Atty. Nelson Logronio, M.D.

Medicine Board Review Series 2012 FEU

[email protected]

LECTURE NOTES IN LEGAL MEDICINE

INTRODUCTION

I. General Consideration

Legal Medicine
- branch of medicine which deals with the application of medical knowledge to the
purpose of law and administration of justice

- It is the application of basic and clinical, medical and paramedical sciences to

elucidate legal matters

Legal Medicine – application of medicine to legal cases

Forensic medicine – application of medical science to elucidate legal problems

Medical Jurisprudence – Knowledge of law in relation to practice of medicine. It is concerned

with rights, duties and obligations of physician with reference to physician patient relationship

Types of Medical Evidence

1. Autoptic or Real evidence – evidence addressed to the senses of the court

2. Testimonial evidence – testimony given orally under oath or affirmation

3. Experimental evidence – evidence to confirm the allegation or opinion of a medical witness

4. Documentary evidence – instrument recorded by means of letters, figures, numbers, or marks

intended to be used for the purpose of recording matters which may be evidently used.

5. Physical evidence – articles and materials found in connection with the investigation and aid in
establishing the identity of the perpetrator

Corpus delicti evidence – objects or substances which may be part of the body of the
crime

Methods of Preservation
1. Photographs, audio/video tape, photastat, Xerox, voice tracing
2. Sketching – rough drawing of the scene or object to be preserved
3. Description – putting into words the person or things to be preserved
4. Manikin – miniature model of a scene or human body indicating marks of the aspects to be
preserved
5. Preservation in the mind of witness – recital of the recollection of the witness
6. Special methods – embalming, refrigeration, drying, placing in a sealed container

II. Deception Detection

A. Devices which record Psycho-physiological response

1. Polygraph or lie detector machine
2. Word association test – stimulus and non stimulus words are read to the subject who is to answer
quickly.
3. Psychological stress evaluator – detects, measures, displays voice modulations

B. Use of drugs that try to “inhibit the inhibitor”

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Medicine Board Review Series 2012 FEU
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1. Administration of “truth serum” – Hyoscine hydrobromide is given hypodermically to induce

delirium

2. Narcoanalysis or Narcosynthesis – Sodium amytal or Sodium pentothal is used to cause

depression of the inhibitory mechanism. The subject talks freely.

3. Intoxication with alcohol

C. Hypnosis – Alteration of consciousness and concentration

Compulsive-depressive and strong willed individuals are not hypnotizable – Lawyers,
accountants, physicians and other professionals

D. Observation, Signs and Symptoms of Guilt

1. Sweating
2. Color change
3. Dryness of the mouth
4. Excessive activity of the Adam’s apple
5. Fidgeting
6. Peculiar feeling inside
7. Swearing to the truthfulness of his assertion
8. Spotless past record
9. Inability to look at the investigator “straight in the eye”
10. “Not that I remember” expression

E. Scientific interrogation
1. Emotional appeal – Interrogator creates a mood conducive to confession. He may be sympathetic
and friendly to the subject

2. Mutt and Jeff technique – There are 2 in vestigators opposite in character – one is arrogant and
the other is friendly

3. Bluff on split-pair – Suspects are investigated separately

4. Stern approach –

5. The subject is given the opportunity to make a lengthy narration

F. Confession – expressed admission of guilt in a criminal case

Judicial – made in court
Extrajudicial – made outside of court

Tokyo Declaration – endorsed by the World Medical Association in 1975. Contains guidelines to be
observed corcerning torture, degrading treatment, or punishment in relation to detention and
imprisonment (November 2009)

Identification of Persons

Ordinary Methods
A. Identification of Living Persons
1. Characteristics which may be changed
a. Growth of hair, beard, mustache
b. Clothing
c. Frequent place of visit

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Medicine Board Review Series 2012 FEU
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d. Grade of profession
e. Body ornamentation
2. Characteristics that may not be easily changed
a. Mental memory
b. Speech
c. Gait
i. Ataxic gait – seen in persons suffering from tabes dorsalis
ii. Cows gait – swaying movement due to knock-knee
iii. Paretic gait – steps are short and feet are dragged
iv. Spastic gait – legs are held together and toes are dragged
v. Festinating gait – short accelerating steps
vi. Frog gait – hopping gait from infantile paralysis
vii. Waddling gait – similar to duck movement

d. Mannerism
e. Hands and feet
f. Complexion
g. Changes in the eyes
h. Facies
i. Hippocratic facies – indicative of approaching death
ii. Mongolian facies – almond eyes, pale complexion, prominent cheekbones
iii. Leonine facies – leprosy, elephantiasis, leontiasis
iv. Myxedemic facies – edematous swelling
i. Left or right-handedness
j. Degree of nutrition

B. Identification of Living and Dead Persons

Ordinary Marks
Race
Stature – a person ceases to increase height after age of 25
Tattoo marks
Weight
Deformities
Birth marks
Injuries leaving permanent results
Moles
Scar
Tribal marks
Sexual organ
Blood Examination

C. Anthropometry/Bertillon System – anthropometric measurements of the body is the basis of

identification

D.Portrait Parle (spoken picture) – verbal, accurate, and picturesque description of the person
identified

E. Extrinsic Factors in Identification

1. Ornamentations
2. Personal belongings
3. Wearing apparel
4. Foreign bodies
5. Identification by friends and relatives
6. Identification records – police, immigration, hospital
7. Identification photograph

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Medicine Board Review Series 2012 FEU
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F. Light as factor
- Best known person cannot be recognized by the clearest moonlight at a distance
greater than 16 – 17 yards

- Best known person cannot be recognized by starlight any further than 10-13 yards.

- Broad daylight – a person can hardly recognize another at a distance more than 100
yards if the person has never been seen before. A stranger may be recognized at a
distance of 25 yards

Scientific Methods of Identification

A. Fingerprinting – most valuable method of identification

Dactylography – art and study of recording fingerprints as a means of identification

Dactyloscopy – art of identification by comparison of fingerprints.

Poroscopy/Locards methods of identification – study of the pores on the papillary or

friction ridges of the skin for purposes of identification

B. Dental Identification
9 years – 12 permanent teeth (8 incissors and 4 molars)
11 years – 20 permanent teeth (8 incisors, 8 premolar and 4 molar)
13 years – 28 permanent, no deciduous teeth
8 – 10 – Calcification begin at the 3rd molar
25 – Root ends of 3rd molar completely calcified

C. Handwriting
 Bibliotics – Science of handwriting analysis. Study of documents to determine
genuiness or authorship

 Graphology – study of handwriting to determine the writer’s personality,

character and aptitude

 Forgery –
1. Traced forgery – outlining of a genuine signature from a document
2. Simulated forgery – Attempt to copy in a freehand manner the
characteristics of a genuine signature
3. Spurious forgery – no attempt to copy the genuine writing

 Disguised writing – deliberate attempt to alter his writing habit or by imitating the
writing of another person

D. Identification of Skeleton
Human skeleton is unchangeable after 20th year

E. Determination of Sex
1. Pelvis
2. Skull
3. Sternum
4. Femur
5. Humerus

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Medicine Board Review Series 2012 FEU
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F. Determination of Age
Hess’s Rule or Haase’s Rule – determination of the age of the Fetus
Fetus less than 25 cm – square root of the length in cm = age in months
Fetus 25 cm or more – Length in cm divided by 5 = age in months

G. Identification of Blood and Blood Stains

1. Physical Examinations
a. Solubility test – Recent blood shed is soluble in saline solution and
imparts a bright red color
b. Heat test – solution of the blood stain will impart a muddy precipitate
c. Luminescence – Stains on the dark fabric emit bluish-white luminescence
in a dark room when sprayed with chemical solutions

2. Chemical Examinations
a. Saline extract of the blood stain plus ammonia will give a brownish tinge
due to formation of hematin
b. Guaiacum/Van Deen’s, Schombein’s Test
c. Phenolphthalein test/Kastle-Meyer Test
d. Leucomalachite Green test

3. Microscopic Examinations
4. Micro-Chemical Tests
a. Hemochromogen crystal or Takayama test – a drop of hemochromogen is
added then examined for presence of salmon color to dark brown and pink
crystals

b. Teichmann’s blood crystal or Hemin crystals – Water with sodium

chloride and glacial acetic acid is added to the fragments of the stain prior
to microscopic examination.

c. Acetone-Haemin of Wagenhaar test – acetone, diluted oxalic acid or

acetic acid is used.

5. Spectroscopic Examinations
6. Biologic Examinations
a. Precipitin test – test to determine whether the blood is of human origin
b. Blood grouping

H. Identification of Hair and Fibers

1. Hair of Children – fine, short, deficient of pigment, devoid of medulla
2. Adolescent – scalp hair becomes long and thick
3. Older patients – white gray color, absorption of pigments and degenerative
changes

DEATH

I. Medico-legal Aspects of Death

A. Kinds of Death
1. Somatic or Clinical Death – complete, persistent and continuous cessation of vital functions of
the brain, heart and lungs which maintain life and health

2. Molecular or Cellular – Death of individual cells

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3. Apparent Death or State of Suspended Animation – transient loss of consciousness or temporary

cessation of vital functions of the body on account of disease, external stimulus, or other forms
of influence. In hysteria, uremia, catalepsy and electric shock.

B. Signs of Death
1. Cessation of Heart Action and Circulation

Examination of Peripheral Circulation

i. Magnus test – ligature is applied around the base of the finger
ii. Opening of small artery -
iii. Icards test – SQ injection of fluorescein.
iv. Pressure on fingernails
v. Diaphanous test – finger webs are viewed through strong light
vi. Application of Heat on the skin – blister formation is detected
vii. Palpation of radial pulse
viii. Dropping of Melted wax – detect inflammatory edema

2. Cessation of Respiration
a. Observe the movement during inspiration and expiration
b. Auscultate
c. Examination with a mirror
d. Examination with a feather or cotton fibers
e. Examination with a glass of water
f. Winslow’s test – saucer with water or mercury is placed on the chest and abdomen
3. Cooling of the Body/Algor Mortis
- Progressive fall of body temperature is one of the most prominent signs of
death
- Rapid during the first 2 hours
- Fall of 15 to 20 degrees Fahrenheit is a certain sign of death

Post-mortem Caloricity – rise of temperature of the body after death due to rapid and
early putrefactive changes during the first 2 hours after death. It may be observed in
1. Cholera
2. Yellow fever
3. Liver abscess
4. Peitonitis
5. Cerabrospinal Fever
6. Rheumatic Fever
7. Tetanus
8. Smallpox
9. Strychnine poisoning

Schourups formula – for determination of time of death by examination of CSF

4. Insensibility of the Body and Loss of Power to Move

5. Changes in the skin
a. Skin becomes pale and waxy looking
b. Loss of elasticity of the skin
c. Opacity of the skin
d. Effect of application of heat
6. Changes in and about the eye
a. Loss of corneal reflex
b. Clouding of cornea
c. Flaccidity of the eyeball
d. The pupil is in the position of rest
e. Tache noir de la sclerotique – yellowish spot in the sclera

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Medicine Board Review Series 2012 FEU
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f. Opthalmoscopic finding –
i. Retina and optic disc is pale and atrophied,
ii. yellow tinge to brownish gray fundus
iii. retinal vessels become segmented
iv. retinal veins and arteries are indistinguishable

7. Action of Heat on the skin

C. Changes in the body following death

1. Changes in the muscle

a. Stage of primary flaccidity (post mortem muscular irritability)

Muscles are relaxed and capable of contracting when stimulated
Pupils are dilated
Sphincter are relaxed
3 – 6 hours

b. Stage of post mortem rigidity (Cadaveric rigidity, Death struggle of muscles)

While body becomes rigid
3-6/ 12/ 24-36
Conditions Simulating
o Heat stiffening – if body is exposed to more than 75C
o Cold stiffening – stiffening of the body when the body is frozen
o Cadaveric spasm/Instantaneous rigor – instantaneous rigidity at the moment
of death due to extreme nervous tension, exhaustion and injury to the nervous
system or injury to the chest.

c. Stage of secondary flaccidity or commencement of putrefaction (Decay of Muscles)

Muscles become flaccid, no longer capable of responding to stimulus

2. Changes in the blood

a. Coagulation of blood
b. Post-mortem lividity/ Cadaveric Lividity/ Post-mortem suggillation/ Postmortem
Hypostasis/ Rigor Mortis
i. Hypostatic lividity – liquid blood gravitates to the most dependent portions of the
body inside the blood vessels.

ii. Diffusion lividity – coagulated blood inside blood vessels has diffused into the
tissues of the body.

3. Autolytic or Autodigestive changes after death

4. Putrefaction of the Body – Breaking down of complex proteins into simpler components
associated with evolution of foul smelling gasses and color-changes in the body
Marbolization –prominence of superficial veins with reddish discoloration during the process
of decomposition. In the abdomen, neck and shoulders

a. Mummification – dehydration of the whole body

b. Saponification or Adipocere Formation – Fatty tissues are transformed to soft-brownish
substance called adipocere
c. Maceration – Softening of tissues in a fluid medium in the absence of putrefactive
microorganism which is frequently observed in the death of fetus en utero.

D. Duration of Death
1. RM – 3-4/ 12/ 24-36
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Medicine Board Review Series 2012 FEU
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2. Post mortem lividity – 3-6

3. Onset of decomposition – 24 – 48
4. Maggots - 24 hours

II. Medico-Legal Investigation of Death

Crime Scene Investigation

Government Official Authorized to Make Death Investigations
1. Provincial and City Fiscals
2. Judges of the Court of First Instance
3. Justice of the Peace
4. Director of NBI
5. Chief of Police

Autopsies – comprehensive study of a dead body performed by a trained physician employing

recognized dissection procedure and techniques. External and internal examination of the body

Post-mortem Examination – External examination of a body without incision

Kinds of Autopsies
1. Hospital or non-official – with the consent of the family for purposes of
a. Determining the cause of death
b. Providing correlations of clinical diagnosis
c. Determining effectiveness of therapy
d. Studying natural course of the disease
e. Educating students and physicians

2. Medico-legal or Official – performed for the purpose of

a. Determining the cause and time of death
b. Recovering and preserving evidence
c. Interpretation and correlation of facts and circumstances
d. Providing factual, objective and medical report
e. Separating death due to external disease from death due to external causes

Persons Authorized to Perform Autopsies and Dissection

1. Health Officers
2. Medical Officers of Law Enforcement Agencies
3. Members of the medical staff of accredited hospitals

III. Causes of Death

A. Medico-Legal Classification of the Causes of Death

1. Natural Death – death caused by natural disease condition in the body
Sudden infant death syndrome – unexpected death of infants under 6 months of age
while in good health
Sudden Unexplained Nocturnal Death – sudden death of healthy men of young age
Cerebral apoplexy – sudden loss of consciousness or death due to hemorrhage from
thrombosis or embolism in cerebral vessels

2. Violent Death – death due to injury of any sort

a. Accidental
b. Negligent – due to reckless imprudence, negligence, lack of skill or foresight
c. Suicidal -

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d. Infanticidal – killing of a child less than 3 days old

e. Parricidal – killing one’s relative ( father, mother, child, spouse)
f. Murder – Killing a person with intent under any of the following circumstances
i. Treachery, taking advantage of superior strength
ii. In consideration of price, reward or promise
iii. By means of fire, poison, explosion, shipwreck, derailment...
iv. On occasion of calamities
v. With evident premeditation
vi. With cruelty
g. Homicidal – killing a person without any of the circumstances qualifying murder
h. Death caused in a tumultuous affray –
Person was killed in a confused or tumultuous affray
Actual killer is not known
Persons who inflicted serious physical injuries are known
i. Death or Physical injuries under exceptional circumstances
i. Surprise by the spouse
There is a valid marriage
Guilty spouse was caught by surprise in the act of committing sexual
intercourse with another person
That the killing or injury was inflicted to either or both at the very act or
thereafter

ii. Surprise of daughter

Daughter is below 18 years of age
Daughter is living with parents
Parents caught her by surprise committing sexual intercourse with the
seducer
Killing was done at the very act of sexual intercourse or immediately
thereafter

B. Pathological Classification of the Causes of Death

1. Death from Syncope – death due to sudden and fatal cessation of action of the heart.

2. Death from Asphyxia – Condition in which the supply of oxygen to the blood or tissues or to
both has been reduced below normal working level

3. Death from Coma – State of unconsciousness with insensibility of the pupil and conjunctivae,
and inability to swallow.

IV. Special Deaths

A. Judicial Death
1. Death by Electrocution – shock, respiratory failure due to bulbar paralysis or asphyxia,
prolonged and violent convulsion

2. Death by Hanging –
a. Dislocation of the cervical vertebrae
b. Partial or complete severance of the spinal cord
c. Rupture of the Cervical muscles
d. Asphyxia due to pressure of the vagus nerve
e. Syncope due to pressure on the vagus nerve
f. Cerebral Anemia

3. Death by Musketry
4. Death by Gas Chamber

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5. Death by crucifixion
6. Cutting asunder – mutilating the body with sharp heavy instrument

B. Euthanasia – deliberate and painless acceleration of death of a person suffering from incurable
distressing disease
1. Active – intentional or deliberate application of the means to shorten the life of a person with or
without the knowledge of a person.
2. Passive – natural course of death is allowed to extinguish the life
a. Orthonasia – patient is allowed to die without treatment

b. Dysthanasia – There is an attempt to extend the life span with extraordinary treatments.

C. Suicide
Psychological Classification
1. 1st degree – deliberate, planned, premeditated, self murder
2. 2nd degree – impulsive, unplanned, under great provocation
3. 3rd degree –

D. Death from Starvation

40%
10 days
50 to 60 days
Factors that influence length of survival
1. Age
2. condition of the body
3. sex
4. environment

Cause of Death
1. inanition
2. Circulatory failure due to brown failure of the heart
3. Intercurrent infection

V. Disposal of the Dead Body

A. Embalming – way of preserving by injecting Formalin, mercury, arsenic

B. Burial or Inhumation –
The following may sign the death certificate
1. attending physician
2. municipal health officer if there is no physician
3. municipal mayor if there is no health officer or physician
4. municipal secretary – in the absence of the mayor
5. any councilor
C. Disposing of the Dead Body in the Sea
D. Cremation
E. Use of the Body for Scientific Purposes
F. Exhumation

Physical Injuries

I. Medico-Legal Aspects of Physical Injuries

Classification of wounds
1. Penetrating – wounding agent enters the body piercing a solid organ or tissue of the body
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2. Perforating – when the wounding agent produces communication between inner and outer
portion of the hollow organs

Legal Classification of Physical Injuries

1. Mutilation - looping or cutting off any parts of the human body, or depriving him some essential
organ for reproduction.

Mayhem – unlawful and violent deprival of another of the use of a part of the body to render him
less able in fighting

2. Serious Physical Injuries – wounding, beating, assaulting, administering injurious substance

without intention to kill

3. Less Serious Physical Injuries – injuries which shall incapacitate the offended party for labor for
10 days or more, or shall require medical attendance for the same period

4. Slight Physical Injuries and Maltreatment – shall incapacitate the offended party for labor from 1
to 9 days

5. Physical Injuries Inflicted in a Tumultous Affray – serious physical injuries are inflicted upon
the participants of a tumultuous affray and the persons responsible cannot be identified

Medical Classification of Wounds

Closed Wounds
a. Petechiae – extravasation of blood in the subcutaneous tissue or under the mucous
membrane due to increase pressure or permeability

b. Contusion – effusion of blood into the tissues underneath the skin

4-5
7-10
14-15
c. Hematoma, Blood Cyst, Blood Tumor, Bukol
d. Musculo-skeletal Injuries
Open Wounds
a. Abrasion (scratch, graze, impression mark, friction mark)
b. Incised Wound, Cut, Slash, Slice
12 hrs – edges are swollen, adherent with blood and leukocyte formation
24 hs – Proliferation of vascular endothelium and connective tissue cells
36-48 – Capillary network complete, fibrolast at right angles to vessels
3-5 days – vessels show thickening

c. Stab wound – penetration by sharp-pointed and sharp edged instrument

d. Punctured Wound – result of a thrust of a sharp pointed instrument
e. Lacerated Wound, Tear, Rupture, Stretch, Putok

Complications of Trauma or Injury

Shock
Hemorrhage
Infection
Embolism
Kinds of Healing of Wounds
Healing by Primary or First Intention – minimal tissue loss and without significant bacterial
communication

Healing by Secondary Intention – extensive loss of tissues and cells, more necrotic debris

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Aberrated Healing Process

a. Formation of Exuberant Granulation or “Proud Flesh” – excessive amount of granulation
tissue may protrude and prevent closing of the wound. Remedied by excision or cautery.

b. Keloid Formation – bulging tumorous scar due to abnormal collagen formation

c. Stricture – contraction of fibrous tissue of the scar formed

d. Fistula or Sinus Formation – communication between an inner cavity and the outside

II. Medico-Legal Investigation of Wounds

Distinctions between Ante-Mortem and Post Mortem Wounds
Possible Instruments Used by Assailants

III. Physical Injuries in the Different Parts of the Body

A. Head and Neck Injuries

1. Direct or Coup Injuries– Physical injury located at the site of the application of force
2. Indirect Injuries
a. Contre Coup injuires– Physical injury found opposite the site of wound
b. Remote Injuries – force is applied in areas not related to the head
c. Locus minoris resistencia– injury is not on the site or opposite the site of application of
force but in areas offering least resistance
d. Coup-contre-coup injuries– Physical injury at the site and opposite the application of
injury

Intracranial hemorrhage
1. Extradural or Epidural – caused by fracture of the skull resulting to laceration of the
blood vessels

2. Subdural Hemorrhage
essentially venous or capillary
most common cause of cerebral compression
may be due to fracture, laceration of the brain, spontaneous rupture
Brain
1. Brain concussion – transitory period of unconsciousness resulting from a blow on the
head.

2. Post traumatic automatism – a person while under the state of post-traumatic automatism
may commit a crime while in an unconscious state.

3. Post traumatic irritability – The victim of a head injury may suffer post-traumatic
irritability and may lead to do act of impulsive violence

B. Chest
Injuries to the Lungs
Injuries to the Heart
Rupture
produced by a blunt instrument or crushing injury
heart is commonly ruptured at the right side towards the base
Death is due to severe hemorrhage, tamponade or shock

Crushing injuries
Due to compression of the chest in VA, dynamite blast

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C. Abdominal injuries
Liver – one of the most vulnerable organs in the abdominal cavity
Spleen
Kidney – “Crush syndrome” – secondary kidney changes followed by edema and anuria

D. Pelvic
E. Extremities

Death or Physical Injuries

I. Death or Physical Injuries Caused by Explosion

Rays emitted during explosion

1. Alpha rays – poor penetrating power that can be stopped by a sheet of paper
2. Beta rays
3. Gamma rays
4. Neutron rays – uncharged and composed of highly penetrating particles

II. Gunshot Wounds

A. Classification of Small Firearms
As to wounding power
1. Low velocity – muzzle velocity not more than 1400 ft/sec, Ex. revolver
2. High power – muzzle velocity 2200 to 2500 ft/sec or more, Ex. Military rifle
As to the nature of the bore
1. Smooth bore – inside of barrel is smooth, Ex. Shotgun
2. Rifled bore – inside of barrel with spiral grooves, Ex. Military rifle
As to Manner of Firing
1. Pistol – fired by a single hand, Ex. Revolver
2. Rifle – May be fired from the shoulder, Ex. shotgun
As to the Nature of the Magazine
1. cylindrical
2. vertical
B. Types of Small firearms
1. Revolver – firearm with cylindrical magazine at the rear of its barrel
2. Automatic pistol – empty shell is ejected when cartridge is fired
3. Rifle – with a long barrel and butt
4. Shotgun – firearm whose projectile is a collection of lead pellets.
Billiard ball ricochette effect – as the shot separate from one another, one shot strikes
another causing changes of the shot course

C. Cartridge or Ammunition
1. Cartridge case or shell
2. Primer
3. Powder or propellant
4. Bullet or projectile

D. Things Coming Out of the Gun Muzzle after the Fire

1. Bullet(November 2009)
2. Flame – does not go beyond 6 inches, and in pistols the flame is often less than 3 inches
3. Heated and Compressed Gas
4. Smoke (soot, Smudging, Fouling, Blackening) – byproducts of complete combustion of
gunpowder that may readily be wiped off. May be seen at a distance of 12 inches
5. Powder grains
Unburned, burning, partially burned powder with graphite which come out of the muzzle.
Responsible for tattooing (stippling, peppering)
Tattoing may be seen at the wound of entrance up to a distance of 24 inches
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E. Movements of the Bullet

As it moves out of the Muzzle
Special Consideration on Bullets
Souvenir – bullet has been lodged and remained in the body
Bullet Migration – bullet is not lodged in a placed previously located.
Tandem Bullet – 2 or more bullets leaving the barrel one after another.

F. Gunshot Wound

Powder Burns – blackening of the margin of the gunshot wound of entrance due to smoke
smudging, gunpowder tattooing and burning of the wound margin

Abrasion Collar (Contusio-abradded Collar, Marginal Abrasion) – Abrasion ring, contact ring
1. pressure of the bullet on the skin causes the skin to be depressed and as the bullet
lacerates the skin, the depressed portion will be rubbed with the rough surface of the
bullet
2. a perpendicular approach will produce an even width of the collar
3. an acute angle will cause an abrasion collar wider at the acute angle of approach

Gunshot Wound of Entrance (Entrance Defect, Inshoot)

1. Contact Fire
large, star-shaped wound of entrance
edges of wound may be everted
entrance is blackened by burns, tattooing and smudging
singeing of the hair is confined only at the site of wound of entrance
muzzle imprint
metal fouling – when the bullet travels through the barrel, its surface is
scraped and the scraping is ejected and strikes the target causing small
abrasions or superficial lacerations of the skin around the wound.
Blood and tissues become pink because of carbon monoxide

2. Loose Contact or Near Fire

Entrance may be large, circular or oval
Abrasion collar is distinct
Smudging, burning, tattoing are prominent with singeing of the hair
Muzzle imprint
Carboxyhemoglobin in the wound and surrounding areas

3. Short Range Fire (1-15cm)

Edges is inverted
Abrasion collar is present
Smudging, burning, tattoing,

4. Medium Range (more than 15 but less than 60 cm)

Edges inverted
Abrasion collar is present
Smudging if less than 30 cm, tattooing
Abrasion collar is present

5. Fired more than 60 cm

Wound is circular or oval
No Smudging, burning, tattoing
Abrasion collar is present

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Exit Wound (Outshoot)

Slit-like, stellate, irregular
Edges are everted

Shotgun Wound of entrance

Contact or Near Contact Shot (Not more than 6 inches)
Long range Shot (more than 6 inches)

Test for the presence of Primer components

a. Harrison and Gilroy Test – cotton swab is moistened with hydrochloric acid to gather
antimony, barium, lead
b. Neutron Activation Analysis
c. Flameless Atomic Absorption Spectroscopy
d. Use of Scanning Electron Microscope

G. Ballistics – study of physical forces reacting on projectiles or missiles

Forensic ballistic (firearm identification – examination of fired bullets and cartridge cases in a
particular gun to the exclusion of others

1. Interior Ballistics (Internal Ballistics) – branch of ballistics whch deals with what happened
to the cartridge and bullet from pulling of trigger until exit

2. Exterior Ballistics (External Ballistics) – deals with what happened to the bullet from the
time it leaves the barrel until impact on the target

3. Terminal Ballistics – concerned with the effects of the bullet on the target;

III. Thermal Injuries or Death

Burns
1. Cold
2. Heat
3. Chemical
4. Electrical
5. Radiation
a. X-ray burns – bronze color of the skin. May produce blister, atrophy of
superficial tissues and obliteration of superficial vessels
b. UV light burns - severe and persistent dermatitis, blister formation

Systemic Effects
1. Heat cramps (Miner’s cramp, Fireman’s cramp, Stoker’s cramp)
Involuntary spasmodic painful contraction of muscles due to dehydration and
excessive loss of chlorides by sweating
2. Heat exhaustion (Heat collapse, Syncopal fever, Heat syncope, Heat prostration)
This is due to heart failure due to heat precipitatead by muscular exertion and warm
clothing
3. Heat stroke (Sunstroke, Heat hyperpyrexia, Comatous form, thermic fever)
Those working in ill-ventilated places with dry and high temperatures or due to direct
sun exposure

Local Effects of Heat

1. Scald – caused by hot liquid
2. Thermal Burns – dry heat

Classification of Burns by Degree (Depuytren’s Classification)

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Medicine Board Review Series 2012 FEU
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1st Degree – erythema or simple redness of the skin with superficial inflammation
2nd Degree – vesicle formation with acute inflamation
3rd Degree – destruction of the cuticle and part of the true skin
4th Degree – whole skin is destroyed with formation of yellow-brown, parchment like
slough.
5th Degree – involvement of deep fascia and muscles
6th Degree - involvement of organs and bones

Heat Stiffening – Pugilistic position

Limbs are flexed and the fingers are partially clenched

IV. Death or Physical Injuries by Lightning and Electricity

A. Elements of lighting that produce injury
1. direct effect from electrical charge
2. surface “flash burns”
3. mechanical effect – results from expansion of air due to superheated atmosphere
4. Compression effect – concussion, shock or unconsciousness (sledge hammerblow)

B. Symptoms of electrical shock

1. surface is cold and moistened
2. breath is stertrous
3. pulse is rapid and irregular
4. pupils are dilated and insensitive
5. Pale face

C. Mechanisms of Death in Electrical Shock

1. VF – in low voltage
2. Respiratory failure due to bulbar paralysis in high voltage
3. Mechanical asphyxia due to violent and prolonged convulsion

Metallization
Specific feature of electrical unjury
The metal of the conductor is volatilized and particles of the metal are driven into the
epidermis

V. Death or Physical Injuries due to change in Atmospheric Pressure (Barotraumas)

A. Increase in Atmospheric Pressure (Hyperbarism)

Condition observed underwater by scuba divers, pearl divers, salvage divers, treasure hunters,
pleasure swimmers
Increase in atmospheric pressure increases the amount of gas dissolved

B. Decrease in Atmospheric Pressure (Decompression)

1. Hypobarism – atmospheric pressure decreases in higher altitude – gas is liberated in body
fluids
Bends – joint and muscular pain
Chokes – substernal distress, non-productive cough, respiratory distress
Substernal emphysema – accumulation of bubbles underneath the skin
Trapped Gas – doubling of the size of hollow organs

2. Anoxia – at higher altitude the oxygen content becomes lesser and lesser

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Medicine Board Review Series 2012 FEU
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C. Helicopter Injuries
Injuries on the head and spinal cord
Crash injuries may be laceration or bursting of the heart due to hydrostatic pressure (Paper
bag Pressure)

VI. Death by Asphyxia

A. Types of Asphyxial Death

1. Anoxic – associated with failure o arterial blood to become normally saturated with oxygen
2. Anemic anoxic – due to decreased capacity of the blood to carry oxygen due to
a. Severe hemorrhage
b. Carbon monoxide poisoning
c. Low hemoglobin in the blood

3. Stagnant anoxic – failure of circulation due to

a. Heart failure
b. Shock
c. arterial and venous obstruction, embolism, spasm, varicose veins, tourniquet

B. Asphyxia by Hanging – form of violent death brought by suspension of the body by a ligature with
the weight of the body as the constricting force

C. Asphyxia by Strangulation – compression of the neck by means of a ligature tightened by a force

other than the weight of the body

1. Manual Strangulation or Throttling – constricting force is the hand

2. Garroting – ligature, metal collar, bowstring is placed around the neck and tightened at the back
3. Mugging (Strangle-hold) – the forearm of the assailant is applied in front of the neck
4. Compression of the neck with a stick – victim is placed on his back behind a post with the
assailant using a stick placed in front of the neck
5. Burking – kneeling or sitting on the chest while hands close the nostrils and mouth of the victim

D. Asphyxia by Suffocation – asphyxia by obstruction of the air passage

1. Smothering – closing of the external respiratory orifices. Nostrils and mouth is blocked
2. Choking – form of suffocation brought about by impaction of foreign body in the respiratory
passages
E. Asphyxia by Submersion or Drowning
Time required for drowning
1. Submersion for 1 ½ minutes is fatal, however a person may survive after 4 minutes of
submersion
2. Average time required for death in drowning is 2-5 minutes

Post-mortem findings
1. External findings
Goose-skin, cutis anserine
Washerwoman’s hand and feet
Eyes are half opened or closed, eyelids livid, pupils dilated
Mouth may be closed or half opened with tongue protruding
Hands firmly clenched
Tete de negri - bronze color of the head and neck of a person who died in
water

2. Internal findings
Emphysema aquosum – lungs are distended overlapping the heart

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Medicine Board Review Series 2012 FEU
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Edema aquosum – lung is doughy, pits on pressure and exudes water and
froth
Champignon d’ocume – whitish foam which accumulates in the mouth
and nostrils
Water and fluid in the stomach and in the middle ear
Right side of the heart filled with blood, left side may be empty
Blood chloride is greater in the left side than in the right side if in salt
water drowning

Gettler’s test – quantitative determination of the Chloride content of the heart

F. Asphyxia by Breathing Irrespirable Gases

1. Carbon monoxide – “silent killer”
2. Carbon Dioxide (carbonic acid gas)
3. Hydrogen sulfide
4. Hydrogen cyanide
5. Sulfur dioxide

VII. Death or Physical Injury Due to Automotive Crash Accident

A. Collisions that take place in automotive crash

i. First Collision – impact of the moving vehicle with another vehicle or fixed object
ii. Second Collision – impact of the unrestrained occupants with the interior of the vehicle

B. Front Impact Crash

C. Side Impact Crash

D. Rear Impact Crash – acceleration-deceleration injury or whiplash injury resulting to muscle spasm
or ligament injury

E. Roll Over Crash (Turn-turtle Impact)

F. Pedestrian-vehicle collision
Front bumper hits the leg
If primary impact is above the center of gravity of the pedestrian, tendency of the body is to
move away from the vehicle and fall on the ground.
If no brake was applied during the accident and at high speed, the pedestrian ill pass over the top
of the hood, windshield and windshield frame
Run over injuries – children whose primary impact is above the center of gravity may fall on the
ground with the wheel passing over the body
Hit and run injuries –tire thread marks, abrasion prints on the vehicle, paint detached from the
vehicle, may be used for analysis

VIII. Death or Physical Injury Due to Athletic Sports

A. Boxing Injuries
1. Spectacle hematoma
2. Cauliflower ears
3. Cerebral Concussion
4. Subdural Hemorrhage
5. Pontine Hemorrhage (Boxer’s Hemorrhage)
6. Cerebral Edema, Ischemia, Herniation

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Medicine Board Review Series 2012 FEU
[email protected]

7. Delayed Consequence of Brain Damage – punch drunkenness/traumatic or pugilistic

encephalopathy
a. Slurred speech
b. Clumsy movement
c. Unsteadiness of gait
d. Tremor
e. Progressive dementia

B. Wrestling Injuries
1. Cervical Spine Injury
2. Knee Injury
3. Shoulder joint and rotator cuff muscles
4. Facial injuries and Mat burns
5. Abdominal hemorrhage

IX. Child Abuse or Neglected Child (Battered child, Battered child syndrome, Maltreatment,
Maltreated child, Ill-treated syndrome)

Act or Omission Affecting the Child’s Health or Welfare

1. Physical Abuse – physical or emotional persuasion that forces or places the child in a potentially
dangerous situation
2. Physical Neglect – Failure to provide the child with the necessities of life

Classification of Child Abuser

1. Intermittent Child abuser
2. One-time Child abuser
3. Constant Child abuser
4. Ignorant Abuser – parents mean well but their attempts at rearing their children result in injury or
death of their children

Medico-legal Aspects of Sex Crimes

A. Virginity and Defloration

Virginity –condition of a female who has not experienced sexual intercourse
Virtuous female – her body is pure and has not had any sexual intercourse though her mind is not
pure

Kinds of Virginity
1. Moral – state of not knowing the nature of sexual life and not having experienced sexual
relation. Applies to children below the age of puberty
2. Physical – woman is conscious of the nature of the sexual life but has not experienced
intercourse.
 True physical virginity
Hymen is intact
Edges of the hymen are distinct and regular
The opening is small and barely admits tip of finger
 False Physical virginity
Hymen is unruptured but orifice is wide and elastic
Admits two or more fingers

3. Demi-Virginity – woman permits any form of sexual liberties as long as they abstain
from rupturing the hymen by sexual act

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Medicine Board Review Series 2012 FEU
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4. Virgo Intacta – refers to a truly virgin woman

Parts of the female body to be considered in determination of virginity

1. Breast - reliable
2. Vaginal canal – that of a virgin is tight and the regosities are sharp and prominent
3. Labia majora and labia minora – in close contact with one another and the vestibule is
narrow
4. Fourchette – that of a virgin is V-shape in appearance. Rounding of the fourchette is
caused by stretching apart of the thighs, instrumentation, horse, bicycle riding, sexual
intercourse
5. Hymen
a. Annular or circular – opening is oval or circular located at the center of the
hymen
b. Infantile – small, usually linear, fleshy and resistant
c. Semilunar or crescentric – concavity facing upward, downward, or sideways
d. Linear – opening is slit-like and running vertically
e. Cribriform – contains several openings
f. Stellate – star-shaped
g. Septate – 2 openings separated by bridge of hymenal tissue
h. Fimbriated – border shows small irregular protrusion towards the opening
i. Imperforate – no opening

Defloration – laceration or rupture of the hymen as a result of sexual intercourse. Laceration not
caused by sexual act are not considered as defloration

Degree of Laceration
1. Incomplete laceration – does not involve the whole width of the hymen
a. Superficial – does not go beyond ½ of the width
b. Deep – involves the whole width but not reaching the base

2. Complete laceration – involves the whole width but not beyond the base
3. Compound or complicated laceration – involves the hymen and surrounding tissues

Duration of laceration
Recent – fresh bleeding laceration
after 24 hours – fresh healing with fibrin formation and edema of surrounding tissue
4-10 days recently healed – healed with congested edges and sharp coaptible borders
Complications of laceration
1. Secondary infection
2. hemorrhage
3. fistulae formation
4. stricture
5. sterility

B. Rape – committed by having carnal knowledge of a woman under any of the circumstances
by force or intimidation
when the woman is deprived of reason or otherwise unconscious
when the woman under 12 years of age even though neither of the preceeding circumstances
are present

(already amended by the new rape law)

Examination for Seminal Fluid and Spermatozoa

1. Specimens that may be examined
a. Wearing apparel of the victim and accused
b. Vaginal smear

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Medicine Board Review Series 2012 FEU
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c. Stains on the body of the victim and accused

d. Stains on the site of the commission
2. Gross Examination
a. Inspection with the naked eye or with hand lens
b. Inspection with UV Light
3. Micro-Chemical Examinations
a. Florence test –
Use of Florence solution (Potassium Iodide, Iodine, distilled water)
Test of the presence of some vegetable and animal substance
Merely a presumptive proof

b. Berberio’s test
Picric acid is added to the stain
Needle-shape crystals with yellow color is produced
Specific for spermatic fluid

c. Puramen Reaction
Base don the presence of spermine in the prostatic fluid
Puramen reagent is used
Cross-like crystals is positive

d. Acid Phosphatase test

Uses diazonium salt

4. Microscopic Examination
a. Hematoxylin, Eosin
b. Dr Hankin’s Method
Fabric with seminal stain is boiled with tannin solution and stained with
carbol-fuschin
c. Ganguli’s Method
Fabric with seminal stain is boiled with tannin solution and stained with
erythrocin and malachite green
Claimed to be the best way to stain spermatozoa in India

5. Biological Examinations
a. Precipitin test (Biological Test of Farnum) – test to determine whether the semen is of
human origin or not
b. Seminal Grouping – specific agglutinable substances A and B are present in the
semen, like that of blood

C. Crimes Against Chastity

1. Qualified Seduction
Seduction is the act of a man enticing a woman to have unlawful intercourse by means of
persuation, promise, solicitation, bribes or other means without use of force
Seduction of a virgin 12-18 years of age,
Seduction of sister or descendant whether virgin or not (Incestuous qualified seduction)
Committed by any persons in public authority, priest, house-servant, domestic, guardian,
teacher, any person entrusted with the education or custody of the woman seduced

2. Simple Seduction
Offended party is over 12 to under 18 years of age
Offended party must be single or widow of good reputation
There must be sexual intercourse
Sexual act was committed by means of deceit

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Medicine Board Review Series 2012 FEU
[email protected]

3. Acts of Lasciviousness
Acts which tend to excite lust; conduct which is wanton, lewd, voluptuous or lewd emotion
The lascivious act is done under any of the following circumstances:
o By using force or intimidation
o By depriving her of reason or otherwise unconscious
o When the woman is under 12 years old
Offended party must be a person of either sex

D. Abduction – carrying of away of a woman with lewd designs

1. Forcible abduction
Victim is a woman
Abduction is against her will
Abduction is with lewd dsign
2. Consented abduction
Offended party is a virgin
Offended party must be over 12 but under 18
Carrying away is with her consent
Taking must be with lewd design

E. Adultery
Woman is married
Had sexual intercourse with a man not her husband
The man knows her to be married even if the marriage was subsequently been declared void

F. Concubinage
Any husband who shall keep a mistress I the conjugal dwelling
Having sexual intercourse under scandalous circumstances with a woman not his wife
Cohabiting with her in any other place

G. Sexual Abnormalities
1. Heterosexual
2. Homosexual
3. Tribadism
4. Bestosexual – sexual desires towards animals
5. Autosexual – self gratification or masturbation – form of self abuse or solitary vice without
the cooperation of another
6. Gerontophilia – sexual desire with elder persons
7. Necrophilia – erotic desire or sexual intercourse with a corpse
8. Satyriasis/ Nymphomania – excessive sexual desire to intercourse
9. Dyspareunia – painful sexual act in females
10. Vaginismus – painful spasm of the vagina during sexual act
11. Oralism
a. Fellatio (Irrumation) – female agent receives the penis of a man into her mouth
b. Cunnilingus – gratification by licking or sucking the external female genitalia
c. Anilism – excitement by licking the anus
12. Sado-masochism – pain or cruel act as a factor for gratification
13. Sodomy – sexual act through the anus of another human being
14. Uranism – sexual gratification by fingering, fondling with the breast, lickng parts of the body
15. Frottage – sexual gratification by compulsive desire to rub his sex organ against another
16. Voyeurism – perversion characterized by compulsion to peep to see other persons undress or
perform other personal activities.

Pregnancy, Delivery, Abortion, Birth, Infanticide

I. Abortion

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Medicine Board Review Series 2012 FEU
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1. Intentional Abortion
Woman is pregnant
Violence was applied or drug was administered, or a person acts upon such pregnant
woman
Fetus dies or is expelled
Offender has intention to abort the pregnant woman

2. Unintentional abortion
Woman must be pregnant
Violence was applied without intention of aborting her
Woman was aborted as a result of the violence

II. Stillbirth

A. Causes of Still-birth
1. Immaturity
2. Congenital diseases
3. Debilitating diseases
4. Local disease of the generative organ
5. Accidents
6. Violence

B. Proof of Live-Birth
1. Presence of Heart Action and Circulation
2. Movement and crying of the child
3. Presence of Respiration
a. Arching of the chest
b. Fall of the level of the diaphragm
c. Expansion of the lungs
i. Hydrostatic Test (Fodere’s Test; Static Test) – the entire lungs is removed and
immersed in water. If it floats, breathing has taken place

ii. Differences Between Unexpanded and Expanded Lung

4. Examination of the Stomach and intestines

Stomach bowel test or flotation test or Breslau’s Second Life test
Stomach and intestines are placed in water. If the organs float breathing has taken place.

5. Changes in the middle ear (Wredin’s test)

Middle ear before birth is filled with gelatinuous embryonic connective tissue

6. Condition of the skin

Skin of a new born is bright red
It darkens to brick red in 2 to 5 days

7. Changes in the Umbilical Cord

Umbilical cord begins to shrink and dry within 12 to 24 hours
Inflammatory redness of the base from 36-48 hours
Falls on the 5th to 6th day

8. Condition of the Heart and Blood Vessels

III. Infanticide (Neonaticide)

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Medicine Board Review Series 2012 FEU
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1. Killing of a child less than 3 years old

Paternity and Filiation

1. Legitimate Children – born in lawful wedlock or within 300 days after dissolution of marriage

2. Illegitimate Children – Born out of wedlock

3. Legitimated Children - Remedy by which a child born out of wedlock is considered legitimate
by subsequent valid marriage of parents

4. Adopted Children -
5. Spurious Children
a. Adulterous – conceived in an act of adultery or concubinage
b. Sacrilegious – born of parent who have been ordained in sacris
c. Incestuous – born by parents legally incapable of marriage because of blood relationship
d. Manceres – children conceived by prostitutes

Disturbance of Mentality

A. Disorders in Perception
1. Illusion – false interpretation of an external stimulus
2. Hallucination – An erroneous perception without external stimulus

B. Classical Classification of Mental Deficiency based on IQ

0-20 - Idiot – congenital and due to defective development of mental faculties.
20-40 – Imbecile – he cannot manage his own affairs
40-70 - Feeble-minded – incapable of receiving proper benefit from instructions in ordinary
school
Moral Defective – Strong vicious and criminal propensities, Devoid of moral sense

C. Somnambulism

D. Hypnotism or Mesmerism

Drug Dependence
Drug Addiction
Drug habituation

Alcoholism
Below 0.05% blood alcohol – not considered intoxicated
0.1% to 0.15% - faculties impaired, unfit to drive
0.15% - drunk
0.5% - coma

Reference: Solis, Pedro P. (1988). Legal Medicine

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