the victim. In wounds inflicted after death, the amount of bleeding is comparatively less if
at all bleeding occurred. This is due to the loss of tone of the
blood vessels, the absence of heart action and the post-mortem
clotting of blood inside the blood vessels.
Violence inflicted on a living body may not show the formation
of a bruise until after death.
2. Signs of Inflammation:
There may be swelling of the area surrounding the wound,
effusion of lymph or pus and adhesion of the edges. Other vital
reactions are present whenever the wound was inflicted during
life, although it may be less pronounced when the resistance of
291
Post-mortem
Wound
auc
. Blood is not clotted; if at all,
it is a soft clot.
3*
. Nd^mflammation or reparative
6. Inflammation and reparative 6
processes.
processes.
Toxicology by N.J. Modi, 12th
(From: Medical Jurisprudence and
ed. p. 237).
y
LEGAL MEDICINE
292
294
LEGAL MEDICINE
296
LEGAL MEDICINE
Injury:
Sometimes it is necessary to determine whether a victim of a fatal
wound is still capable of speaking, walking or performing any other
volitional acts. A dying declaration may be presented by the prosecutor mentioning the accused as the assailant; the offender may
allege that the physical injuries inflicted by him while the victim was
inside his house and that he walked for some distance where he fell,
or that the victim after the fatal injury made an attempt to inflict
injuries to the accused which justified the latter to give another fatal
blow. The determination of the victim's capacity to perform volitional acts rests upon the medical witness.
As a general rule, severe injury of the brain and the cranial box
usually produces unconsciousness, but after a while.the victim may be
capable of performing volitional acts. The power to perform volitional
acts is dependent upon the areas of the brain involved. Wounds of
the big blood vessels, like the carotid, jugular or even the aorta, do
not prevent a person from exercising voluntary acts or even from
running a certain distance. Penetrating wound of the heart is often
considered to be instantaneously fatal but experience shows that the
victim may still be capable of locomotion. Rupture of the organs
is not always followed by death. The victim has for sometime still
retains the rapacity to move and speak.
Extreme caution must be exercised by the physician in expressing
his opinion as to the limitation of powers possessed by the injured
person to perform acts of volition, locomotion, or speech subsequent
to receipt of extensive or fatal injury or wound.
298
LEGAL MEDICINE
Chapter XI
PHYSICAL INJURIES IN THE DIFFERENT
PARTS OF THE BODY:
1. HEAD AND NECK INJURIES:
Injuries of the head must not be underestimated. They must
be treated with extreme care. The absence of an external wound
on the head does not itself permit a conclusion that there is no
internal damage. Contusion and hematoma of the scalp may only
be appreciated during the post-mortem examination. The presence of hair further augments the difficulty of appreciating
head injuries.
The presence of bleeding from the ear, nostrils and mouth may
be associated with basal fracture. Fracture of the vault and other
portions of the cranial box may cause unconsciousness and this
may be mistaken for simple intoxication. It is preferable to have
the patient under careful, intelligent and continuous observation
for at least twelve to twenty-four hours to avoid risk to the life
of the patient. X-ray examinations may be useful in order to
determine the presence of fracture. However, it is not uncommon
that no fracture is observed, and yet the intracranial injury is
quite severe.
Factors Influencing the Degree and Extent of Head Injuries:
a. Nature of the Wounding Agent:
Weapons with a small striking face usually produce a localized depressed fracture with laceration of the scalp. The degree
of injury depends upon the degree of violence applied, the
thickness of the scalp struck and the weight of the weapon.
Violent contact with the wheel of a motor vehicle causes
fissure or comminuted fracture of the cranial box. There is
always an associated injury of the brain substance and laceration of the meninges.
Penetrating injuries of the skull like those caused by a dagger,
a nail or a bullet, may leave a clean-cut opening with the shape
and size of the wounding weapon. A glancing hit of a bullet
may cause a gutter-like depressed fracture of the vault of the
skull.
299
300
LEGAL MEDICINE
301
Injuries:
Remote
applied in
the head.
fracture of
LEGAL MEDICINE
302
Fracture:
303
304
LEGAL MEDICINE
Hemorrhage at the region of the vault produces a discusshaped clot with compression of the brain substance and this
may cause neurologic disturbance.
If the patient lives for
sometime, there will be an organization of the clot and a
fibrous thickening of the dura.
A person suffering from extradural hemorrhage may complain of headache, vomiting and drowsiness. The pupils may be
dilated on the side of the hemorrhage. Examination of the
cerebro-spinal fluid shows absence of blood, unless it is complicated with hemorrhage in other regions in the cranial cavity.
b. Subdural Hemorrhage:
Unlike extradural hemorrhage, subdural bleeding is essentially venous or capillary. It is the most common cause of cerebral
compression. It may be a consequence of fracture of the skull,
laceration of the brain, spontaneous rupture of the blood vessels
on the surface of the brain or laceration of the dura and meningeal vessels. It usually comes from the small blood vessels
which cross the subdural space to the subarachnoidal area.
Majority of subdural hemorrhages are traumatic in origin
although a few may be due to a natural disease of the blood
vessels of the brain. There are difficulties in ascertaining the
cause and source of such hemorrhage.
305
Extensive s u b d u r a l h e m o r r h a g e
Munro-Merritt Method:
4 to 5 days
Increasingly prominent membrane with extension of the fibroblasts into the underlying
clot.
The membrane has become 12 14 cells in
thickness.
Pigment-laden phagocytes are
found.
Clot broken up into islands by the invasion
of strands of fibroblasts.
8th day
11th day
306
LEGAL MEDICINE
15th day
26th day
Hemorrhage:
307
tissue involved is necessary to determine the presence of pathology of the blood vessel.
Traumatic cerebral hemorrhage is usually due to laceration or
contusion of the brain in contre-coup injuries. Severe crushing
of the skull in vehicular accident cases may cause the sharp
fractured edges of the bone to lacerate the brain and produces
severe cerebral hemorrhage. It may involve the gray matter
only but in severe cases the hemorrhage extends up to the white
matter.
Distinction between Cerebral Apoplexy and Post-traumatic Intracerebral Hemorrhage:
a. In traumatic intracerebral hemorrhage the interval between the
injury and onset of "stroke" (symptoms) is usually a week or
less.
b. In traumatic intracerebral hemorrhage, the injury to the head
must be sustained when the head is in motion and the hemorrhage is the result of the coup-contre-coup mechanism.
c. The location of traumatic intracerebral hemorrhage is in the
central white matter of the frontal or temporo-occipital region.
Cerebral apoplexy is usually at the basal ganglia, a very uncommon site of traumatic intracerebral hemorrhage.
d. History of hypertension prior to the "stroke" and evidence of
degenerative disease are present in cerebral apoplexy. There
is a history of head trauma in traumatic intracerebral hemorrhage.
(Gradwohl's Legal Medicine, 2nd ed. by F.E. Camps, p. 312).
Brain:
a. Laceration of the Brain:
Lacerations of the brain may be:
(1) Direct or Coup Laceration:
This is produced by the fracture of the skull. The edges
of the fractured bone lacerate the arachnoid and the underlying brain tissue. It may occur any where in the brain but it
usually follows the line of fracture. The most frequent
sites are the parietal and the frontal lobes.
( 2 ) Contre-coup Laceration:
Contre-coup laceration occurs usually directly across the
point of impact and fracture. Contre-coup injuries occur
only when the head is free to move at the time of the
impact. If the head is held immovable the mechanism of
contre-coup will not operate. A frontal impact may pro-
308
LEGAL MEDICINE
duce laceration of the cerebellum while an impact in the
occipital region may cause contre-coup laceration of the
fronta-. and temporal lobes of the brain.
Brain laceration may lead to granulation tissue formation and ultimately to fibrosis in the absence of infection.
(GradwohVs Legal Medicine by F.E. Camps ed., 2nd ed., pp. 317319).
309
310
LEGAL MEDICINE
In traumatic compression, the symptoms do not appear
immediately after the injury. The symptoms depend upon the
area of the brain involved but signs of increased intracranial
pressure are always present.
Vomiting, headache, irregular
breathing, incontinence of urination and defecation, and
paralysis are usually present. Recovery develops when the cause
is completely removed but usually the patient has loss of
memory, epilepsy, paralysis, or insanity as a sequelae.
311
LEGAL MEDICINE
312
of the base of the anterior cranial fossa may also produce contusion of the eyelids, and this may be distinguished from contusion due to a blow by the absence of swelling and skin injuries
in the former.
The eye may be lacerated by a blunt weapon or by a piece of
stone. Acute inflammatory changes usually occur with injury
of the cornea, iris and lens and may require total enucleation of
the eyeball. Penetrating wounds due to sharp instruments or
bullets may cause meningitis or total blindness.
b. Nose:
Fracture of the nasal bone is a common sequelae of fist blows,
and may cause severe epistaxis and facial deformity. The nose
may be bitten in a quarrel, cut with a sharp-edge instrument,
and contused, abraded or lacerated by a blow. In suicide, the
muzzle of the death gun might be placed in the nostril and may
cause no visible wound of entrance.
Injuries of the nose are usually dangerous to life on account
of the extension of infection to the brain.
c. Ear:
A blow on the ear may produce a rupture of the tympanic
membrane leading to permanent or temporary deafness. Hemorrhage coming from the ear may suggest fracture of the base of
the middle cranial fossa. In a quarrel, the pinna of the ear may
be cut off or markedly lacerated or contused by a strong blow.
The trauma in the ear may cause septic infection and may
extend to the brain and causes death.
d. Mouth:
Contusion, laceration and swelling of the lips are usually
observed in a fist blow, kick or bite. It may or may not be
associated with fracture of the teeth or injury of the gum.
Fracture of the lower jaw is usually due to direct violence
and the most common site is at the region of the insertion of
the canine and at the region of the condyle. Fracture of the jaw
is always associated with laceration of the gums which may
extend to the floor of the buccal cavity.
Occasionally a gunshot wound in suicidal case is found
inside the mouth and investigators are usually at a loss in the
examination and location of the wound of entrance.
Infections following injury of the mouth may extend to the
upper respiratory system and cause edema or gangrene of the
glottis.
313
Neck:
Abrasions of the neck may be present in cases of manual
strangulation. Ligature marks are present in death by hanging or
strangulation by ligature. Incised wounds may be homicidal or
suicidal. Suicidal cut-throat wounds are usually diagonal while
homicidal wounds are usually horizontal. Incised and stab wounds
of the neck may involve the trachea and the big blood vessels and
nerves and in most cases, end fatally.
Asphyxia, pneumonia,
hemorrhage and shock are the common causes of death from
neck injuries.
Wounds of the esophagus are not common. They are usually
accompanied by wounds of the trachea and large blood vessels
of the neck. Severance of the recurrent laryngeal nerve causes
aphonia.
Contusion or rupture of the muscles, severance of the nerves are
sometimes observed in severe trauma applied to the neck. Forcible blow in the anterior portion of the neck may cause unconsciousness or even death due to reflexed inhibitory action on
the vagus nerve.
Vertebral Column and Spinal Cord:
a. Fracture of the Vertebrae:
Fracture of the vertebrae is dangerous to life because of the
involvement of the spinal cord.
Injury of the cord due to
fracture of the upper four cervical vertebrae causes paralysis of
the phrenic nerve, while those due to fractures of the fifth cervical vertebra to the first dorsal vertebrae may cause paralysis of
all the extremities. Injury of the cord at other levels may not
cause immediate death but complications like hypostatic
pneumonia, bed sores and other secondary infections may set
in and cause death.
The causes of the fracture of the spine may be:
( 1 ) Direct Violence:
The fracture of the spine may be due to a blow by a
heavy instrument coming from the back, fall from a height,
collision with motor vehicles and hit of a projecting instrument.
(2) Indirect Violence:
Indirect violence may be due to a fall on the feet or
buttocks, forcible bending of the body as in wrestling, a
blow on the chin or forehead, forcible bending of the head
towards the sternum, and slight twist of the body if the
person is suffering from Pott's disease.
314
LEGAL MEDICINE
Recovery from spinal fracture may cause deformity or
paralysis of certain areas of the body. Injury of the spine is
usually associated with considerable, pain.
315
316
LEGAL MEDICINE
317
318
LEGAL MEDICINE
Stomach:
Spontaneous rupture of the stomach may be observed in cases
of gastric ulcer or new growth. A blunt force applied at the upper
portion of the abdomen may cause bruising or even rupture. The
pyloric end and the greater curvature are the most frequent sites
of a rupture.
Penetrating stab wounds of the stomach are dangerous to life
on account of a hemorrhage, infection and injury to the adjacent
organs like the liver. Tearing of the stomach is common when
the person is run over by a motor vehicle at the region of the
abdomen.
Intestine:
Ulcer at the duodenum may rupture spontaneously. The same
is true in cases of tuberculous, amoebic, cancerous or typhoid
ulcerations. Peritonitis and hemorrhage are the common causes
of death.
Traumatic rupture may be due to a blow, kick, fall or vehicular
accident. When force is applied to the front portion of the abdominal wall, the intestine may be pressed between the vertebral
column and the force applied, producing either partial or complete
severance or laceration.
Its septic contents will scatter in the
abdominal cavity and cause generalized peritonitis.
Injuries caused by sharp instruments or by gunshots usually
cause multiple lesions in the intestine and may also involve other
visceral organs. The intestine may be involved in vehicular accidents and on account of the grinding force of the wheel, severe
hemorrhage, laceration and herniation in the abdominal wall are
usually observed.
The mesentery may be contused, lacerated or crushed but in
most cases its involvement is secondary to lesion in the intestine.
Liver:
The liver is one of the most vulnerable organs in the abdominal
cavity because of its size, weight, location, friability, and fixed
position. Injuries are frequently met in cases of blow, kick, crush,
fall or sometimes in sudden contraction of the abdominal wall.
The right lobe is more frequently involved than the left owing to
its size and exposed location. Rupture is usually transversely or
anteroposteriorly.
On account of its extreme vascularity, the
victim usually dies of severe hemorrhage, shock and very rarely of
supervening infection.
Sometimes recovery occurs after slight
laceration but occasionally, abscess develops.
319
Stab and gunshot wounds of the abdomen may involve the liver.
Severe hemorrhage or shock usually causes the death. It may be
lacerated by the fractured ends of the lower ribs in crush injuries.
The gall bladder may be ruptured as a result of a kick, blow or
crush injury. It may be inju*ed-by penetrating weapons. Death
is due to hemorrhage and the effusion of bile into the peritoneal
cavity.
Spleen:
The spleen usually suffers traumatic rupture resulting from the
impact of a fall or blow and from the crushing and grinding
effects of wheels of motor vehicles. Although the organ is protected at its upper portion by the ribs and also by the air-containing visceral organs, yet on account of its superficiality and
fragility, it is usually affected by trauma. Congestion and diseased
condition of the spleen, as in malaria, typhoid, kala-zar, make it
more easily susceptible to slight trauma.
Laceration of the spleen is more common at the region of the
hilus and the lesion may be longitudinal or transverse. Lesion on
the convex surface is also common especially when the force is
applied to the left flank. On account of the vascular nature of
the organ and its proximity to the plexuses of nerves, the victim
usually dies of severe shock or hemorrhage.
Penetrating stab wounds of the spleen are common but most
often other visceral organs are also involved. Death is due to
hemorrhage.
Kidney:
Traumatic injury of the kidney may be due to a blow at the
lumbar region somewhere at the region of the 12th rib. It may be
ruptured at the slightest violence when it is diseased as in cases of
hydronephrosis, pyelonephritis, tuberculosis, abscess or tumor.
The kidney may also be ruptured when the individual is run over
by a vehicle or severely crushed from a fall
Injury of the kidney is accompanied by peri-renal hematoma
which consists of blood and urine. Death is due to a severe
hemorrhage, loss of kidney functions and shock. Abdominal
hemorrhage is present only if there is injury to the peritoneum
concomitant to the lesions in the kidney.
The adrenals may be contused, crushed or lacerated by severe
violence. The right is more prone to injury of its vulnerable
location.
"Crush syndrome" These are secondary kidney changes in
crush injuries. Edema and anuria follow a crush. If death super-
320
LEGAL MEDICINE
321
Chapter XII
DEATH OR PHYSICAL INJURIES
CAUSED BY EXPLOSION
Explosion is the sudden release of potential energy producing a
localized increase in pressure.
Investigation of death or physical injuries that is produced by explosion must be concerned in determining the following:
1. What exploded?
2. What caused it to explode?
3. H o w it produced the injury?
4. H o w was it initiated?
Classification of Explosion as to the Source of Energy:
1. Mechanical (Hydraulic) Explosion This occurs when the pressure inside a container exceeds its structural strength. Explosions
of air pressure tanks for cleaning or paint spray, water pressure
tanks to establish water pressure, and the air pumped kerosene
burner are examples of mechanical explosions. These explode
when the pressures applied are in excess of the strength of the containers. As the container disintegrates, there is a rapid localized
increase in pressure resulting in the characteristic explosive sound.
2. Electrical Explosion When electricity arcs through the air, a
phenomenon that occurs when two objects of different electrical
potential are brought close to one another, a large amount of heat
develops. This heat rapidly expands the air in and around the arc
which produces the popping sound of an arc. Lightning though
it occurs in a much complex form with extremely high temperature,
may be an example of an electrical explosion.
3. Nuclear Explosion The release of a significant amount of energy
by fusion or fission and consequently with a significant increase of
destructiveness.
Atomic Explosion Atomic nuclei can be regarded as stored
condensed energy. The uncontrolled release of this energy constitutes atomic explosion.
4. Chemical Explosion Chemical explosion occurs when a chemical
reaction'produces heat and gas at a rate faster than the surroundings
can dissipate. At the start of the reaction the initial heat or gas
322
323
324
LEGAL MEDICINE
Laboratory Medicine by V. Di Maio, Vol. 3, No. 2,
June 1983, pp. 309-314).
Death or physical injuries due to detonation of high explosives
may be due to the following causes:
The destructive effects varies with the kind and amount of
explosive used and the location of the victim at the time of the
explosion. The explosion is accompanied by blast, flame and
fragment primarily.
The nature and extent of the injuries
suffered by the victim may be:
(a) If the victim is in contact with the explosive, as when he is
manipulating, carrying or sitting on it at the time of the
explosion, there is complete disruption or fragmentation of
the body. Pieces of the body may be found several meters
away from the site of explosion. Some parts of the body may
be found hanging on the electric power line, bones completely
shattered, skin and other soft tissues may be found scattered at a certain distance from the site of the explosion.
325
ii.
iii. The ear is the organ most vulnerable to the blast. Most
person at the vicinity of the explosion may suffer from
slight reddening of the tympanic membrane which
signifies that the cochlea has been damaged
(e) Burns from the flame or heated gas The instantaneous or
momentary flame of high intensity during explosion may
cause singeing of the eyebrow, scalp hair and eyelashes.
Clothings may also be burned. Body surface in contact with
the flame or exposed to the heated air may develop burns,
the degree of which depends upon the intensity and duration
of exposure.
(f) Asphyxia due to lack of oxygen Explosion causes consumption of oxygen in the surrounding atmosphere, thereby
limiting the amount available for human consumption.
(g) Poisoning by inhalation of carbon monoxide, nitrous or
nitric gases, hydrogen sulfide, sulfur dioxide, or hydrocyanic gas The by-products of combustion may be protoplasmic poison or may cause death by interfering with the
326
LEGAL MEDICINE
normal transportation and utilization of air by the tissues
of the body.
(h) Direct injury by the flying missiles The injury due to
flying missiles is influenced by the proximity of the individual to the site of explosion, velocity of the missiles,
manner or approach of the missiles on the body surface
involved and the subsequent complications arising from
such injuries.
The shrapnel wound may go much deeper or the foreign
body may lodged inside the body. The edges of the missiles
may be irregular or smooth so that the lesion on the skin
may appear like an incised wound. If lacerated, the surrounding tissues may be contused.
The following explosives may cause shrapnel wound:
Grenade
Rifle or hand.
Bomb
Demolition or incendiary.
Mine.s
Underground or submarine.
Exploding missiles Anti-aircraft
( i ) Injuries from the falling debris If the explosion took place
in a building the victim may be injured and buried under the
rubbles. The victim may suffer from multiple injuries of
whatever description or die of traumatic or crash asphyxia.
327
Griess
Diphenylamine
No color
Pink to red
Pink
Pink to red
Pink to red
Pink to red
No color
Pink to red
Blue
Blue
Blue-black
Blue
Blue
Blue
No color
Blue
Alcoholic KC
No color
No color
No color
No color
No color
No color
Red
Red-violet
Griess Reagent:
Solution 1 Dissolve 1 mg. sulfanilic acid in 100 ml. of 30% acetic
acid.
Solution 2 Dissolve 1 g. alpha-naphthylamine in 230 ml. of boiling
distilled water, cool.
Decant the colorless supernatant liquid and mix with 110 ml. of
glacial acetic acid. A d d solutions 1 and 2 and a few milligrams of
zinc dust to the suspect extract.
Diphenylamine Reagent:
Solution 1 Dissolve 1 g. diphenylamine in 100 ml. concentrated
sulfuric acid.
Alcoholic KOH Reagent:
Solution 1 Dissolve 10 g. of potassium hydroxide in 100 ml. of
absolute alcohol.
(Criminalistics by Richard Saferstein, p. 242).
Other Tests on Extract:
1. Infra-red spectrophotometry.
2. X-ray diffraction.
3. Gas chromatographic analysis.
ATOMIC B O M B E X P L O S I O N :
Atomic nuclei can be regarded as storage of highly condensed
energy and that the uncontrolled release of this energy constitute an
atomic explosion. The explosion is caused by the fission of about
100 pounds of uranium and liberates energy equal to that of a
328
LEGAL MEDICINE
329
erythema,
disorientation
Effects:
330
LEGAL MEDICINE
3. Kind of Radiation The biological damage is not always proportional to the energy absorbed, but it depends on the kind of
energy emitted. Gamma and neutron radiations are most destructive.
4. Fractional Doses A single dose may be lethal when administered
fractionally over a long interval of time.
5. Sensitivity Muscles and connective tissue are radioresistant while
actively dividing tissues like blood forming organs, intestinal
epithelium are quite radiosensitive.
Other Sources of Radiation:
1. Natural Source:
a. Cosmic Origin Radiation from the sun or from outer space.
b. Terrestial Origin Chiefly from radiothorium series of granite
rocks.
2. Man-made Source:
a. Diagnostic X-ray Equipment:
The filament inside a vacuum tube is heated by a strong
electric current so that it will emit electrons. The electron is
driven on an anode target (Rhenium and molybdenum) which
causes the development of electromagnetic energy, the wave
length and the ability to penetrate depends on the kilovoltage
applied. The higher the voltage, the shorter is the wave length
and the more penetrating are the X-rays.
As the X-ray passes the tissues of the body, the degree of
absorption depends on the density. The bones absorb more
X-ray than the air containing tissues. Naturally the film behind
receives a differential amount of X-ray. The denser substance
like the bone, will be represented by a lighter image while the
less denser organs will have a darker image.
In a fluoroscope, the X-ray after passing the body goes to a
screen and the differential absorption of X-ray by the body is
reflected in the fluoroscopic screen (Legal Medicine by Tadeschi
p. 86).
b. Clinical nuclear pharmaceutical agents.
c. Therapeutic radiation apparatus.
d. Radiation sources used in industry, like nuclear power plant
The problem of the use of nuclear power in generating plants
is the disposal of the radioactive waste which may be in the
form of:
( 1 ) Gases chiefly emitted from the vapor.
Chapter XIII
/ G U N S H O T WOUNDS
D E A T H O R P H Y S I C A L INJURIES B R O U G H T A B O U T B Y
POWDERED PROPELLED SUBSTANCES
Death or physical injuries brought about by the powder propelled
substances may be due to the following:
1. Firearm Shot The injury is caused by the missile propelled by
the explosion of the gunpowder located in the cartridge shell and
at the rear of the missile. The direction of the movement of the
missile is influenced by the desire of the person firing the firearm. The missile may be single as in the case of a pistol or revolver
or may be of multiple shots or pellets as in the case of a shotgun.
The cartridge shell is physically preserved after the fire.
2. Detonation of high explosives, as in grenades, bombs and mine
explosion. Explosion of the gunpowder inside the metallic container will cause fragmentation of the container. Each fragment or
shrapnel is moving with certain velocity without any predetermined direction.
I. FIREARM W O U N D
Definition of Firearm:
1. Technical
Definition:
GUNSHOT WOUNDS
333
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LEGAL MEDICINE
GUNSHOT WOUNDS
335
LEGAL MEDICINE
336
GUNSHOT WOUNDS
337
338
LEGAL MEDICINE
Explosion of one grain of black powder (one grain = 0.065
gm.) will produce 200 to 300 cc. of gas composed of carbon
dioxide (50%), carbon monoxide (10%), nitrogen (35%),
hydrogen sulfide (3%) and traces of methane and oxygen. The
solid residues following its combustion are potassium sulfate,
potassium sulfide, potassium carbonate together with its original
components.
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LEGAL MEDICINE
( b ) To withstand deformity in automatic loading process;
and
(c) To prevent deformity when carried and exposed to
rough handling.
A jacketed bullet may be:
i. Full Jacketed Bullet the whole bullet up to the
base is enveloped with a metallic jacket.
ii. Semi-jacketed Bullet The nose or free end is partly
or fully exposed while there is relatively thin but
tough coating of the base and the cylindrical portion.
This is made to permit expansion of the bullet when
it hits hard objects. Semi-jacketed bullets may be
hollow-point.
The general rule is that soft-metal, round nose
bullets are fired from a revolver; full-jacketed bullets
are fired from a rifle and self-loading firearm; semijacketed bullets are fired from an automatic (selfloading) firearm or rifle.
Special Bullets:
a. Armour Piercing Bullet made of steel with copper coating
(jacket).
b. Phosphorus Flare or Tracer Bullet This consists of an aluminum tip and is packed with incendiary (phosphorus) which
burns during flight. It is used to determine the direction of the
fire. The speed of sound in air is 1,087 feet per second or 331.3
meters per second.
c. Plastic Bullet used for target practice.
d. Bullet with Plastic Sabot The bullet together with the sabot
travel up to the bore. The bullet never comes in contact with
the barrel and therefore there will be no rifling marks imparted
in the bullet but on the sabot. The front half of the sabot has
six slits. As the sabot leaves the barrel it offers resistance and
the slit part of the sabot will fold backward, causing resistance
and falls away.
At three feet, the sabot and bullet are still in line.
At 6 to 7 feet, they strike the target separately.
The sabot itself travels approximately 50 feet.
e. Bullet with Secondary Explosion The bullet may leave the
barrel and upon reaching a certain distance it produces secondary explosion and shrapnel splinters.
f. Soft Point Bullet A bullet which is easily flattened upon
hitting the target to increase the wounding effect.
GUNSHOT WOUNDS
343
FIREARM
For purposes of Medico-legal Investigation, the following Parts of a
Firearm are important:
1. The trigger with the firing pin.
2. The barrel.
Other Parts of a Firearm:
1. Handle or Butt The portion of the firearm used for handling it.
It may house the magazine.
2. Firing Chamber The place where the cartridge is held in position
before the fire mechanism starts.
3. Breechblock The steel block which closes the rear of the bore
against the force of the charge. The face of this block which comes
in contact with the base of the cartridge is known as the breechface.
4. Trigger Guard.
5. Front and Rear Sight.
6. Safety Device like safety lock.
7. Sling.
In a Self-loading Firearm, the following are the Additional Parts:
1. Extractor The mechanism by which the spent shell or ammunition is withdrawn from the firing chamber.
2. Ejector The mechanism by which the empty shell or ammunition is thrown from the firearm.
1. Trigger:
This is a part of the firearm which causes firing mechanism.
Except in a single action firearm, pressure on the trigger is the
commencement of the whole firearm mechanism. To avoid accidental firing, the trigger is surrounded by a trigger guard.
Classification of Firearm Based on Trigger Mechanism:
a. Relation of Cocking and Trigger Pressure:
(1) Single Action Firearm The firearm is first manually
cocked then followed by pressure on the trigger to release
the hammer.
Example: Home-made "Paltik".
( 2 ) Double Action Firearm A pressure applied on the trigger
will both cock and fire the firearm by release of the hammer.
Example: Standard Revolver.
b. Number of Shots on Pressure on the Trigger:
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LEGAL MEDICINE
(1) Single Shot Firearm A pull or pressure on the trigger will
cause only one shot.
Example: Revolver.
(2) Automatic Firearm A continuous pressure on the trigger
will cause a series of shots until the trigger pressure is
released.
Example: Machine gun.
Shotgun
Self-loading pistol
Revolver
Service rifle
4
3
3
6
lbs.
to 4 lbs.
to 5 lbs.
to 7 lbs.
2. Barrel:
a. Riflings:
The inner surface of a shotgun and that of a home-made
gun is smooth while single shot standard firearms are with
riflings.
The inner surface of the barrel has a series of parallel spiral
grooves on the whole length called riflings. The space between
the two grooves is the land. The riflings are made to have a
strong barrel grip on the bullet, to stabilize its movement and
to impart a rotational movement on the bullet. Incidentally,
the rifling reflected on the bullet becomes an important factor
in the identification of firearms.
Gun manufacturers vary the way the riflings are imprinted
in the inner surface of the barrel on the following aspects:
(1) Number The number of lands and grooves varies from 2
to 12.
Most high velocity firearms have 4 to 6 grooves. Some
firearms have multiple shallow grooves and this is known
as microgroove6 rifling.
GUNSHOT WOUNDS
345
Direction of
Riflings
1. Revolvers:
- Webley, 455, .38, .32
Colt, all calibers
Smith and Wesson, .45, .32
- J.T. & S. & W. model
7
6
5
4
right
left
right
right
2. Automatic Pistols:
- Webley, .455, .32, .25
Browning
Mauser, .25
- Colt, .45, .38, .25
Delta
Victoria (Spanish make)
Luger P-08, 9 mm. (German)
Fibrique National, 9 mm. (Belgian)
6
6
6
6
6
6
6
6
right
right
right
left
left
left
right
right
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LEGAL MEDICINE
English Caliber
.22 Inch
.220 Inch
5.6
.25 "
.250
6.5(6.35)
.28
.280
7.0
.30
(.32 Rev.)
.300 " (.303)
7.65
.32
.320 "
8.0
.35 (.351)
.350
9.0
.38
.360 "
9.3
.38
.370
9.5
.38-.40-.41 Inch
410
10.0
.405 Inch
10.5
.44 "
.440 "
11.0
.45
.450 " (.455)
11.25
(From:
Modern Criminal Investigation by Harry Soderman and
John O'Connell, 4th ed., p. 201).
To convert millimeter calibration to inches, multiply the caliber
in millimeters by 0.03937 or divide by 25.4.
To convert inches calibration to millimeters, multiply by 25.4 or
divide by 0.03937.
M
GUNSHOT WOUNDS
347
portion of the barrel. The hit by the firing pin on the percussion
cap will cause generation of a sufficient heat capable of igniting the
primer. The primer will in turn ignite the gunpowder or propellant
which will cause evolution of gases under pressure and temperature.
The marked expansion of the gases will force the projectile forward
with certain velocity. Owing to the presence of the rifling at the
inner wall of the bore, the barrel offers some degree of resistance
to the projectile. Inasmuch as the rifling marks are arranged in a
spiral manner, the projectile will produce a spinning movement as
it comes out of the muzzle.
Together with the bullet passing out of the barrel are the highpressured heated gases, unbumt powder grains with flame and
smoke.
During explosion, there is a backward kick of the firearm which
in an automatic firearm causes the cocking and the empty shell thrown
out by the ejector. The backward movement is called recoil of the
firearm.
Things Coming Out of the Gun Muzzle After the Fire: ^
1. Bullet.
2. Flame.
3. Heated, compressed and expanded*gas.
4. Residues coming from:
a. Bullet:
(1) Fragment (jacket, lead).
(2) Lubricant.
b. Powder particles:
( 1 ) Powder grains (unbumed, burning).
(2) Soot.
(3) Graphite.
c. Primer:
( 1 ) Lead, barium, antimony, etc..
d. Barrel:
(1) Lubricant.
(2) Rust, dust, etc..
(3) Scraping from bullet by previous fire.
e. Cartridge case:
( 1 ) Copper, zinc.
Bullet's Kinetic Energy:
Kinetic energy is energy associated with motion. In the English
system it is express in foot pound or the work of a force resulting
when a weight of one pound is brought to a height of one foot.
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Kinetic Energy =
MV
M = Mass (Weight)
V = Velocity
G = Gravity
2G
Tissue damage of a bullet of a very high velocity is very much
greater than those with much less velocity.
The damage cause by a bullet with impact velocity similar to
muzzle velocity is greater than when the impact occurred at a reduced speed after the bullet has travelled a distance.
Bullet Efficiency:
The cartridge powder charge can be burned in approximately
0.00001 second. The conversion rate by combustion of the gunpowder to bullet energy is about 30 to 32 percent. The loss of
some energies from the gunpowder explosion may be due to:
a. Loss of energy to force the bullet out of the cartridge case,
rifling and friction in the barrel.
b. Heating of the barrel and chamber.
c. Escape of some of the compressed gasses at the breech and
barrel.
d. N o t all gunpowder are ignited.
Obturation:
This is the sealing or prevention of gunpowder gas after explosion from escaping so as to maintain high pressure in the
firing chamber thereby increasing the propulsive power on the
bullet. This is maintained:
a. By insuring that the bullet tightly fits the bore throughout its
entire length;
b. By sealing the cartridge case to the chamber wall; and
c. By preventing leakage between the primer cap and its retaining
wall in the cartridge.
Ballistics Coefficient:
This describes the ability of a bullet to maintain its velocity
against air resistance. It may be expressed in the following formula:
C ballistic coefficient
m mass
i form factor
d diameter
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The sudden release of the expanded gas from the muzzle following the bullet is known as a muzzle blast.
Smoke (Soot, Smudging, Fouling, Smoke Blackening):
This is one of the byproducts of complete combustion of the
gunpowder and other elements with the propellant. It is light,
almost black, and lack sufficient force to penetrate the skin. It is
merely deposited on the target and readily wiped off. It may be seen
with a distance of up to 12 inches.
The presence of smudging at the wound of entrance infers
a near shot. The shape may also be useful in determining the trajectory. A circular shape deposition may be typical of a perpendicular approach of the bullet while in case of an acute angle the
deposition may appear to be elliptical.
Powder Grains:
This consists of the unburned, burning and partially bumed
powder, together with graphite which come out of the muzzle.
Inasmuch as it is relatively heavier than smoke, it leaves the barrel
with appreciable velocity and in near shot, it is responsible to the
production of tattooing (stippling, peppering) around the gunshot
wound of entrance.
In close range, the powder grains penetrate the dermal and epidermal layers of the skin and may cause hemorrhage in deeper tissue
which cannot be removed by ordinary wiping. Microcontusion may
be observed around the punctured area and the shape of the puncture
may denote the shape of the penetrating grain. As the distance of
the gun muzzle to the target increases, the area of destruction increases, but the density of tattooing decreases.
In case of black powder, the residue is composed of nitrates,
thiocyanates, thiosulphates, potassium carbonates, potassium sulphate
and potassium sulphide, while in smokeless powder, the residue is
composed of granules with nitrites and cellulose nitrates with graphite.
The presence of tattooing or stippling may be seen around the
wound of entrance up to a distance of 24 inches, although there may
be considerable variation from gun to gun.
Powder Burns:
Powder burns is a term commonly used by physicians whenever
there is blackening of the margin of the gunshot wound of entrance.
The blackening is due to smoke smudging, gunpowder tattooing and
to a certain extent burning of the wound margin. It is the combined
effects of these elements that are considered to be powder bums.
Actually, such blackening is primarily due to smoke smudging and
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Force:
When the bullet traverses organs filled with fluid, like a full
stomach, cerebral ventricle, heart chambers, the liquid contents
within the lumen of these organs are displaced radially away from
the bullet path producing extensive laceration.
The displaced
fluid carries with it the kinetic energy which in turn acts as a
secondary projectile causing destruction of tissues not on the path
of the bullet.
4. Shock Wave:
This is the dissipation of kinetic energy in a radial direction
perpendicular to the path of the bullet when the bullet velocity is
more than the speed of sound (the speed of sound is 1,087 feet
per second).
The severe intensity of the wave causes severe
shocking effect on the adjacent tissues and may cause actual
destruction or lessening of function.
5. Fragmentation or Disintegration of the Bullet:
When the bullet hits a hard object (bone), it fragments to
several pieces.
When the bullet velocity is more than 2,000
ft/sec. it disintegrates and each fragment has sufficient kinetic
energy to cause injuries similar to the mother bullet. It may cause
laceration, fracture and shocking effect, thus increasing the
destructive effect of gunshot. This causes more "shocking power"
or "knockdown power" of the bullet.
GUNSHOT WOUNDS
353
/
Gunshot Wound of Entrance (Entrance Defect, Inshoot):
The appearance of the gunshot wound of entrance depends upon
the following:
1. Caliber of the Wounding Weapon:
Excluding other factors which may influence the size of the
wound of entrance^ the higher the caliber of the wounding bullet
the greater will be the size of the wound of entrance'/ It must not
be overlooked that the manner of approach of the bullet to the
skin, the distance of the muzzle of the firearm to the skin surface,
the deformity or splitting of the bullet and the portion of the skin
surface involves modification of the size and shape of the entrance.
2. Characteristics Inherent to the Wound of Entrance:.
The wound of entrance, as a general rule, is'oval or circular
with inverted edges,' except in near shot or in grazing or slap
wounaT'^ATUieTDuiret approaches the skin, there is an indentation
of the skin surface but later, on account of the extreme pressure;
the skin tissues give way. The rough surface of the bullet comes
in contact with the skin thereby producing a contusion or abrasion
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354
GUNSHOT WOUNDS
355
by
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(2) The gun muzzle is pressed on the body, pushed momentarily away and then hit the body again because of the
continuous inward pressure.
( 3 ) When the gun is fired on areas of the body where bony
tissue is superficial, like the scalp, the muzzle blast has the
tendency to creep in the loose connective tissue between
the skull and the skin thereby pushing the skin outward
to press on the gun muzzle.
e. The bullet may cause radiating fracture and the pressure of the
gases may cause fragmentation of the skull and a severe laceration of the brain and its meninges.
f. Blood and tissue become pink due to carbon monoxide.
g. Fragments of lead and bullet jacket may be found.
Metal Fouling When the bullet travels the whole length of the
tight fitting barrel, it is rotated by the lands and grooves. Its surface
is scraped by the lands and the scraping is ejected from the barrel and
strikes the target. It may lodge on the clothings or may cause small
abrasions or superficial lacerations on the skin around the main
wound.
h. Singeing of hair.
Gunshot wound of entrance with contusion collar, powder burns and tattooing.
GUNSHOT WOUNDS
357
laceration.
The gas from the muzzle can easily penetrate
deeper structures.
b. Edges are everted due to outward slapping of the skin. In some
instances, soft tissues (blood, fibrous and muscular tissues)
may be found inside the gun barrel. This is due to the negative
pressure created in the barrel after the blast.
c. Singeing of the hair, blackening of the wound due to fouling,
burn, and tattooing.
d. Muzzle imprint due to outward slapping of the skin and heat.
e. Pinkish color of the deeper structures due to carbon monoxide.
Loose Contact or Near F i r e : ^
1. Entrance wound may be^large circular or oval depending upon the
angle of approach of the bullet.
2^Abrasion collar**or ring is distinct.
3^Smudging, burning and tattooing are prominent with singeing of
the hair.
4. Muzzle imprint may be seen depending upon the degree of slapping of the skin of the gun muzzle.
5. There is^blackening of the bullet tract to a certain depth.
6.TJarboxyhemoglobin is present in the wound" and surrounding areas.
Short Range Fire ( 1 to 15 cm. distance): ^
1. Edges of the entrance wound is inverted.
2. If within the flame reach (about 6 inches in rifle and high powered
firearms and less than 3 inches from an ordinary handgun), there is
an area of burning.
S.^mudging is present'due to smoke.
4. "Powder tattooing* is present (dense and limited dimension of
spread).
S.'vAbrasion ring'br collar is present (contact ring).
Medium Range Fire (more than 15 cm. but less than 60 c m . ) : ^
1. Gunshot wound with* inverted edges'and with abrasion collar is
present.
T
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GUNSHOT WOUNDS
359
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360
3. Testimony of witnesses:
The testimony of the witness as to the position of the victim
and the assailant when the firearm was fired may determine which
of the wounds is the entrance wound.
Determination of the Trajectory of the Bullet Inside the Body of
the Victim:
The following must be taken into consideration to determine the
course of the bullet inside the body of the victim:
1. External
Examination:
Examination:
Wound at
GUNSHOT WOUNDS
361
Examination:
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362
Exit Wound
GUNSHOT WOUNDS
363
6. Underlying
protruding.
tissues
are
not
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GUNSHOT WOUNDS
365
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GUNSHOT WOUNDS
367
5. X-ray Examination:
The use of an X-ray is almost indispensable in the examination
of gunshot injuries. The use of the apparatus will facilitate recovery of the lodged bullet together with the location of its
fragments.
The body might have been X-rayed with unspent and spent
ammunition clinging on the clothings and may be mistaken to
be inside the body; teeth fillings or crown may resemble bullet on
X-ray examination of the skull. "Migratory" bullets may be found
in some parts of the body away from the bullet tract. Victim
may have "bullet souvenir" on account of a previous gunshot
injury and may confuse the examiner as to be an effect of recent
shot.
Clothings:
The effects of the garments on the movement of the bullet depend
upon:
1. The number of layers of fabric between the muzzle and subjacent
skin;
2. Nature of the fabric which may be closely woven or loose mesh,
light or heavy, cotton or synthetic fibers.
3. Muzzle-clothings distance.
Examination of the External Wearing Apparel of the Victim of
Gunshot maybe Significant in Investigation because:
1. It may establish the possible range of the fire:
a. Contact Fire:
(1) There is a tear of the clothings covering the skin at the site
of the gunshot wound with fusion of its fibers in case of
artificial fabric. Fibers are turned outward away from the
body.
(2) Soot deposit and gunpowder tattooing around the torn
fabric. Burning of the fibers are visible.
(3) Muzzle imprint (profile of the muzzle) especially in artificial fabric may be present.
(4) Dirt and greasy deposit is carried by the bullet and may be
wiped out and be visible on the torn clothing.
b. Not Contact but Near Shot:
The same findings as in contact shot except when it is beyond the flame range and absence of muzzle imprint.
c. Far Fire:
There is a hole tear with inward direction of the thread.
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GUNSHOT WOUNDS
)<GUNSHOT WOUNDS MAY BE SUICIDAL,
HOMICIDAL OR ACCIDENTAL
369
.
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GUNSHOT WOUNDS
5. Location of the missile, if lodged in the body.
371
(
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LEGAL MEDICINE
d. Autoloading:
A pull of the trigger not only fires and ejects the shell but
also reloads the next shot and locks it for firing.
Shotgun Cartridge:
A shotgun cartridge is usually 2-3/4 or 3 inches long and the
diameter depends on the gauge of the firearm. The base and the
lower portion of the cylindrical portion is made of brass with the
primer cap at the center of the base. Attached to the free end of
its cylindrical portion is the cylindrical laminated paper tube to
complete the shell casmg.
When the trigger is pulled, the firing pin activates the primer
which in turn ignites the powder charge. Explosion of the gunpowder will cause propulsion of the wad and pellets (shot) in front.
The muzzle velocity of the pellet is relatively smaller as compared
from those discharged from rifled firearms.
Except for the presence and nature of the slug, the component
of the shotgun blast is almost the same as that of a rifled firearm.
It also consists of gunpowder, flame, smoke, pellets and wad.
Shotgun Wound of Entrance:
1. Contact or Near Contact Shot (not more than 6 inches):
On account of the greater quantity of gunpowder in the shotgun cartridge, there is relatively more damage due to muzzle
olast, flame and gunpowder at the site of the wound of entrance
as compared with rifled fire.
a. If the shot is made perpendicular to the skin surface, the wound
of entrance is round but if the shot is made with an acute angle
with the skin the wound is oval. In both instances, the wound
border may be smooth or slightly rugged.
b. The entrance wound is burned, the width of which increases
as the muzzle-skin distance increases but does not exceed 6
inches.
c. There is blackening due to smoke.
d. Gunpowder tattooing is densely located in a limited area. The
area of spread is directly proportional to the muzzle skin
distance.
e. There is contusion of the tissue that has been blackened by
gunpowder.
f. There is singeing of the hair (less than 6 inches).
g. Subcutaneous and deeper tissues are severely disrupted.
h. Blood and other tissues along the bullet tract shows presence
of carbon monoxide.
GUNSHOT WOUNDS
377
i..Wad or its fragments together with shot (pellets) may be recovered from the bullet tract.
2. Long Range Shot (more than 6 inches skin-muzzle distance):
a. At 2 to 3 feet muzzle-skin distance, there is still a single wound
of entry although there may be isolated shots causing independent entry.
b. At 3 to 4 feet distance the wound of entry is usually serrated
or scalloped circumference and often referred to as a "rat
hole".
c. At about 5 to 6 feet distance, the wad tends to produce an
independent injury usually an abrasion at the vicinity of entry
of the shots. The wounding capacity of the wad is very much
less as compared with the shot on account of its lightness and
size.
d. At 6 feet, the shots begins to separate from the conglomerate
shot and at 10 feet each shot already produces independent
wounds of entry.
As the shot begin to separate from one another, there is
the tendency for one shot to strike another causing changes
of the shot course. This phenomena is called "billiard ball
ricochette effect".
e. Smudging due to smoke may be observed up to 15 inches.
f. Gunpowder tattooing may be detected up to 24 inches.
g. In an unchoked shotgun, to estimate the muzzle-target distance,
the following rule must be applied.
Measure the distance between the two farthest shot (pellets) in
inches and subtract one, the number thus obtained will give the
muzzle-target distance in yards.
The character of the wound and the degree of dispersal is influenced by the muzzle-target distance, gauge of the shotgun, degree
of choke and the type of ammunition. However, it is highly recommended to have an experimental shot with the firearm using similar
cartridge and under the same environmental conditions.
A close shot produces more serious injuries because the shots
are concentrated on a specific target and because of greater kinetic
energy of the pellets.
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I / D E T E R M I N A T I O N O F T H E PRESENCE O F
G U N P O W D E R A N D PRIMER C O M P O N E N T S
GUNSHOT WOUNDS
379
Examination:
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382
with
a Linked X-ray
GUNSHOT WOUNDS
383
80 cc.
60 cc.
50 cc.
10 grams
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Ballistic c o m p a r i s o n m i c r o s c o p e
reasons
GUNSHOT WOUNDS
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2. Brain Substance:
Bullet wound in the brain substance is usually a rugged tunnel
with a diameter larger than that of the caliber of the bullet, with
marked ecchymosis of the surrounding area and filled with fresh
and clotted blood. Fragments of bones may be felt in the tunnelled bullet tract. In most cases, injury of the brain causes
sudden loss of consciousness and incapable of voluntary movement.
GUNSHOT WOUNDS
391
4. Neck:
The bullet may pierce the front portion of the neck and may
involve the cervical portion of the spinal cord; thus causing instantaneous death if the upper portion is involved. The course of the
bullet may involve the carotid or jugular vessels and death may be
due to profused hemorrhage. The anterior wall of the esophagus
may be perforated and the bullet may enter into the gastrointestinal tract and expelled through the bowel. Injury to the
trachea and upper bronchi may cause asphyxia or aspiration
pneumonia.
Chest:
1. Chest Wall:
The bullet wound on the chest wall usually has an upward course
and may involve both sides. The bullet may strike the rib, sternum or the body of the vertebra and may cause deformity or
deflection of its course. When the intercostal or mammary vessels
are injured, there will be profused hemorrhage. Hemothorax of
more than a liter is observed in fatal cases.
2. Lungs:
The passage of a bullet in the lungs produces a cylindrical tunnel
much larger than the diameter of the projectile with bloody
contents and ecchymotic borders. When the pulmonary vessels
are involved, profused hemorrhage is observed which produces
death before medical or surgical intervention can be instituted.
If only one lung is involved, the profuse hemorrhage may cause
collapse of the lung, displacement of the heart, and mediastinum
towards the uninjured side. Emphysema is present when there is
marked injury to the air sacs. Involvement of the bigger bronchi
may cause asphyxia with the lung partially atelectatic and emphysematous.
The victim may not die immediately but later may
develop aspiration pneumonia or cerebral embolism.
3. Heart:
Bullet wound of the heart may be circular or stellate witn
subepicardial hemorrhage in the surrounding tissue. The course
may be of any direction but the right ventricle is often involved
because of the large surface area of exposure in front.
Gunshot wound of the heart as a general rule does not prevent
the victim from running, walking, climbing stairs, or do other
forms of volitional acts for death-is not usually instantaneous.
Wound of the auricle is more rapidly fatal as compared with the
wound of the ventricle on account of the thickness of the musculature of the latter which produces temporary closure of the
wound. Bullet may lodge in the musculature of the ventricle and
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Abdomen:
Abdominal gunshot wounds are quite frequent but not as serious
as those of the chest and head because of its amenability to surgical
operation. In most cases injuries are not only limited to one organ
but to several organs. Injuries to the visceral organs may not be
found along the course of the bullet on account of their mobility
and their capacity to change their forms. Involvement of the vertebral column may cause injury to the spinal cord. The mesenteric
vessels, aorta, vena cava, and other big abdominal blood vessels
may be lacerated and cause severe hemorrhage.
Bullet wound of the liver and other parenchymatous abdominal
organs may cause stellate perforations which are usually larger than
the caliber of the bullets that cause them. The tunnel which is also wide
may contain fragmented tissue, fresh and clotted blood. On account
of the richness of the blood supply of the parenchymatous organs,
profuse hemorrhage is the natural sequela. Loss of function, especially of the kidneys, pancreas, etc. may lead to fatal results.
Bullet wounds of the stomach and other hollow organs are usually
small on account of the contractility of the walls. The wound of
entrance is smaller than the wound of exit. Grazing injury may
simulate a lacerated wound. Injury of the viscus is usually multiple
and with less hemorrhage except when it involves the mesenteric
vessels.
Timely surgical intervention may prevent untoward complications. However, death due to peritonitis is not rare on account
of the spilling of its contents into the abdominal cavity.
GUNSHOT WOUNDS
393
Extremities:
Bullet wounds in the extremities may show the characteristic lesion
of gunshot wounds.
Usually the wound is not so serious except
when it involves the principal blood vessels and nerves. The bony
tissue may be involved producing comminuted fracture of the bone
and deflection of the course of the bullet. Septic infection, thrombosis, hemorrhage, deformity are not unusual after-effects.
Chapter XIV
THERMAL INJURIES OR DEATHS
^ffiermal injuries are those caused by an appreciable deviation
from normal temperature, capable of producing cellular or tissue
changes in the body. Thermal death is one primarily caused by
thermal injuries.
Exposure to severe cold may cause frost-bite, while exposure to
high temperature may cause burning or scalding.
I. DEATH OR INJURY FROM COLD
Death or injury due to a cold is not common in tropical countries.
The primary cause of death is attributed to the decreased dissociation of oxygen from hemoglobin in the red blood cells and diminished
power of the tissue to utilize oxygen. Cold produces a vascular
spasm which results to anemia of the skin surface followed by
vascular dilatation with paralysis and increased capillary permeability. Prolonged exposure may cause necrosis and gangrene.
The degree of damage depends upon the severity of the cold, the
duration of exposure, area of the body involved, sex and humidity.
Cold damp air is more fatal than cold dry air. A short exposure to
cold temperature may not be deleterious to the body as long exposure to low but not to freezing temperature. Children and aged
individuals are more susceptible to cold weather on account of their
limited thermotaxic reserved. Individuals whose vitality have been
diminished by fatigue, lack of food, alcoholism, and previous illhealth are less able to withstand the effects of cold. Women are
more resistant to cold than men on account of their greater deposits
of subcutaneous fat.
The action of cold in the body is partly local and partly reflex in
the circulatory system. Exposure to cold will diminish the dissociation power of oxygen from hemoglobin, thus starving the brain
and other nervous center with oxygen.
The effect of low temperature consists of a local damage to the
exposed tissue and systemic change involving the whole body
Effects of Cold:
y . Local Effect (Frostbite;
First
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LEGAL MEDICINE
c. Audible cracking sound on flexing the knee and other big joints
apparently due to the breaking down of the frozen synovial
fluid.
d. Petechial hemorrhage in the lungs, brain and kidneys.
e. If death occurs after sometime, pathological findings related to
complications, like bronchopneumonia, toxemia due to gangrene, etc. may be found.
The body tissue fluid evaporates slowly if the body is frozen,
hence, mummification develops later.
However, the individual
cell, tissues and organs are well-preserved.
II. DEATH OR INJURY FROM HEAT
The effects of heat in the body may be local at the application, or
general when the whole body is affected.
Classifications of Heat Injury:
1. General or Systemic Effects:
a. Heat cramps.
b. Heat exhaustion.
c. Heat stroke.
2. Local
Effects:
a. Scald.
b. Burns.
( 1 ) Thermal.
( 2 ) Chemical acids and alkalies.
( 3 ) Electrical and lightning.
( 4 ) Radiation X-ray, ultraviolet, etc.
G E N E R A L OR SYSTEMIC EFFECT:
1. Heat Cramps (Miner's Cramp, Fireman's Cramp, Stoker's Cramp):
This is the involuntary spasmodic painful contraction of muscles
essentially due to dehydration and excessive loss of chlorides by
sweating. This is seen among laborers working in rooms with high
temperature and with profused perspiration.
Symptoms:
a. The -onset is usually sudden as muscles cramp with agonizing
pain.
b. The cramp is accompanied by headache, dizziness and vomiting.
c. The face is flushed, pupils are dilated with tinnitus and abdominal pain.
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399
Extensive scalding
400
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401
Burns w i t h c a r b o n i z a t i o n o f the b o d y
LEGAL MEDICINE
402
endings. Healing may leave a scar which contains all the elements of the true skin, consequently without contracture.
d. Fourth Degree:
The whole skin is destroyed with formation of slough which is
yellowish-brown or parchment-like. The surface is ulcerated and
on healing a dense fibrous scar tissue develops. The scar may
subsequently contract and cause deformity of the part. On
account of the complete destruction of the nerve endings, this
kind of burn is not very painful.
e. Fifth Degree:
There is involvement of the deep fascia and muscles. This
may result to severe scarring effect and deformity.
f. Sixth Degree:
There is charring of the limb involving subjacent tissues,
organs and bone.
If death does not ensue immediately inflammatory changes may develop in the surrounding tissues.
Distinctions Between Burns and Scald:
Burns
Scalds
f. Clothings
burned.
are
not
usually
403
Healing of extensive
404
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405
406
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407
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intoxication
409
b. Internal Findings:
( 1 ) Blood is cherry-red in color owing to the presence of
carboxyhemoglobin.
( 2 ) Increase in the lymphoid tissue, especially of the intestine
and lymph glands.
( 3 ) Marked dehydration.
( 4 ) Hemoconcentration with increased capillary permeability.
( 5 ) Congestion of visceral organs.
( 6 ) Cloudy swelling of liver and kidneys.
(7) Enlargement
infarcts.
especially
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A number of persons may die from burns when fire breaks out
in an inhabited house, or when an explosion occurs in a factory.
The Revised Penal Code considers the killing of a person by
means of fire as murder. The setting of a building on fire must be
an intentional means to kill the person inside the building to make
it a murder (Art. 248). There should be the actual design to kill
and that the use of fire should be purposely adopted as a means
to that end (People v. Burns 41 Phil. 418).
ontaneous Combustibility:
It is claimed by some authorities that the human body can
ignite itself spontaneously and b u m itself to death. This is hardly
possible on account of the high percentage of water in the human
body. Spontaneous combustibility may be utilized as a defense
in cases of homicidal burns if it is really probable.
-eternatural Combustibility:
It is claimed that the human body is inflammable on account of
the presence of gases which easily ignite. The gases are said to be
the products of the action of microorganisms in the body. This
explains the presence of phosphorescent light in the graveyard
during night time. If ever the theory is true, then there can only
be a partial combustion of the human body.
Chemical Burns (Corrosive Burns):
Chemical burns are the action of strong acids and alkalies and
other irritant chemicals which cause extensive destruction of the
tissue. Healing is quite slow and may require plastic surgery. The
most common of the chemicals are concentrated sulfuric acid,
nitric acid, hydrochloric acid, caustic soda and potash, lysol, etc.
Chemical burns may be followed by keloid scars.
Characteristics of Lesions:
a. Absence of vesication.
b. Staining of the skin or clothing by the chemical.
c. Presence of the chemical substance.
d. Ulcerative patches of the skin.
e. Inflammatory redness of the skin surface.
f. Healing is quite delayed on account of the action of the chemicals to the underlying tissue.
Distinctions Between Thermal and Chemical Burns:
a. There is an absence of blister in case of chemical bums while
blister may be present in thermal burns.
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412
Severe
burning
and
staining
of
the
skin
of
b y muriatic acid.
Treatment:
a. Neutralization of the corrosive substances.
b. Protection of the eye from involvement.
c. Prevention of infection of the lesion.
d. Other supportive or symptomic treatments.
Burns from corrosive fluids are quite rare and are usually due to
accidents in chemical laboratories. Vitriol throwing is common in
England. Intentional spilling or throwing of corrosive fluid causes
physical injury and on account of the deforming scar it produces,
it becomes a serious physical injury. Corrosive burns are commonly observed in suicidal ingestion with spilling of the chemical
around the mouth and neck.
4. Electrical Bums:
There are three kinds of electrical burns, namely: contact
burns, spark burns, and flash burns. The characteristic feature of
all of them is that their depth is greater than the surface appear-
413
ance this would suggest that severe sloughing of the tissues may
occur later.
a. Contact Burn due to a close contact with an electrically live
object, and the degree will vary from small and superficial
lesion to charring of skin if contact is maintained.
b. Spark Burn due to a poor contact and the resistance of dry skin
and shows a pricked appearance with a central white zone
(parchment) and surrounding of hyperemia. This burn, which
may be essential to the proof of electrical contact, can be very
difficult to identify, and sections should be cut in an attempt
to establish their nature.
c. Flash Burn the appearance varies from the arborescent
pattern of lightning burns to the "crocodile skin" appearance
of high voltage flash
(From: Practical Forensic Medicine by
Camp and Purchase, p. 238-239)
5. Radiation Burns:
a. Burns from X-ray:
The burns from X-ray depends upon the degree of intensity
and period of exposure. Slight-exposure will produce reddening and inflammation of the skin which will pass away within
a short period of time leaving a bronze color on the skin.
Higher degree of over-exposure may produce blister, atrophy
of the superficial tissue and obliteration of the superficial blood
vessels. In very severe cases, there may be ulceration of the
tissue which may later lead to malignancy.
b. Ultraviolet Light Burns:
Overdose of ultraviolet light may lead to severe and persistent dermatitis. There is uncomfortable irritation of the skin
and may later develop into a blister.
Chapter XV
PHYSICAL INJURIES OR DEATH BY LIGHTNING
AND ELECTRICITY
DEATH OR PHYSICAL INJURY BY LIGHTNING:
slAghtning is an electrical charge in the atmosphere. Its place of
occurrence and intensity are unpredictable. The flash of lightning is
due to the passage from a thunder cloud to the earth of a direct
electric current of enormous potential, amounting to something
like 1,000 million volts and about 2,000 amperes. Along the path
of the current, a great portion of its energy is liberated, most of
which is converted into heat. The size of the tract is variable and
may produce branching flash along its course. Because of the enormous power of destruction, it is capable of producing injury to
the human body.
Elements of Lightning that Produce Injury:
1. Direct effect from the electrical charge:
The electrical charge of lightning may pass to the body producing electrocution. The human body especially its nerves, is a
good conductor of electric current.
2. Surface "flash" burns from the discharge:
Some of the electrical energy in a lightning is transformed to
heat energy. The superheated air may cause burning of the skin
of the victim. The flash burn may produce arborescent marking
but are by no means typical.
3. Mechanical effect:
The expansion of the air on account of the superheated atmosphere may bring about mechanical injury. It may result to laceration of the body surface, severe tearing of the clothings and
displacement of parts of the body.
4. Compression effect:
The compressed air pushed before the current with superheated atmosphere may produce a backward wave. This causes
the "sledge hammerblow" on the body of the victim, thereby
producing concussion, shock, or unconsciousness to the victim.
414
415
Unconsciousness.
Slow, deep and interrupted respiration.
Pulse is slow and weak.
Pupils are dilated and sensitive to light.
Relaxation of the entire muscular system.
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A victim of lightning
417
Post-mortem Findings:
1. External:
Marked tearing of the wearing apparel.
Burns of different degrees on the skin surface.
Wounds of almost any description.
Magnetization of metals in the wearing apparel.
Fusion of metals and glasses.
Singeing of the hair of the scalp and other parts of the body.
2. Internal:
Fracture of bones.
Hemorrhage due to the laceration or the rupture of organs.
Petechial hemorrhages of the lungs, pericardium, brain.
Rupture of the blood vessels and the internal organs.
Medico-Legal Aspect:
Investigation of death due to lightning is not by itself of any
medico-legal interest for it is an accidental death. No one can be
held responsible to the effect of a fortuitous event. However, its
investigation may be useful to eliminate the possibility that death is
due to the felonious act of another person.
DEATH OR PHYSICAL INJURIES F R O M ELECTRICITY:
The main cause of death in electricity is shock. Ordinary domestic
line is from 100 to 250 volts and it is sufficient to produce death.
The effect of 300 volts and above may be similar to lightning stroke.
Voltage is not only the factor causing the injury. As a matter of fact,
amperage or intensity of the electrical current is the principal factor.
The damage to the body by an electrical discharge depends upon
several factors which may increase or decrease the electrical conductivity of the body. The presence of moist skin, wet floor, barefoot and proximity of metals, increase the conductivity of the body
to electricity. Dryness of the skin, presence of rubber boots or
shoes, dryness of the floor and better insulation of the metallic
conductor increase the resistance. An increase in the conductivity
of the body will promote more injury.
Factors which Influence the Effect of Electrical Shock:
1. Personal idiosyncracy Individual personality, physical condition, and the existence of mental or bodily distress at the time,
influence the effect of a shock.
2. Disease A person suffering from cardiac disease is predisposed
to death from electrical shock.
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Electrical arborization.
Bums with metallization.
Intense vascular congestion of the dura mater.
Eyes congested and pupils dilated.
Trachea may be congested.
Lungs deeply engorged and edematous.
Congestion of visceral organs.
Treatment:
1. Remove the victim from live wire installations. Close the switch
and remove the victim and in which case, care must be exercised
by the rescuer.
2. Artificial respiraton which must continue for about an hour until
positive proof of death is present.
3. Treatment of shock or coma. As soon as spontaneous respiration
is established, raise the temperature of the patient by the application of hot water in bottles and blankets. Cerebral edema may
be treated by lumbar puncture. Stimulant may be given to improve the health.
Medico-Legal Aspect:
Death by electrocution is mostly accidental.
They are very
rarely, suicidal or homicidal.
Accidental electrocutions usually
occur in grounded laundry line, electric stoves and outlets.
Chapter XVI
DEATH OR PHYSICAL INJURIES DUE TO CHANGE
OF ATMOSPHERIC PRESSURE (BAROTRAUMA)
The normal atmospheric pressure at sea level is 760 millimeters
of mercury. A person is subjected to an increase of atmospheric
pressure as he goes deeper in a body of water and a decrease as he
ascends higher in the atmosphere.
I N C R E A S E O F A T M O S P H E R I C P R E S S U R E (Hyperbarism):
This condition is observed underwater by scuba divers, pearl
divers, salvage divers, treasure hunters, pleasure swimmers, etc..
Henry's law provides that "at constant temperature, the amount
of gas dissolved in a liquid is directly proportional to the pressure."
As the diver goes deeper into the body of water, the atmospheric
pressure he is subjected to increases. The atmospheric pressure is
doubled at 10 meters and this increases further as he goes deeper.
As a consequence of this, there is an increase in the amount of gas
dissolved in the blood and other body fluids.
Before a diver enters a body of water he breaths deeply to fill
up his lungs with an estimated volume of six liters. This air is gradually absorbed by the body fluid so that at a depth of six meters the
diver needs twice the volume of air normally required when on the
surface with an increase fourfolds at a depth of 33 meters.
The longer the diver remains under pressure and the deeper is
the descent, the greater is the degree of gas saturation of the tissue
and the greater the length of time required for subsequent decompression.
In the process, nitrogen, an inert gas which constitute approximately 80% of the air in the lungs is also dissolved in the body fluid
and this causes the so-called "nitrogen narcosis" (rupture or drunkenness of the deep). This condition is preceded by a feeling of euphoria.
The absorption of gas in the lungs will cause decrease pressure on
the pulmonary tissue as compared with that of the pulmonary
circulation and this difference in pressure will cause transfer of
fluid from the pulmonary capillaries into the alveolar space causing
pulmonary edema. A rapid descent may cause rupture of the blood
vessels and hemorrhage.
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423
becomes lower and more gas will be liberated by the body fluid.
The release of gases from the body fluid will cause:
a. "Bends" Joint and muscular pain due to the presence of air
bubbles.
b. "Chokes" Substernal distress, a non-productive coughing and
respiratory distress. This is the result of bubble formation in
the pulmonary capillaries or from the effects of extravascular
mediastinal bubbles exerting pressure on the mediastinal contents and adjacent pulmonary tissue.
c. Substernal emphysema Accumulation of bubbles underneath
the skin and is observed as a crepitation on palpation of the
skin.
d. Trapped gas may result in the doubling of the size of hollow
viscus, like the stomach and intestine at 18,000 feet level. The
size quadruples at 33,000 feet. Expansion of the size of the
stomach may cause diaphragmatic herniation.
Modern aircraft flying at high altitude have been pressurized to
remove the ill-effects of low atmospheric pressure.
2. Anoxia At higher
phere becomes lesser
8,000 to 15,000 feet
above sea level must
human demand.
altitude the oxygen content of the atmosand lesser. Hypoxia will be felt between
level. Aircraft flying beyond 34,000 feet
be provided with oxygen to maintain the
A I R C R A F T INJURIES A N D F A T A L I T I E S :
Causes of Injuries and Fatalities in Aircraft are:
1. During the Flight:
a. Altitude:
Hypobarism (Decompression).
b. Speed Passengers and crew may suffer from spatial disorientation and windblast.
The sudden change of direction at a speed of 500 miles
tends to drain blood from the brain to the lower parts of the
body resulting to a momentary black-out or unconsciousness.
c. Toxins Carbon dioxide, carbon monoxide, and other irrespirable gases may saturate the cabin compartment and cause
asphyxia.
d. Temperature At high altitude, the temperature falls and at
the height of 25,000 feet, it is 40 below zero.
Death may be due to frostbite or freezing of the body.
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Chapter XVII
DEATH BY ASPHYXIA
'Asphyxia is the general term applied to all forms of violent death
which results primarily from the interference with the process of
respiration or the condition in which the supply of oxygen to the
olood or to the tissues or both has been reduced below normal level.
Types of Asphyxial Death:
1. Anoxic Death:
This is associated with the failure of the arterial blood to
become normally saturated with oxygen. It may be due to:
a. Breathing in an atmosphere without or with insufficient oxygen,
as in high altitude.
b. Obstruction of the air passage due to pressure from outside, as
in traumatic crush asphyxia.
c. Paralysis of the respiratory center due to poisoning, injury or
anesthesia, etc.
d. Mechanical interference with the passage of air into or down
the respiratory tract due to:
( 1 ) Closure of the external respiratory orifice, like in smothering and overlaying.
( 2 ) Obstruction of the air passage, as in drowning, choking with
foreign body impact, etc.
( 3 ) Respiratory abnormalities, like pneumonia, asthma, emphysema and pulmonary edema.
e. Shutting of blood from the right side of the heart to the left
without passage through the lungs as in congenital anomalies
like potent foramen ovale.
2. Anemic Anoxic Death:
This is due to a decreased capacity of the blood to carry
oxygen. This condition may be due to:
a. Severe hemorrhage.
b. Poisoning, like carbon monoxide.
c. L o w hemoglobin level in the blood.
3. Stagnant Anoxic Death:
This is brought about by the failure of circulation. The failure
of circulation may be due to:
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DEATH BY ASPHYXIA
427
a. Heart failure.
b. Shock.
c. Arterial and venous obstruction, incident to embolism, vascular
spasm, varicose veins, or the use of tourniquet.
4. Histotoxic Anoxic Death:
This is due to the failure of the cellular oxidative process, although the oxygen is delivered to the tissues, it cannot be utilized
properly. Cyanide and alcohol are common agents responsible for
histotoxic anoxic death.
Phases of Asphyxial Death:
1. Dyspneic
Phase:
The symptoms are due to the lack of oxygen and the retention
of carbon dioxide in the body tissue. The breathing becomes
rapid and deep, the pulse rate increases, and there is a rise in the
blood pressure. The face, hands and fingernails become bluish,
especially in the case of infants.
2. Convulsive Phase:
This is due to the stimulation of the central nervous system by
carbon dioxide. The cyanosis becomes more pronounced and the
eyes become staring and the pupils are dilated. Examination of the
visceral organs shows small petechial hemorrhages, commonly
known as Tardieu Spots.
The TardieuSpots are caused by the
hemorrhage produced by the rupture of the capillaries on account of the increase of intra-capillary pressure. It usually appears
in places where the tissue is soft and the capillaries are not well
supported by the surroundings, as in visceral organs, skin, conjunctivae, and capsules of glands.
The victim may become unconscious during the convulsive
stage.
3. Apneic Phase:
The apnea is due to the paralysis of the respiratory center of
the brain. The breathing becomes shallow and gasping and the
rate becomes slower till death. The heart later fails.
Recovery at this stage is almost nil due to the permanent
damages inside the brain on account of prolonged cerebral anoxia.
Classifications of Asphyxia:
1. Hanging.
2. Strangulations:
a. Strangulation by ligature.
b. Manual strangulation or throttling.
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DEATH BY ASPHYXIA
429
Mechanism of Death:
There is a ligature around the neck with a knot or with a sliding
noose, and the other end is fastened to an elevated object like peg,
nail, window casing, door knob, tree, etc..
Upon suspension of the body, the weight causes the noose or band
to tighten, producing pressure at the region of the neck.
The pressure of the band will cause the air passage to constrict, the
larynx is pushed backwards and its opening is closed by the contact
of the anterior to the posterior laryngeal wall producing asphyxia.
The pressure of the ligature may also cause compression of the
superior laryngeal nerve, carotid arteries and jugular veins producing
cerebral anoxia.
The form of furrow that develops in the neck depends upon the
type of ligature, the number of loops around the neck and the point
of suspension.
Protrusion of the tongue depends upon how pressure is applied
around the neck. If above the larynx and in an upward direction,
the tongue will be pushed outward and will protrude from the mouth,
but if the pressure is below the larynx, the tongue is kept inside the
buccal cavity.
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Ligature in Hanging:
1. Materials used in Ligature:
The thinner the ligature and the tougher the material, the more
pronounced will be the mark on the skin of the neck. If the
material is soft and broad the ligature impression on the neck is
less marked.
If hanging is done with evident premeditation as in the case of
suicide, a special quality of material may be used. Rolled beddings, leather belts joined together, rope, electric wire and vines
are oftenly used. The rope is commonly used as a ligature because
it is easily available and strong.
2. Noose:
There may be no sliding noose at the end of the ligature. It
may be tightened after it has been encircled around the neck and
the pressure on the air passage, blood vessels and nerves of the
neck is established when the body is suspended. Metal buckle,
ring, or sliding noose may be attached to the end to make it slide.
3. Mode of Application of the Ligature:
The ligature may be placed around the neck with a single loop
or with two or more loops. This can be distinguished on the
nature of the ligature marks. In single loop, there is but one
ligature furrow, but if there are several loops, there will be several
ligature marks with an intervening redness between the furrows.
There is more tendency to have more pressure in single loop ligature
on account of the concentration of force at the weight as compared with two or more loops.
4. Position of the Knot:
The knot or joint is usually located on either side of the neck.
The head is flexed opposite the location of the knot. The level
of the ligature around the neck may differentiate hanging from
strangulation by ligature.
In hanging, the ligature is usually
found above the thyroid cartilage on account of the upward
pull of the constricting force, while in case of strangulation by
ligature, the loop is found below the thyroid cartilage. It is not
easy to retain the knot beneath the chin."
5. Course of the Ligature around the Neck:
The .usual appearance is that the groove or ligature mark is
deepest opposite the location of the knot. However, if the knot
is just underneath me chin, the groove at the back of the neck is
not deep on account of the firmer skin and muscular tissue. The
course of the ligature forms an inverted V-shape with the vertex as
the location of the knot.
DEATH BY ASPHYXIA
431
Symptoms:
1. Gradual loss of sensibilities.
2. Sensation of constriction of the neck.
3. Loss of consciousness and muscular power.
4. Numbness of the legs and clonic convulsion.
5. Sensation of ringing inside the ear.
6. Sensation of flash of light before the eyes.
7. Face becomes red, with eyes prominent and feeling of heat in the
head.
If the victim is timely rescued and revived after artificial respiration,
he will suffer the following symptoms:
1. Whistling sensation inside the ear.
2. Watering of the eyes.
3. Difficulty of breathing and swallowing.
4. Sensation of numbness of both legs.
All of the above symptoms may last for 12 days after the rescue.
Amount of tension in the ligature sufficient to occlude the vital
structures of the neck:
Jugular veins
Carotid artery
Trachea
Vertebral artery
LEGAL MEDICINE
432
occlude the carotid arteries, jugular veins and vagus nerve, then
unconsciousness develops immediately and death is accelerated.
2. Point of Application of the Ligature:
When the ligature is made below the larynx, death is almost
instantaneous, but when applied above the larynx, death may not
occur for three to five minutes. Hanging with the knot situated
on one side of the neck may delay death because the closure of
the cerebral vessels cannot be completely maintained. If the knot
is just below the jaw, maximum pressure is at the back of the
neck causing merely partial occlusion of the windpipe and blood
vessels of the neck, thereby delaying death.
3. Other Factors:
a. Physical condition of the subject.
b. The rate of consumption of oxygen in the blood and tissues.
The loss of sensibility is due to the pressure of the ligature on
the blood vessels causing disturbance in the cerebral circulation.
Ordinarily'respiratory movement may persist one to two minutes
and the heart action for 15 to 30 minutes so that artificial resDiration mav successfully revive the victim.
Treatment:
1. Induce the Natural Acts of Respiration:
a. Ligature must be loosened and the mouth must be wiped to
DEATH BY ASPHYXIA
433
External Appearance:
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DEATH BY ASPHYXIA
435
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LEGAL MEDICINE
DEATH BY ASPHYXIA
437
the ends after crossing at the back or front of the neck, or several
folds of the ligature may be around the neck tightly placed and the
ends are knotted, or a loop is thrown over the head and a stick
inserted beneath it and twisted till the noose is drawn tight.
If the ligature is made of a soft material and is applied smoothly
around the neck, no visible mark will be observed after death. Hard
rough ligature applied with force more than that required to kill may
produce extensive abrasion and contusion at the area of application.
Strangulation by ligature may be observed in infanticide using the
umbilical cord as the constricting material. This must be differentiated from accidental strangulation by- the umbilical cord during
child birth. In accidental strangulation during child birth, the umbilical cord is abnormally long and there is no disturbance in the
wharton's jelly.
Strangulation by ligature is commonly observed in rape cases, but
the presence of findings in the genitalia and other physical injuries
are the distinctive findings.
Distinctions in the Post-mortem Findings in the Neck between Death
by Hanging and Death by Strangulation with Ligature:
Hanging
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DEATH BY ASPHYXIA
439
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DEATH BY ASPHYXIA
441
ASPHYXIA BY SUFFOCATION
LEGAL MEDICINE
442
their head and go down to the face covering the nostrils and mouth
and consequently cause suffocation because of the inability of the
children to extricate themselves by tearing it.
CHOKING:
This is a form of suffocation brought about by the impaction of
foreign body in the respiratory passage.
The most common foreign bodies impacted are:
a. Vomitus, especially when the person is under the influence of
alcohol.
b. Regurgitation of food from the stomach, as coagulated milk in
children.
c. Bolus of food.
Cafe' coronary A restaurant patron apparently has a
sudden heart attack in the middle of his dinner and dies without
much untoward symptoms. Autopsy may reveal a large mass of
food lodged in his throat and the cause of death is in.fact
asphyxia by choking. This usually happens when the person has
a high blood alcohol level which apparently anesthetized his
gag reflex. It is an accidental rather than a natural death.
d. Detached membrane in diphtheria.
e. False set of teeth.
f. Blood in tonsillectomy operation.
g. Respiratory hemorrhage as in tuberculosis.
Most of suffocation by choking is accidental, although it may be
utilized in suicide or in homicide.
The post-mortem finding in suffocation by choking is the same as
other forms of asphyxia plus the presence of the foreign body in the
respiratory tract.
D. ASPHYXIA BY SUBMERSION OR DROWNING
This is a form of asphyxia wherein the nostrils and mouth has
been submerged in any watery, viscid or pultaceous fluid for a time
to prevent the free entrance of air into the air passage and lungs. It
is not necessary for the whole body to be submerged in fluid. It is
sufficient for the nostrils and mouth to be under the fluid. Children
may be drowned in an ornamental pool or "tilapia" pond, and an
epileptic or a drunk person may be found drowned in a shallow
creek.
Mechanism of Drowning:
When a person does not know how to swim and falls into a deep
body of water, his body will sink on account of the momentum of
DEATH BY ASPHYXIA
443
the fail and because the specific gravity of the human body is slightly
more than that of the water. Later, the body will be buoyed because
of the instinctive movement of the individual, coupled with the
presence of air underneath his clothings. While under water, the
breath is held but upon reaching the surface there i6 an attempt to
breathe. Air and water then gets into the mouth and nostrils. Then,
he will endeavor to raise his hand which will cause him to sink under
water. He then alternately appears and disappears on the surface and
everytime he attempts to breathe, water will get in. Because of the
entrance of the fluid, there will be violent coughing which will expel
the air in the lungs and creates an imperative desire to breathe,
during which more water is drawn in. The drawn-in water may go to
the lungs or to the stomach. The water fills the bronchioles forcing
the residual air to be in the lung surface and causing the lungs to
balloon and become soggy and edematous. Death usually occurs 2
to 5 minutes later.
Phases of Drowning:
1. "Respiration de surprise" occurring at the moment when the
mouth and nose are covered with fluid consisting of one deep
inspiration.
2. Phase of resistance which consists* of a short period of apnea due
to the irritation of the sensory laryngeal nerve endings by the cold
water.
3. Dyspneic phase with a forceful respiratory movement.
4. Another apneic phase.
5. Terminal respiration, after which the breathing stops permanently.
(Brouandel cited on Gradwohl's Legal Medicine by Camps, p.
277).
Causes of Death in Drowning:
1. Typical Drowning:
The primary cause of death in ordinary submersion in water is
asphyxia. The water interferes with the free exchange of air in the
air sacs.
2. Atypical Drowning:
In atypical drowning cases, the causes of death may be due to
the following:
a. Cardiac inhibition following submersion due to the stimulation
of the vagus nerve.
b. Laryngeal spasm due to submersion. The inhaled water may
cause spasm of the larynx.
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DEATH BY ASPHYXIA
445
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447
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(3) Blood chloride estimation obtained twelve or more
hours after death from drowning in fresh water are of
little diagnostic value on account of the diffusion of the
fluid on both chambers of the heart.
c. Stomach:
There are plenty of fluid and other foreign materials that are
also found in the case of drowning. The absence of water shows
that death is rapid or submersion is made after death. It is
impossible for water to get into the stomach if the body is
submerged after death.
d. Brain:
The brain is congested and the big blood vessels are engorged.
e. Blood:
Aside from the difference in the chloride contents, the blood
becomes dark on account of the absorption of all its available
oxygen. There is a reduction of its hemoglobin contents on
account of dilution. The red blood cells may be crenated.
f. Other Organs:
The liver is engorged with dark fluid blood. The spleen and
the kidneys are dark in color and congested. Water may be
present in the middle ear due to violent inspiration when the
mouth is full of water.
Findings Conclusive that the Person Died of Drowning:
1. The presence of materials or foreign bodies in the hands of the
victim. The clenching of the hands is a manifestation of cadaveric
spasm in the effort of the victim to save himself from drowning.
2. Increase in volume (emphysema aquosum) and edema of the lungs
(edema aquosum).
3. Presence of water and fluid in the stomach contents corresponding
to the medium where the body was recovered.
4. Presence of froth, foam or foreign bodies in the air passage found
in the medium where the victim was found.
5. Presence of water in the middle ear.
Floating of the Body in Drowning:
The body may not immediately be recovered after drowning
because it is under the water. The specific gravity of the human
body is slightly more than that of the water. Within 24 hours, on
account of the decomposition which causes the accumulation of gas
in the body, the body floats. The floating of the body is markedly
influenced by the weather, condition of the fluid medium where
DEATH BY ASPHYXIA
449
drowning took place, presence of wearing apparel, age, sex and body
built. The body when recovered, floats usually with flexed extremities. This is due to the dominance of the flexor muscles over the
extensors in the process of rigor mortis. The head is submerged
because it has a higher specific gravity than the rest of the body.
And because the head is now the most dependent portion of the
body, more blood accumulates in the face. This explains the dark
bloated condition of the face during the early stage of decomposition,
otherwise known as "fete de negri" or the bronze color of the head
and neck of a person who died in water during the process of decomposition.
Determinations
Accidental:
1. Suicidal
Whether
Drowning
is
Suicidal,
Homicidal
or
Drowning:
Drowning:
a. There are evidences of struggle like physical injuries and destruction of the clothings of the victim.
b. Articles belonging to the assailant may be found near the place
where the deceased was recovered.
c. Presence of a motive for the killing.
d. Presence of ligature on the hands or legs which could not
possibly be applied by the victim himself.
'
J
I
\
\
e. Presence of physical injuries which could not have been selfinflicted, like gunshot wound at the back, severe injuries in the
head, etc..
f. Testimony of witnesses.
3. Accidental Drowning:
a. Absence of mark of violence on the body surface.
b. Condition and situation of the victim immediately before death
which may make one inclined to believe that it is accidental.
c. Exclusion of suicidal or homicidal nature of the drowning.
d. Testimony of a witness or witnesses who saw the incident
happened.
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LEGAL MEDICINE
E.
COMPRESSION A S P H Y X I A , (TRAUMATIC
OR
CRUSH ASPHYXIA)
compressing
Burking:
This is a form of traumatic asphyxial death invented by Burke and
Hare for the purpose of murdering people to be sold to medical
schools for dissection. The murderer kneel or sit on the chest and
with his hands close the nostrils and mouth of the victim. By this
method, there will be no external marks to indicate how respiration
has been obstructed.
Internal examination may show signs of
asphyxia.
DEATH BY ASPHYXIA
451
Symptoms
None.
Tightness across the forehead, mild headache,
breathlessness on exertion.
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LEGAL MEDICINE
20-30
30-40
Carbon dioxide is the gas blown out of the lungs during respiration,
product of complete combustion of carbon containing compounds,
and the end result of fermentation and decomposition of organic
matters.
It is a colorless, heavy gas often mixed with carbon monoxide and
hydrogen sulfide and is often found in drainage pipes, deep wells,
sewage taftks and other places where decomposing organic matters
are present. Some refrigerants and dry ice is composed of carbon
dioxide.
A small amount of gas which is mixed with air (2%) is a potent
stimulant to increase rate and depths of breathing, however, stronger
DEATH BY ASPHYXIA
453
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LEGAL MEDICINE
10 ppm
20 ppm
100 ppm
200 400 ppm
2,000 ppm
DEATH BY ASPHYXIA
455
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LEGAL MEDICINE
It must not
DEATH BY ASPHYXIA
457
(Chlorovinyl-dichlorarsine):
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LEGAL MEDICINE
Chapter XVIII
DEATH OR PHYSICAL INJURIES DUE TO
AUTOMOTIVE CRASH OR ACCIDENT
AUTOMOTIVE CRASH:
Factors Responsible to an Automotive Crash:
1. Human Factor (Driver):
a. Mental Attitude reckless driving, showing of, inattention,
fatigue, inexperience.
b. Perceptive Defect Defective vision incapable of seeing an
impending crash or defective hearing, unable to perceive whistle
of train or automotive horn.
c. Delayed or Sluggish Reaction Time Reaction time is the
space of time the driver perceives an impending danger and the
actual application of the brake. A quick reaction time may
prevent the occurrence of a crash by sudden deceleration before
the impact occurs.
d. Disease The driver may develop an epileptic fit or suffer
from a heart attack while on the steering wheel.
e. Chemical Factor Alcohol is the most common. It blurs and
diminishes the field of vision, blunts the senses of hearing and
makes sluggish response to an impending danger.
Depressant drugs, like sedatives, tranquilizers, and narcotics
do prolong the reaction time, impairs the power of decision and
rational thinking.
Smoking marijuana may interfere with time and space perception, and attention to complicated task of driving.
A leak in the exhaust system of the vehicle may cause entry
of carbon monoxide into the passengers compartment, especially in the air-conditioned cars, and may cause unconsciousness
of the occupants including the driver due to poisoning.
Other drugs, especially psychotrophic, may cause delirium,
unconsciousness which may cause impairment of reaction to a
traffic situation.
2. Environmental Factor:
Bad or poorly maintained roads, poor visibility, atmosphere,
rain, blind intersection, parked vehicle obstructing the view, trees
too close to the road, absence of road signs, etc. have contributed
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scars at the wrist or stab wounds in the chest and abdomen. Prior
psychiatric evaluation may reveal pathological findings and suicidal
tendency.
Homicide by Motor Vehicle:
Death by motor vehicle is usually on account of negligence and
rarely intentional. The driver may be reckless, lack the necessary
skill, aggressive, under the influence of drugs as the proximate cause
of the crash.
The simulation of a crash may occur to conceal a prior homicide.
Victim of other means of violent death (stabbing, shooting, mauling)
may be placed on the road to simulate that he is a victim of "hit and
run".
The driver may be shot while driving and lost control of the
vehicle to crash with another vehicle or fixed objects.
A careful investigation and post-mortem examination will reveal
the manner of death.
PEDESTRLAN-VEHICLE COLLISION:
Death or Physical Injuries to Pedestrian:
Pedestrian's injury or death is usually the result of two impacts
both of which are capable of causing severe trauma.
1. Primary Impact:
This is the first violent contact between the pedestrian and the
motor vehicle. Usually, the front bumper hits the leg of the victim.
The severity of the injury depends on the position of the victim
when the impact occurred, speed of the moving vehicle, and the
amount of bodily support (clothings and other apparel the victim
was wearing).
The movement of the body after the primary impact depends
on the location of the impact. If the contact is below the center
of gravity, the tendency of the body is to move backwards to
hit the hood, windshield or even the top of the car. The average
height of the bumper is 40 to 60 cms. from the ground and
considering the pedestrian with shoes on, the most common site
of the impact is the upper portion* of the leg. However, if the
driver had effectively applied the brake before the impact occurred, the place of contact will be on a much lower level. This
is due to the downward dive of the front end of the vehicle
immediately following the application of the brake.
Fracture of the leg bones as a consequence of the primary
impact is called bumper fracture.
The leg carrying the body
weight has more tendency to be fractured. If the victim is stand-
465
ing and the body weight is supported by both legs, there is more
chance for the bones of both legs to be fractured. The end of the
fracture usually protrudes through the skin opposite the place
of contact of the leg with the bumper.
If the primary impact is above the center of gravity of the
pedestrian, the tendency of the body is to move away from the
vehicle and fall on the ground.
If the brake was applied during or immediately after the crash
the car slow down faster than the movement of the pedestrian
who continues moving forward and land on the road. If no
brake was applied during the accident and at high speed, the
pedestrian will pass over the top of the hood, windshield and
windshield frame.
2. Secondary Impact:
This is the subsequent impact of the pedestrian to .the ground
after the first impact. The injury sustained by the pedestrian
depends mostly on the force of the ground impact, nature of the
road and part of the body involved. It is the secondary impact
that accounts for the multiple abrasions and contusions on the
body of the pedestrian-victim.
3. Run Over Injuries:
Children who receive the primary impact above the center of
gravity may fall on the ground with the car wheel passing over
the body. The pedestrian may be run over by the moving vehicle
during the initial impact or thereafter. Crash fracture, skid or tire
marks, rupture of organs and internal hemorrhage may be seen at
autopsy. Usually, the victim dies of shock and death that in most
cases it is instantaneous, especially when there is a crashing injury
on the head.
4. Hit-and-run Injuries:
A fast moving vehicle may run over, hit or side-swipe a pedestrian
or collide with another vehicle or fixed object and get away from
the scene without regard to the unfortunate victim. This usually
happens when the driver is drunk or "high", at night time, in an
isolated road and with no eyewitnesses or someone who could
take note of the identity of the vehicle.
Tire thread marks, abrasion prints of parts of the vehicle in
contact with the victim and paint detached from the vehicle found
in the crime scene or body of the victim may be submitted for
laboratory analysis, for comparison with that one of the suspect
car.
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Victim:
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Chapter XIX
DEATH OR PHYSICAL INJURIES
DUE TO ATHLETIC SPORTS
In line with the physical fitness program, an appreciable number
of people are now involved in athletic sports of their own choice.
This incidentally increases the number of injuries and fatalities.
Although most injuries and fatalities are, as a rule, due to accident
or from natural cause, inquiries as to the adequacy of the medical
supervision, sufficiency of training of the contestants, utilization of
the safety measures and proper observation of the rules may be the
subject-matters of medico-legal investigation.
Some Aspects of Sport Development:
1. Training Method:
To develop weight-lifting,
a lifter must lift a very heavy
weight during his practice. To develop speed, a runner must run
very fast during his practice.
Besides, two or three intense workout each week, an athlete
also needs one endurance workout.
2. Injuries:
If the athlete is injured, he is rehabilitated by not allowing him
to participate in the sport that caused the injury and by finding
another sport that does not cause pain.
Every time the muscles are exercised intensely, injuries occur
and it will take at least 48 hours for the muscles to heal.
Future recurrence is being prevented by correcting the cause
of the injury.
Although, continuous exercise despite the pain
will result in further injury, neither is it necessary to stop exercising altogether. For in every week without exercise, it may
take several weeks of training to regain prior condition.
3. Nutrition:
Muscle endurance depends on how much glycogen can be
stored in the muscle cells. The glycogen storing capacity can be
increased by exercising the muscles until most of the glycogen is
depleted. Depletion, in the average top runner, occurs at 1-1/2
to 2 hours while on a bicycle racer it is 3 to 5 hours.
Competitive athletes need to eat large amount of carbohydraterich foods to help them store glycose as liver and muscle elvrnwn
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A
Rotational
Acceleration
Linear
Acceleration
C
Injury to Carotid
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Rotation
(angular) Acceleration:
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(2) Linear (Translational Acceleration):
A straight blow on the face may cause focal ischemic
lesions, notably in the cerebellum.
Vascular spasm associated with focal ischemia are known to occur after
subarachnoid hemorrhage and often manifest themselves
a few days after bleeding. In groggy boxers, sudden linear
acceleration also may produce hyperextension of the neck,
which is known to damage axons of the medullary-pontine
angle and the reticular substance, resulting to a knockout.
( 3 ) Injury to the Carotid:
Blows to the neck can damage the carotid. Dissecting
aneurysm or occlusion by thrombus may follow. Pressure
on the carotid sinus induces reflex mechanism that causes
hypotension and bradycardia associated with decrease
bloodflow to the brain. A loss of muscle tone and brief
fainting spell will contribute to a boxer's groggyness, and
increases his susceptibility to head acceleration by successive
blows.
( 4 ) Impact Deceleration:
After a knockout, the boxer hits the rope or mat. Fall on
the back produces rapid deceleration which typically results
in contre-coup contusions of the orbital surface of the
frontal lobes and the tips of the temporal lobes. The crest
of the convolutions are torn apart, which is associated with
parenchymal and sub-arachnoidal hemorrhage.
Furthermore, the inert brain will glide within the cranial cavity,
causing para-saggital gliding contusion (small hemorrhage in
the cortical and subcortical white matter as well as subdural hematomas).
Cerebral Edema, Ischemia and Herneation:
Severe trauma on the head is usually followed by cerebral
edema.
It increases pressure on the swollen brain within a
confined space of the cranial cavity which affects the blood
flow.
The vessels are squeezed resulting in ischemia which
further contributes to edema.
The mounting pressure intracranially causes the brain to
herneate over the edge of the tentorium and through the
foramen magnum. Hemorrhagic necrosis of the brain at the
point of herniation (inferior temporal lobes and cerebellar
tonsils) develops rapidly.
Death results from ischemia and
hemorrhage in the midbrain and upper pons after such herniation.
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iv. Astrocytes appear swollen and nerve cells show
chromatolysis and cytoplasm vacuolated.
( 2 ) In case of death after a chronic sequelae:
(a) Abnormality in the septum pellucidum.
( b ) Cerebellar and other scarring.
(c) Small areas of scarring in the cerebellar tonsil and
medulla oblongata.
(d) Reduction of the brain weight.
(e) Lateral ventricle widely dilated with thinning of the
corpus callosum.
(f) Loss of pigmented nerve cells in the substantia nigra.
477
Chapter XX
CHILD ABUSE OR NEGLECTED CHILD
(Battered child, Battered child syndrome, Maltreatment syndrome,,
Maltreated child, Physically abused child, ni-treated syndrome.)
It is the physical and mental injury or maltreatment of a child by
a person who is responsbile for the child's welfare, under circumstances which will indicate that the child's health or welfare is
harmed or threatened thereby. The infliction must be willful and
not accidental.
The victim is of tender age, usually less than 3 years old. It occurs
in all levels of the economic strata. Usually, only one child is involved. Parents are frequently immature, self-centered, impulsive
and with poorly controlled aggression.
Duties of Parents:
Art. 46, The Child and Youth Welfare Code General Duties:
Parents shall have the following general duties toward their children:
(1) To give him affection, companionship and understanding;
( 2 ) To extend to him the benefits of moral guidance, self-discipline
and religious instruction;
(3) To supervise his activities, including his recreation;
(4) To inculcate in him the value of industry, thrift and selfreliance;
(5) To stimulate his interest in civic affairs, teach him the duties
of citizenship, and develop his commitment to his country;
( 6 ) To advise him properly on any matter affecting his development and well-being;
(7) To always set a good example;
(8) To provide him with adequate support, as defined in Article
290 of the civil Code:
Support is everything that is indispensible for sustenance,
dwelling, clothing and medical attendance, according to the
social position of the family.
Support also includes the education of the person entitled
to be supported until he completes his education or training
for some profession, trade or vocation, even beyond the age
of majority. (Art. 290, Civil Code).
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When the death of the minor shall result from such
abandonment, the culprit shall be punished by prision
correccional in its medium and maximum periods; but if
the life of the minor shall have been in danger only, the
penalty shall be prision correccional in its minimum and
medium periods.
The provisions contained in the preceding paragraphs
shall not prevent the imposition of the penalty provided
for the act committed, when the same shall constitute
a more serious offense.
( 2 ) Art. 277, Revised Penal Code Abandonment of minor by
person entrusted with his custody; indifference of parents:
The penalty of arresto mayor and a fine not exceeding
500 pesos shall be imposed upon anyone who, having
charged with the rearing or education of a minor, shall
deliver the said minor to a public institution or other
persons, without the consent of the one who entrusted
such child to his care or in the absence of the latter, without the consent of the proper authorities.
The same penalty shall be imposed upon the parents
who shall neglect their children by not giving them the
education which their station in life requires and their
financial condition permits.
Chapter XXI
MEDICO-LEGAL ASPECTS
OF
SEX CRIMES
VIRGINITY A N D DEFLORATION
A. VIRGINITY
Virginity is a condition of a female who has not experienced
sexual intercourse and whose genital organs have not been altered
by carnal connection.
A woman is a "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 (Thomas v. State, 19 Ga. App. 104, 91 S.E. 247,
250).
The presumption of a woman's virginity arises whenever it is
shown that she is single and continuous until overthrown by proof
to be contrary (U.S. V. Alvarez, 1 Phil. 242). A woman is presumed
to be a virgin when unmarried and of good reputation.
A defendant has the previous sexual intercourses with the
victim before he was charged'with consented abduction for acts
committed thereafter. The woman was considered "virgin" within
the meaning of the law (U.S. v. Casten, 34 Phil. 808). However, in
another case, it was established that the defendant's character,
before the alleged seduction, was opened to question. The woman
considered no longer a virgin (U.S. v. Suan, 27 Phil. 12).
of Virginity:
1. Moral Virginity The state of not knowing the nature of sexual
life and not having experienced sexual relation. Moral virginity
applies to children below the age of puberty and whose sex
organs and secondary sex characters are not yet developed.
2. Physical Virginity A condition whereby a woman is conscious
of the nature of the sexual life but has not experienced sexual
intercourse. The term applies to women who have reached sexual
maturity but have not experienced sexual intercourse.
There are no conclusive medical findings to show that a woman
is physically virgin. Reliance is given to the absence of laceration
of the hymen, but a woman might have had previous sexual
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intercourse and yet the hymen was unruptured while others might
not have the experienced of sexual relations but have laceration
of the hymen.
If the findings show absence of laceration of the hymen, distinction should be drawn between true and false physical virginity.
a. True Physical Virginity A condition wherein the hymen is
intact with the edges distinct and regular and the opening small
to barely admit the tip of the smallest finger of the examiner
e. n if the thighs are separated.
b. False Physical Virginity A condition wherein the hymen is
unruptured but the orifice is wide and elastic to admit two or
more fingers of the examiner with a lesser degree of resistance.
The hymen may be laxed and distensible and may have previous
sexual relation. In this particular instance the physician may
not be able to make a convincing conclusion that the subject
is virgin.
3. Demi-Virginity This term refers to a condition of a woman who
permits any form of sexual liberties as long as they abstain from
rupturing the hymen by sexual act. The woman may be embraced,
kissed, may allow her breasts to be fondled, her private organ to
be held and other lascivious acts. The woman allows sexual
intercourse but only "inter-femora" or even "inter-labia" but not to
the extent of rupturing the hymen.
4. "Virgo Intacta" Literally the term refers to a truly virgin
woman; that there are no structural changes in her organ to infer
previous sexual intercourse and that she is a virtuous woman. Inasmuch as there are no conclusive evidences to prove the existence
of such condition, liberal authorities extend the connotation of
the term to include women who have had previous sexual act or
even habitually but had not given birth.
Parts of the female body to be considered in the determination of
the condition of virginity:
1. Breasts The breasts (mammary glands) are functionally related
to the reproductive system since they secrete milk for nourishment of the young child. At their inner structures are 15 to 20
lobes of glandular tissues supported by conr>active tissue namework with variable amount of adipose tissue.
On the ventral surface of each breast is a cylindrical projection
called nipple and at its rounded tip are perforations which are the
openings of the ducts draining the milk glands. The nipple is
surrounded by a pigmented area called areola which becomes dark
brown during pregnancy.
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488
minora and the clitoris. The labia minora is soft, pinkish in close
contact with one another, and its vestibule is narrow. Entry of the
male organ may cause the labia to gape due to stretching of their
borders.
The condition of both labia is not a reliable basis in determining
virginity. A woman may be a virgin but with a gaping labia, while
others might have had previous delivery but the labia are still
coaptated. The condition of the labia is much more related to the
general physical condition of the woman rather than the absence
or the presence of previous sexual intercourse. A stout woman
usually can preserve the plump, coaptated and firm labia while
skinny women usually have gaping labia.
4.
Fourchette:
The fourchette present a V-shape appearance as the two labia
minora unite posteriorly. After severe distention, the sharpness
of the acute angle may become rounded with retraction of the
edges.
The rounding of the fourchette and the retraction of the edges
can be a consequence of so many causes. Stretching apart of the
thighs, instrumentation, horse or bicycle riding may produce the
condition other than sexual intercourse.
5. Hymen:
Physicians give much attention in the examination of the
hymen in the determination of virginity.
Classification
of Hymen:
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490
Thin hymen
491
Fourchette:
The normal V-shape of the fourchette is lost on account of the
previous stretching during insertion of the male organ. Withdrawal of the stretching force will cause retraction of its walls
with rounding of the base.
Retraction of the fourchette is not a good sign of defloration
inasmuch as it can be due to other causes. Ballet dancing, separation of the thighs, tree climbing, cycling, horse riding, insertion
of foreign body, etc. may cause retraction of the fourchette
without previous sexual act.
The fourchette, together with the perineum and lower portion
of the posterior vaginal wall, may be lacerated by sexual act or
some other causes.
3. Vaginal canal:
After repeated sexual acts, there is diminution of the sharpness
or obliteration of the vaginal rugosities. There will be laxity of
its wall so that insertion of a medium size tube during the medical
examination can be done with slight resistance.
The changes in the vaginal rugosities or the laxity of its wall
cannot be relied upon as a proof of defloration because instrumentation during medical examination, masturbation or insertion
of foreign bodies or other similar or related acts will cause the
development of such condition.
The vaginal wall, together with the vulva, may suffer injury
during defloration or some other causes.
Predisposing causes of vulvo-vaginal injuries during sexual act:
a. Virginity Sex organ does not have previous experience to
stretching or coital act.
b. Prepuberty The genital organ is not yet fully developed to
subject it to full physiological function.
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sides may be termed 9:00 (left side) and 3:00 (right side)
positions.
(3) Duration of the laceration:
The determination as to how long the laceration took
place can be approximated by the changes observed in the
lacerated tissue.
(a) Fresh bleeding laceration The laceration is of recent
origin.
( b ) Fresh healing with fibrin formation and with edema of
the surrounding tissue Usually after 24 hours.
(c) Healed laceration with congested edges and with sharp
coaptible borders Depending upon the degree of
laceration and the presence or the absence of complications, the said laceration could have occurred
4 to 10 days. Sometimes, the said finding is termed
"recently healed" laceration.
( d ) Healed laceration with sharp coaptible borders without
congestion Some times have passed by after the laceration has healed. Ordinarily it can be inferred that
hymenal laceration took place approximately more than
ten days or 2 to 3 weeks.
( e ) Healed laceration with rounded non-coaptible borders
and retraction of the edges Laceration took place long
before the date of the examination which is probably
more than a month's time.
( 4 ) Complications of laceration:
A vast majority of laceration of the hymen healed uneventfully, although in rare instances complications set in.
The following are the possible complications:
( a ) Secondary infection There may be activation of the
bacterial flora in the vaginal canal or a superimposed
infection may set in, especially among women with
poor hygienic habit. Gonorrheal infection is not uncommon when the offender is suffering from the disease
at the time of the sexual act.
( b ) Hemorrhage This is a rare complication but this may
be present in severe compound laceration of the hymen.
Surgical intervention may' be necessary to control the
bleeding. Blood analysis to determine the presence of
blood disease may be indicated when there is disproportion between the injury and the amount of hemorrhage. Blood transfusion may be required when the
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496
2. Systemic Effects:
a. An increase in the pulse rate;
b. Marked increased in blood pressure making its peak during
orgasm;
c. An increase of peripheral flow of blood experienced as an
increase of body warmth;
d. Tomescence (engorgement of blood), which is the consequence
of this peripheral flow concentrating on erectile tissue;
e. Increased respiration;
f. A decrease in bleeding during arousal, which is reversed
subsequently;
g. A decrease in sensory perception;
(1) There is blunting of the sense of touch.
( 2 ) Pain may be largely lost; sensation which could be
sharply painful may only be experienced as no more
than a mild touch stimulation.
( 3 ) Alertness of hearing and vision is clearly decreased.
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.
Seminal emission is carried on by the peristaltic action of the
vas deferens, seminal vesicle and prostate.
Ejaculation results from the contraction of the pelvic floor
muscle and the bulbospongiosus and ischiocavernosus muscles.
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.
The physiological changes are similar in both male and female.
The difference is only in the speed of response. In the male,
sexual arousal is psychological followed by physical, while in the
female it is primarily physical.
DEATH RELATED TO SEXUAL ACT
1. Death of the Male Partner:
a. Death from natural cause:
During sexual intercourse, the male as an active subject
develops increase blood pressure, tachycardia and hyperventilation due to emotional response and muscular exertion.
If he is suffering from cardio-vascular disease or insufficiency
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SEX CRIMES
499
Its
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SEX CRIMES
that the hymen be ruptured
Black, 4th ed., p. 268).
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When a woman has been forcibly made to lie down, she will utilize
her elbow as the fulcrum so that abrasions will be observed on both
elbows. In the attempt of the victim to stand, she will flex her neck
forward. The offender will then push her head backwards, causing
hematoma at the region of the occiput. To prevent penetration of
the male organ she will try to flex her thighs and knees. The offender
will give a strong blow to the inner aspects of both thighs so that the
victim will be compelled to straightened them.
The victim may suffer all types of physical injuries depending
upon the resistance offered by her and the degree of force applied
by the offender.
Rape Committed by Employment of Intimidation:
The application of threat will cause fear in the victim of the
untoward consequence.
If she will not accede to the will of the
offender, the crime may constitute intimidation.
Inasmuch as intimidation is purely subjective it cannot be proven
by medical evidence.
Rape Committed by Depriving the Victim of Her Reason or Otherwise Made Unconscious:
1. Deprival of Reason:
a. Rape committed on insane or mentally deficient woman:
The fact that the victim is a woman, 14 years of age, feebleminded and can only speak mono-syllables is sufficient to
constitute the act committed to be rape (People v. Doing, C.A.
49 O.G. 2331).
Sexual intercourse with an insane woman is considered rape
(People v. Layson, C.A. 37 O.G. 318).
But, sexual intercourse with a deaf-mute woman is not rape,
in the absence of proof that she is an imbecile (People v. Nava,
C.A. 40 O.G. 4237).
The proof of the mental condition of the victim is the
medical findings of the physician who must certify whether the
woman-victim of rape is suffering from insanity or mental
deficiency which is sufficient to deprive her of her reason.
b. Rape committed while the woman is under the influence of
alcohol or other depressant drugs:
Inasmuch as the woman is not in possession of her rational
mental faculties, in the absence of a decided case, this may also
be rape.
c. Sexual act on a woman under the influence of sex stimulating
drugs:
SEX CRIMES
503
In the case of U.S. v. Lung (28 p. 235, 37 A.M. St. Rep. 505),
cited by Reyes, where the consent of the woman was induced
by the administration of drugs which incited her passion and
the drug dose did not deprive her of her reason, the accused
was not guilty of rape. But if this case should happen in the
Philippines and would be decided by our local court, I think it
would be a rape case because the stimulating drug actually
deprived her of her reason.
2. The woman-victim is unconscious:
a. Sexual act committed while the woman is on her natural sleep:
The woman while asleep felt the weight of a man in carnal
relation with her. Believing that he was her husband, she called
him by his name but received no answer. She again called him
and found out that the voice was different from that of her
husband. She then pushed him and then ran after him. The
offended party was a deep sleeper in the first hour of the night
and it was not impossible for the accused to insert his organ
into her genitalia before she awoke. The crime of rape was
committed (People v. Gorcino, 53 Phil. 234).
b. Sexual act on a woman suffering from sleeping sickness is also
rape because the woman is unconscious.
c. Sexual act on a woman who is unconscious because she was
knocked-out:.
If the offender inflicted physical injuries on a woman sufficient to make her unconscious before the sexual act was done,
it is rape.
On seeing a lavishing figure of a woman taking a bath, the
accused hit her and after she became unconscious, he had sexual
intercourse with her. The accused was found guilty of rape
(People v. Sanico, C.A. 46 O.G. 98).
d. Sexual act after administration of narcotics or other "knockout" drugs:
The sexual act made on a woman while she is under the influence of narcotics or other depressant drugs is rape because
the woman is unconscious.
3. When the woman is under 12 years of age:
If the carnal relation is made on a female below 12 years of
age, it is always rape regardless of whether or not force or intimidation is applied or the child is.not deprived of her reasons or
otherwise unconscious. Rape of a woman below 12 years old is
also called statutory rape. The sexual act is still rape even if the
child consented or even if the child is a prostitute.
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The reason for penalizing carnal relation is that one must not
take advantage of the meager intelligence and incomplete physical
development of a child below the age of 12.
When the offended party is a girl less than 12 years old, rape is
committed although she consented to the sexual act (People v.
Villamora C.A. 37 O.G. 497). It is also rape even if the girl less
than 12 years of age is a prostitute (People v. Perez, C.A. O.G.
6337).
SEX CRIMES
SOS
there was any resistance on her part or that the defendant had
used force, violence and intimidation, the defendant was acquitted
(U.S. v. DeDios, 8 Phil. 279).
The defendant attempted to commit the crime of rape in an
open field on a woman whom he has courted for 2 years and in
the presence of other persons. The offended party allowed the
defendant to visit her after the attack. The defendant was acquitted (U.S. v. Estacio, 18 Phil. 432).
A complaint in the prosecution of rape is not valid unless it is a
complaint of the offended party. The complaint signed and sworn
to by the chief of police is not valid in the prosecution for rape
(People v. Manaba, 58 Phil. 665). An information not signed by
the offended party is insufficient to confer jurisdiction on the
court to hear and determine a charge of attempted rape (People
v. Trinidad, 59 Phil. 163). The filing of the complaint by the
father of the offended party who is a girl only fourteen years of
age which alleges the commission of the offense is a sufficient
compliance of the Revised Penal Code to confer jurisdiction for
trial of the offense charged (People v. Imas, 65 Phil. 419).
i
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SEX CRIMES
507
The victim may appear exhausted, despondent on account of the public humiliation she will suffer, or may be
hostile to the investigator. Care and more psychologic approach
is necessary in order to get her full cooperation and consent.
f. Examination of the body for signs of violence:
If actual force was applied in the commission of the crime,
there must be signs of physical violence on the body of the
victim.
Her whole body must be subjected to inspection.
Physical injuries must be described and the exact location must
be determined. Areas of tenderness or swelling must not be
overlooked and if necessary X-ray pictures must be taken to
determine bone lesions.
Determination of the probable age of the physical injuries
found is material. Does it correspond to the alleged date of
commission? .
g. Examination of the genitalia, including the breast:
The breasts must be examined for the presence of finger
marks or application of pressure. They might have been roughly handled or the nipples bitten.
The vulva may show swelling, tenderness, contusion, abrasion,
laceration or may be smeared with blood, semen and other
foreign bodies.
The hymen may show fresh laceration, swelling or bruising.
There may be healed lacerations or signs of physical virginity.
In the pubic hair, the following medical evidence may be
gathered:
( 1 ) Pubic hair of the offender.
(2) Semen and spermatozoa.
( 3 ) Blood stains.
( 4 ) Body louse.
Abrasion which is normally found in the posterior commissure is usually brought about by friction or a violent attempt of
insertion.
The vaginal canal may show obliteration of the
rugosities or even purulent discharge.
2. Examination of the alleged offender:
a. Physical development, mental condition and strength:
The relative physical development and strength of the victim
and the offender must be compared to determine whether the
offender can overpower the resistance offered by the victim.
b. Evidence of physical injuries:
The whole body must be examined. The victim, in the
course of the struggle, may inflict bodily harm to the offender.
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SEX CRIMES
509
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510
1.65 gms.
2.54 gms.
30.00 cc.
SEX CRIMES
511
of saline and put into a micro tube and to the extract is added a
few drops of Puramen's reagent (5% solution of 2.4 dinitro
l-naphthol-7-sulfonic acid, flavianic acid). The tube is then
placed in a refrigerator for a few hours. In a positive reaction, a
yellow precipitate of spermine flavianate can be seen at the
bottom of the tube.
When examined microscopically, the
precipitate is found to consist of small cross-like crystals of a
characteristic shape. Puramen reaction is found to be very
reliable and rather characteristic of seminal fluid
(Modern
Criminal Investigation by Soderman, p. 250).
d. 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. The method
of estimating the activity of a stain on clothings or other
materials is to extract with distilled water and perform the acid
phosphatase determination on the filtered extract.
The following solutions are necessary in the performance of
the test:
(1) Citrate buffer solution pH 4.9 to 5.2:
Citric acid monohydrate 18.9 g. dissolve in 500 ml. distilled
water.
Sodium hydroxide 1 N 180 ml.
Hydrochloric acid 0.1 100 ml.
The pH adjusted sodium hydroxide and hydrochloric
acid to 4.9 to 5.2. A liter is prepared and stored in a
refrigerator. The solution is stable for six months.
(2) A suitable substrate:
A saturated solution of sodium alpha-naphthanil phosphate.
(3) A diazonium salt (Naphthanil Diazo Blue B)
Reaction: If acid phosphatase is present, the substrate is
hydrolized to produce alpha-naphthol, which is coupled with
a diazonium salt to produce a highly colored dye. In the
absence of the enzyme, the reaction does not appear.
Procedure:
There are three glass slides placed side by side on top of a
white paper.
Slide one (1) is the negative control with filter paper.
Slide two ( 2 ) is the positive control with filtered paper
impregnated with seminal stain.
Slide three (3) is with the suspected material.
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512
Examinations:
a. A dried spermatic fluid stain on the slide is stained with hematoxylin or methylene blue and counter-stained with eosin.
Examined under the microscope, under high power and under
oil immersion, spermatozoa and bacterial infection can be
seen. The presence of a complete spermatozoon will undoubtedly infer the presence of seminal fluid, although semen may be
present without spermatozoa, such as in cases of aspermia
(semen without spermatozoa) or oligospermia (semen with few
spermatozoa).
b. Dr. Hankin's Method:
The fabric with seminal stain is boiled with tannin solution
before dissolving in a solution of potassium cyanide so as to
render the spermatozoa capable of removal. The fabric is then
placed on a slide, teased with carbol-fuchsin. This is examined
with a medium power lens.
c. GangulCs Method:
The same procedure as that of Dr. Hankin but the staining
is with erythrocin and malachite green. This is claimed to be
the best way to stain spermatozoa in India.
4. Biological
Examinations:
SEX CRIMES
513
b. Seminal Grouping:
Specific agglutinable substances A and B are present in the
semen, like that of the blood. Seminal grouping is similar to
that of the blood. The test is of value for elimination. A
positive result does not definitely imply that the person is the
owner of the semen in question. A negative result will totally
exclude the alleged accuse as the possible owner of the semen.
The mere presence of speunatozoa on the stain shows the
presence of spermatic fluid, but the absence of spermatozoa does
not prove that the stain is not seminal. The semen may be present
without spermatozoa.
The presence of one complete, unbroken spermatozoon is sufficient to make the conclusion that the stain or fluid is seminal.
It is quite necessary also to examine for infectious disease in
connection with the laboratory examination for semen and
spermatozoa.
How long after sexual intercourse can spermatozoa be found in the
vaginal canal?
Authorities differ in their opinions in this respect:
1. ". . . but, there is every reason to believe that the life of the
effective sperm in the maternal passage is very short, probably
less than thirty hours" (Taylor's Principles and Practice of Medical Jurisprudence by K. Simpson, 12th ed.. Vol 2, p. 32).
2. "There has been a great number of observations this latter point,
and the evidence points to a comparatively short life of the sperm
in the female tract and the period appears shorter with the number
of observations. It is a present belief that the life of the sperm in
the vagina is a matter of hours and its total life in the female tract
is a matter of two or three days at most" (Forensic Medicine by
S. Smith, 10th ed., p. 311).
3. ". . . that spermatozoa may survive less than two hours in the
vagina, but tfiey live as long as forty-three hours both in the cervix
and uterus where the secretion are more favorable" (Medical
Jurisprudence & Toxicology by J. Glaister, 12th ed., p. 325).
4. "Spermatozoa may remain motile in the vagina up to 17 days"
(A Synopsis of Forensic Medicine & Toxicology by C. Thomas,
2nd ed., p. 97).
5. "Fertilization of the ovum does not necessarily occur immediately
after coitus, as it is known that spermatozoa can remain alive in
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the upper recesses of the vagina for more than two weeks" (Coy\
p. 246).
6. "Some observers have reported finding spermatozoa in the vagina
after seven hours while others have reported finding them as long
as 48 hours after intercourse" (Homicide Investigation by L.
Snyder, 1st ed., p. 327).
Can a woman be raped while she is on her natural sleep?
Occasionally, it may happen, but highly improbable. To a normal
virgin it is hard to conceive that such act could ever be committed
without her knowledge, inasmuch as she has never experienced it.
But, such act may be possible to a woman who has had several
sexual intercourses and to those who have given birth.
Can a woman commit the crime of rape on a man?
In the definition of the crime of rape, it is "committed by having
carnal knowledge of a woman." The law specifically states that it
can only be committed on a woirian and not on a man (inclusio
unius et exclusion alterios). She committed acts of lasciviousness.
Can rape cause death?
Although it may not be usual, the introduction of a matured male
sex organ into the vagina of a young girl may produce local injury
sufficient to produce death. The death may be due to hemorrhage
brought about by the laceration of the vaginal canal, shock, subsequent infection such as gangrene or peritonitis.
Laceration of the vagina with accompanying hemorrhage can also
occur even in adult women if the man's sex organ is exceptionally
big, especially when the sexual act was done roughly.
Can the husband commits the crime of rape on his wife?
The husband cannot be guilty of rape committed on his wife.
Marriage is a license of the husband to have sexual intercourse with
his wife. The purpose of marriage is procreation and there can be
no procreation if there is no sexual intercourse.
However, if there is a decree of legal separation by the court, the
husband may be guilty of rape on his wife. Legal separation does
not dissolve the matrimonial tie between the husband and wife, but
merely separation in bed.
The husband may be guilty also of rape on his wife if he is a
principal by cooperation or by inducement for the act committed
by another man.
SEX CRIMES
SIS
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imposed is one degree higher than that of ordinary qualified
seduction.
The reason for the reduction of the requirements and the
imposition of a higher penalty is that the father or ascendant
and the brother are obliged to lead the descendant or sister to
the path of rectitude and morality, but instead virtually persuaded her to become immoral or be a party to the condemnable act.
Elements of ordinary qualified seduction:
a. The offended party must be a virgin;
b. The offended party must be over twelve but under eighteen
years of age;
c. There must be sexual intercourse between the offender and
the offended party; and
d. The sexual act was done through abuse of authority or
confidence.
( 1 ) Those who acted with abuse of authority:
(a) Person in public authority
( b ) Guardian
( c ) Teacher
( d ) Person who in any capacity is entrusted with the
education or custody of the woman seduced.
( 2 ) Those who seduced through abuse of confidence:
( a ) Priest
( b ) House-servant
( c ) Domestics
Elements of incestuous qualified seduction:
a. Sexual act between the offender and offended party; and
b. Blood relation between the offender and offended party.
(1) Brother who seduces his sister, or
(2) Ascendant who seduces his descendant.
A public school teacher who is in charge of education
had sexual intercourse with a student, is guilty of qualified
seduction (People v. Cariaso, 50 Phil. 884). The accused
need not be the teacher of the woman seduced. Suffice
it is if the accused is a teacher in the same school who has
moral influence over the student (Santos u. People, 40
O.G. supp. 6, 23).
The offended party went to the catholic church to
confess. The accused priest embraced and kissed her and
in spite of her resistance she was brought to the store-
SEX CRIMES
517
E S E D U C T I O N :
Art, 338, Revised Penal Code Simple seduction The seduction of a woman who is single or a widow of good reputation, over
twelve but under eighteen years of age, committed by means of
deceit, shall be punished by arresto mayor.
Elements of the Crime:
1. The offended party is over twelve but less than eighteen years
of age;
2. The offended party must be single or a widow of good reputation;
3. There must be sexual intercourse done by the offender with
her; and
4. The sexual act was committed by means of deceit.
The statute making simple seduction a crime is not to punish
illicit intercourse, but to punish the seducer who by means of his
promise of marriage, destroyed the chastity of an unmarried
female of previous chaste character, and who thus draws her aside
from the path of virtue and rectitude, and then fails or refuses
to fulfill his promise, a character so despicable in the eye of every
decent honorable man (People v. Iman, 62 Phil. 92).
Deceit is a fraudulent and cheating misrepresentation, artifice,
or device, used by one or more persons to deceive and trick
another, who is ignorant of the true facts, to the prejudice and
damage of the party imposed upon (French v. Vining, 102 Mass.
132, 3 Am Rep. 440). Deceit may be:
a. Suggestion, as a fact, of that which is not true, by one who
does not believe it to be true;
b. The assertion, as a fact, of that which is not true, by one who
has no reasonable ground for believing it to be true;
c. The suppression of a fact, by one who is bound to disclose
it, or who gives information of other facts which are likely
to mislead for want of communication of that fact; or
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520
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521
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SEX CRIMES
523
PROSTITUTION
Prostitutes are women who, for money or profit, habitually
indulge in sexual intercourse or lascivious conduct (Art. 202,
N o . 5, Revised Penal Code).
Requirements to be satisfied before a woman may be considered a prostitute:
1. She habitually indulges in sexual intercourse or lascivious acts.
A single isolated sexual intercourse or lascivious act for
money profit will not make a woman a prostitute. There
must be habituality or repeated acts. This makes prosecution
for the crime difficult. Medical evidence on this matter is purely presumptive.
A woman may still be considered a prostitute although she
does not indulge in the habitual sexual intercourse because
habitual indulgence in lascivious acts also makes her a prostitute.
2. When the habitual sexual intercourse or lascivious act is done
for money or profit.
Habitual sexual intercourses with several men but not for
money or profit will not make a woman a prostitute.
The penalty imposed on a woman who has been proven to
be a prostitute is arresto menor or a fine not exceeding 200
pesos, and in case of recidivism, by arresto mayor in its medium
period to prision correccional in its minimum period, or a fine
ranging from 200 to 2,000 pesos, or both, in the discretion of
the court (Art. 202, last par., Revised Penal Code).
Reasons why some women become prostitutes:
1. Physiological and psychological traits Prostitutes are seldom
nymphomaniac, although nymphomaniacs may become prostitutes. Some of them are found to be emotionally unstable,
psychopathic, neurotic, suggestible, or addicted to the use of
tobacco, alcohol and narcotic drugs. They may be lonely and
may lack association with the intimate family circle.
2. Economic factors They are financially hard up and indulge
in the business for fear of starvation. Their earnings are meager
and cannot maintain a decent life or cope with the domestic
needs.
3. Home and neighborhood A great number of them comes
from broken homes, over-crowded homes with members of
both sexes sleeping in the same room, or having a male border
or roomer. In some instances the mother is a prostitute, and
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SEX CRIMES
525
Effects of Prostitution:
1.
2.
3.
4.
5.
6.
7.
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V u l v a o f prostitute w i t h l e u c o d e r m a
Methods of Control:
1. Legalized but regulated:
a. Segregation of prostitute in a restrictive area.
b. License given to the house of prostitution.
c. Periodic examination ol the prostitutes.
Defects of the Method:
a. Segregation does not segregate.
b. Many prostitutes fail to register, either through negligence
or desire to avoid the stigma which registration creates.
c. The medical inspection does not protect.
d. Regulations create a false sense of security (overconfidence).
e. Regulations promote prostitution, foster immorality, corrupt
officials and increase crime.
2. Strict prohibition:
a. Strict enforcement of legislation against prostitution and all
activities connected with it.
b. Education of the public regarding sex, prostitution and
venereal disease.
c. Adoption of medical measures and establishment of medical
facilities for the diagnosis and treatment of venereal disease.
d. Rehabilitation of prostitutes.
SEX CRIMES
527
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SEXUAL ABNORMALITIES
529
ditions do not exhibit criminal intent but manifesting mental aberrations which may be a subject-matter for the psychiatrist to treat.
Environment, degree of education, degree of morality, habits, etc.
are some of the factors responsible for such sexual maladjustments.
There is no specific provision of our Revised Penal Code on any of
the unnatural sexual offenses, although certain provisions of the code
may be made applicable.
Municipal ordinances of cities and towns may penalize unnatural
sexual offenses in consonance with the power to promulgate rules
and regulations necessary for the promotion of public safety, moral
and welfare.
Provisions of the Penal Code which may be Applicable to Unnatural
Sexual Offenses:
1. Grave Scandal:
Art. 200, Revised Penal Code:
The penalties of arresto mayor and public censure shall be
imposed upon any person who shall offend against decency or
good customs by any highly scandalous conduct not expressly
falling within any other article of the code.
Requisites of the Crime:
a. The offender performs act or acts;
b. Such act or acts is/are highly scandalous and offending against
decency and good customs;
c. It is also necessary that the act or acts be committed in a public
place or within the view or knowledge of the public (U.S. v.
Samaniego, 16 Phil. 663).
2. Immoral doctrines, obscene publications and exhibitions:
Art. 201, Revised Penal Code:
That penalty of prision correccional in its minimum period or a
fine ranging from 200 to 2,000 pesos, or both, shall be imposed
upon:
a. Those who shall publicly expound or proclaim doctrines openly
contrary to public morals;
b. The authors of obscene literature, published with their knowledge in any form, and the editors publishing such literature;
c. Those who in theaters, fairs, cinematographs or any other place
open to public view, shall exhibit indecent or immoral plays,
scenes, acts or shows; and
d. Those who shall sell, give away or exhibit prints, engravings,
sculptures or literature which are offensive to morals.
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SEXUAL ABNORMALITIES
531
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532
SEXUAL ABNORMALITIES
533
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SEXUAL ABNORMALITIES
535
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LEGAL MEDICINE
As to Visual Stimulus:
1. Voyeurism A form of sexual perversion characterized by a compulsion to peep to see persons undress or perform other personal
activities.
The offender is sometimes called "Peeping Tom".
Usually after peeping, he masturbate in excess.
2. Mixoscopia (Scoptophilia) A perversion wherein sexual pleasure
is attained by watching couple undress or during their sex intimacies.
As to Number:
Normal sexual relation is only between a man and a woman, but
deviation in sexual behavior may attain gratification when more than
two persons are participating.
1. Troilism (Menage a trois') A form of sexual perversion in which
three persons are participating in the sexual orgies. The combination may consist of two men and a woman or two women and
a man. The usual activity may be fellatio, kissing the buttock,
sucking the breast, a "suixante-neuf" (sixty-nine) arrangement,
or coitus combined with other sexual practices. Sexual gratification
is attained in the "eternal triangle".
A husband may request his wife to invite another woman
and spend their night in a room. In their nude condition, the
husband may perform cunnilingus to the woman and at the same
time performing coitus with his wife. The invited woman may
remain doing nothing other than kissing the buttock of the husband.
2. Pluralism A form of sexual deviation in which a group of
person participate in the sexual orgies. T w o or more couples
may perform sexual act in a room and they may even agree to
exchange partners for "variety sake" during the "sexual festival".
Other Sexual Deviates:
1. Coprolalia A form of sexual deviation characterized by the need
to use obscene language to obtain sexual gratification. Sometimes
they go beyond uttering profane words by making some writings
and sketches on the walls of toilets.
2. Don Juanism The term applied by psychiatrists to describe a
form of sexual deviation characterized by promiscuity and making
seduction of many women as a part of his. career. The pervert
cannot find anyone to be a permanent companion.
3. Indecent exposure (Exhibitionism) This is the willful exposure
in public places of one's genital organ in the presence of other
persons, usually of the opposite sex. Usually, the exhibitionist is
naked. It is the act of men whose sexual satisfaction is attained
SEXUAL ABNORMALITIES
537
principally by exhibition with or without performance of masturbatory act. Women may expose themselves naked in public
as in "bubble and fan" dances and the "strip tease" acts in night
clubs.
In civilized society, exhibitionism committed in public places
is harmful to the sense of decency and good morals, hence it is
punishable.
One evening two detectives and a reporter with a camera
entered one of the burlesque shows and they found the theater
dark with a dim light in the stage where a woman was seen
swaying her hip to and fro and sometimes raising her feet
one after another. She had on an "abbreviated" nylon panty
and patches on her breasts to interrupt her stark nakedness.
There were about 100 people inside the theater and while the
girl (accused) was dancing the people shouted in Tagalog
"Sigue, muna, sigue, nakakalibog".
The dancer was later apprehended and charged for immoral
exhibition. H E L D : She was found guilty, because the act
deprived or corrupted those minds which were susceptible to
immoral influence.
The object of the law is to protect the
public. The reaction of the public during the show showed
the act to be immoral (People v. Aparici, G.R. 13375).
Sexual Reversal:
1. Transvestism ("Sexo-esthetic inversion", "Psychical hemaphroditism" or "Metamorphosis sexualis paranoica") A form of
deviation wherein a male individual derives pleasure from wearing
the female apparel. This condition is found sometimes in females
who desire to dress themselves in male attire. The transvestite has
a psychic identification with the opposite sex. A female transvestite may imagine that she possesses a penis. It is quite difficult
to detect a female transvestite, since it is quite common for
women to wear slacks or dress in masculine tailored ways.
Transvestites are, as a rule harmless insofar as they have no
desire to assault anyone.
Like exhibitionists they are merely
interested in attracting attention. Transvestitism is a symptomatic
expression of some deep underlying sexual maladjustment amenable to psychotherapy.
2. Transexualism There is a dominant desire in some persons to
identify themselves with the opposite sex as completely as possible
and to discard forever their anatomical sex. So strong is the compulsion to have the opposite sex that they hate their genitalia as
a persistent evidence that they are not what they want to be, and
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sometimes attempt to castrate themselves or mutilate their external genitalia. They may go to the extreme of taking for a long
period of time sex hormones to develop secondary sex characteristics of the opposite sex. They may go to the extent of subjecting themselves to surgery to change their anatomical sex.
3. Intersexuality A genetic defect wherein an individual show
intermingling, in varying degrees, of the characteristics of both
sexes including physical form, reproductive organs, and sexual
behavior.
Classification of Intersexuality:
a. Gonadal agenesis The sex organs (testes or ovaries) have never
developed. This condition can be determined very early in
fetal life.
b. Gonadal dysgenesis The external sexual structures are present
but at puberty the testes or the ovaries fail to develop.
( 1 ) Klenefetter's syndrome A male type of dysgenesis in
which although the anatomical structure is entirely male,
the nuclear sexing is female (Chromatin positive), characterized by the presence of small testes with fibrosis and
hyalinization of the seminiferous tubules. It is associated
with X X Y chromosomes.
( 2 ) Turner's syndrome Structurally and phenotypically
female but the ovaries are small. There is sterility with the
absence of the second X chromosomes.
c. True hermaphroditism A state of bisexuality, having both
ovaries and testicles. The nuclear sex is usually female. The
character may be neutral or whichever is dominant.
d. Pseudohermaphrodite Sex organ is anatomically of one sex
but the sex characters is that of the opposite sex.
( 1 ) Male pseudohermaphrodite Gonads are testicles but the
character is effeminate.
( 2 ) Female pseudohermaphrodite
with masculine character.
Chapter XXII
PREGNANCY
Pregnancy is the state of a woman who has within her body the
growing product of conception or a fecundated germ. It commences
from the time the egg cell is fertilized and terminates at the time
such product of conception is expelled or delivered. The average
duration of pregnancy is 270 to 280 days from the first day of the
last menstruation. There is no perfect way of determining its duration, although several methods are employed, none of the methods
are perfectly reliable.
Legal Importance of the Study of Pregnancy:
1. Pregnancy is a ground for the suspension of the execution of the
death sentence in a woman:
Art. 83, Revised Penal Code:
Suspension of the execution of the death sentence:
The death sentence shall not be inflicted upon a woman within
the three years next following the date of the sentence or while
she is pregnant, nor upon any person over seventy years of age.
In this last case, the death sentence shall be commuted to the
penalty of reclusion perpetua with the accessory penalties in
article 40.
2. A conceived child is capable of receiving donation:
Art. 742, Civil Code:
Donations made to conceived and unborn children may be
accepted by those persons who would legally represent them if
they were already born.
3. A conceived child may exercise civil rights:
Art. 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.
Art. 41, Civil Code:
For civil purposes, the foetus is considered born if it is alive at
the time it is completely delivered from the mother's womb.
However, if the foetus had an intrauterine life of less than seven
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PREGNANCY
541
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LEGAL MEDICINE
also give rise to the same symptoms. The hypertonicity of the
stomach, peptic ulcer, gastric hyperacidity may simulate
morning sickness of pregnancy.
3. Changes in the Breast:
There is increase in size and sensation of tightness of both
breasts. The pinkish-brown color of the areolae are changed
into dark-brown or black. The tubercles of Montgomery are
developed and the tissues are erectile. Colostrum is found on
the third month. Secretion of milk may occur in a non-pregnant woman, as in tumor of the ovary.
4. Progressive Enlargement of the Abdomen:
At the end of the third month, the fundus of the uterus is
at the level of the brim of the pubic bone. At later periods,
there is gradual increase in size of the uterus capable of perception by palpation on the abdominal wall. The enlargement of
the abdomen may be due to tumor of the uterus or ovarian
cyst, or other abdominal pathology.
The relation between the age of the fetus and the level of
the fundus of the uterus is as follows:
3 calendar months (complete) 3 fingers above the pubic bone.
4 calendar months
"
Between the symphysis and
umbilicus.
3 fingers below the umbilicus.
5 calendar months
At the level of the umbilicus.
6 calendar months
3 fingers above the umbilicus.
7 calendar months
6 fingers above the umbilicus.
8 calendar months
9 calendar months
More than 8 fingers above the
umbilicus.
Note: In some women the 9th month has the same level as the
8th month because sometimes the head of the fetus
approximates the pelvic cavity so that fundus does not
go so high.
b. Hegar's Sign:
Bi-manual examination of the gravid uterus shows extreme softening of the cervix.
c. MacDonald's Sign:
On account of the softening of the isthmus, the fundus of
the uterus is anteflex, so by bi-manual examination, there is
an easy approximation of the fundus and the cervix.
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d. GoodelVs Sign:
When the cervix of the uterus feels as hard as the tip of
the nose, pregnancy does not exist, but when it is as soft as
the lips, the uterus is gravid.
6. Funic Souffle or Umbilical Souffle:
Funic souffle, sometimes called umbilical souffle, is the
whistling sound synchronous with the fetal heart beat and is
only of subordinate value owing to the possibility of other
sounds being mistaken for it.
7. Ballottement:
This is the feeling perceptible to the fingers on giving
sudden impulse to the child through the neck of the uterus.
The child floating in liquor amnii is driven by the impulse
against the other side of the uterus, and it is this blow against
the womb that is perceptible to the hand placed on the abdomen.
8. Braxton-Hick's Sign:
This is the rhythmical contraction and relaxation of the
uterus, perceptible to the hand when resting on the abdomen.
The interval of contraction is usually five to twenty minutes
and lasting from two to five minutes. Fibroid uterus may
also give this sign.
9. Bladder Irritability :
Irritability of the bladder is a common occurrence among
pregnant women. This is noticeable at the second month of
pregnancy, manifested as frequent urination. However, it has
of no diagnostic value because even a non-pregnant woman
may manifest the same symptom.
10. Capricious Appetite:
Women during the early stage of pregnancy or even thereafter may have specially capricious appetite. The desire for a
particular class or kind of food is shown by a conceiving
woman. Not all women do manifest this sign and its presence will not conclusively show the presence of pregnancy.
11. Abnormality in Pigmentation:
The pregnant woman usually manifest pigmentations in
some parts of the body especially in the abdomen and perineum. It may not be very prominent among colored people.
Pigmentation may be present in some diseases, like Addison's
disease.
PREGNANCY
545
LEGAL MEDICINE
546
2. Reagents:
a. Pregnancy Slide Test antiserum (human H C G antiserum from
rabbit)
b. Pregnancy Slide Test antigen ( H C G latex suspension, chemically bound)
3. Procedure:
Place 1 drop of urine, then 1 drop of Pregnancy Slide Test
antiserum 1 in one of the circles on the test slide and mix
thoroughly with a disposable stirring rod.
A d d 1 drop of Pregnancy Slide Test antigen 2 (shake well).
Mix well with the stirring rod, distributing the mixture over the
whole area of the circle.
Carefully agitate the slide with a circular motion to ensure
that the fluid revolves slowly within the circle.
Read the result after two minutes.
4. Interpretation of result If there is no agglutination (homogeneous) the urine tested came from a pregnant woman. If there
is agglutination (granular), the urine came from a non-pregnant
woman.
5. Sensitivity H C G concentration of 1.5-2.4 IU/ml urine and
over are detectable with "Pregnancy Slide Test". A positive
reaction is often possible within 5 days of the missed menstrual
period.
Usually the pregnancy will be diagnosed 12 days
after the missed menstrual period.
6. Remarks Fresh urine preferably morning urine is suitable
for use.
It is advisable to have controlled urine from known positive
or negative subjects.
If the result is doubtful, it is advisable to repeat the test a
few days later.
B. Gravindex HCG Slide Test The principle involved and procedure
is practically the same as the Pregnancy Slide Test. Gravindex is
merely a trade name.
Characteristics of the fetus in various periods throughout pregnancy
(Calendar Months):
End of first month
PREGNANCY
547
At term
548
LEGAL MEDICINE
3. Corpus Luteum:
Corpus luteum may be well-developed and attains a certain
size, however, it may gradually retrogress, but it is usually welldeveloped at the time of delivery. The changes in the corpus
luteum may also be found in fibroid tumor or other pathological
condition and even in cases of congestion.
Duration of Pregnancy:
The average duration of pregnancy is 270 to 280 days from the
onset of the last menstruation. There is no means of determining it
with certainty. The evidence derived from pregnancy following a
single coitus is trustworthy, but inasmuch as some authorities
consider more than two weeks as the life span of the spermatozoa
in the vaginal canal, it is hard to ascertain the exact date of fertilization. There is no synchrony between coitus and fertilization.
Abnormally Prolonged Gestation:
Cases in which pregnancy extends to 300 days can now be regarded
as well established. Many examples of longer duration have been recorded, but most of them are doubtful. Eden quotes sex cases which
have been accepted as authentic in which the calculated period of gestation lay between 311 and 336 days, the weights of the infant ranging
from 12-3/4 to 13-1/4 pounds. In all cases where the gestation much
over 300 days is alleged, confirmatory evidence should be expected
in the exceptional weight and size of the child (A Handbook of
Medical Jurisprudence and Toxicology by W. Brend, 8th Rev. ed.,
p. 113).
Minimum Period of Gestation Compatible with Viability of the Child:
Most authors hold that a child born at one hundred and eighty
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 three
or four 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 (Cox's Medico-Legal Court Companion by Bhattacharyya, 4th Revised ed., p. 248).
Methods of Estimating the Date of Expected Delivery:
1. From the date of the first day of the last menstruation, add seven
days and count three months backwards.
2. Count forward nine calendar months from the date of the first
day of the last menstruation and add one week.
PREGNANCY
549
3. Count forty 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, (supra,
p. 542)
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 multigravidas and 22 weeks in primagravidas from the date of
the quickening. This has been found not to be reliable.
Proofs of Previous Pregnancy:
1. Laxity of the abdominal wall.
2. Presence of striae of pregnancy on the abdominal wall.
3. Perineum is lax with a scar if there was previous laceration. Fourchette is markedly retracted.
4. Vestige only of the hymen is present (caruncula myrtiformis).
5. Breast is lax with enlarged nipples.
6. Vaginal examination shows previous laceration of the cervix.
Super fecundation:
This is the fertilization made by separate intercourses of two
ova which have escaped at the same act of ovulation.
Superfoetation:
This is the fertilization of two ova which have escaped at different acts of ovulation. This is possible before the time the decidua
vera has united with the decidua reflexa; that is, before the end of
the third month of pregnancy.
Pseudocyesis or Spurious Pregnancy:
It is an imaginary pregnancy usually observed among women
nearing menopause or in younger women who are very desirous of
having children. The patient will present all the subjective symptoms
of pregnancy, associated with an increase in the size of the abdomen
due frequently to abnormal and rapid deposition of fat or to tympanism.
The menses may not totally disappear but may present
abnormalities which the patient may attribute to her supposed condition. The patient may imagine fetal movement which in reality
is muscular contraction. There is great difficulty in persuading the
woman to believe that she is not pregnant.
550
LEGAL MEDICINE
PREGNANCY
551
Chapter XXIII
DELIVERY
Delivery is the process by which a woman gives birth to her
offspring.
Puerperhun is the interval between the termination of labor
(delivery) to the complete return of the reproductive organ to its
normal nonpregnant state.
Puerperium usually lasts from 6 to 8
weeks.
The study of delivery is important because proof of delivery is
necessary in judicial action on the following:
1. Legitimacy
2. Abortion
3. Infanticide
4. Concealment of birth
5. In slander or libel
Methods of Delivery:
1. Natural
Route:
DELIVERY
553
554
LEGAL MEDICINE
7. Uterus is enlarged and palpable:
Immediately after delivery, the uterus does not return to
its original size. It takes time for its sub-involution. Due to
the flaccidity of the abdominal wall, the enlarged uterus is
easily palpable.
8. Laxity of the perineum with possible tear:
The perineum is elastic and may yield to distention provided it is given ample time to stretch and provided the fetus
is not so big in size. The passage of the fetus at the outer end
of the birth canal is responsible for the relaxation of the connective tissue and muscles of the perineum. If there is abrupt
distention, a perineal laceration may be produced. Laceration
of the perineum is frequent when the second stage of labor
is accentuated by push from the fundus of the uterus.
DELIVERY
555
(supra p. 545).
B . SIGNS O F R E M O T E D E L I V E R Y I N T H E L I V I N G :
1. Changes in the breast:
The breast becomes pendulous and linea albicantes are found
on the skin on account of the retraction of its size. There is
dark color of the areolae and the consistency is soft. The nipples
are prominent due to the sucking of the child.
2. Vulva and perineum:
Scar of the previous laceration may be present.
marked retraction of the fourchette and perineum.
There is
3. Hymen:
Remains of the hymen may only be present in the form of
carunculae myrtiformis. Very rarely is the hymen preserved
after delivery.
4. Signs of previous laceration of the cervix:
The opening of the cervical canal may no longer be seen as
a round hole but slit-like on account of the previous laceration
during delivery.
5. Presence of striae of pregnancy or linea atrophica on the abdominal wall.
POST-MORTEM F I N D I N G S I N A W O M A N W H O D I E D R E C E N T L Y
AFTER D E L I V E R Y :
1- Findings in the uterus:
a. Laceration or contusion of the cervix.
b. Uterus is enlarged and flabby.
c. The inner surface of the uterus is bloody and rugged-looking.
d. Dark color sloughy and gangrenous sinuses are evident at the
endometrial lining at the site of the former placenta.
e. There is relative hypertrophy and increase in thickness of the
uterine wall.
556
LEGAL MEDICINE
Chapter XXIV
ABORTION
The Revised Penal Code does not define abortion, but merely
mentions circumstances which makes abortion criminal and punishable. Authorities differ as to the length of intra-uterine existence
which may be considered abortion. Some define 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 viability.
Viability is the point at which the fetus is "potentially able to live
outside the mother's w o m b " , albeit with respiratory aid. And, later,
as when it is capable of meaningful life outside the mother's womb
(The Rights of Doctors, Nurses and Allied Health Professionals by
Annas and Glantz, p. 202).
In the legal viewpoint, abortion is 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. According to Viada, 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.
(
**wi
LEGAL MEDICINE
558
Intentional Abortion:
Art. 256, Revised Penal Code:
Any person who shall intentionally cause an abortion shall
suffer:
1. The penalty of reclusion temporal, if he shall use any violence
upon the person of the pregnant woman.
2. The penalty of prision mayor if, without using violence, he
shall act without the consent of the woman.
3. The penalty of prision correccional in its medium and maximum periods, if the woman shall have consented.
Elements of Intentional Abortion:
a. That the woman is pregnant.
b. That violence was applied, or drug was administered, or a person
acts upon such pregnant woman.
c. That the effect of such violence, drug or acts of the offender,
the fetus dies or is expelled.
d. That the offender has the intention to abort the pregnant
woman.
ABORTION
559
Unintentional Abortion:
560
LEGAL MEDICINE
ABORTION
S61
or Natural Abortion:
Abortion:
Abortion which will not take place had it not been for some
form of inducement or intervention. Induced abortion may be:
X- Therapeutic Abortion:
Abortion purposely done to preserve the life of the mother.
Preservation of the health of the mother may also be a ground
to induce therapeutic abortion. The phrase "to preserve the life
of the woman" does not only mean to preserve the life of the
woman from death.
b\ Criminal Abortion:
Abortion done without any therapeutic indication but with
criminal intent is punishable by law.
Post-mortem Abortion:
This is the expulsion of the product of conception after death of
the pregnant woman brought about by the post-mortem contraction
of the uterine muscles. It is possible during the early stage of preg nancy when the fetus is small. During the later stage, the contraction of the uterus may cause its rupture and expel its contents of
pregnancy into the abdominal cavity.
Reasons Why Some Women Procure Abortion:
1. To preserve the life and health of the pregnant woman.
2. To terminate prematurely illegitimate pregnancy in order to coni
ceal the dishonor of the woman.
;
3. Financial difficulty.
in the family.
562
LEGAL MEDICINE
ABORTION
563
564
LEGAL MEDICINE
(2) Ecbolics:
Ecbolics are substances which when taken cause death or
expulsion of the product of conception by stimulation of
the uterine muscles.
The Most Common Ecbolics are:
(a) Ergot
( b ) Quinine
(c) Pituitary Extract
(d) Lead and Mercury
(4) Gamboge
( 5 ) Aloes
( 6 ) Elatrium
ABORTION
565
No definite autopsy findings may be seen, except the presence of the gravid uterus, remnants of the fetus and placenta,
and the laceration or perforation.
Secondary shock may
develop later and may be due to hemorrhage, infection or
corrosions.
b. Hemorrhage and Anemia:
Occasionally, big pelvic vessels are injured or failure of the
uterine wall to contract is observed in abortion. The rupture
of the blood vessels may be due to the injury of the uterine
and vaginal wall of injudicious instrumentation.
Adherent
placental tissue, infection, presence of foreign bodies and atony
of the uterus may cause hemorrhage for failure of the uterine
muscles to contract.
c. Embolism:
(1) Air Embolism:
The air may enter the lacerated vessels of the vagina and
uterine wall and carried by the blood to the inferior vena
cava, heart and block the pulmonary circulation. In cases
wherein the foramen ovale is potent, the air may escape
pulmonary circulation and block the cerebral circulation.
(2) Fat Embolism:
The injection of oily fluid or laceration of the adipose
tissue may cause the formation of fat emboli in the blood
stream which may lodge in the heart, lungs and brain. Fat
emboli may be observed in the renal glomeruli, coronary
LEGAL MEDICINE
566
Embolism:
endocarditis
with
multiple
septic infarctions.
ABORTION
567
Formation:
568
LEGAL MEDICINE
ABORTION
569
570
LEGAL MEDICINE
ABORTION
571
572
LEGAL MEDICINE
ABORTION
573
574
LEGAL MEDICINE
countries where abortion law is liberal. This trend is inconsonance to solve a future problem of an over-populated world.
Chapter X X V
BIRTH
Legal Importance of the Study of Birth:
1. Birth determines personality:
Art. 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.
Art. 41, Civil Code:
For civil purposes, the foetus is considered born if it is alive at
the time it is completely delivered from the mother's womb.
However, if the foetus had an intra-uterine 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 w o m b .
2. Appearance of a child is a ground for the revocation of donation:
Art. 760, Civil Code:
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 has legitimate or legitimated
or illegitimate children, even though they be posthumous.
3. Proof of live-birth must first be shown before death of the child
by the prosecution in the case of infanticide:
Art. 255, Revised Penal Code Infanticide:
The penalty provided for parricide (reclusion perpetua to death)
in article 246 and for murder (reclusion temporal in its maximum
period to death) in article 248 shall be imposed upon any person
who shall kill any child less than three days of age.
In medicine, birth is the entire delivery of a child with or without
its separation from the body of the mother. It is not necessary that
the cord should have been cut or the placenta expelled. It is the
cessation of the symbolic relation between the mother and the fetus.
Birth may be:
575
576
LEGAL MEDICINE
A. STILL-BIRTH:
When the child has not breathed or has not shown any sign
of life after being completely born.
Causes of Still-birth:
1. Immaturity.
2. Congenital diseases or malformation.
3. General debilitating diseases:
a. Acute specific infection.
b. Toxemia.
c. Kidney disease.
d. Acute liver disease.
e. Septicemia.
4. Local disease of the generative organ:
a. Syphilis.
b. Ablatio placenta, intra-placental hemorrhage, or extensive
infarction.
c. Kind of the cord.
d. Placenta previa.
5. Accidents in the delivery:
a. Disproportion of the birth canal and the fetus.
b. Injudicious forcep application.
c. Prolapse of the cord or strangulation of the cord.
d. Hemorrhage.
e. Abnormal presentation.
f. Influence of narcotics, anesthesia or intoxicating liquor.
g. Puerperal insanity.
h. Prolonged labor.
i. Hasty parturition.
j . Spasm of the larynx,
k. Hemorrhage of the cord.
6. Violence, either deliberate or accidental at birth.
B. L I V E - B I R T H .
In live-birth the child after birth exhibited clear signs of vitality
and viability is not necessary. In law, the presumption is every newborn child found dead was born dead. The burden of proof lies on
those who declare otherwise. To have a child acquire personality
distinct as that of the mother, there must be proof of life after
complete separation from the mother's womb.
BIRTH
577
Proofs of Live-Birth:
1. Presence of Heart Action and Circulation:
The presence of heart sound when the new-born is examined
by means of a stethoscope is a sign of life. Sometimes the pulse
is imperceptible by palpation especially when the child suffered
much during labor.
2. Movement of the Child and Crying:
The first instinct of the child after birth is restlessness and
crying. Children born after severe and prolonged second stage
of labor, may be too weak to move or cry. After a while, they
begin to move and later cry upon application of bodily stimulus.
3. Presence of Respiration:
Proofs that respiration has taken place:
a. There is arching of the chest.
b. Fall of the level of the diaphragm:
Before birth, the diaphragm reaches the level of the 4th
or 5th rib, but if respiration has taken place, it reaches
to the level of the 6th or 7th ribs. This test is not conclusive but merely corroborative.
c. Expansion of the lungs:
Appearance of the lungs if respiration has taken place:
(1) The lungs fill the thoracic cavity and overlapping the
heart and thymus gland.
(2) The lungs are voluminous, with rounded edges and pinkmottled color.
(3) The surface is covered with mosaic of expanded air
vesicles, giving a marble appearance.
(4) On pressure, they crepitate, and on section they exude
froth.
Appearance of the lungs before respiration has taken place:
(1) The lungs are found at the back of the thoracic cavity
behind the heart and thymus gland.
(2) The lungs are smooth, small, of a uniform dark blue-red
color, with sharp edges and present the appearance of a
piece of liver.
(3) When squeezed between the finger and thumb they do
not crepitate.
(4) On section they appear solid and exude blood but not
froth.
LEGAL MEDICINE
578
BIRTH
579
Hydrostatic test is no longer necessary in the following instances because of the presence of stronger proofs of live-birth
or still-birth.
a. When the fetus is born less than 180 days of intrauterine life.
b. When the fetus is a monster which is not capable of living
a separate existence.
c. When the umbilical cord is separated and the umbilicus is
cicatrized.
d. When the stomach on dissection contains coagulated or halfcoagulated milk as a result of digestion.
e. When the fetus shows signs of intrauterine maceration.
Differences Between Unexpanded and Expanded Lung
Unexpanded
Lung
Expanded
a. Volume is small.
b. Edges are more or less
sharply projected beyond
the thymus and heart.
c. Color is dark brown or uniform purplish gray with
no mottling.
d. Feels solid.
e. On section, a
blood exudes.
Lung
little
very
h. Microscopic examination
shows collapsed air sacs.
580
LEGAL MEDICINE
The normal content before birth is albuminous substances
and mucous. The presence of sugar, starch or milk indicates
live-birth.
b. Stomach-Bowel Test or Floatation Test or Breslau's Second
Life Test:
Ligate the cardiac end of the stomach and the lower end
of the intestine and remove. Place the whole mass of organs
in water. If the organs float, breathing has taken place. Dip
the organs under water and open the stomach and intestine.
Note the liberation of air bubbles going up the surface of the
water, if breathing has taken place.
BIRTH
581
582
LEGAL MEDICINE
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.
(Gradwohl's Legal Medicine by Camps, 3rd ed., p. 416).
Chapter XXVI
/ I N F A N T I C I D E (Neonaticide)
InpaHticide is the killing of a child less than three days old.
Art. 255, Revised Penal Code, Infanticide:
The penalty provided for parricide in article 246 and for murder
in article 248 shall be imposed upon any person who shall kill any
child less than three days of age.
Jf the crime penalized in this article 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 periods, and if said crime be committed for the same purpose
by the maternal grandparents or either of them, the penalty shall be
prision mayor.
'
If the~killing was done by
direct ascendants, or either of
the same as that of__parricide.
any other person, the penalty is
584
LEGAL MEDICINE
ment, there is more chance for the child to die, but with modern
neonatal management the child had all the chances to live.
A few hours after birth the child was deliberately killed. Is
the killing a case of infanticide?
According to Art. 41, Civil
Code
. . If the foetus had an intra-uterine life of less than
seven months, it is not deemed born if it dies within twentyfour hours after its complete delivery from the maternal womb",
and birth determines personality. Can the crime of infanticide
be committed on someone who is not yet a person as contemplated by law?
Motives for Committing Infanticide:
1. To conceal dishonor especially when there is no reason for her to
give birth to a child. She may be single, widowed, estranged from
the husband or living separately where access is not possible.
2. Financial reason An added member to the family may cause
increased financial burden. Care of the child may prevent the
mother to pursue her means of livelihood.
3. Desired number of children has already been attained. Infanticide
is made as a substitute for ineffective family planning.
4. Congenital abnormality of the child.
5. Parent is suffering from mental abnormality.
6. Belief that the child will bring bad luck to the family.
Criminological Characteristics:
1. It is most often committed by the mother.
2. The criminal act is almost always committed in the home.
3. The crime scene shows no manifest disturbance, no witnesses and
no noise or outcry.
4LThe trauma applied is so minimal that when applied to an adult
it will not even produce lethal effect.
5. A newly born child found dead was born dead. The burden of
proof that a living child has been killed is placed on the prosecution.
Type of Evidences in Infanticide:
In cases of alleged infanticide the prosecution must show the
following proofs:
1. That the child was born alive.
2. That the child was deliberately killed.
3. That the child killed was less than three days old.
INFANTICIDE
585
586
LEGAL MEDICINE
f. Burning:
This form of killing an infant is not common. This may be
resorted to with the simultaneous burning of the dwelling place
to conceal offense.
g. Deliberate exposure to heat or cold:
The child may be exposed to direct sunshine or may be
placed in a basin of cold water until death.
Post-mortem Findings in Cases of Infanticide:
1. Complete examination of the skin surfaces may show presence of
marks of physical violence in the form of fingernail marks especially at the neck. There may be other forms as abrasion, contusion,
hematoma, or lacerated wounds; ligature or pressure marks on the
neck.
2. Examination of the mouth and upper portion of the alimentary
tract may show signs of irritation if death is due to poisoning.
3. Laceration or other forms of injury of the upper portion of air
passage with deformity of the trachea and larynx.
4. The lungs may show petechial hemorrhages, emphysema, or signs
of drowning.
5. There may be fracture of the bones, laceration of the internal
organs, cerebral hemorrhages, etc.
6. In cases of poisoning, the organs must be preserved and sent to a
competent toxicologist for proper analysis.
Chapter XXVII
PATERNITY AND FILIATION
Paternity is the civil status of the father with respect to the child
begotten by him. Filiation is the civil status of the child in relation
to its mother or father (2 Sanchez Roman 952),
Legal Importance of Detemining Paternity and Filiation:
1. For Succession:
In legal succession, the right of the legitimate children is different from that of the illegitimate children. The law give more
rights in the property of the deceased parent to legitimate children.
2. For Enforcement of the Naturalization and Immigration Laws:
Naturalized citizens give "ipso facto" Philippine citizenship to
their minor children at the time of their naturalization under
certain qualifications. Thus, the* minors, in order to avail themselves of the effects of naturalization, must prove that they are
legitimate children of the naturalized citizen at the time of naturalization.
A minor child of a naturalized or permanent resident alien may
be given the right to land into our shores upon proofs that such
minor is a legitimate child of a naturalized Filipino or that of a
permanent resident alien.
Kinds of Children:
A. Legitimate Children:
1. Legitimate children (proper).
2. Legitimated children.
3. Adopted children.
B. Illegitimate Children:
1. Natural Children:
a. Natural children (proper).
b. Natural children by presumption.
c. Natural children by legal fiction.
2. Spurious Children:
a. Adulterous children.
b. Incestuous children.
c. Manceres children.
d. Sacrilegious children.
588
LEGAL MEDICINE
A. LEGITIMATE CHILDREN
589
LEGAL MEDICINE
590
591
LEGAL MEDICINE
592
anger declare that the child is not that of the husband although
it is not true.
b. The husband may connive with the wife and let her declare the
child as illegitimate and thus decrease his right over the properties of the husband.
c. Between legitimacy and illegitimacy, the law is in favor of
legitimacy. A child must not be punished by the wrongful
acts of his parents.
Presumption of illegitimacy based on ethnic reasons:
Art. 257, Civil Code:
Should the wife commit adultery at or about the time of the
conception of the child, but there was no physical impossibility
of access between her and her husband as set forth in article 255,
the child is prima facie presumed to be illegitimate if it appears
highly improbable, for ethnic reasons, that the child is that of the
husband. For the purposes of this article, the wife's adultery need
not be proved in a criminal case.
Example:
A and B, both white-Americans were legally married. During
the period of conception for the child C, the wife had an illicit
relation with X, a negro. The child born has dark skin, wiry and
curly hair and with thick lips. There is no ancestor in A and B
who is negro. The child C is prima facie presumed illegitimate.
Marriage of women within 300 days following death of husband,
annulment of marriage or other forms of marital dissolution:
Art. 84, Civil Code:
No marriage license shall be issued to a widow till after three
hundred days following the death of her husband, unless in the
meantime she has given birth to a child.
The Revised Penal Code penalizes a widow re-marrying before
the expiration of 301 days following her widowed:
Art. 351, Revised Penal Code Premature marriages:
A widow who shall marry within three hundred and one days
from the date of the death of her husband, or before having
delivered if she shall have been pregnant at the time of his death,
shall be punished by arresto mayor and fine not exceeding 500
pesos.
The same penalties shall be imposed upon any woman whose
marriage shall have been annulled or dissolved, if she shall marry
before her delivery or before the expiration of the period of
three hundred and one days after the legal separation.
593
The purpose of the above provisions of law is to prevent disputed paternity of the child born after the subsequent marriage
celebrated within the three hundred days following the dissolution
of the first marriage.
However, where deceased husband was proven to be impotent
or sterile, the widow who contracted a premature marriage was not
held criminally liable (People v. Masinsin, C.A. G.R. 9157, June
1953).
Presumption of legitimacy if the widow marries within three
hundred days following the death of the husband:
Art. 259, Civil Code:
If the marriage is dissolved by the death of the husband, and the
mother contracted another marriage within three hundred days
following such death, these rules shall govern:
(1) A child born before one hundred eighty days after the
solemnization of the subsequent marriage is disputably
presumed to have been conceived during the former marriage, provided it be born within three hundred days after
the death of the former husband;
( 2 ) A child born after one hundred eighty days following the
celebration of the subsequent marriage is prima facie
presumed to have been conceived during such marriage,
even though it be born within the three hundred days
after the death of the former husband.
Example of N o . ( 1 ) :
A widow married 100 days after the death of her first husband. A child is born 175 days after the celebration of the
second marriage.
The child is disputably presumed to be
legitimate insofar as the first husband because the child is born
within 180 days following the celebration of the second marriage and within 300 days after the death of the first husband.
Example of N o . ( 2 ) :
A widow married 80 days after the death of the first husband.
A child is born 200 days after the celebration of the second
marriage. The child born is prima facie presumed to be legitimate child of the second husband because the child was
born after 180 days following the celebration of the second
marriage.
Flaw of the presumption:
A widow married 50 days after the death of the first husband.
A child was born 200 days following the celebration of the second
marriage. Following the provision of the presumption, the child
594
LEGAL MEDICINE
595
596
3. Adopted Children:
Adoption is 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. The purpose of adoption is to
establish a relationship of paternity and filiation and to afford
persons who have no child of their own consolation of having one
by legal fiction. The child wherein paternity and filiation is established is an adopted child and with all the legal rights as a
legitimate child in relation to the adopting parents.
Persons who may be adopted:
a. The natural child, by the natural father or mother;
b. Other illegitimate children, by the father or mother;
c. A step-child, by the step-father or step-mother
Civil Code); and
(Art. 338,
597
B. ILLEGITIMATE CHILDREN
Illegitimate children are those who were born out _of lawful
wedlock or after a competent time after its dissolution.
1. Natural Children:
a. Natural
Children (Proper):
LEGAL MEDICINE
598
599
General feature
Manner of gesture
Personal peculiarities
Personal deformities
600
LEGAL MEDICINE
Chapter XXVffl
PATERNITY A N D FILIATION ON
NON-CONVENTIONAL METHODS OF PROCREATION
The standard method of reproduction is the introduction of the
male sperm into the generative organ of a female through sexual intercourse followed by fertilization, growth and development of the
conceptus and its subsequent delivery. No technical manipulation or
medication is employed as it is a physiologic process.
However, modern advancement of medicine modified the conventional method as a solution to some specific problems of reproduction.
Artificial Insemination and In Vitro Fertilization as a
modality of management has gone beyond the experimental stage of
procreation and now recognized and used to solve problems. Other
methods are still in their experimental stage and whatever problems
(medical, legal or moral) that may develop will depend and will be
solved in the future.
A. ARTIFICIAL INSEMINATION
Artificial insemination is a medical procedure by which the
semen is introduced into the vagina by means other than copulation
for the purpose of procreation. Some physicians consider the term
"therapeutic insemination" as a more suitable term for the procedure (Sagall).
Artificial Insemination Classified According to the Source of Semen:
1. A . I . H . (Artificial Insemination Homologous, Artificial Insemination
Husband) When the sperm comes from the husband.
2. A . I . D . (Artificial Insemination Donor, Artificial Insemination
Heterologous) When the sperm comes from a donor other than
the husband.
3. A . I . H . D . (Artificial Insemination Husband Donor, Polled Donor
Semen) When the donor semen comes from the husband and a
third party donor.
Medical Indications for Artificial Insemination :
1.
For A.I.H.:
a. When the deposition of the husband's semen within the vagina is
by coitus, this is prevented because of anatomic or psychologic
601
602
LEGAL MEDICINE
difficulties on the part of either husband or wife;
603
will constantly attest to both partners and the husband's incapacity for biologic fatherhood.
3. The physician must use all reasonable precautions in selecting the
donor; with thorough medical, psychologic and social screening
to exclude donor with potential transmissible undesirable traits,
features and details.
4. The physician must, under no circumstances except by court
order, reveal the fact of artificial insemination or 'the identity
of the donor or of the couple to each other or to other persons.
5. The physician must use freshly donated sperm or frozen semen
that has been prepared and stored according to currently accepted
methods with the source properly identified.
6. The insemination procedure must be performed by the physician
in accordance with the currently accepted techniques.
7. Full and valid consents and releases should be obtained in writing
from all parties involved, and each consent must be an "informed
consent," particularly on the part of the prospective parents, who
should be fully appraised of the psychologic and legal complication and the possibility of the birth of a defective child (Legal
Medicine Annual 1973 by C. Wecht, p. 483).
Status of the Child Born by Artificial Insemination:
Artificial insemination as a remedy for reproductive infertility has
been developed and recognized recently. The issue as to the status
of the children born as a consequence of artificial insemination has
never been brought squarely in our court. The following may be the
possible status of the child born as a consequence of artificial insemination :
1. In A . I . H . , there is no doubt that the child is a legitimate child of
the husband because the semen came from him. No foreign blood
is introduced into the family.
2. In A . I . D . , with the consent of the husband, the child born must
also be considered legitimate although the fertilization semen is
not from the husband. His consent to the artificial insemination
may be considered as a waiver to the illegitimate status of the
child. Even if the child is considered illegitimate, the child can
be adopted by him making the child's status legitimate.
3. In A . I . D . , without the consent or if it is against the will of the
husband, the child must be considered illegitimate, specifically
a child born because of adultery. This is an intrusion into the
conjugal home of a foreign element against the will of the husband.
If the child is considered born because of adultery, did the wife
commit adultery?
Adultery is committed by "having sexual
604
LEGAL MEDICINE
60S
decree arguing that because the child has resulted from A . I . D . , the
husband is not the father of the child and therefore he is not entitled
to visitation right. The court, however, predicted on the assumption that the procedure had been performed with the consent of the
husband, rules that "the child has been potentially adopted or semiadopted by the defendant and with the particular reference to
visitation, he is entitled to the same right as those to which a natural
parent under the circumstances would be entitled (Strand v. Strand
78N.Y.S. 2d 390(1918).
In an action for a divorce, the Wife alleged that her husband had
no visitation right since the child had been conceived from a donor
sperm. The court upheld an axiomatic legal principle: "When a
child is born within marriage by whatever legal method, there is
legal presumption that both marriage partners are its parents (Ohlson
v. OhlsonNo. 54, S. 138, 875 (Super. Ct. Cook Country, Sept. 1955).
Child born by artificial insemination is illegitimate:
The trial judge granted the divorce but denied the husband of
visitation rights and the custody of an A . I . D . child declaring that
"Heterologous artificial insemination", with or without the consent
of the husband, is contrary to public policy and good morals, and
constitutes adultery on the part of the mother. A child so conceived
is not a child born in wedlock and therefore illegitimate. As such,
the mother and the father have no rights or interests of the said
child
(Dornbus v. Dornbus, No. 51, S. 13 875 (Super Ct. Cook
Country, No. 1954, appeal dismissed 12 III. App. 2d 473 (1956).
A child conceived by A . I . D . is illegitimate, but the husband at
the time of birth was obliged to give support. The trial judge ruled
that because the husband had consented to the artificial insemination procedure there arose "an implied contract to support the
child although the court considered the child illegitimate (Gursky
v. Gursky, 242 NnYlS. 2d 406, 39 Misc. 2d 1083 Sup. Ct. 1936).
Child born by artificial insemination is entitled for support:
The husband consented in writing for artificial insemination of
the wife. A male child was conceived and born. The spouse later
had a divorce and the wife was given custody of the child. The
wife later became ill and disabled so she applied for a state support
of the child. The District Attorney brought a criminal action against
the husband to force him to provide for the child's support. The
court ruled that "reasonable man who, because of his inability to
procreate, actively participates and consents to his wife's artificial
insemination, knows that such behavior carries with it legal responsibilities of fatherhood and criminal responsibility of nonsupport (People v. Sorenson, 66 Cal. Rptr. 7, 437 P. 2d 499 (1968).
606
LEGAL MEDICINE
B. IN VITRO FERTILIZATION
608
LEGAL MEDICINE
LEGAL MEDICINE
610
611
612
LEGAL MEDICINE
unless found to be unconstitutional.
better solution to the problem.
Chapter XXIX
MEDICO-LEGAL ASPECT OF MARITAL
UNION A N D DISSOLUTION
A. AS TO REQUISITES OF A V A L I D M A R R I A G E :
Art. 52, Civil Code:
Marriage is not a mere contract but an inviolable social institution. Its nature, consequences and incidents are governed by law
and not subject to stipulation, except that the marriage settlements may to a certain extent fix the property relations during
the marriage.
Art. 53, Civil Code:
No marriages shall be solemnized unless all these requisites are
complied with:
(1)
(2)
(3)
(4)
LEGAL MEDICINE
614
615
Disparity in age.
Venereal disease.
Masturbation preferred to coitus.
Infidelity.
LEGAL MEDICINE
616
Septate hymen.
Tight thick hymen.
Fear of pain or inability to stand pain.
Ignorance of genital anatomy.
Ignorance of sex technique.
Fear of pregnancy.
Sense of shame regarding genitals and coitus.
Contraceptive Methods:
1. Contraceptive Methods in General
Condom
Coitus interruptus
Douche
Suppository
Safe period
Nothing
Gold-stem wishbone pessary
Vaginal diaphragm (rubber)
French pessary (cervical
type)
Lanteen pessary
617
External coitus
Abstinence
Nothing used
Some Common Complaints After Marital Union:
1. Male sex inadequacy.
2. Prolonged debilitating disease of one of the partners.
3. Anxiety over economic security.
4. Manual clitoral stimulation preferred to coitus.
5. Too frequent pregnancy.
6. Lack of privacy (poor housing).
7. Husband's preference to perversion.
8. Cultural aesthetic inequalities between parties.
9. Faulty attitude of husband and wife toward normal sex and
marriage intimacies.
(From: JAMA, Vol 115, No. 4, July 27, 1949, pp. 270-285,
by Mario Pichel Warner, M.D.).
C. A S T O A N N U L M E N T O F M A R R I A G E :
Art. 85, Civil Code:
A marriage may be annulled for any of the following causes,
existing at the time of the marriage:
(1) That the party in whose behalf it is sought to have the marriage annulled was between the ages of sixteen and twenty
years, if male, or between the ages of fourteen and eighteen
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 twenty
or eighteen years, as the case may be, such party freely
cohabited with the other and both lived together as husband
and wife;
LEGAL MEDICINE
618
(2)
(3) That either party was of unsound mind, unless such party,
after coming to reason, freely cohabited with the other
as husband or wife;
(4) 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 may be;
(5)
(6) 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.
Art. 86, Civil Code:
Any of the following circumstances shall constitute fraud
referred to in number 4 of the preceding article:
(1)
(2)
( 3 ) Concealment by the wife of the fact that at the time of the
marriage, she was pregnant by a man other than her husband.
There are several grounds for the annulment of marriage which
are of 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 and to determine whether she or he
could have been of unsound mind at the time of the celebration
of marriage. The phrase "physically incapable of entering into
married state" includes impotency of a party. The court or any
of the parties in interest to the contract of marriage must determine whether or not she is pregnant at the time of the celebration
of marriage.
D. AS TO LEGAL SEPARATION:
Our law recognizes only relative divorce but not absolute divorce.
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, Revised Penal Code Who are guilty of adultery?
Adultery is committed by any married woman who shall have
sexual intercourse with a man not her husband and by the man
619
by prision
correccional in its
Chapter XXX
IMPOTENCY AND STERILITY
I. IMPOTENCY
Impotency is the physical incapacity of either sex to allow or
grant to the other legitimate sexual gratification. A person may be
impotent but not sterile, or sterile but not impotent although both
conditions may exist at the same time.
Legal Importance of Impotency:
A. Impotency, if proven,
legitimacy:
Art. 255, Civil Code:
will
overthrow
the presumption
of
Children born after one hundred and eighty days following the
celebration of marriage, and before three hundred days following
its dissolution or the separation of the spouses shall be presumed
to be legitimate.
Against this presumption no evidence shall be admitted other
than that of physical impossibility of the husband's having access
to his wife within the first one hundred and twenty days of the
three hundred days which preceded the birth of the child.
This physical impossibility may be caused:
(1) By the impotence of the husband;
( 2 ) By the fact that the husband and wife were living separately, in such a way that access was not possible; and
( 3 ) By the serious illness of the husband.
B. Impotency may be a ground for the annulment of marriage:
Art. 85, Civil Code:
Marriage may be annulled for any of the following causes
existing at the time of marriage:
(5)
( 6 ) 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.
The physical incapacity referred to in the above provision
includes impotency.
620
621
In order that such impotency may be a ground for the annulment of marriage, the following requisites must be present:
1. One of the parties to the marriage is not aware of the existing
impotency of the other party. If the other party to the marriage know of the impotency of the future spouse before the
marriage, then it is considered a waiver on his part.
2. The impotency must be present at the time of the celebration
of marriage.
3. The impotency suffered by the party must be incurable. If the
impotency can be remedied by medical or surgical intervention,
then it cannot be a ground for the annulment of marriage.
4. Such impotency must be absolute.
C. Impotency may be a defense in rape:
An accused in the crime of rape may claim of his inability to
commit the offense on account of his impotency. Medical evidence must be shown in support of his allegation.
D . Impotency may be
sexual behavior:
cause
to
LEGAL MEDICINE
622
3. Emotion:
Some females manifest vaginismus due to actual pain on
contact or to the fear of pain on sexual intercourse. This condition is usually common among virgins. This is produced by
the violent contraction of the constrictor muscles of the vaginal
orifice and may also be brought about by the contraction of
the adductor muscles of the thighs. Anesthesia may cure the
condition and pregnancy may produce a permanent cure. In
the male, emotion may lead or produce temporary impotency.
4. Hormonal dysfunction may also lead to temporary or permanent
impotency.
B. Local or Organic, in Direct Connection with the Sexual Organs:
1. Congenital
Defects:
a. In Males:
(1)
(2)
(3)
(4)
b. In Females:
(1) Absence of vagina.
( 2 ) Vagina ill-developed, e.g., may be too small.
( 3 ) Vagina occluded by intrauterine disease.
2. Disease or Accident:
a. In the Males:
(1) Penis:
( a ) Acute diseases of the penis, as gonorrhea.
( b ) Chronic diseases as epithelioma.
( c ) Complete amputation of the penis.
( 2 ) Testis:
(a) Removal of the testis.
( b ) Sexual abuse.
b. In the Females:
( 1 ) Vaginal ulceration.
( 2 ) Diseases of the vulvae.
( 3 ) Obstruction of the vaginal canal due to tumor, cyst or
fibroid.
II. STERILITY
Sterility is the loss of power of procreation and is absolutely
independent of whether or not impotence is present. A man or a
woman may be sterile and yet not impotent, and impotent yet not
sterile.
623
Causes of Sterility:
A. General or Functional,
Organs:
Conditions:
a. In the Male:
( 1 ) Absence or nondevelopment of testicle.
( 2 ) Absence or nondevelopment of penis.
(3) Maldevelopment of the testicle.
( 4 ) Misplacement of the testicle.
( 5 ) Malformation of the penis, as in epispadias or hypospadias.
b. In the Female:
(1) Absence or maldevelopment of the ovary.
(2) Absence or maldevelopment of the uterus.
(3) Absence of the vagina.
2. Acquired
Conditions:
a. In the Male:
(1)
(2)
(3)
(4)
b. In the Female:
(1)
(2)
(3)
(4)
(5)
Methods of Sterilization:
A. On the part of the 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 prostrate gland
to form the ejaculant, can be divided and the cut ends tied
(vasectomy); thus newly produced sperm cannot join the
ejaculant and the ability of the male to fertilize the female
is lost.
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LEGAL MEDICINE
Chapter XXXI
MEDICO-LEGAL ASPECT
OF
DISTURBANCE OF MENTALITY
I. INSANITY
Insanity may be defined in its sociological, medical and legal
concept.
In the sociological viewpoint, insanity is the persistent inability
through mental causes to adapt oneself to the ordinary environment.
It is the loss of power of the individual to regulate his actions and
conduct according to the rules of society in which he moves.
Insanity in medicine is the prolonged departure of the individual
from his natural mental state arising from bodily disease.
Insanity in law covers nothing more than the relation of a person
and the particular act which is the subject of judicial investigation.
The term insanity is commonly used to be synonymous with
lunacy, madness, unsoundness of mind, mental derangement, mental
disorder or mental aberration or alienation.
Legal Importance of the Determination:
1. In the Civil Code:
a. Insanity is a restriction on the capacity of a natural person to
act:
Art. 38, Civil Code Minority, insanity or imbecility, the
state of being a deaf-mute, prodigality and civil interdiction are
mere restrictions on capacity to act, and do not exempt the
incapacitated person from certain obligations, as when the
latter arise from his acts or from property relations, such as
easements.
b. Insanity modifies or limits the capacity of a natural person to
act:
Art. 39, Civil Code The following circumstances, among
others, modify or limit capacity to act: age, insanity, imbecility,
state of being a deaf-mute. . . . The consequences of these
circumstances are governed in this Code, other codes, the Rules
of Court and in special laws. Capacity to act is not limited on
account of religious belief or political opinion.
625
626
LEGAL MEDICINE
DISTURBANCE OF MENTALITY
627
(1)
( 2 ) If the testator was insane, or otherwise mentally incapable of making a will, at the time of its execution.
g. An insane cannot give consent to a contract:
Art. 1327, Civil Code The following cannot give consent to
a contract:
( 1 ) Unemancipated minors:
( 2 ) Insane or demented persons, and deaf-mutes who do not
know how to write.
h. The guardian or the insane himself, if there is no parent or
guardian shall be held liable for damages due to his insanity:
Art. 2180, Par. 3, Civil Code Guardians are liable for
damages caused by the minors or incapacitated persons who
are under their authority and live in their company.
Art. 2182, Civil Code If the minor or insane person causing
the damage has no parents or guardian, the minor or insane
person shall be answerable with his own property in an action
against him where a guardian ad litem shall be appointed.
A guardian ad litem is a guardian appointed by the court to
prosecute or defend a suit on behalf of a party incapacitated
because of minority or insanity.
2. In the Revised Penal Code:
a. Insanity exempts a person from criminal liability:
Art. 12, Revised Penal Code Circumstance which exempt
from criminal liability The following are exempt from criminal liability:
( 1 ) An imbecile or an insane person, unless the latter has
acted during lucid interval.
b. A person who becomes insane after final sentence:
Art. 79, Revised Penal Code Suspension of the execution
and service of the penalties in case of insanity When a
convict shall become insane or an imbecile after final sentence
has been pronounced, the execution of said sentence shall be
suspended only with regard to the personal penalty, the provisions of the second paragraph of circumstances number 1 of
article 12 being observed in the corresponding cases.
If at any time the convict shall recover his reason, his sentence shall be executed, unless the penalty shall have prescribed
in accordance with the provision of this Code.
The respective provisions of this section shall also be observed if the insanity or imbecility occurs while the convict is
serving his sentence.
628
LEGAL MEDICINE
DISTURBANCE OF MENTALITY
629
Visual
Auditory
Olfactory
Gustatory
Tactde
b. Disorder of Memory:
( 1 ) Dementia A form of insanity resulting from degeneration
or disorder of the brain characterized by general mental
weakness, forgetfulness, loss of coherence, and total inability to reason but not accompanied by delusion or uncontrollable impulse (Hibbard v. Baker, 104 N.W. 339, 141
Mich. 124).
Some Types of Dementia:
(a) Acute Dementia a form of temporary dementia,
occurring in young people and induced by conditions
630
LEGAL MEDICINE
likely to produce that state, like malnutrition, overwork, dissipation or too rapid growth.
( b ) Dementia Paralytica(General Paralysis of the Insane)
Degeneration of physical, intellectual and moral power
leading to paralysis ("cirrhosis of the brain").
( c ) Dementia Praecox (Schizophrenia) Dementia of the
adolescence and characterized by loss of memory.
( d ) Senile Dementia Occurring in advanced age and
characterized by loss of memory, with childish and silly
behavior and physical degeneration.
(e) Toxic Dementia Characterized by weakness of mind
or feeble cerebral activity resulting from continuous
administration or use of toxic chemicals.
( 2 ) Amnesia (Loss of Memory):
(a) Anterograde Amnesia Loss of memory of recent
event.
( b ) Retrograde Amnesia Loss of memory of past events
and observed in trauma of the head.
DISTURBANCE OF MENTALITY
631
632
LEGAL MEDICINE
sical health is not greatly affected. (Forensic Medicine,
Sydney Smith and Frederick Fiddes, 10th ed., p. 387).
(2) Melancholia Intense feeling of depression and misery
which is unwarranted by his physical condition and external environment. He is absorbed by his miserable thought.
Aural hallucination is common.
Every patient suffering
from melancholia is a potential suicide case.
Robbers Harpaophobia
Sacred things Hierophobia
Sharp objects Belonophobia
Sun Heliophobia
Trees Dendrophobia
( 3 ) Fear of Place:
Churches Ecclasiophobia Crowds Ochlophobia
Empty room Kenophobia Sea Thalassophobia
Enclosed room
Home surroundings
Claustrophobia
Ecophobia
School Scholionophobia _ River Potamophobia
DISTURBANCE OF MENTALITY
Railways Siderodro
mophobia
633
13 at table Trikaidekaphobia
LEGAL MEDICINE
634
DISTURBANCE OF MENTALITY
635
2. Physical Examination.
3. Instrumentations:
X-ray, electroencephalogram,
apparatus.
scanning
and
other modern
4. Mental Examination:
Psychologic Testing
Psychiatric Evaluation
INSANITY A N D CRIMINAL RESPONSIBILITY:
Fundamental Principles in Criminal Responsibility:
1. A sane man is assumed to be
sequence of his criminal act.
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LEGAL MEDICINE
The wife of the accused and her cousin testified that the accused was continuously out of his mind for many years. The
assistant district health officer who examined the accused testified
that he was suffering from violent mania and that condition could
be present at the time he killed the deceased. There was no
motive for the accused to kill the deceased. The court considered
the accused insane (People v. Bascos, 44 Phil. 204).
The accused was suffering from malignant malaria when she
attacked, wounded and killed her husband. It has been shown
that malaria affected the nervous system and caused complications
like acute melancholia and insanity at times. The accused was
considered not criminally liable (People v. Lucena, 69 Phil. 350).
2. As a Mitigating Circumstance:
Art. 13, Revised Penal Code Mitigating circumstances The
following are mitigating circumstances:
8. That the offender is deaf and dumb, blind or otherwise
suffering from 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. A n d , finally, any other circumstance of a similar nature
and analogous to those above mentioned.
The fact that the accused is suffering from a mild behavioral
disorder as a consequence of an illness she had in early life is
regarded as mitigating circumstance under Art. 13, Par. 8 or in
Par. 9 of the Revised Penal Code (People v. Amit. 82 Phil. 820).
One who was suffering from acute neurosis which made him
ill-tempered and easily angered was entitled to the mitigating
circumstance because illness diminished his exercise of will power
(People u. Carpenter C.A. G.R. 4168 Apr. 22, 1940).
Phase In The Criminal Act Where The Evidence Of Insanity Of
The Accused Must Be Established:
The evidence of insanity must be referred to at the time preceding
the act under prosecution or to the very moment of its execution.
In order to ascertain a person's mental condition at the time of the
act, it is permissible to receive evidence of the condition of his mind
during a reasonable period both before or after that time. To prove
insanity, circumstantial evidence, if clear and convincing, will suffice
(People v. Bonoan, 64 Phil. 93).
DISTURBANCE OF MENTALITY
637
Rules Utilized By Courts to Determine Whether The Mental Condition Of An Accused Exempts Him From His Criminal Liability:
Art. 12 ( 1 ) of the Revised Penal Code provides that "an imbecile
or an insane person, unless the latter has acted during lucid interval"
is exempt from criminal liability.
In the medical viewpoint a person is insane when he is suffering
from mental derangement or confusion or a condition which prevents
a person from orienting himself. It is a prolonged departure of the
individual from his natural mental state arising from bodily disease.
The legal definition of insanity by which the court is guided is
more of an intellectual and moral concept rather than medical. It
is a defect of the mind which renders a person incapable of entertaining a criminal intent. The law further presumes every person to
be sane and to possess a sufficient degree of reason to be responsible
for his act unless the contrary can be proven.
The following rules have been adopted by courts to determine
whether an accused is suffering from insanity to exempt him from
criminal liability :
1. Earlier Test for Insanity:
a. "Wild Beast Rule":
A person is exempted from criminal liability if he is totally
deprived of his understanding and memory and knows no more
than an infant, a brute, or a wild beast of what he is doing.
The rule has been applied in England (Arnold case, 1724)
and in the United States (State v. Pike, 49 N . H . 399), but was
not universally accepted because:
a. Its application is limited to violent crimes against a person;
and
b. It is quite hard to measure the aggressive behavior of a wild
beast.
b. Delusion Rule:
A person is not responsible for his act if he is suffering from
delusion although he knows that his act is wrong.
This rule was applied to the James Hadfield case wherein the
accused attempted to kill King George III of England while
entering the Drury Lane Theater. Hadfield was found to be
suffering from a delusion although he knew at the time that he
was actually firing a gun at the King.
A person with delusion may be insane but his suffering from
delusion may not necessarily affect his judgement in a particular
act. If a person who is suffering from delusion commits an
illegal act which has no relation to the particular delusion from
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LEGAL MEDICINE
DISTURBANCE OF MENTALITY
639
to
the
McNaghtensRule:
(1) The rule is too rigid and strict that it unjustly subjects the
insane to punishment.
( 2 ) It is based solely on cognitive factor and ignores emotion
and will.
( 3 ) The test is unintelligible to psychiatrists because it requires
a moral judgment by the physician; a judgment outside of
his professional training, experience and competence.
In the United State 36 states adopt the rule.
b. Irresistible 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.
Criticisms to the Irresistible Impulse Rule:
(1) On account of its laxity it opens the door for the escape of
many persons who are sane and should be prosecuted as
criminals.
(2) There is difficulty in differentiating irresistible impulse from
impulse which can be actually resisted.
( 3 ) It fails to differentiate between real insanity and mere
impulsive condition.
c. 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 the mental disease or
defect?
Criticisms to the Durham Rule:
(1) There seems to be uncertainties in the definition of "mental
disease or defect". Does it include personality disorders,
character defect, sociopathic disorder which are clinically
true mental diseases?
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LEGAL MEDICINE
(2) There is ambiguity of the term "product". When is an act
the "product" of the diseased mind or deranged mental
condition within the scope of the rule?
(3) The application of the rule will create a fear that all criminals would be regarded by psychiatrist as mentally ill,
and hence, no one will be subjected to criminal prosecution or conviction.
d. 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.
Criticisms to the Currens Rule:
Like the Durham Rule, a large number of the prison population will be considered not guiltv by reason of insanity.
e. American Law Institute Rule:
In 1955, The American L a w Institute with the support of
the American Bar Association, formulated the following rule of
criminal responsibility:
(1) A person is not responsible for his criminal conduct if at the
time of such conduct as a result of 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 ) TVie term "mental disease or defect" does not include an
abnormality manifested only by repeated criminal or
otherwise anti-social conduct.
Criticisms to the American Law Institute Rule:
( 1 ) Some authorities, even psychiatrists, objected to the inclusion of item ( b ) of the rule. It has been pointed out that
such exclusionary division discriminates between the poor
and the well-to-do offenders. The poor defendants cannot
avail themselves of a more rigid and more searching inquiry
into their mental state but merely superficial, one done by
government physicians.
( 2 ) It does not give the court a simple, helpful guide in their
effort to decide whether the accused was insane at the time
of his act.
( 3 ) The phrase "or to conform his conduct to the requirement
of the law" permits the defendant to find refuge in what is
equivalent to the "irresistible impulse" test.
DISTURBANCE OF MENTALITY
641
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LEGAL MEDICINE
timid and easily irritated. He cannot guard himself against common physical dangers. The deficiency is usually associated with
physical abnormalities like microcephaly and mongolism. Mentality never exceeds that of a normal child over 2 years old. The
I.Q. is between 0 20.
2. Imbecile Although the mental defect is not as severe as that of
idiots, he cannot manage his own affairs. He may be able to speak
but with poor command of the language. He can easily be aroused
to passion and may show purposeful behavior. He may be trained
to do simple work under supervision. The mental age may be
compared to a normal child from 2 to 7 years old and the I.Q. is
20 - 40.
3. Feeble-minded Person whose mental defect, although not
amounting to imbecility, is pronounced such that he requires care,
supervision, and control for his protection and for the protection
of others. He is incapable of receiving proper benefit from instructions in ordinary school. He lacks initiative and ability for any
work or responsibility. He has a mentality similar to that of a
normal child between 7 to 12 years old and an I. Q. of 40-70.
Moron A feeble-minded person of considerably higher intelligence as that of an imbecile but his intellectual faculties and
judgment are not as well developed as in a normal individual.
He can carry routine duties in civilized society as long as the
demands made upon his mental capacity is not too discretionary.
He is amenable to the customs of the community and may not
present so much of a social problem.
4. Moral Defective In addition to the mental defect, there are
strong vicious and criminal propensities, so that the person requires care, supervision and control for the protection of others.
He is devoid of moral sense and often shows intellectual deficiency,
though he may be mentally alert. He is careless; pleasure loving;
and a devil-may-care sort of young man or woman who adheres to
the principles of "live today for tomorrow we die", "live fast and
die young" and "it is only happiness that counts".
(A Sypnosis of Forensic Medicine & Toxicology by C. Thomas,
2nd ed., p. 125).
Because of the stigma that may likely be attached to the child if
the classical classification (idiot, imbecile, feeble-minded) is used,
new classifications have been adopted by some countries. Mental
retardation is classified as follows:
1. Profound I.Q. is under 20, and capable at most to limited
self-help. There is most likely a need for hospitalization or some
type of environment in which care is available throughout his
life-time.
DISTURBANCE OF MENTALITY
643
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LEGAL MEDICINE
given to different parts of the body and clothings. The
total number of points is then converted into a quantitative
measure of intelligence. The test can provide evidence for
personality functioning and conflicts as well as intelligence
estimate.
(2) Raven Progressive Matrices Test: A series of designs in
which a part is removed from each member of the series, and
the individual is presented with six alternative parts from
which to choose the part which is missing in the original
design. This test is useful in measuring the person's ability
to reason by analogy, for comparison and to indicate the
logical method of thinking.
DISTURBANCE OF MENTALITY
645
Classification
"Near" genius or genius
Very superior intelligence
Superior intelligence
Normal or average intelligence
Dullness, rarely classified as feeble-minded
Borderline deficiency, sometimes classified
as dullness, often as feeble-minded
Definitely feeble-minded
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DISTURBANCE OF MENTALITY
647
Method:
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DISTURBANCE OF MENTALITY
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LEGAL MEDICINE
650
Types of Malingering:
1. "Feigned or Fictitious" Malingering:
Malingering is built up out of pure imagination and does not have
the slight basis of fact. The disease or injury which a person
allegedly is suffering from does not exist at all.
Example:
2. "Factitious" Malingering:
This is a form of malingering whereby something really exists as
a fact but is converted to a more serious disability or injury, or
to an exaggeration of the real complaint. Here the person is really
suffering from an injury or disease but he may exaggerate or
amplify the seriousness of the complaint or nature of the injury or
disease.
Example: A person might have received a small superficial
scratch but complained of severe and unbearable pain
and incapacity to move.
Points which Make a Physician Suspect that a Person is Malingering:
1. Presence of a Cause for the Subject to Malinger:
A person may feign disease or injury because he wants to avoid
something, like military training, court trial or other obligations
which he does not like, or he wants to get something, like sympathy or greater civil damages.
2. Inconsistency Between the Injuries or Disease Suffered from and
the Symptoms or Disability Manifested:
In factitious malingering the subject may show certain manifestations which, in the ordinary course of life, are inconsistent
or not proportionate to the actual physical disability present.
3. Symptoms Not Supported with Organic Lesion:
A woman may allege that she has been abused by force and that
she bied profusely, but on physical examination a few hours after
the alleged assault, no sign of physical injury was noticed on her
private organ.
4. Abrupt
Onset
of Symptoms:
DISTURBANCE OF MENTALITY
651
placing of the injured portion under plaster cast and the patient
may refuse because it may put him to some inconvenience.
A person may complain of some disturbance in the gastrointestinal tract but when prescribed magnesium sulfate, he refused to
take it.
Whenever a physician is requested to examine a patient to
determine whether he is malingering or not, he must utilize all
of his senses, have a keen observation and apply methods of
detection appropriate for the occasion.
Ways to Determine Malingering:
There is no specific test for a specific form of malingering. The
test applicable depends upon the demand of the occasion considering the attitude of the subject and the nature of the malingering.
The tests may be:
1. General Procedure The method is applicable to all forms of
malingering:
a. Observation of the subject during his unguarded moments:
A person cannot always be conscious that somebody is
observing him. He may for some moments unconsciously show
his normal condition and not exhibit the disability feigned.
b. Complete history and physical examination:
The history that may be narrated by the subject may not be
compatible with the result of the physical examination and the
manifesting symptoms are common among malingerers.
c. Application of general anesthesia.
d. Application of sudden unexpected minimal amount of electrical
stimulus.
2. Specific Procedure:
a. Feigning Blindness:
(1) Place a convex 12D lens before the "good" eye and a weak
concave lens (say 0.25D) before the "blind" eye and ask the
patient to read Snellen's test types from a distance of 6
meters. If he succeeds in reading it is a definite proof that
he is malingering, since it is impossible to read the type
through such convex lens.
(2) Place a lighted candle
patient, and a prism
before the good eye.
means that good vision
(3) Take a firearm and
towards the revolver,
LEGAL MEDICINE
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DISTURBANCE OF MENTALITY
653
Chapter XXXII
DRUG DEPENDENCE
1. Biosocial Factors Responsible for the Emergence of Drug Problems:
a. It is less than three hours flight westward from the Philippines
to the Golden Triangle, the primary source of opium supply
for legitimate and illegitimate use. From this source narcotics
have been transported all over the world and in some instances
the Philippine ports are used for transshipment. There are
several instances where opium has been discovered and confiscated in the airports allegedly en route to a foreign port.
b. The Philippines is endowed by nature with a humid, warm
tropical weather most conducive to luxuriant propagation and
growth of marijuana plant. This accounts for vast tracks of
land in the mountain region of the north yielding vigorous
plants and bountiful harvest.
c. A demographic study of our population revealed that a greater
part of our population is getting younger and younger. A great
number of our citizenry belongs to the age group most susceptible to marijuana.
d. The Philippines is a mirror image of America. There are reports
that in some states of the Union one out of four children is
drug dependent. This prevailing situation in the United States
is seemingly brought to our shores.
e. Men are by nature pleasure loving or hedonistic. The feeling
of euphoria, well-being, day-dreaming, hallucination, vigor,
illusion, develops whenever a person is under the influence of
drug.
Whenever a man intends to do something, he always
measures the amount of pleasure and pain that accompanies it.
f. The profit motive of the pushers, planters, and retailers is
another factor. In any human activity, profit and risk go hand
in hand. More risk more profit principles dominate human
action in periods of economic difficulties.
g. The gradual disappearance of the olden nuclear nature of the
the Philippine family and the emergence of a permissive society
. have contributed to the rise in drug problems.
( 1 ) The western system of less control of parents over children
has gradually become a fashion of time.
654
DRUG DEPENDENCE
655
( 2 ) The world's clamor to respect human rights has reverberated in all corners of the world.
( 3 ) The constitutional provision that "no person shall be
deprived of his right, liberty or property without due
process of law" has been extended in its application to
include almost everything.
h. As we enter another decade, we begin to feel the impact of the
discoveries, explorations, and researches done in the past.
Scientists have discovered new drugs for the purpose of alleviating human diseases or symptoms of diseases. Pain, a scourge
of mankind, is now a thing of the past. Exploration of the
deeper structure of man, organ transplantation, and control
of human behavior are now of common occurrence. Botanists,
pharmacologists, and pharmacognosists have delved deeper
into structures, contents, manner and site of action of the
potent, contents of the members of the plant kingdom. New
drugs have been synthesized, and have produced beneficial, as
well as deleterious effects on mankind.
D A N G E R O U S D R U G ACT
The provisions of the Revised Penal Code on crimes relative to
opium and other prohibited drugs (Art. 190 194) have been
repealed by Republic Act N o . 6425 as amended, otherwise known
as Dangerous Drug Act of 1972.
During the past decades opium and other allied drugs have been
considered to be the only drugs found to be harmful to mankind and
society so that they are the ones subjected to social control. But, in
the recent past, new drugs have been discovered to be naturally
existing while others have been synthesized which are equally or even
more harmful than opiates. It is therefore imperative to enact new
laws to include and intensify control on all drugs deleterious to
human beings and to society as a whole. In response to the social
demand, the Dangerous Drug Act of 1972 was passed by the defunct Congress of the Philippines.
A dangerous drug is a drug whose use is attended by risk and
therefore unsafe, perilous and hazardous to people and/or to a
society. A drug is any substance, vegetable, mineral or animal in
origin, used in the composition or preparation of medicine or any
substance used as medicine.
The Dangerous Drug Act has classified drugs which are subject to
control into prohibited drugs and regulated drugs. It did not define
what is a prohibited or what is a regulated drug. It merely enume-
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rates the drugs which are included in the category of prohibited and
those considered regulated drugs for the purpose of graduating
penalties. Violation of different acts relative to prohibited drugs has
higher penalties as compared with the same acts committed in violation of the regulated drugs. The classification is not based on their
pharmacologic effects but on societal reaction in the control on
specific acts of specific drugs. If society has a strong adverse attitude
against any drug, then it will be included in the enumeration of
prohibited drugs. The following drugs or group of drugs are considered dangerous and are governed, by the Dangerous Drug Act.
1. Prohibited Drugs:
a. Opium and its active components and derivatives, such as heroin
and morphine;
b. Coca leaf and its derivatives, principally cocaine;
c. Alpha and beta cocaine, hallucinogenic drugs, such as mescaline,
lysergic acid diethylamide ( L S D ) and other substances producing similar effects;
d. Indian hemp and its derivatives;
e. All preparations made from any of the foregoing; and
f. Other drugs, whether natural or synthetic, with the physiological effects of a narcotic drug (Sec. 2.2, N o . 1, R . A . 6425).
2. Regulated Drugs:
a. Self-inducing sedatives, such as secobarbital, phenobarbital,
pentobarbital, barbital, amobarbital and any other drug which
contains salt or a derivative of a salt of barbituric acid;
b. A n y salt, isomer or salt of an isomer, of amphetamine, such as
benzedrine, or any drug which produces a physiological action
similar to amphetamine; and
c. Hypnotic drugs, such as methaqualone or any other compound
producing similar physiological effects (Sec. 2. No. (2), R. A.
6425).
Any drug or group of drugs included in the classification may
cause a user to be drug dependent. Drug dependence means a state
of psychic or physical dependence, or both, on a dangerous drug,
arising in a person following administration or use of that drug on
a periodic or continuous basis (Sec. 2(g), R . A . 6425). Drug dependence may either be a condition of drug addiction or drug habituation.
1. Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug, whether synthetic
or natural, and found to be detrimental to the individual and to
the society ( W H O ) .
DRUG DEPENDENCE
657
PENALTIES UNDER
1. Prohibited Drugs
Prohibited Act
Penalty
Importation of prohibited
drugs.
Section
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7
Manufacture of prohibited
drugs.
Life imprisonment to
death and a fine of
20,000
to
30,000
pesos.
6 yrs. & 1 day to 12
yrs. imprisonment and
a fine of 6,000 to
12,000 pesos.
14 yrs. & 1 day to
life imprisonment, revocation
of
license,
and a fine of 14,000
to 30,000 pesos.
10
11
Unlawful prescription
prohibited drugs.
of
12
Unnecessary prescription of
prohibited drugs.
13
2. Regulated Drugs
14
Importation
drugs.
15
of
regulated
DRUG DEPENDENCE
659
16
17
18
Unlawful prescription
regulated drugs.
of
19
Unnecessary prescription of
regulated drugs.
Hypnotics.
Sedatives and Tranquilizers.
Hallucinogens and Psychomimetics.
Stimulants.
Deliriants and Intoxicants.
HYPNOTIC DRUGS
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LEGAL MEDICINE
DRUG DEPENDENCE
661
Stage of Stupor:
a. The person suddenly becomes quiet.
b. There may be headache, giddiness, lethargic condition and
uncontrollable desire to sleep.
c. When asleep, he can be aroused by external stimuli.
d. Pupils are contracted, face and lips are cyanosed.
e. There is itching sensation all over the skin.
f. Pulse and respiration are still normal.
Stage of Narcosis:
a. The patient passed into a deep coma.
b. He cannot be aroused by external stimuli.
c. Muscles are relaxed and reflexes are lost.
d. Skin secretion is completely suspended although the skin feels
cold and clammy.
e. The face is pale, the lips are livid and there may be a drop of
the lower jaw.
f. The pupils are contracted to almost a pinpoint and they're
insensible to light.
g. Conjunctivae are injected.
h. The pulse is slow, small and compressible.
i. Respiration is slow, labored and stertorous.
If dosage is lethal and no prompt and proper treatment is given,
the following symptoms of the toxicity may be observed:
j. Lividity of the face increases and pulse becomes slower, irregular and imperceptible,
k. Respiration becomes slower, feeble and later Cheyne-Stokes
and the patient may die of asphyxia.
1. The heart may beat for a while but later stop,
m. Convulsion may occur with the pupils dilated immediately
after death.
4. Consequences of Continuous Use of the Drug:
a. Development of tolerance to the drug. The drug is taken in
large quantity without producing any effect or without fatal
consequence.
b. Physical and moral deterioration.
c. Untruthfulness, dishonesty and mental deterioration.
d. When under the influence of the drug, he is calm and composed, but becomes restless and irritable when deprived of
the drug.
e. May develop constipation and intercurrent infection, like
tuberculosis.
f. Those who try to inject themselves develop scars and abscesses
in the skin.
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LEGAL MEDICINE
DRUG DEPENDENCE
663
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LEGAL MEDICINE
DRUG DEPENDENCE
665
Anxiety.
Involuntary twitching of the muscles.
Tremor of the hands and fingers.
Progressive weakness.
Dizziness.
Distortion of visual perception.
Nausea and vomiting.
Insomnia and loss of weight.
Precipitated drop of blood pressure on standing,
Convulsion of the grand mal type.
METHAQUALONE:
Methaqualone is a sedative drug in a smaller dose and a hypnotic
in a bigger dose. The effect is similar to barbiturates and action is
within 30 minutes after administration; the effect is for 6 to 10
hours. It has no analgesic effect but can potentiate the analgesic
effect of other drugs like codeine.
The hypnotic dose is 150
500 mg. and the fatal dose is probably 5 grams.
The symptoms of poisoning are nausea, gastric irritation, vomiting
muscle twitching, hypertonia, cardiac arrhythmia, tachycardia and
respiratory depression.
LEGAL MEDICINE
666
Most fatal poisoning results from the ingestion of drug in combination with other drugs. It is possible that the combination made
on the drug is more toxic than methaqualone alone due to potentiation.
Excretion of the drug is relatively slow so it is inevitable that the
drug will accumulate during multiple dosing.
Post-mortem findings are not specific and similar to barbiturate
poisoning.
Mandrax, a proprietary medicine commonly used by adolescent
drug dependents and contains 250 mg. of methaqualone with 25 mg.
of diphenhydramine, an anti-histaminic drug. The combination has a
powerful hypnotic effect and it is alleged to produce its effect by
selective action of the thalamico-cortical part of the ascending
reticular-activating system by reducing the inflow of sensory impulse
to an otherwise unaffected cortex. This results into a state of
indistinguishable form of normal sleep. The drug can also produce
anti-histaminic effect.
Psychological rather than physical dependence tends to occur
after several dosage.
Dependents sometimes complain about an
effect called "Stonewalling '. This means that several mandrax tablets
taken may cause insensitivity and drowsiness to such an extent that
the individual may walk into a wall or barrier or crash a motor
vehicle into a wall, an embankment or other obstacle.
1
H A L L U C I N O G E N S OR PSYCHOMIMETIC D R U G S
1. Classification:
a. Natural
Source
Amanita muscaria Mushroom
Banisteria caapi vine
Cannabis sativa Hemp
Catnip plant
Datura plant
Epena tree bark
Iboga plant root
Kaba Piper M. plant
Nutmeg tree seeds
Active principle
Unknown
Harmine
Cannabinols
Unknown
Scopolamine
Unknown
Ibogaine
Unknown
Myristicine
DRUG DEPENDENCE
Ololiuqui Morning glory
Peganum harmala plant
Peyote cactus
Piptadenia peregrina
Psilocybe Mushroom
Virola Nutmeg family
667
Lysergic acid
Harmine
Mescaline
Bufotenin
Psilocybin
Elemicin
b. Synthetic
Name
DET
DITRAN
DMT
DPT
LBJ
LSD
MDA
MMDA
PCP
PCPA
STP-DOM
TMA
Chemical Name
Diethytrytamine pipidylbenzilate
Pipidylbenzilate
Dimethyl tryptamine
N ( 1 ) N dipropyltryptamine
N ( C H 3 ) 3 piperidylbenzilate H C L
D Lysergic Acid Diamide
3, 4 Methylenedioxyamphetamine
5 methoxymethlenedioxyamphetamine
Phencyclidine
p-chlorophenylalanine
2, 5 dimethoxy 4 methylamphetamine
3, 4, 5, trimethoxyamphetamine
MARIJUANA.
Marijuana is a Mexican term meaning "pleasurable feeling".
Marijuana is a mixed preparation of the flowering tops, leaves, seeds
and stem of the hemp plant, Cannabis sativa. The plant may grow
from 3 to 10 feet high, but may grow as tall as 16 feet. The highest
quality of marijuana is derived from choice hemp grown in hot, and
humid places and from the mixture containing mostly of resin
covered tops and upper leaves. The flowering tops of both male
and female plants produce a sticky resin which contains Tetrahydrocannabinol or T H C , the major pharmacological active ingredient.
The potency of the mixture depends on the resin content and this
is determined mainly by the plant strain and also by the factors
involved in cultivation, harvesting and preparation of the crop.
There are many species of cannabis and other plants reported to
contain T H C . On a study, it's been reported that 117 of 350 plants
of cannabis contains 0% of T H C . Another study showed that the
THC content ranges from 0.04% to 6.1%.
Questions:
1. Does our local marijuana plant contain THC?
2. If so, how much does it averagely contain?
3. What will be the effect on the toxic contents if grown in high
mountain or in the lowland?
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DRUG DEPENDENCE
669
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LEGAL MEDICINE
DRUG DEPENDENCE
Cannabis Sativa in Western Medicine by T.H. Mikuriya.
Physician, 1656).
671
The New
The fact that many heroin addicts have smoked marijuana does
not establish a casual relationship between marijuana smokers and
opium addiction. The "stepping stone theory" is considered invalid
and that the progression to stronger drugs that occurs is a result of
personality and environmental factors and not dependent on the
pharmacological properties of marijuana (Acute and Chronic Toxicity of Marijuana by D.E. Smith, U. of California Press, 1969).
Marijuana does not cause aggressive criminal behavior. The
pacifying effect of marijuana makes the individual non-aggressive
rather than cause violent crime (Marijuana Problem by W.R. McGlothis, AmJ of Psychiatry, 125, 370, 1958).
There is no evidence that marijuana leads to sexual debauchery.
Marijuana is not an aphrodisiac. There were reports of greater
sexual enjoyment while high and the possible explanation is the
increase sensory awareness and the distortion of time which would
seem to prolong the duration of orgasm (Cannabis by W.H. McGlothin, The Marijuana Paper, Indianapolis, 411, 1966).
However, recent findings revealed that cannabis may act on
hormone regulators and produces impotence and temporary sterility.
Heavy marijuana smokers have lowered sperm counts and impotence.
Hormones such as leuteihizing hormone, anti-diuretic hormone,
growth hormone, and prolactin are also affected by marijuana
(Marijuana by Gabriel G. Nahas, JAMA Vol. 233, No. 1, Jul. 1975).
Marijuana also affects the body's cellular processes which include
reduction of the number of T-lymphocytes with the resultant interference in the immune process. There is also increase in the number
of cells with broken chromosomes (JAMA, Vol. 232,No. 9 June 2,
1975, p. 923).
Metabolism:
Marijuana has three major components: T H C , cannabidiol and
cannabinol. All of them have pharmacologic activity. Variance in
the amount of the active constituents has some bearing in the difference in pharmacologic activities.
The metabolism of cannabinoid takes place in the liver and possibly on other site, like the lung. The cannabinoids are rapidly
hydrolyzed into some form of 11-hydroxy compounds. A small
amount is found in the blood and there is a major metabolites
in the feces.
There is a rapid elimination of T H C from the blood during the
first 40 minutes, then a much slower elimination in the next 24
hours.
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LEGAL MEDICINE
L Y S E R G I C A C I D D I E T H Y L A M I D E ( L S D - 2 5 ; D ) Lysergic acid
diethylamide tartrate.)
The drug was first synthesized by Dr. Albert Hoffman and Dr.
Arthur Stell while working in a Swiss pharmaceutical firm. LSD is
synthesized from the alkaloids or ergot (Claviceps purpurea), a
fungus that parasitizes rye and other grains in Europe and America
and diethylamide portion of ergotamine ergonevine, the active
oxytocic and vasoconstrictor drugs.
The synthesis was found to
have strange and potent central effects.
It may be medicinally used in the treatment of alcoholism and
opium addiction and is the drug of choice to induce tranquility and
reduces the need for analgesic in cases of terminal cancer.
L S D is colorless, tasteless, odorless, usually in liquid form and
taken orally.
1. Symptoms:
a. Physiological Dilatation of the pupils, over-activity of reflexes,
increase of muscle tension, lack of coordination, visual disturbance, laughter.
b. Somatic Dizziness, weakness, tremor, nausea, drowsiness,
parasthesia (sensation of pricking, tingling or creeping of the
skin) and blurred vision.
c. Perceptual Alteration of shapes and color; music appreciation with abnormal intensity; focusing difficulty; sharpening of the hearing sense, recurrent voice accompanied by
brilliant hallucinatory color sensation (synesthesia or seeing
sound, hearing color, etc.).
d. Psychic M o o d alteration, tension, distortion of time sense,
difficulty in thought expression, depersonalization, dreamlike feeling and visual hallucination. Delusion of omnipotence
is common such that a user thinks he can fly from a high building. A number of deaths occur in this manner.
2. Dose and Tolerance:
It is more than 100 times more potent than psilocybin and
4,000 times more potent than mescaline in producing psychological effect.' L S D is a very potent drug. A dose of 15 microgram
can produce psychological effects. The normal dose is from 100
to 250 microgram.
L S D has the capacity to develop rapid tolerance. In a few days
of repeated use, a formerly effective dose will no longer cause a
response but physical and psychological dependence does not
develop.
DRUG DEPENDENCE
3. Untoward
673
Effects:
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LEGAL MEDICINE
Gates"
include
effect,
intense
nausea,
Mescaline produces effects similar to L S D but less potent. Although it may produce vivid hallucination, psychotic reactions are
far less common as compared with L S D .
MUSHROOM-PSILOCYBIN - This is available in powder and
liquid form and extracted from mushroom (psilocybe) which grows
in Mexico. The effect is similar to mescaline.
DATURA An anti-cholinergic agent and a constituent of "Asthmador", an over the counter preparation for asthma. High dose
induces disorientation, confusion, hallucination and eventually coma.
Other signs of mydriasis, tachycardia, decreased salivary action,
urinary retention and warm, flushed skin are also observed.
NUTMEG (Myristica) It is the powdered seed kernel of the East,
Indian Tree, Myristica fragrans, which contains a hallucinogenic
substance thought to be myristicin. When ingested it produces
euphoria, hallucination and acute psychotic reaction.
The side
effects are similar to that of atropine, but nutmeg produces early
pupillary constriction.
STIMULANTS
AMPHETAMINES:
Amphetamine was first synthesized in 1927 as a substitute for
epinephrine which was isolated from the adrenal gland and from
ephedrine obtained from the Chinese herb ephedra vulgaris.
The Most Common Preparations of Amphetamine in the Market are:
1. Dextreamphetamine (Dexedrine) also called "co-pilot", "dexies",
or "orange".
2. Amphetamine (Benzedrine) also called "bennies", "splash",
"peaches".
DRUG DEPENDENCE
675
676
LEGAL MEDICINE
COCAINE:
Cocaine is an alkaloid from the leaves of the coca shrub cultivated extensively in Bolivia and Peru. It is also grown in Java,
Taiwan and Sri Lanka. The leaves are harvested from the plant not
less than 10 months old. The matured leaves are plucked, dried and
packed in bales.
Cocaine may be taken by injection, by chewing or by sniffing of
crystals through the nostrils.
The coca leaf is chewed by many
DRUG DEPENDENCE
677
Indians of the Andes for its stimulating effects and also for depressing appetite. Repeated sniffing of cocaine crystals into the nasal
passage may cause gradual erosion and perforation of the nasal
membrane.
Cocaine stimulates the sympathetic system causing increased
pulse rate, dilatation of the pupils and perspiration. It is a euphoriant and speedily relieves fatigue. Cocaine is said to cause sexual
excitement and the drug therefore is popular among the undersexed
or sexual perverts.
Tolerance to the drug is slow and dependence tends to be psychological rather than physical.
If cocaine is taken for a period of time, especially in excessive
dosage, it may cause pallor, poor appetite, salivation, loss of weight,
and damage to the nasal membrane and cartilage in sniffers. Cutaneous scars of old injection sites may be evident and habitual cocaine
eaters develop black teeth and tongue.
Magnan's Symptom or the feeling as if grains of sand are lying under
the skin or small insects (cocaine bugs) are creeping on the skin is
the most characteristic symptom.
It has been reported that cocaine leads to erotic tension in women.
Death may be due to epilepsy or respiratory failure.
The drug when withdrawn from the user may cause withdrawal
symptoms in the form of insomnia, reactive depression, and paranoid
attitudes which may lead to paranoid psychosis.
Users of cocaine recently combine it with heroin called "mixing
the gravy" to counteract lethargy and social isolation effect of
heroin.
Medically the use of cocaine has markedly declined and its major
use is only as anesthesia of the nose and throat. On account of the
disadvantages observed in the use, the synthetic procaine becomes
the wildly used substitute under the trade name of novocain.
Prostitutes inject a solution of cocaine into the vagina.
This
gives the individual a sense of local constriction and exhilarating
systemic feeling.
In men cocaine is applied locally to the glans
penis to increase the duration of the sexual act. It may cause sexual
perversion especially in homosexuality or in libidinous outrages.
In fatal dose, death is due to cardiac or respiratory failure.
Cocaine "body packer" Syndrorpe refers to the ingestion of
multiple small packages of cocaine for the purpose of transporting
the contraband. The drug is placed in a durable, non-digestible
container, taken by mouth to be recovered at the place of destination in the fecal discharge. Aside from human beings, the pack-
678
LEGAL MEDICINE
ages are fed to camels or ducks. In the case of ducks they are slaughtered to retrieve the drug. Rupture of the container while in the
alimentary tract with consequent cocaine poisoning has been reported
in literature.
DRUG DEATH:
Drug related death may be classified into three categories:
1. Primary drug fatalities those which death is due to the toxic
or adverse effect of the chemical agent, with or without the contributory influence of pre-existing, unrelated natural disease.
2. Secondary drug fatalities those arising from medical complications of drug abuse, such as viral hepatitis and bacterial endocarditis.
3. Drug-associated fatalities those caused by homicidal, accidental
and suicidal violence stemming directly or indirectly from activities related to the obtaining and use of illicit drugs.
The qualitative and quantitative determination of the dangerous
drug in the human body or the pathologic changes in organs cannot
be utilized as the basis of the cause of death. There are other
factors to be considered which may be responsible for the death:
1. The decedent may be usually susceptible to the deleterious effect
of the drug;
2. The combination of the drugs taken can interact in an additive
fashion;
3. Some pre-existing natural disease may have contributed to the
death;
4. The rapid absorption of large quantity of the drug can kill prior to
complete absorption of all the substance from the gastro-intestinal
tract;
5. Normal metabolic degradation of the chemical can reduce its
blood concentration during the prolonged survival interval in
which respiratory complications and hypoxic encephalopathy
maintain coma and act as the immediate cause of death.
(Modern Legal Medicine,
Curran, et. at., p. 1129).
Psychiatry
and
Forensic
Science
by
DRUG DEPENDENCE
679
Addition of one drop of glacial acetic acid to the chloroform, water system will:
(a) Destroy the purple color of the chloroform layer and
change it to a very weak blue if the sample contains the
free acid or sodium salt of a barbiturate:
( b ) Reduce the color of the chloroform layer to a faint
green if the sample contains the free acid or sodium
salt of a thiobarbiturate. On further addition of the
acid the color will change to a light yellow green.
c. Marijuana:
Duquenois-Levine test Solution A is a mixture of 2%
vanillin and 1% acetaldehyde in ethyl alcohol; solution B is
concentrated hydrochloric acid; and solutions A , B and C are
added respectively to the suspected material. A positive result
is shown by purple color in the chloroform layer.
680
LEGAL MEDICINE
d. LSD:
Van Urk test (1% p-dimethylaminobenzaldehyde and 10%
concentrated hydrochloric acid in ethyl alcohol). This reagent
turns blue-purple in the presence of L S D . However, owing to
the extremely small quantities of L S D in illicit preparations,
this test is difficult to conduct under field conditions.
e. Cocaine:
Cobalt Thiocynate test (2% cobalt thiocyanate in water).
This reagent produces a blue flaky precipitate in the presence
of cocaine. The test is not reliable as many other drugs and
diluents respond in the same manner.
4. Chromatography:
a. Thin layer chromatography.
b. Gas chromatography.
In both methods the drug is separated from the diluent while
providing for its identification.
5. Spectrometry:
Selective absorption of light by drugs in the UV (Ultra-violet)
and IR (Infra-red) regions of the electromagnetic spectrum. UV
spectrum is not conclusive for the positive identification of drug
because other drugs may very well produce an indistinguishable
spectrum, but may be useful to establish the probable identity
of the drug.
IR spectrophotometry can specifically identify substances, but
the substance to be identified must be in pure form. A combination of preliminary screening by UV followed by verification
through infra-red spectrophotometry is the most ideal approach to
drug identification.
DELIRIANTS
Drugs which cause delirium, intoxication and other mental and
psychic disturbances when the toxic vapors and fumes are inhaled
are not covered by the Dangerous Drug Act of 1972 as amended,
hence Presidential Decree N o . 1619 was promulgated on July 23,
1979.
Drugs included in P.D. 1619:
Volatile substances including any liquid, solid or mixed substance
having the property of releasing toxic vapors or fumes containing
one or more of the following chemical compounds:
Methanol
Stryene
Ethanol
Napthalone
Isopropanol
N-pentane
DRUG DEPENDENCE
Ethyl acetate
N-propyl acetate
N-butyl acetate
Acetone
Methyl ethyl ketone
Methyl butyl ketone
Benzene
Tolouene
Xylene
681
N-hexane
N-heptane
Methylene Chloride
Trichloroethylene
Tetrachloroethylene
Nitrous oxide
Dichlorodiflouremethane
Isoamyl nitrate
Chloroform
682
LEGAL MEDICINE
DRUG DEPENDENCE
7.
8.
9.
10.
683
684
LEGAL MEDICINE
DRUG DEPENDENCE
685
Loss^of
Prescription Forms
for
No.
686
LEGAL MEDICINE
Chapter XXXIII
ALCOHOLISM
Ethyl alcohol ( C H O H , Ethanol, grain alcohol) i> a colorless
transparent, volatile liquid with aromatic odor and with boiling
point at 7 8 C . Like any other types of alcohol, it is formed out
of the fermentation of various carbohydrates in grains, fruits or
flowers, and from other materials subjected to and isolated by
distillation.
2
Ethyl alcohol is commonly used as solvents, antiseptic and beverage. When ingested, it does not require digestion before absorption.
Although the word "alcohol" refers to a large group of chemical
compounds in possession of hydroxyl radical ( O H ) , whenever alcohol is used as part of a beverage, it refers to ethyl alcohol.
Alcoholic beverages are primarily a mixture of water and ethyl
alcohol with small amount of other substances which impart the
characteristic odors and tastes. These substances are called "congeners" since they are simultaneously produced during the fermentation process.
The congeners consist of organic acids and
esters or even other types of alcohol. It is the congener content
that imparts the so called "odor of alcohol" among drinkers.
A drunkard is a 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.
A habitual drunkard is 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. (People v. Amenamon, 37 O.G. No.
114, p. 2324).
Classification of Commercially Available Alcoholic Beverages:
1. Wine A product of natural alcoholic fermentation with wide
variety of sugary materials including fruit juices and contains not
less than 7% but not more than 17% of alcohol by volume. In
fermented beverages the alcohol content is expressed in volume
percent.
687
688
LEGAL MEDICINE
ALCOHOLISM
689
690
LEGAL MEDICINE
shall contain not less than 2% and not more than 10% by
volume of alcohol.
ALCOHOLISM
691
692
LEGAL MEDICINE
ALCOHOLISM
693
intestinal wall.
Warm drinks dilate gastric capillaries to cause
more absorption.
6. The optimum concentration of alcohol in beverages between 10
to 20% is the most rapidly absorbed.
After absorption, alcohol is distributed throughout the body in
proportion to the water contents.
Parts of the body with more
water content (blood, urine, brain, liver, kidney) have the highest
concentration while those with low water contents (fat, bone) have
the lowest concentration.
Pharmacologic Effects of Alcohol:
Ethyl alcohol depresses the central nervous system in descending
order from the cerebral cortex to the medulla oblongata. It causes
depression or temporary functional paralysis of the ganglionic cells.
The more specialized the cells are, as in the cerebral cortex, the more
sensitive they are to alcohol. A moderate dose will cause disturbance
in the intellect and fine muscular movement, but bigger doses will
involve depression of the ganglion cells of the lower brain centers in
the basal ganglia and brain stem causing the person to be stuporous
and even comatose.
Effects on the Special Senses:
1. Vision With increasing amount of alcohol intake the acuity is
progressively diminished to the point where vision to obscure to a
degree comparable to wearing dark sunglasses at night. There is
diminution of the peripheral vision similar to that of a person
viewing an object by means of a binocular (tunnel vision), the
amount of blood alcohol is somewhere between 100 to 200 mg.,
ocular coordinator is impaired and diplopia develops.
2. Hearing The increasing amount of alcohol intake diminishes the
ability of the individual to perceive and appreciate varying intensities of sound. This is the very reason why in a drinking party at
the start of the drinking the conversation is in a low tone, but as
the alcohol level in the blood increases the group tends to talk
louder. This also accounts for the tendency of drivers not to perceive the sound of horns and train whistles when intoxicated and
to become more prone to vehicular accidents.
3. Touch The sense of touch is diminished with the increased
amount of alcohol intake.
The blunting of touch sensation is
responsible for frequent cigarette burns on the hand of chronic
alcoholics.
4. Taste There is a decrease in the sense of taste. When a person is
drunk, all food taste good.
LEGAL MEDICINE
694
5. Smell The perception of smell is depressed by alcohol. Malodorous substances may be undetected by those under the influence of alcohol.
"Proprioception" or the so-called "sixth sense" is also impaired.
Blunting of judgment is one of the first mental functions affected
by alcohol.
This leads to automobile accidents, poor business
decisions, gambling losses, fights and injuries.
The faculty of attention deteriorates rapidly and this is the principal reason why individuals even with low level of alcohol end up
as traffic victims.
Motor skills are also impaired progressively with increasing amount
of blood alcohol. Reaction time is prolonged.
Ability to hear is blunted and recall memory is often markedly
disturbed.
Moral standard is blunted and lowered, and there is a tendency to
distort reality.
It increases the desire for sex but markedly impairs the performance; a prolonged intercourse without ejaculation is often the
result (Legal Medicine Annual 1969, pp. 241-268).
Other Effects:
1.
2.
3.
4.
ALCOHOLISM
695
696
LEGAL MEDICINE
ALCOHOLISM
697
698
LEGAL MEDICINE
ALCOHOLISM
699
consumed
700
LEGAL MEDICINE
Ounces of
Blood alcohol
body weight x 0.68 x concentration
0.8
ALCOHOLISM
701
by
Gonzales,
Vance,
702
LEGAL MEDICINE
ALCOHOLISM
703
704
LEGAL MEDICINE
ALCOHOLISM
705
706
LEGAL MEDICINE
1. Analysis of Blood:
Analysis of the blood is probably the most widely accepted
way to determine the concentration of alcohol in the body.
It is a direct method of estimation although the subject may
refuse blood extraction for such analysis.
Alcohol should not be used to sterilize the skin before withdrawal for it might possibly give a false high reading. The blood
sample must be drawn by a physician, nurse or other competent
technician under sterile condition.
On account of the great
number to be tested, especially those traffic violators, it makes
the blood analysis quite impractical.
2. Analysis of the Breath:
The concentration of alcohol in the blood can be determined
indirectly by making a quantitative determination of alcohol in
the respired air. The basis of the analysis is that there is a constant
ratio between the concentration of alcohol in the blood stream
and in the alveolar air.
707
ALCOHOLISM
Insofar as breath alcohol determination is concerned, the following are the available instruments.
Device &
Manufacturer
Method of
Detection
Alcolyzer
(Intoximeters, Inc.)
Bect-ton-D ickenson
(Becton-Dickenson)
Chromic Acid
Kitigawa Drunk-OTester
( K o m o Chemical
Industrial Company)
Chromate salt in acid
Sober-Meters SM-1,
SM-6 SM-9 and SM-9A
(Luckey Laboratories)
Alco-Halt
Catalytic combustion
(Mine Safety Appliance
Co.)
Bat III
(Century Systems,
Inc.)
Catalytic combustion
Indicator
Response
Color Change
Orange-yellow
to green
Color change
Orange-yellow to
green
Color change
Orange-yellow to
blue-gray
Color change
Orange-yellow to
green
Lights-pass or fail
Pointer-warn
fail
or
A . L . E . R . T . , Model
Taguchi Mos ConducJ3A (Alcohol Counter
tor
Measures, Inc.)
Lights-Pass, warn
or fail
Alco-Sensor
(Intoximeters, Inc.)
Fuel cell
Lights-Pass, warn
or fail
Alco-Sensor II
(Tntoximeters, Inc.)
Fuel cell
Digital readout
708
LEGAL MEDICINE
ALCOHOLISM
709
710
LEGAL MEDICINE
ALCOHOLISM
711
Chapter XXXIV
MEDICO-LEGAL ASPECT OF POISONING
Definition of Poison:
A poison is anything other than physical agencies which is capable
of destroying life, either by chemical action on the tissues of the
living body, or by physiological action by absorption into the living
system.
Legally, a poison is a substance which, if applied or administered
internally, has been applied or administered with the intention to kill
or to do harm.
The intent in the administration is the essential element in law.
The quantity does not affect culpability, nor is the law concerned
with the quantity in which the substance acts.
(From: A Synopsis of Forensic Medicine & Toxicology by E. W.
Caryl Thomas, 2nd ed., p. 142).
In cases of suspected poisoning, it is not advisable to confine the
toxicological analysis to the stomach and its contents because:
1. The gastrointestinal tract is only one of the means of entry of
poison into the body. It is possible for poisonous substances to
gain entry by inhalation, by absorption through the skin, by intravenous, intramuscular and subcutaneous injection, or by introduction into the vagina or rectum. Analysis of the gastric content
would not eliminate poisoning as a factor when poison gains
entrance into the body via other route.
2. Even if the poison was taken orally, after a significant period of
time (4 to 6 hours) has elapsed from ingestion to death, the
poison might have passed out of the stomach and could no longer
be present in identifiable amount.
3. If analysis of the gastric contents disclosed presence of possible
toxic substance, it is possible that the said poison could have been
introduced post-mortem to conceal the real cause of death.
4. Except in cases of poisoning by strong corrosive agent, there must
be a demonstration of absorption of the poisonous agent. This
can be shown by the presence of the toxic materials in other
organs or parts of the body.
712
713
Action:
LEGAL MEDICINE
714
Putrefaction:
a. Most volatile compounds are lost as a result of putrefaction.
b. Putrefaction of normal tissue components may produce substances which yield chemical reactions similar to those obtained
from toxic compounds.
c. Some substances, like alcohol and cyanide, may be produced
in the process of putrefaction of normal components.
d. Many substances which might be present in the tissue may
undergo chemical changes and may no longer respond to the
identifying test made for them.
Minimum Amount
mination:
1. Brain
2. Liver
3. Kidney
4. Stomach content
5. Spleen
6. Urine
7. Blood
8. Bile
One hemisphere
500 gms.
One whole kidney
50 gms.
Whole spleen
All avilable up to 100 cc.
100 cc.
AH available
715
Organs to be Submitted
Liver, kidney, stomach contents
Liver, urine, hair
Blood, liver, kidney, urine, brain
Stomach and liver
Blood placed in a sealed container
Stomach and contents, esophagus
Stomach and contents, liver, urine
Brain, liver, kidney, urine
Stomach, liver, kidney
Kidney, liver, bone
Liver, kidney, stomach
Stomach and contents, liver, blood
Liver, blood
Brain, liver, lungs, blood
Method of Administration:
Poisons may enter the body in the following ways:
a. Orally:
Except irritants and corrosives, poisons must be digested or
absorbed in the gastric or intestinal mucosa before producing
effect.
b. Hypodermically:
Poison reaches the blood stream without passing the digestive
organs. This method is only available for such substances that
are soluble in the lymph and tissue juices.
c. Intramuscularly:
Absorption is faster than in the hypodermic method.
d. Endodermically:
The poison may be rubbed into and absorbed through the
skin.
e. By Rectum, Vagina or Bladder:
Absorption through the rectum is about twice as much as
absorption through the mouth.
f. By the Lungs:
Poison through this route may be made of a substance which
can be transformed to gaseous state.
716
LEGAL MEDICINE
2. Idiosyncrasy:
Some persons possess sensitivity to certain foods or drugs. The
most common drugs are potassium iodide, arsenical preparations,
aspirin and the sulfas. As to foods, the most common are fish,
shrimps, eggs and oysters.
3. Age:
There are substances which are considered poison for babies but
wholesome for adults, while the opposite is true for other substances.
There are substances which children can take more than the
proportionate dose in adults, like mercury and belladonna. In case
of some other drugs, children may be so sensitive that they cannot
take the proportionate dose for their age, like opium preparations.
4. Habit:
The body may acquire tolerance to some drugs. Habit diminishes
the effect of certain poisons. Tobacco, alcohol, opium, barbiturates, arsenic are good examples of this.
5. Dose:
The effect of drugs and poisons in the body is usually proportional to the dose taken.
Example: Alcohol, when taken in small dose, stimulates body
reflexes and tone, while large amount depressed the
whole body.
Fatal Dose:
This is the smallest dose known to cause death:
smallest amount which will certainly cause death.
not the
717
Cowling's Rule:
Divide the age of the child on his next birthday by twenty-four
and the fraction of the adult dose is to be used.
Example: If the child is 8 years old, then 8/24 equals 1/3 of
the adult dose.
Gabius stated a series of fractions of the adult dose which may be
used for different ages:
For a child one year or less
2 years
3 years
4 years
7 years
14 years
20 years
Above 20 years
1/12
1/8
1/6
1/4
1/3
1/2
2/3
For adult dose
LEGAL MEDICINE
718
Poison
Disease
Coma
Collapse
Diphtheria,
Fever,
Delirium
Belladonna,
Hyoscyamus, Cannabis, Alcohol,
Camphor.
Paralysis
Convulsion
N u x vomica, Arsenic,
Antimony.
Analine, Antifibrin
Atropine, Hyoscyamus,
Aconite, Alcohol, Conium, Chloroform.
Belladonna,Hyoscyamus
Tetany,
lepsy.
Cyanosis
Enlarged pupil
Dry skin
Cholera,
Hysteria,
Epi-
719
Vomiting
Acute rheumatism.
Purgation
Colic
Volvulus, Obstruction.
Lead,
Cholera, Diarrhea.
Cramp
Arsenic,
Anti-
mony.
(From: A Synopsis of Forensic Medicine & Toxicology by E. W.
Caryl Thomas, 2nd ed., p. 147).
TREATMENT
POISONING:
OF
PATIENT
SUFFERING
FROM
ACUTE
Tube:
LEGAL MEDICINE
720
c. Physical Reaction:
100
88
40
100
parts
parts
parts
parts
721
LEGAL MEDICINE
722
Examination:
(1) The bodily openings must be noted for any peculiar smell
characteristic of some poisons.
Examples: Carbolic acid, hydrocyanic acid, phosphorus,
chloroform, etc.
(2) The tongue, mouth and esophagus must be examined for
inflammation, erosions and stainings.
( 3 ) The larynx, trachea and bronchi must be opened to see the
effect of volatile irritants.
( 4 ) Examination of the stomach:
(a) The color of the stomach wall may sometimes indicate
poisoning by certain drugs.
Examples:
Mercury usually produces a slate-color stain.
Arsenic may produce white particles adherent to
possible yellow sulfides.
Strong sulfuric acid and concentrated oxalic acid
may produce blackened or charred wall.
Hydrochloric and carbolic acids produce white wall.
However, the color changes may be due to food,
bile or post-mortem changes.
( b ) Ulceration:
Strong corrosive may produce ulceration of the wall.
This must be differentiated with simple ulcer and cancerous growth.
(c) Actual perforation:
This may be found in poisoning by strong mineral
acids, especially sulfuric acid.
It must also be differentiated from perforation brought about by disease
of the wall.
( d ) Softening:
Usually found in poisoning by strong alkaline irritants. It must be differentiated from post-mortem
digestion of the stomach wall.
723
Organs Required
LEGAL MEDICINE
724
Minimum Amounts
Indications
Bile
Blood
All available
20 to 30 ml.
Brain
100 gm.
Fat
100 gm.
Hair
Fingernail clipp i n gs
or
whole nails
As much as possible
I n t e s t i n a l con- 30 gm.
tents
In
Kidney
100 gm.
Liver
100 gm.
Lung
1 lobe
Muscle
100 gm.
Spinal fluid
All available
Spleen
25 gm.
Stomach contents
All available
Urine
All available
Vitreous
humor
instances
in which
poison presumably was
taken orally.
725
d. Carbolic Acid
e. Oxalic Acid
2. Caustic Alkalies:
a. Potassium Hydroxide
b. Sodium Hydroxide
c. Ammonia
3. Compounds:
a. Zinc Chloride
b. Antimony Trichloride
B. Irritants:
1. Non-metals
2. Salts of Metals
3. Vegetable Irritants:
a. Castor oil
b. Digitalis
c. Belladonna
d. Croton Oil, etc.
LEGAL MEDICINE
726
4. Animal Irritants:
a. Cantharides
5. Food Irritants
C. Narcotics:
1. Somniferous Group:
a. Opium
b. Chloral
2. Deliriant:
a. Belladonna
b. Hyoscyamus
D. Depressants:
1. Neural Depressant:
c. Synthetic Hypnotics
c. Stamonium
d. Cocaine
a. Aconite
b. Conium
2. Cerebral Depressants:
a. Hydrogen Cyanide
c. Laurel Water
c. Camphor
d. Arseniureted Hydrogen
e. Carbon Disulfide
2. Irrespirable Gases:
a. Chlorine
b. Benzene
c. Hydrogen Cyanide
G. Contact Poisons:
1. Vegetable Irritants
2. Animal Irritants
3. Chemical Irritants
H. Vulnerants:
1. Nails
2. Broken Glasses
3. Dust
727
The Forensic Chemistry Division of the National Bureau of Investigation, Department of Justice made the following classification
based on the Chemical Standpoint:
A . Gaseous Poisons (Poisons Present in the Gaseous State):
Carbon dioxide; Carbon monoxide; Hydrocarbons; Hydrogen
sulfide; Sulfur dioxide; the Oxides of nitrogen (Nitrous oxide,
Nitric acid and Nitrogen dioxide); war gases.
B. Inorganic Poisons:
1. Corrosives (Poisons characterized principally by an intense and
destructive action a few organic corrosives are included in
this group for the sake of completeness):
a. Acid; Mineral and Organic:
Sulfuric acid; Hydrochloric acid; Nitric acid; Oxalic acid;
Acetic acid.
b. Alkaline Corrosives:
Potassium hydroxide; Sodium hydroxide; Calcium oxide;
Ammonium hydroxide.
c. Halogens:
Chlorine; Bromine; Iodine; Fluorine.
d. Corrosive Metallic Salts:
Silver; Zinc.
e. Organic Corrosives:
Phenol; Pyrogallol; Formaldehyde.
2. Metallic Poisons and Salts: (These chemicals are protoplasmic
irritants, but their chief action is the deleterious effect produced after absorption into the system.)
a. Heavy Metals:
Phosphorus; Antimony; Arsenic; Bismuth; Mercury; Lead;
Radioactive substances; Thallium; Gold; Osmium; Platinum;
Nickel; Chromium; Tin; Vanadium.
b. Inorganic Salts:
Alum; Alkaline earths; Magnesium sulfate; Lithium salts;
Potassium salts; Boric acid and borax; Tellurium; Sodium
silicate.
C. Organic Poisons:
1. Volatile Poisons (Volatile liquids or easily sublimated solids
many of which are irritants; their chief action occurs after
absorption):
a. Alepathic Compounds:
Methyl alcohol; Ethyl alcohol; Fuel oil; Amyl
alcohol;
728
LEGAL MEDICINE
Tertiary or Dimethyl carbinol; acetaldehyde; Paraldehyde;
Methyl chloride; Methyl bromide; Tribromoethanol; Ethyl
chloride; Ethyl bromide; Ether; Chloroform; Bromofonn;
Chloral hydrate; Carbon tetrachloride; Tetrachlorethane;
Amyl nitrite; Nitroglycerin; Carbon bisulfide; Hydrocyanic
acid and the cyanides; Paraffin hydrocarbons.
b. Atomic Compounds:
Benzene series; Essential oils.
729
D. Miscellaneous Poisons: (Associated with botulism; food poisoning; mushroom poisoning; snake venom poisoning).
1. Food Poisoning:
Toxic substances in the food; Abnormal hypersensitivity to
normal constituents of food.
2. Poisonous Plants.
3. Poisonous Animals and Their Poisons:
Arachnids; Centipedes; Insects; Caterpillars; Vertebrates.
4. Biological Products.
5. Ground Glass.
FOOD POISONING
Food poisoning is a state of ill-health resulting from food which
has some abnormal or noxious content.
Food May Cause Disease in the Following Ways:
1. Lack or excess.
2. Unbalance proportion of proper constituents.
3. Absence of certain constituents, including vitamins and specific
proteins.
4. Idiosyncracy. The most common reaction occurs in the gastrointestinal tract in the form of nausea and vomiting. The sensitivity
may be manifested in the form of rashes.
5. Presence of abnormal constituents:
a.
b.
c.
d.
e.
f.
730
LEGAL MEDICINE
Symptoms:
a. Vomiting and diarrhea.
b. Abdominal pain.
c. Prostration.
d. Collapse with cold sweating.
e. Rigor with pain at the back and limbs.
f. Headaches and dizziness.
Post-mortem Examination:
a.
b.
c.
d.
e.
Bacteriology:
The members of the salmonella group which may cause food
poisoning are:
a.
b.
c.
d.
B.
B.
B.
B.
Enteritidis
Paratyphosus A
Paratyphosus B
Aertryke
e. B. Suipestifer
f. B. Psittacosis
g. B. Abortus equi
Botulism:
This is a specific infection in which symptoms arises from the
ingestion of a very potent exotoxin of anerobic Clostridium botulinum.
Poisoning is usually due to ingestion of food stored and
prepared in unsatisfactory conditions and eaten without cooking.
LAWS O N POISONS A N D O T H E R POISONOUS
SUBSTANCES IN THE PHILIPPINES
731
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. 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.
732
LEGAL MEDICINE
POST-MORTEM F I N D I N G S IN SOME
CHEMICAL POISONING
A. Sulfuric Acid:
1. External Appearance:
a. Putrefaction is frequently delayed.
b. There are cutaneous stains in areas where the corrosive liquid
has been spilled. The stains are frequently found in the angles
of the mouth and running in a linear fashion from the posterior part of the lips to the chin.
c. The outer layers of the skin are destroyed and the derma is
parchmentized, while the deepest layer is reddish-brown in
color.
d. The lips may be blackened.
e. The tongue and mucous membrane of the mouth may be
softened, corroded and white in color.
2. Internal Appearance:
a. Internal findings are usually confined to the changes due to
the local action of sulfuric acid.
b. Cardio-Vascular System:
( 1 ) The aorta may be found with the outer wall blackened
and corroded.
( 2 ) The blood in the vessels may be coagulated and hardened. This produces black arborescent cast in the smaller
vessels and in their branches and larger cylindrical casts
in the vessels of greater caliber.
c. Respiratory System:
( 1 ) The epiglottis may be blackened and shrunkened.
( 2 ) The mucous membrane of the larynx and trachea may be
swollen and congested.
( 3 ) Death may be due to asphyxia when acid has been
inspired.
( 4 ) The diaphragm may be perforated after the escape of the
acid into the peritoneal cavity.
(5) The surface of the lungs and pleura is then tough, leathery
and stained brown.
d. Digestive System:
( 1 ) Mucous membrane of the pharynx is gray and may be
softened. Patches of brownish color are scattered in the
pharynx due to the effusion of dark-colored blood.
733
LEGAL MEDICINE
734
2. Internal Appearance:
The only changes are those due to the local action of the
alkali.
a. Pharynx is lined by softened and hyperemic mucous membrane.
b. Edema may be considerable especially at the opening of the
larynx.
c. Esophagus is corroded in its upper part.
d. Peritoneal surface is pale and blood vessels are filled with
dark fluid blood.
e. Stomach contents are viscid, turbid fluid.
f. The mucous membrane of the stomach at the region of the
cardiac end is brownish-red in color, uneven and hardened.
g. The wall of the stomach is edematous and with a soapy feel.
h. The entire length of the intestine is congested.
i. Larynx and trachea are inflamed and congested.
j . Bronchial tree is congested and contains viscid mucous.
E. Ammonia (Ammonium Hydroxide):
1. External Appearance:
Lips, mouth, pharynx and larynx are inflamed with patchy
erosion of the mucous membrane.
2. Internal
Appearance:
735
Appearance:
LEGAL MEDICINE
736
737
b. Respiratory System:
( 1 ) There may be ulceration of the nasal septum.
(2) Bronchitis may be present.
c. Digestive System:
( 1 ) Tongue may be coated.
( 2 ) Mucous membrane of the stomach is inflamed with
ulcerative patches. The whole surface is covered with
tenacious mucous with blood or blood streaks.
( 3 ) Mucous membrane of the duodenum and upper part of
the jejenum, ascending colon and rectum are inflamed.
( 4 ) Peyer's patches are swollen and minute ulcerative areas
are common.
d. The liver is enlarged and shows advanced fatty changes.
e. The kidneys are enlarged. On section, the cortex is swollen
and pale.
L Mercury (Perchloride and Nitrate Salts):
1. External Appearance:
If the salts (perchloride or nitrate) of mercury has been taken
by mouth, it produces corrosion of the epithelium and swelling
of the lips.
2. Internal
Appearance:
a. Digestive System:
(1) The mucous membrane of the mouth is softened, whitish
and sodden-looking.
( 2 ) The esophageal mucosa is corroded, softened and inflamed in patches.
(3) The muscular coat of the stomach is contracted and the
mucous membrane is thrown into folds. The surface is
converted into a grayish-white layer. The mucous membrane is reddened and with dark ecchymosis. There are
areas of necrosis with white color and those that are
found at the cardiac and pyloric end are easily detached.
(4) The small intestine shows severe inflammation. It takes
the form of diphtheritic enteritis and this is most prominent at the cecum.
(5) The whole of the large intestine shows severe inflammation. The mucous membrane is thickened and' the
contraction of the muscles made it thrown into folds.
The summit of the folds is converted into a grayishwhite necrotic layer. The rest of the mucosa is deep red,
swollen and soft.
LEGAL MEDICINE
738
b. Renal System:
Emaciation.
Skin shows icterus.
Parotid glands are sometimes enlarged.
Wasting of the muscles of the shoulder, arm and forearm.
Gouty tophi and arthritis or simple effusion of fluid may be
found in joints.
2. Internal
Appearance:
739
Organs:
LEGAL MEDICINE
740
d. Respiratory System:
(1)
(2)
(3)
(4)
e. Digestive System:
( 1 ) Mucous membrane of the pharynx, esophagus and
stomach is apparently normal, but may be congested.
(2) Subserous ecchymosis is present.
(3) If potassium cyanide is taken, the stomach may be
wrinkled, reddish-brown in color and the blood vessels in
the wall are distended.
f. Congestion with edema of the brain.
g. Other organs do not show any gross changes.
APPENDIX
BASIC PRINCIPLES OF PHILIPPINE CRIMINAL L A W
C R I M I N A L O R PENAL L A W DEFINED:
Criminal or Penal L a w is 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 R E V I S E D P E N A L
CODE and in the penal provision of other statutes.
The Revised Penal Code took effect on January 1, 1932. ( A r t . 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)
( e ) Felonies defined under different title ( A r t . 114-367).
Characteristics of Penal Laws:
( 1 ) It must be general:
The penai 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 enforcible 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.
A P P L I C A T I O N OF THE PROVISIONS OF THE REVISED PENAL CODE:
Except as provided in the treaties and laws of preferential application,
the provisions of 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
743
LEGAL MEDICINE
744
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:
a. The Philippine consents that the United States shall have the
right to exercise jurisdiction over the following offenses:
(1) Any offense committed by any person within any base except:
(a) Where the offender and the offended parties are citizens
of the Philippines, and
(b) The offense is against the security of the Philippines.
(2) Any offense committed outside the bases by any member
of the armed forces of the United States in which the offended party is also a member of the armed forces of the
United States.
(3) Any offense committed outside the base by member of the
armed forces of the United States against the security of
the United States.
b. The Philippines shall have the right to exercise jurisdiction over
all other offenses committed outside the bases by any member
of the armed forces of the United States.
2.
I I . 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.
APPENDIX
2.
S.
4.
5.
745
DEFINITION OF FELOND2S:
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
LEGAL MEDICINE
746
APPENDIX
747
748
LEGAL MEDICINE
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.
APPENDIX
749
LEGAL MEDICINE
750
Unlawful
aggression;
APPENDIX
751
752
LEGAL MEDICINE
APPENDIX
753
754
LEGAL MEDICINE
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.
APPENDIX
755
5. To do justice:
The criminals are punished by the State as a n act o f retributive
justice, a vindication of absolute right a n d moral l a w 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)
LEGAL MEDICINE
756
APPENDIX
757
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.
( A r t 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.
758
LEGAL MEDICINE
OF
CRIMINAL
LIABILITY:
I . Total Extinction:
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L E G A L MEDICINE
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^T,^
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'
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Co., St. Louis.
I N D E X
-AAbduction, 520
Abortion, 557
causes, 558
clinical types, 557
complications, 565
medical evidences, 567
methods of, 562
penal provisions, 558
practiced by physicians, 560
pros and cons, 572
Abrasion, 260
Abrasion collar, 351
Abuse against chastity, 527
Accessories, 749
Accomplices, 749
Acetone-haemin or Wagenhaar test, 100
Acid phosphatase test, 511
Active aggressive offender, 33
Adipocere formation, 149
Adopted children, 596
Adultery, 521
Age determination, 90
Aircraft injuries and fatalities, 423
Alcohol, 687
absorption, 692
concentration in blood, 694
effects, 693
fate of alcohol in the human body, 701
susceptibility, 700
symptoms, 695
tolerance, 700
Alcoholic beverages, classified 687
Alcoholism, 687
causes, 690
chemical test for intoxication, 708
societal reaction, 710
Algolagnia, 533
Algor mortis, 120
American Law Institute rule, 640
Ammonia poisoning, 734
Ammunition, 336
Amnesia, 630
Amphitanunes, 674
Anamnesis, 634
Anemic Anoxic death, 426
Anilingus, 533
Anoxic death, 426
Anthropometry, 52
Apathy, 632
Apparent death, 116
Arresto mayor, 756
Arresto menor, 756
Arsenic poisoning, 736
Artificial msemination, 601
classification, 601
precaution, 602
status of the child, 603
Asphyxia, 426
classification, 427
death from, 199
mechanism of death, 429
phases, 427
Asphyxiant gas, 457
Associative evidence, 16
Athletic sports, 469
Atmospheric pressure injuries, 421
Atomic bomb explosion, 327
effects to human body, 328
place of, 328
Attempted crime, 748
Autolytic changes after death, 136
Automatism, 212
Automotive crash, 459
factors responsible, 459
purpose of autopsy, 467
Autopsies, 163
hospital autopsies, 163
kinds of, 165
medico-legal autopsies, 164
mistakes, 178
persons authorized to perform, 165
preliminary stages, 170
767
L E G A L MEDICINE
768
procedures, 168
when required, 165
Autosexual, 532
Avulsion, 275
- B -
769
INDEX
justifying, 750
mitigating, 751
Circumstantial evidence, 19
Clark's rule, 716
Cobalt thiocynate test, 680
Cocaine, 676
Cocaine "body packer" syndrome, 677
Codicil, 626
Cognition, disorder in 629
Cold, local and systemic effect 394
Cold stiffening, 128
Coma, death from 201
Comparison microscope, 385
Complex crime, 757
Compression, asphyxia by 450
Compression, brain 309
requisites, 746
Criminal law, 5, 743
application, 743
characteristics, 743
Criminal liability, 746
Criminal offenders, types 33
Crural index, 83
Culpa, 745
Cunnilingus, 533
Currenslaw, 640
Concubinage, 522
Concussion, brain 309
Concussion, cerebral 259, 309
Condensed reactant explosion, 323
Confession, 36
Consented abduction, 521
Conspiracy, 757
Constitutional tolerance, 700
Consummated crime, 749
Consumption tolerance, 700
Content of thought, disorder 630
Contraceptive methods, 616
Contre-coup injury, 243, 301
Contusion, 255
Contuso-abradded collar, 351
Coprolagnia, 535
Coprolalia, 536
Corpus delicti, 37
Corpus delicti evidence, 16
Corruption of minors, 527
Coup injury, 243, 300
Cowling's rule, 717
Crash asphyxia, 450
Cremation, 228
Crib death, 184
Crime scene investigation, 159
Crime scene methods of search, 161
Crime stages of execution, 747
Criminals, persons criminally liable 749
Criminal intent, 746
- D Dactylography, 56
Dactyloscopy, 56
Dangerous drug, 655
770
LEGAL MEDICINE
INDEX
Feeble-minded, 642
Felonies, 745
elements, 745
Fetishism, 534
Fiber identification, 105
Fictitious malingering, 650
Fingerprints, 56
kinds of impression, 57
floaters, 58
types, 59
Firearm, 332
caliber, 346
classification of small firearms, 334
parts, 343
Firearm action, mechanism 346
Firearm cartridge, 336
Fire investigation, 408
Fireman's cramp, 396
Florence test, 510
Fodere's test, 578
Food poisoning, 729
Foot and hand impression, 46
Forcible abduction, 520
Forensic, 3
Fourchette, 488, 491
Fracture, skull 302
Fracture a la signature, 302
Friction mark, 260
Frostbite, immersion foot 394
Frottage, 535
Funeral, 225
limitations, 226
requirements, 225
- G Gagging, 441
Gait, 44
Gait pattern, 44
Ganguli's method, 512
Garroting, 440
Gas, heated and compressed 349
Gas chamber, death by 207
Gerontophilia, 533
Gettler's test, 447
Gonadal agenesis, 538
Graphology, 66
771
Grave scandal, 529
Gravindex slide test, 546
Guaiacum test, 98
Gunpowder, 337
identification, 378
residue determination, 378
Gun smoke, 350
Gunshot, 369
accidental, 370
destructive effects, 352
effects on clothings, 367
factors affecting entrance, 367
from revolver or automatic, 373
homicidal, 370
suicidal, 369
Gunshot wound, 353
bigger than caliber, 358
contact fire, 354
determination of trajectory, 360
entrance, 353
evidence of entry, 359
exit, 361
far range, 358
loose or near contact fire, 357
medium range, 357
short range, 357
smaller than caliber, 359
Gutter fracture, 303
- H Hair identification, 107
Hallucination, 629
Hallucinogens, 666
Handgun, 334
automatic pistol, 335
revolver, 335
Handwriting, 65
factors which determine, 67
forgery, 73
movements, 66
Hanging, asphyxia by 428
cause of death, 431
death by, 206
ligature, 430
post-mortem finding, 433
treatment, 432
LEGAL MEDICINE
772
I Icard'stest, 118
Identification, 41
importance, 41
methods, 42
rules in personal identification, 41
Idiot, 641
Illusion, 629
Imbecile, 642
Immersion foot, 394
Impossible crime, 746
Impotency, 620
causes, 621
Impression mark, 260
Impulsion, 633
Incendiarism, 535
Incest, 533
Incestuous seduction, 515
Incised wound, 263
Indecent exposure, 536
Infanticide, 194, 583
how committed, 585
motives for committing, 584
post-mortem findings, 586
types of evidence, 584
Infantosexual, 531
Inhibition, death by 184
Injurious substances, administration 250
Injury, complications 283
Inquest officer, 156
Insanity, 625
Insanity and criminal responsibility, 635
Instantaneous physiologic death, 184
Instantaneous rigor of muscles, 128
Intelligence test, 643
Intentional abortion, 558
Intermembral index, 83
Interrogation, 32
techniques, 35
Intersexuality, 538
Intoxication, cause of death 702
conditions simulating, 697
degree, 696
test, 697
Intoxication with alcohol, 30
Intracranial hemorrhage, 303
Investigation, crime scene 160
composition, 160
equipments, 160
importance, 160
methods, 161
techniques, 35
INDEX
Investigator's attitude & conduct, 33
In vitro fertilization, 606
basis of legality, 608
possible situations, 607
procedure of, 606
problems of surrogate mother, 610
status of the child, 612
Irrational offender, 34
Irresistible impulse rule, 639
Irrespirable gas, asphyxia by 451
Ischium-pubis index, 83
- J Jacquemin-Chadwick's sign, 542
Judicial death, 203
methods, 204
Jurisprudence, 4
- K Kansas statute on death, 113
Kastle-Meyer's test, 98
Kidney punch, 472
Klenefetter syndrome, 538
- L Lacerated wound, 272
Laceration, brain 307
Lacrimator, 456
Langer's line, 276
Lascivious acts, 518
Law, 3
Lead poisoning, 738
Legal medicine, 1
history, 7
nature of study, 1
scope, 1
Legal separation, 618
grounds for, 618
Legitimate children, 588
presumption, 588
Legitimation, 595
Length of survival, child 581
Less serious physical injuries, 251
Leucomalachite green test, 98
773
Lewisite, 457
Lie detector, 22
errors, 26
inadmissibility, 25
phases, 23
Light factor in identification, 55
Lightning, 414
classes of burns, 415
diagnostic point, 415
effect in the body, 415
Line of cleavage, 276
Live-birth, 576
proof of, 577
signs of maturity, 581
Livor mortis, 131
Locus rninoris resistencia, 243
Low order explosion, 323
Luminaria tent, 562
Lung irritant gas, 457
Lysergic acid diethylamide, ( L S D ) 672
Lysol poisoning, 735
- M MacDonald's sign, 543
Maceration, 150
Magnan's symptom, 677
Magnus test, 118
Malingering, 649
causes, 649
types, 650
Malt liquor, 689
Maltreated child, 478
Mandrax, 666
Mania, 631
Mannikinism, 535
Manouvrier's formulae, 78
Manual strangulation, 439
manner of death, 439
methods, 439
post-mortem findings, 439
Marbolization, 137
Marginal abrasion, 351
Marijuana, 667
classification, 668
effects, 669
774
LEGAL MEDICINE
Missile, 338
Mixoscopia, 536
Molecular or cellular death, 116
Moral defective, 642
Moron, 642
Motorcycle crash, 468
Mugging, 440
Mummification, 148
Munro-merritt, ageing subdural
hematoma 305
Murder, 195
Muscle changes following death, 126
Musculoskeletal injuries, 258
Musketry, death by 206
Mustard gas, 457
Mutilation, 246
Mysophilia, 535
- N Narcissism, 535
Narcoanalysis, 30
Narcosynthesis, 30
Nasal index, 82
Natural child, 595
Necrophilia, 533
Negative autopsy, 179
Neglected child, 478
Negligent autopsy, 180
Negligent death, 192
Nerve gas, 458
Nitric acid poisoning, 733
Non-emotional offender, 34
Nuclear explosion, 322
- O Observation, 31
Obsession, 631
Occupational marks, 47
Opium, 659
derivatives, 660
symptoms, 660
Opium addiction, evidence 662
post-mortem findings, 663
Orbital index, 82
Organs, average measurement 176
775
INDEX
donations, 230
Orthothanasia, 208
Ospresiophilia, 534
Overlaying, 441
- P Palmar strangulation, 440
Paralyzant gas, 458
Pardon, effect 757
Parricide, 194
Partialism, 535
Passive inadequate offender, 34
Paternity, proof 599
Pathological drunkenness, 704
Patterned wound, 245
Pearson's formulae, 76
Pedestrian-vehicle collision, 464
Pedophilia, 531
Pelvic index, 82
Penalties, 754
classification, 755
effects, 756
Personal identification, 42
ordinary methods, 42
scientific methods, 55
Petechiae, 255
Phenolphthalein test, 98
Phenol poisoning, 735
Philadelphia protocol, 114
Phobia, 632
Phosgene, 457
Phosphorus poisoning, 739
Physical injuries, 246
administration of injurious
substances, 250
examination of wounded body, 288
less serious, 251
mutilation, 246
serious, 248
slight, 253
under exceptional circumstances, 198
Plastic bag suffocation, 441
Pluralism, 536
Poison, 712
classification, 725
laws, 730
L E G A L MEDICINE
776
- Q Qualified seduction, 515
-
R -
Race determination, 82
Radiation, 328
factors responsible for the effects
of, 329
rays emitted by radioactive
substances, 328
other sources, 330
Rape. 500
elements of the crime, 500
evidence, 501, 505
Rational offender, 34
Reclusion perpetua, 755
Reclusion temporal, 755
Regulated drug, 656
Remedial law, 5
Rigor mortis, 126
Rule of nine 278
Russian roulette, 370
- S Sadism, 534
Sado-masochism, 533
Saponification, 149
Satyriasis, 533
Scald, 398
Scar, 51
Schombein's test, 98
Schourup's formula, 122
Scratch, 260
Scientific identification, 55
age, 90
blood, 95
dental, 61
fingerprint, 56
handwriting, 65
hair and fibers, 107
skeleton, 75
sex, 86
Sea disposal, 227
Sedatives, 664
Seduction, 515
INDEX
State of suspended animation, 116
Static test, 578
Stature, 48
Statutory rape, 503
Sterility, 622
causes of, 623
Sterilization, methods 623
Sternutator gas, 458
Still-birth, 576
causes, 576
Stimulants, 674
Stoker's cramp, 396
Strain, 259
Strangulation, asphyxia by 436
cause of death, 437
post-mortem findings, 438
treatment, 437
Subarachnoidal hemorrhage, 306
Subdural hemorrhage, 304
Subluxation, 259
Submersion, asphyxia by 442
Subnormality, 643
Succession, 626
Sudden infant death syndrome, 184
Sudden unexplained nocturnal death, 185
Suffocation, asphyxia by 441
Suicide, 193, 211
evidence, 212
methods employed, 212
psychological classification, 211
Suicide automotive crash, 463
Sulfur dioxide, 455
Sulfuric acid poisoning, 732
Superfecundation, 549
Superfoetation, 549
Survivorship, presumption of 155
Suspect, 33
Suture obliteration, 85
Syncope, death from 199
- T Tache noir de la sclerotique, 125
Takayama test, 99
Tandem bullet, 368
Tardieu spot, 433
777
Tattoo marks, 49
Tattooing, gunpowder 350
Tear gas, 456
Thalidomide, 673
Thermal burns, 400
Thermal injuries, 394
Thermic fever, 397
Throttling, 439
Tokyo declaration, 38
Topinard and Rollet formula, 78
Tracing evidence, 16
Transexualism, 537
Transvestism, 537
Trench foot, 394
Trend of thought, disorder 631
Trigger, 343
classification, 343
Trigger pressure, 344
Troilism, 536
Truth serum, 29
Tumultuous affray, 197, 254
Turner's syndrome, 538
Typewriter identification, 74
- U Unintentional abortion, 559
Unnatural sexual offenses, 528
Uranism, 535
Urolagnia, 534
- V Vaginal canal, 487, 491
Vampirism, 535
Van deen's test, 98
Vehicular crash evidence, 466
Vehicular run over injury, 465
Vehicular turn-turtle impact, 462
Vesicant, 457
Violent death, 190
Virginity, 485
determination of, 486
kinds of, 485
Virgo intacta, 486
Vital reaction, 241
L E G A L MEDICINE
778
LEGAL MEDICINE
P R I N I E U BY
Copyright 1987
By
PEDRO P. SOUS
PREFACE
The professions of Medicine and Law, together with Theology
are considered the most ancient and most learned of professions as
they have commanded respect since the dawn of history. Both
Medicine and Law are dedicated to the service of humanity; Medicine,
which its goal is to preserve lives and maintain the health of the
people while Law has as its goal to promote peace and order and give
justice to one whom justice is due. Both professions are involved in
the pursuance of truth. A medical practitioner is trained to diagnose
the true ailment the patient is suffering so as to institute the appropriate treatment, while a lawyer is concerned with the true nature
of the law and the basis for its promulgation in consonance with the
demands of society. Practitioners of both professions have to
respect the right of their clients or patients. In so far as the information gathered by the physician from his patient is concerned, it
must be held in confidence by the former. In the same manner the
lawyer cannot disclose information which he gathered from his
client.
However, there are appreciable divergencies between Law and
Medicine, the main purpose of Law is to maintain peace and order,
respect human rights and promote equality, while that of Medicine
is to save the lives and preserve the health of the people. In the
doctor-patient relationship, the physician has the right to diagnose
and treat patients with limited interference from outside influences,
while in the lawyer-client relationship, external interference is inevitable. In defending a client-complainant, the lawyer is confronted
by the defendant, cross-party complainant or a third party defendant.
In the area of investigation or research; in Medicine, substantial
correlation between a scientific fact and a specific social factor is
considered sufficient, while in Law, there must be preponderance or
absolute correlation between a crime and its effects.
There is an aphorism which states that "people follow Medicine
and Law follows people". The stride of Law has a slower pace than
that of Medicine. Because of the advancement of Medicine, crimes
which would have been consumated in the past, can now become
frustrated. In criminal acts which would formerly have resulted in
deaths, the victims may, with the application of modern medical
management procedures, be able to live. Physical injuries can now be
classified of the lesser serious type on account of modern medicines
iii
iv
LEGAL MEDICINE
like antibiotics and other potent bactericidal drugs. Injuries which
have produced permanent deformity as a consequence, no longer do
so because of plastic surgery. The moment of death which was
considered an uncertain future event can now be predetermined if a
patient is hooked to a mechanical life-saving apparatus.
It is essential that the professions of Medicine and Law complement each other to be able to serve the best interest of the people.
A connecting link must be built to bring them closer. This indeed is
the primordial objective of Legal Medicine. Legal Medicine is the
proper venue or forum which will both harmonize and serve the
purposes of the two disciplines. There is an increasing need for
scientific medical facts in the field of Law and the administration of
justice. Substantive and procedural laws must also be made to
conform with established medical facts.
It has never been the intention of the author to include all
aspects of Medicine which has to do with the legal issues. The subject
of Legal Medicine is quite pervasive and encompassing that a comprehensive treatment is not possible considering the time allocated
to the subject in the undergraduate courses. What are included
herein are some of its basic principles. Details of specific subject
matters may be studied in textbooks of the different specialties
if Medicine.
TABLE OF CONTENTS
CHAPTER
I.
Page
INTRODUCTION
GENERAL CONSIDERATION
DECEPTION DETECTION
Polygraph 22
Word Association Test 28
Psychologic Stress Evaluator 28
Truth Serum 29
Narcoanalysis or Narcosynthesis 30
Intoxication with Alcohol 30
Observation 31
Scientific Interrogation 33
Admissibility of Evidence through Interrogation
Confession 36
Tokyo Declaration 38
IDENTIFICATION
HI. MEDICO-LEGAL ASPECTS OF IDENTIFICATION
Identification of Persons 42
Anthropometry 52
Portrait Parle S3
Extrinsic Factors in Identification 54
Light Factor in Identification 55
'Fingerprinting 56
Dental Identification 61
Handwriting 65
Identification of Skeleton 75
Determination of Sex 86
Determination of Age 90
Identification of Blood and Blood Stains 95
Identification of Hair and Fibers 105
21
34
41
TABLE OF CONTENTS
111
Types of Death 112
Kinds of Death 116
Signs of Death 117
^Changes in the Body following Death 126
Changes in the Muscles 126
Changes in the Blood 130
Autolytic or Autodigestive 136
Putrefaction 136
Special Modification to Putrefaction 148
Duration of Death 151
Presumption of Death 154
Presumption of Survivorship 155
V. INVESTIGATION OF DEATH
Inquest Officer 156
Crime Scene Investigation 160
Autopsies 163
156
182
203
218
TABLE OF CONTENTS
PHYSICAL INJURIES
LX^MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES
Physical Injuries brought about by Physical Violence 240
^Classification of Wounds 242
. Legal Classification of Physical Injuries 246
<
Mutilation 246
Serious Physical Injuries 248
Administering Injurious Substances or Beverages 2S0
Less Serious Physical Injuries 251
Slight Physical Injuries or Maltreatment 253
^Medical Classification of Wounds 254
Factors Affecting the Severity of Wounds 278
Fatality of Wound 282
Complication of Wound 283
Healing of Wounds 285
x. INVESTIGATION OF WOUNDS
Outline of Investigation of Physical Injuries 288
Determination Whether the Wounds were Inflicted
During Life or After Death 290
Length of Survival of the Victim 293
Possible Instruments Used by Assailant 294
Which Injuries Sustained Caused Death 294
Which of the Wounds was Inflicted First 295
Effect of Medical and Surgical Intervention 295
Volition Power of the Victim 296
Relative Position of the Victim & Assailant 297
Extrinsic Evidences in Wounds 297
XI.
XII.
viii
TABLE OF CONTENTS
414
TABLE OF CONTENTS
ix
426
459
469
478
XXI.
Rape 500
Examination for Seminal Fluid and Spermatozoa
Other Crimes Against Chastity 515
.Seduction 515
A6ts of Lasciviousness 518
421
509
TABLE OF CONTENTS
Adduction 520
Adultery and Concubinage 521
Prostitution 523
Abuse Against Chastity 527
Unnatural Sexual Offenses and Sexual Abnormalities
528
PREGNANCY
Legal Importance of the Study 539
Medical Evidences of Pregnancy 541
Signs and Symptoms of Pregnancy 541
Laboratory Tests 545
Signs of Pregnancy in the Dead 547
Duration of Pregnancy 548
Proofs of Previous Pregnancy 549
XXIII. DELIVERY
Methods of Delivery 552
Signs of Recent Delivery 553
Signs of Remote Delivery in the Living 555
Post-mortem Finding in a Woman who Died Recently
After Delivery 555
^ ABORTION, BIRTH AND INFANTICIDE
XXIV. ABORTION
/Clinical Types 557
Causes of Abortion 558
^ Kinds of Abortion 561
How Abortion is Induced or Procured 562
Medical Evidences 567
Therapeutic Abortion 569
Religious Consideration 574
XXV. BIRTH
Legal Importance of the Study 575
Still-Birth 576
Live-Birth 576
Proofs of Live-Birth 577
Hydrostatic Test 578
Signs of Maturity of the Child 581
XXVI. INFANTICIDE
Motives for Committing Infanticide 584
Criminological Characteristics 584
Type of Evidences in Infanticide 584
Post-Mortem Findings 586
539
552
557
575
583
TABLE OF CONTENTS
PATERNITY AND FILIATION
XXVH. CONVENTIONAL METHOD OF PROCREATION
Kinds of Children 587
Legitimate Children 588
Illegitimate Children 597
Evidences of Paternity and Filiation 599
Medical Evidences 599
Non-Medical Evidences 600
XXVIII. NON-CONVENTIONAL METHOD OF PROCREATION
Artificial Insemination 601
In Vitro Fertilization 606
xi
587
601
XXX.
XXXI.
MARITAL RELATION
MARITAL UNION AND DISSOLUTION
Requisites of a Valid Marriage 613
Marital Relation 614
Annulment of Marriage 617
Legal Separation 618
IMPOTENCY AND STERILITY
Impotency 620
Legal Classification 620
Causes of Impotency 621
Sterility 622
Causes of Sterility 622
Methods of Sterilization 623
DISTURBANCE OF MENTALITY
INSANITY AND MENTAL DEFICIENCY
Legal Importance 625
Some Manifestations of Mental Disorders 629
Insanity and Criminal Responsibility 635
Mental Deficiency 641
Classical Classification
641
Methods of Estimating Mental Capacity 643
Ways of Hospitalizing an Insane Person 647
Malingering 649
Causes of Malingering 649
Types of Malingerer 650
Ways of Determining Malingering 651
Other Conditions Manifestating or Simulating
Disturbance of Mentality 652
613
620
625
xii
TABLE OF CONTENTS
654
XXXIII. ALCOHOLISM
Classification of Commercially Available
Alcoholic Beverages 687
Absorption and Distribution of Alcohol 692
Effects of Alcohol 693
Degree of Intoxication 696
Physical Tests to Determine Drunkenness 697
Factors Responsible for the Tolerance and
Susceptibility to Alcohol 700
Causes of Death in Alcoholics 702
Chemical Test for Intoxication Admissible in
Evidence 708
Methods Used in Alcohol 708
Societal Reaction to the Problem of Alcoholism 710
687
TOXICOLOGY
XXXTV. POISONING
Definition 712
Site of Action of Poisons 713
Signs and Symptoms That May Lead One to Suspect
Poisoning 717
Differential Diagnosis of Poisoning 718
Treatment of Patient Suffering from Acute Poisoning 719
Medical Evidences 721
Classification of Poisons 725
Food Poisoning 729
Laws on Poisons and Other Poisonous Substances
in the Philippines 730
Post-mortem Findings in Some Chemical Poisoning 732
712
TABLE OF CONTENTS
xiii
759
INDEX
767