June 21

Legal medicine (AKA forensic medicine) branch of medicine that deals with application of
knowledge to legal problems and proceedings

Medical jurisprudence - branch of law that deals with application of law to medicine or
conversely medical science to legal problems

Forensics application of scientific knowledge to legal problems and proceedings

- Used in the pursuit of justice in court proceedings and in the protection of the public from
environmental hazards

Pathology branch of medicine that deals with diagnosis of disease and causes of death by
means of laboratory exams of body fluids, cell samples and tissues from the body.
if alive = biopsy
if dead = autopsy; systematic external and internal examination of the dead
a subspecialty is forensic pathology: a forensic pathologist examines persons who died
suddenly, unexpectedly, violently or a medically unattended death, an expert in determining
the cause and manner of death, involved in crime investigation, case coordinator for the
medical, forensic and scientific assessment of a given death (may be the lead investigator),
expert in interpreting the scene of death, assessing the consistency of witnesses and
interpretation of pattern injuries
Medico-Legal officer physician who is involved in medico-legal duties
SEC. 95 Code of Sanitation: Any medical officer (MHO, RHO, District Health Officer), medical
offices from law enforcement agencies, CHR and members of the medical staff of accredited
hospitals.
Medico-legal cases: deaths or injuries involving persons who have no means of being
identified, those who are pronounced dead on arrival on ERs, deaths under the following
circumstances [death occurred within 24 hours of admission, clinical cause of death is
unknown, unexpected sudden death especially when the person was of apparent good health,
d/t natural disease but associated with physical evidence of foul play, death as a result of
violence, suicide or poisoning, death d/t negligence of a 3 rd person, including cases of child
abuse, physical and sexual abuse, rape, drug addiction and iatrogenic causes of injury, disease
or death (one caused by the medical professional such as the doctor/nurse), etc]
Child protection specialist - new kind of specialist in the field of pediatrics; deals with
medico-legal cases of children who were allegedly abused

NO formal training on how one becomes a Medico-legal officer.

Doctor as a witness:
Can either be a professional witness or an ordinary/ fact witness or both
Give factual medical evidence, cannot give comments or opinions BUT an expert witness
can give an opinion about medical facts

 Expert witness has special knowledge as well as current knowledge or skill gained by
education, training, or experience in the field of expertise
Explain scientific matters that may or may not be understood by judges
Medical expert testimony could either be for the prosecution or for the defense
Medical testimony must be objective and accurate
Law does not make a qualification of an expert physician based on a medical specialist (so
look into their qualifications, their formal training etc)
Child Protection has set qualifications of a doctor who can provide care for the sexually abused
child and these are doctors who can also give expert testimony in court.
pediatrician, gynecologist, pediatric gynecologist, family medicine (important that theres
exposure to children)
formal training
updated with research studies
experience
regular conference, consult one another here and abroad etc
Pre-trial preparation of the expert witness refreshes the level of expertise, enhances quality of
opinion expressed and saves time. Lawyers must also be prepared in their questioning.

Permit the witness to explain and LISTEN.

Know the value of the medical literature presented. When it comes to research the best level of
evidence is a blind test that is random.

Protect your witness. Do not allow your witness to be harassed by the other side. If its a child
witness know the rules in examination of a child witness.

What you should not do:

ask a question you do not already know the answer

do not quarrel with the witness
ask clear questions
Allow witness to explain his answer. An expert witness has a right to explain.
do not ask long and complex questions especially with children
do not ask absolute questions (always, never etc) nor use unnecessary adjectives

June 28
DEATH
A person is alive because of the 3 main parts of the body:
The brain;
The respiratory center; and
The circulatory center
You heart pumps blood throughout the body to circulate oxygenated blood. These are the two
most important systems: your cardiac and circulatory system and respiratory system that will
keep you alive, and the main center for control is the brain.

Definition of death:
The cessation of life in a previously living organism. It is a process, not a single event.

Medical and legal status of death:

Medical Doctor proclaims or pronounces a person dead.
Legal Extinction of the persons identity, etc.
The ascertainment of death is a chemical problem. It s the doctor who will determine when a
person has died.

Stages of Death:
Clinical or somatic death
Brain death
Biological death
Cellular death
Clinical or somatic death:
The respiratory and circulatory functions have ceased. But because of an advancement in
medicine, the circulatory and respiratory functions may be restored through resuscitating
measures.
You may end up as a person whos wide awake, continuously breathing, heart still beating.
Or you may end up as a person whos awake, heart beating, but youre not breathing on
your own. Or you may end up as a person whos just out. You are unconscious and cannot
communicate with your environment. Youre breathing, either on your own with your heart
beating on your own, or your respiration is being assisted, with your heart beating on its
own.
If theres irreversible unconsciousness, with spontaneous respiration and heart beat, it
cannot be accepted as true death. The person is still breathing on his own. Hes
unconscious but hes breathing on his own, his heart beating.
Brain death:
If the brain does not receive oxygenated blood within 3-7 minutes, your heart stops
beating. Neurons die if theres no oxygen brought to the brain within 7 minutes.

Brain death follows a stage:

The cerebral cortex or that part of the brain with higher functions die first.

The cerebellum (the part of the brain thats for keeping your balance and coordination)
follows.
The last to go is the brain stem. It is in the brain stem where the cardiac and respiratory
centers lie. Its the stem brain thats what will keep you alive.
So we have what we call a persistent vegetative state. Youre completely unconscious but
youre breathing on your own, with your heart beating. Or you may have assisted
ventilation. And it is assumed in such a state that the brain itself is functioning. Higher brain
centers are dead except for the brain stem. Because the brain stem is not dead yet, the
cardiac and respiratory centers are working. So even if youre totally unconscious, you may
be breathing on your own and your heart is beating on its own. Or your heart is beating but
your are breathing through a ventilator. And the only thing thats needed is to keep feeding
the patient. So these are the people we call vegetables.
Biological death:
Here finally, even the brain stem dies. All components of the brain die, closely followed by
cellular death.

Cellular death:
Think of cells as mini tiny factories. So in cellular death, these factories shut down one by

one. And eventually, they would just break up and decay.

Cellular death itself also does not happen all at once. Cells die slowly. Because evidence
now is showing that, lets say, your skin and bones may remain what you call metabolically
active (still alive for many hours). Thats why after death, if you need to transplant or use
bones or skin, they may be harvested and cultured up to 12 hours after the heart has
ceased beating. Neurons of course die after 3-7 minutes. The heart and kidney can still be
used if theyre harvested within 8 hours of cessation, after the person is pronounced death.
So its very important, especially when were talking about transplantation. The person
must be pronounced dead by the attending physician.
So death actually takes a long time. It doesn t mean that just because the person stops
breathing and his heart is not beating, he s dead. It s a transfer from one state of viability to
another and may be slow or rapid depending on certain factors, like your age. The very young
and the very old, they die faster. Very young, because they re very immature, the very old
because of the wear and tear. They don t have defenses anymore so they can die really fast. If
you re very thin, if you re malnourished, if you have all these diabetes and heart problems,
your death will be faster. Or environmental factors (good thing it doesn t snow here). If you re
sickly and its cold outside, you re not wearing anything, or you re malnourished, you re going
to die fast.
So it s the physician who pronounces death when what you call the point of irreversibility has
been breached. And when is that? When does a doctor say that the point of irreversibility has
been breached?
Traditionally, when the doctor doesnt feel a pulse or doesnt hear the heart beating and the
person is no longer breathing, we say the person may have died.
Other ways of finding out whether that person is really dead is by putting a mirror on the
face, at the mouth and nose, of the person. If theres no condensation on that mirror, it means
the person is not breathing.
What we can do is also look into the eyes, through the pupils. We can see what we call the
fundus where you can see the blood vessels. If the blood vessels are not pulsating, that
means the heart is no longer beating. We can use EEG (electroencephalogram) test. But in the
province, you dont have EEG. The doctor usually uses what you call the ophthalmoscope to
look into the eye and check if theres still pulsation. Sometimes, they dont have a mirror, so
doctors bring compacts, like the ladies. So its just a pulse or listening to the heartbeat.
You can also try to monitor response by giving painful stimulation to the patient. One is
pressure on the glabella (N.B. the space between the eyebrows, unless you have a unibrow!),
pressure on the sternum, or pinch the finger. So if the person is alive, hes going to drive you
away because these are very painful areas. Especially if the person is lying down and youre
standing up, and you put so much pressure, that can be very painful.
The other ones and very importantly, will be the absence of brain stem reflexes. Meaning
the response to pain stimuli in these areas come from the brain stem. If these are absent, that
means the brain stem is dead.
Corneal reflex what we do is get a wisp of cotton and touch the cornea. You know
how painful that is. So a person will blink. If youre dead, you wont feel anything
anyway. So a live person will be in pain.
Shine light into the pupils if youre dead, your pupils are expected to be dilated. If
you shine a light, the pupils should normally constrict. A dead person will not have that
reflex anymore.
Oculovestibular response we inject ice cold water into the ear. And we normally
expect the eyes to move the opposite side. So if the eyes will not move, then theres no
reflex.
Gag reflex when you put a tube, catheter, or tongue depressor and try to stimulate
the back of the throat. Youre going to gag if youre alive.

Apnea test (apnea means no respiration at all) this is done mostly on people on
ventilators. What is done is, we get what we call arterial blood gases. Essentially, we
want to know what the level of oxygen and carbon dioxide is in the blood. So while on
the ventilator, oxygen is flowing into the lungs. We get the arterial blood gases then the
ventilator is turned off for about 5-10 minutes. After that period of time, arterial blood
gases again are taken. If the oxygen level of the blood is very, very lowtheres a
certain numberif the carbon dioxide level is very, very high, that is a sign that the
patient is not breathing at all. If all of these are not present, then the person is dead.
Plus, you can also have a silent EEG where no more brain activity is going on.
There are criteria for death. As I said earlier, because of new developments in medicine, a
person may not be declared dead immediately. Of course, the first thing that came up was your
cardiac pulmonary resuscitation (CPR). But we have other advancements. We have fibrillators.
First, when a person suffers from a heart attack, it has been proven that the heart fibrillates.
The person faints because the heart fibrillates. How does a heart look like when it s fibrillating?
Imagine a bag of live worms. You look at the outside. It s just going like that. Instead of
pumping blood out, your heart is just going like that when you suffer from heart attack. If you
put your stethoscope on the chest, you re not going to hear it so you re going to say he s dead.
But applying defibrillators can still revive the heart. That s why its very important if any of you
witness a person who may be undergoing a heart attack to just have to call the emergency
medical services. Here we have ERUF. They have defibrillators just to get your heart to start
pumping immediately.
There s what you call for a person who needs a heart transplant. They have what you call
assisted devices (not a pacemaker). It s practically there pumping because the heart muscle
itself is not pumping, or inadequately pumping. You have you ventilators. These are machines
that help you breathe.
But we have a problem wherein because of modern resuscitation technology, even if all brain
functions will have ceased except for the cardiac and respiratory centers your heart can still be
beating, but you may still be connected to a ventilator. So are you going to say that the person
is practically dead? The heart is still beating. The brain stem is still alive. Can you say that
person is dead?
If you discontinue ventilation, is it homicide? Because its very hard to keep this person alive
for a long time. It can be physically, emotionally, financially draining. The care there is every
hour, every minute. You turn that person to sides and hes not even responding to you.
So how does one determine death?
Uniform Determination of Death Act defines death as either:
irreversible cessation of the circulatory and respiratory functions; or
irreversible cessation of functions of the entire brain, including the brain stem.
And the determination of death must be made in accordance with accepted medical
standards.
Harvard Criteria essentially the same definition.
Unreceptivity and unresponsiveness meaning theres a total unawareness of externallyapplied stimuli, pain stimuli, etc. There must be complete unresponsiveness despite application
of painful stimuli.
No spontaneous movement or breathing absence of spontaneous muscular movement or
breathing, as well as absence of response to stimuli, such as pain, touch, sight, etc.
No reflexes
Confirmation by two EEGs there must be two EEGs taken 24 hours apart.
I dont know if you remember this person. This one person was essentially declared dead. Shes
breathing on her own, her heart is beating, she was just being fed. But the husband, probably
tired of taking care of her, went to court and asked the court to declare her dead, so they just
stopped her feeding, and she died of starvation. To me, she does not fall under the Harvard
criteria or the Uniform Determination of Death.

 So let s go to organ and tissue transplantation. In organ transplantation, there are instances
when the person must be dead first. If you will look at the Organ Donation Act of 1991, death is
defined as:
The irreversible cessation of circulatory and respiratory functions or the irreversible
cessation of all functions of the entire brain, including the brain stem. A person shall be
medically and legally dead if either:
(1) In the opinion of the attending physician, based on the acceptable standards of
medical practice, there is an absence of natural respiratory and cardiac function and,
attempts resuscitation would not be successful in restoring those functions. In this case,
death shall be deemed to have occurred at the time these function ceased ; or
(2) In the opinion of the consulting physician, concurred in by the attending physician,
that on the basis of acceptable standards of medical practice, there is an irreversible
cessation of all brain functions; and considering the absence of such functions, furthers
attempts at resuscitation or continued supportive maintenance would not be successful
in restoring such natural functions. In this case, death shall be deemed to have
occurred at the time when these conditions first appeared.
The death of the person shall be determined in accordance with the acceptable
standards of medical practice and shall be diagnosed separately by the attending
physician and another consulting physician, both of whom must be appropriately
qualified and suitably experienced in the care of such patients. The death shall be
recorded in the patient's medical record.
So the attending physician may call another consultant; he and the attending physician can be
the ones to declare a person dead.
Now going to problems regarding transplantation, the problems are consent and
authorization who will consent or authorize to donate organs, who will determine death in case
of procurement from a cadaver. And there is a problem of rationing organs, there s not enough
organs for transplantation. More so in the US and Europe where they do a lot of organ
transplantation. So here for us, a person who may execute or authorize to have a part of his
body donated is anyone above 18. In the US, there in their driver s license, it s indicated if you
want to donate your body or a part of your body, and automatically, you ll be sent to the
hospital and the hospital will harvest your organs. Of it could be anybody somebody of legal
age can sign for you. Your parents, siblings, or guardian. And the organs have to be harvested
within 8 hours. So you have to consider the time to remove, travel time, time to operate the
recipient, etc., so you have to make the decision fast.
Manner of executing a donation:
The death of a person from whose body an organ will be removed after its death for the
purpose of transportation to a living person, shall be diagnosed separately and certified by
2 qualified physicians, neither of who should be a member of the recipient team. The
surgeon who will be the one to remove the organ cannot be the people who will declare that
person dead, etc. Its conflict of interest. It should only be the attending physician.
Sources of organs:
Fetus contains cells which we call stem cells. They contain cells that have the potential
to become any kind of tissue, provided that tissue is placed in the right environment. So if you
put a tissue in the area of the heart, that tissue will develop into heart cells. Anencephaly
infants are babies born with only the brain stem intact. They dont have a skull cap, they dont
have the higher brains, but just the tiny brain stem. Thats why theyre alive, they have all
those reflexes, theyre breathing except for that abnormal head. But when they die, their hearts
can be used for transplanting to babies with congenital heart diseases.
Artificial animal transplants The problem here is, its not matching. I dont know how
compatible you can be with a pig or a cow. And the problem there also is, that animal may have
some kind of disease which the human never gets. Whats going to happen is, its passed on to
the human being who received the disease from the pigs heart. So how are you going to cure
that illness?

We do have problems with using animal tissue, although the Philippine Heart Center
used to transplant pigs heart valves, etc. into heart valves of patients but theyve
stopped.
Homologous transplantation when tissue is removed from one part of the body and put
back into your own body. So you scrape skin from your thigh, probably to cover a burned area
in your back. Or you chip part of your pelvis and transplant it to an area where theres a bad
fracture, for that fracture to heal faster. Or in cases of Jehovahs Witnesses, who cannot accept
blood from any other person. I had an experience where a patient had to undergo an open
heart surgery. (For those who undergo open heart surgery, you heart has to stop beating.) So
the blood must go through a cardio-pulmonary bypass machine and then returned back to your
heart, bypassing the heart and lungs. So in this case, its the patients own blood thats
circulating, diluted with IV fluids.
Your tissue is taken from a living donor and these tissues will be matched first with a
recipient. If youre compatible, your blood can be extracted and transfused to another person.
Theres what you call bone marrow transfusion, for patients with leukemia with white blood
cell problems. There are also people who will donate their own kidneys for a fee.
But bear in mind the Anti-Trafficking in Persons Act 2003, Sec. 4., wherein youre not
allowed to sell your organs. Now, cadaver donation is actually the major source of all
tissues for transplantation. So your drivers license may indicate that you want to
donate an organ or everything. Most of organs for transplantation come from dead
people but they must be harvested soon after the patient is declared dead.

Cloning if you have problems, theyll just give you your clone.

July 5
When everybody dies changes can happen. How do we estimate the time of death?
EARLY CHANGES THAT HAPPEN AFTER DEATH:
1. Rigor Mortis
2. CadavericRigidity
3. Post Mortem Hypostasis
4. Cooling of the body after death or Algor Mortis
When the heart stops and the breathing stops eventually theres a falling blood pressure,
theres no more oxygen and the cell method will stop working and because of that your nerve
cells will die and theres going to be no more neurological activity.
When blood pressure falls down and theres no more circulation, you would become pale. There
would be pallor personae, there will be eye changes, reflex is gone, the pupils will not dilate
and will not constrict if its shown light, the blood vessels in the fundus that you see that are
actually retina. You wont see any pulsation and if you touch the eye, its very soft. Muscles will
become flaccid. As soon as there is a loss of the muscle tone it becomes flaccid and this is
termed the primary flaccidity and this may retain any activity and may respond to other forms
of stimuli thats why you might see some twitching of the toes or some muscle twitching thats
reacting to the stimuli. Its not actually dictated by higher senses. There will also be loss of
muscle tone so your anal sphincter will just come out. Your urinary sphincter, your urine will
just come out. Or some semen might just be emitted but that doesnt mean that he had just
had sex before he died. There will be revegitate of the gastric contents because there is a
sphincter in the esophagus and in the stomach. That will also be relaxed so when the person
falls on his back or even head down stomach opening relaxes, gastric sphincter will flow
backwards this can be confused as if the person died because of asphyxiation (gastric contents
going into the airway). The only way we can say that a person died because of asphyxiation
from aspirating food is from eyewitnesses account. If food debris can be found down to the
smallest part of the lung and then we can say he asphyrated and that is the cause of his death.
Rigor mortis. The temperature dependent physico-chemical changes or chemical reactions
occur within motor cells as a result of lack of oxygen.
Difference between a normal metabolic pathway and the anoxic (no oxygen pathway). A
normal metabolic pathway happens within your body, within your system. An important

reproduction of energy in your body, your ATP using oxygen. So if there is no more oxygen its
just glucose that is being used to produce ATP but then without oxygen it will not go through
this process of oxidity >>>> lactic acid pathway and will produce a lot of lactic acid in the
body. With the lack of oxygen, very little ATP or energy, more of lactic acid what happens
is>>>Your muscles are made up of fibers of cells-acti enmycin fibers. They bind together and
they form a gel and that makes the muscles stiff. Its that lactic acid that will cause your
muscles to gel up thus become stiff. And this can develop fast especially if theres no blood in
the >>>> levels. Especially during exercise or when the acidic levels are high or when
somebody is stressed or during electrocution when the muscle will be repetitively stimulated,
the muscles will keep flexing and flexing, the oxygen levels can be low, glycogen or glucose
levels can be low, it will become acidic so rigor mortis can be very fast. It may not be detected
in people who have low muscle bulk. Theres not much muscle. So whats there to harden? It is
usually detectable first around the eyes and around the jaws and fingers and it will develop
from the head down, from the smaller muscle down to the larger muscle groups. In determining
the presence or absence of rigor mortis, it is only estimating the time of death. Rigor mortis is a
variable process because it can be affected by a lot of environmental factors. It is unreliable to
find out the time when the person died. If the person is exposed to a cold temperature he will
develop rigor mortis longer as compared to a person who is in a warmer temperature which will
be of shorter duration. In temperate conditions its first detected in the face between 1 to 4
hours after death, in the limbs between 4 to 6 hours after death, the strength of rigor will
increase in the legs 6 to 12 hours. After that, when cellular metabolism or decomposition of the
cells begin, the muscles now will lose its cohesiveness, its gel-like property now will get lost. In
this stage of rigor mortis, the body ends enters the stage of secondary flaccidity which occurs
between 24 to 50 hours after death. Two types of rigor mortis: primary flaccidity within 24
hours, it becomes stiff; after that the stiffness is gone and thats called secondary flaccidity.
One can test for rigors. If a joint is flexed at death, apply some pressure. If it jerks back, that
means theres rigidity. If the body feels warm and is flaccid, it may have been dead for less
than 3 hours. If it is warm but stiff, it may have been dead for 3 to 8 hours. When the body is
cold and stiff, it may have been dead for 36 hours. If it is cold and flaccid up to secondary
flaccidity, therefore, more than 36 hours.
Cadaveric rigidity. Another term for this is instantaneous rigor or captalictic rigidity. This is
based on certain findings wherein some people die holding grass in their hands or holding a
gun when he died. Most likely the mechanism behind has something to do with a neurogenic
kind of activity when that person is highly stressed at the time of death. Forensically, if a
person dies and is found in the water and holding on to something like a grass found outside of
that body of water then that person was alive before he was found in the water. Or that person
may be holding something that belongs to the alleged perpetrator or whoever was with that
person last may be holding on to something.
Post mortem hypostasis. At death, circulation stops, all muscles relax, including the muscles
in the blood vessels. With the relaxation of the muscle tone in your blood vessels, the blood will
settle down in areas where the blood vessels are dependent. The blood has cells and fluid. The
passive settling of the blood cells under the influence of gravitiy to the blood vessels in the
lowest area of the body. This is forensically important. It is not always seen in the body. It may
be absent in the young or in the old, those who are anemic. It may >>>> by that skin colors,
jaundice or yellowish coloring of the skin. It mostly forms on the back, buttocks sides, and back
of the neck because usually when a person dies hes lying flat on his back but there are some
areas of that persons back that could be so pressed on a certain part, like on the bed. A person
died on his back so the buttocks probably pressed on the bed will have >>>> called blanching.
Meaning, the blood vessels have been squeezed, so blood vessels could settle in this area. The
part of the butt not in contact with the bed may be found to have a post mortem hypostasis.
You can tell the persons position when he died. When hes hanging, hypostasis will be on the
lower extremities not in the torso. Gravity. If the body fall head first, the hypostasis will be in
the upper part of the body as compared to the lower part of the body. There may be some
changes in the color after death. If the color changes in a cherry pink color, most likely that
person died of carbon monoxide poisoning; dark red, by poisoning; bronze, infection caused by
an organism called >>>>. If the body was moved and hypostasis is already happening, there
could be layering of that hypostasis.
Algor Mortis. The body will take on the temperature of the environment. It is useful indicator

of the time of death during the first 24 hours post mortem. The use of body temperature as
estimation applies only to cool and temperate climates not much in tropical areas because the
cooling of our body will not be as much because our environment is warm. Its best measured
using core temperature like rectal temperature taken at examination or on discovery. Using oral
temperature is not advisable.
Examining gastric contents at the time of death will only tell you what he ate the last time. It is
difficult to use this estimation of the time of death. Before, it was believed that our stomach
empty into the intestines within one hour. Thats no longer correct. It also depends on the kind
of food that you eat. Fatty foods remain longer in the stomach compared to non-fatty food.
Another method is looking at the presence of insects in the body. There are some insects that
like to feed on the human body. Depending on what stage of the insect. You have to get a
forensic entomologist. In other countries, depending on the season, they look at the animal
bites. In the winter season, its just the bears that are there in the forest. If its summer, its
just the squirrels that are there.
It is very important that an examiner gives an estimation of the time of death. There is a
bracket probability giving an earliest or latest time which the doctor feels that death must have
occurred. Its within a range.
Decomposition or putrefaction. Most common root of decomposition of the body after
death and early changes may be confused to be signs of violence or trauma. There is
liquefaction of soft tissues over a period of time. The earlier the process starts the faster it
progresses. In a week or so the body cavities will burst and the tissues will liquefy and drain
away onto the ground.
Mummification. The body cavities dry up and it usually happens in hot or warm environment
and also in cold dry areas.
Adiposerum. Theres a chemical change in the body fat; the features are retained apparently no
decomposition happens.
Immersion. It slows down the process of decomposition. A body will decompose in air faster
than in water. The most common position of the body in the early stage is, if the chest contains
air then the chest is floating and the limbs are hanging in the water so your hypostasis is
expected to be in the hands and in the feet. If there are animals in the water, expect also that
there will be bites in your hands and feet. If the water is shallow, expect the hands and the feet
to be dragging on the river bed. Loss of epidermis first and then there will be gaseous
decomposition so that the body will start to float. There could be adiposere formation if the
body is under water. When the body is buried it will decay more slowly but if the surrounding is
wet, very acidic, the body will decompose faster. Eventually your skin will fall off. Within two
years, no more skin tissues, it will then be all skeletal and what will remain will be your
tendons, your ligaments, hair and nails. Within five years, nothing is left on the bones and all
the joints now will be disarticulated. You can use the bone marrow to get the mytocondreal
DNA. Its one way of identifying a person. But the mytocondreal DNA is only that of the mother.
Post mortem injuries. It can be determined by looking at the edge of the wound. If you are
injured before you died, there will be inflammatory response after your injury. If youre injured
after your death, there will be no more inflammatory process that will go on.
Embalming. It is a physically invasive process in which special device are implanted and
chemicals and techniques are used to give an appearance of restful repose. First the bag is
placed on the stainless steel, place the person in table washed with insecticide and germicide
and olfactant, the insides of the nose and mouth are swabbed with solution, the muscles are
massaged to soften it, creams is placed on the face and then massage so it will look soft. The
facial features are set by putting cotton in the nose so its not gonna collapse, putting eye caps
below the eyelids so it will not look sunken.
Arterial embalming. They inject an embalming fluid into an artery. They inject one gallon or
so of a mixture of formaldehyde and other chemicals with water. Chemicals are also injected
thru syringe into the other parts of the body.

Cavity embalming. The trucar is inserted intto the navel and an instrument is inserted to
puncture organs that contain air. Gases and fluids are withdrawn. Fluid is put inside the cavity.
The anus and vagina are tucked with gauze to prevent seepage of fluid. Incisions and holes are
made in the body, tinatahi, and then the body is washed again. This is the whole embalming
process.
Exhumation. This is the province of a skilled and experienced forensic pathologist. If the
cause of death is poisoning, the pathologist must also get soil samples because there might be
fluid in the body that may have seep into the soil or in the coffin and fluid from these areas is
best taken to determine if theres any poison present there to determine if the person really
died of poisoning. When you exhume a body you have to ask the court, there has to be a court
order first. There must be legal reason for exhuming a body.

July 12
DEATH INVESTIGATION.. It involves police investigation and the application of forensic science.
Kinds of death that require investigation in the Philippines, understand the principles of death
investigation including the autopsy. Learn and understand the contents of a medico legal
autopsy report and how the medico legal findings become useful to the legal system.
The purpose of death investigation is to identify and develop an understanding of the death of
that person.
Two types of death investigation:
1. Clinical death investigation happens within the hospital. The doctor or the medical officer
or the pathologist wants to know what that person died of, what was the illness, did he die of a
certain disease or injuries, or of poisoning. Its just within the hospital setting.
2. Medico legal investigation - maybe theres some foul play in the cause of death. It may be
that there is a police investigation going on regarding the death of that person.
When that natural death occurs, the doctor will sign the death certificate, once the death
certificate is signed then the body can be disposed of the, the death certificate will include the
cause and manner of death. If the death is natural and no doctor can complete the certificate
then that death must be investigated and the death be classified. Death that cannot be
examined by the doctor is examined by a variety of legal officers-the medico legal officers or
the medical examiners.
Herein the country based on the Code of Sanitation, cases where autopsies were performed are
those that are required by special laws upon the orders of a competent court, a mayor or
provincial or city fiscal upon the written request of police authorities whether the solicitor
general or the city or provincial fiscals are authorized by existing laws shall be when necessary
to dis>>> and to take possession of the remains for examination to determine the cause of
death, whenever the nearest of kins shall request in writing the authorities concerned to a
certain cause of death. In order to be autopsied you have to get the consent of the relatives
and more often than not they will not consent. If there is foul play you have to run through this
people like the city fiscal or the police just to ask for a request for autopsy. And the police
authorities wont even ask for the autopsy for the medico legal investigation of the death of the
person. These are the problems in our country its very hard to go beyond. It might be that a
member of the family killed that person. If somebody is in the hospital and somebody in the
room killed that patient, the doctor will wonder how he can die suddenly. Sudden infant deaths.
These are the cases that need medico legal investigation.
DOAs, people who died and had not been identified, unexpected sudden death especially when
the deceased was in an apparent good health, death with natural disease but associated with
physical evidence suspicious of foul play, death as a result of violence, accident, suicide,
poisoning, death due to the negligent or improper act of another person, deaths of persons

whose bodies are too burned. These are deaths that also need medico legal investigation based
on the Center for Disease Control in 1998. It includes death which had occurred in custody,
these are the types of death that ate not listed in our law that are classified as medico legal
cases. A year ago, there were 19 deaths in the BBRC and theres no autopsy that was done.
Deaths of persons whose bodies need to be cremated or buried at sea because once you
cremate the body you have no more body to exhume. Thats related to disease relating to the
employment to or accident on the job, deaths that are related to the disease that might
constitute as threat to public health. These are the deaths that are not included in our list.
In the US, they have a death investigation team. An author says that death investigation is
composed of a coroner, a medical examiner and a forensic autopsy technician (theres no such
thing daw, its the embalmer). They have to involve themselves with the people who
investigate the scene they also do their own investigation on the backgrounds, conduct
examination in the laboratory, they also deal with evidence that consult with concerned parties
like the all types of forensic people as well as the police investigators and they must testify in
court. In our country, we have a medical examiner, but most often than not it is really the
embalmer who does the autopsy. Our medico legal officer will just look at what the embalmer is
doing. Doctor Fortun was doing an autopsy on a child and she found something unusual when
she feels the rib of the child, theres may be a fracture. She tells the medico legal officer who
had autopsied that girl and said feel this out. This is abnormal. The medico legal officer said, he
called the embalmer and say, will you please feel that rib if its abnormal or not. The laboratory
examinations will have to be done in Manila, the PNP Crime Lab and the NBI Crime Lab. (I
dont know and I dont think they obtain evidence, I dont think they even consult with
concerned parties but they will testify in court. And I dont know what kind of information they
get if theyre only looking at the body. And Im speaking from experience.)
Aims of a death investigation: the medico legal officer must find out who died, when that
person died, why that person died, and where that person died, and how that person died. The
doctor will have to go to the scene together with the police officers. Or a trained pathologist is
the best person to investigate this death; he has to get physical and testimonial evidence,
photographs and videos and trace evidence, social history, interview the family and the
relatives. Get the medical history of that person, medical records from the hospital or medical
records from the physician.
Medico legal report is important in the process of death investigation.
Autopsy is a post mortem examination where the examiner wants to see with his own eyes. Its
a scientific investigation of a dead body performed primarily to determine the cause of death
and identify the disease that are present. In academic institution these are only for teaching
and research purposes. But for forensic autopsies it is to determine whether a given death was
an accident, homicide or suicide or a natural event. An autopsy can be performed by any
doctor but must be performed ideally by a properly trained pathologist. Our medico legal
officer had not had any formal training in doing autopsies.
Persons authorized to perform autopsies in our country:
The aim is identify the body, estimate the time of death, identify and document the nature and
number of injuries.
Specific objectives: interpret significance and the effects of the injuries, identify the presence of
any natural disease, interpret and identify the significance of the natural disease present,
identify the presence of poisons, interpret the effect of any medical or surgical treatment. It is
not just looking. It is also analyzing what is seen and has also to see whats not there.
Autopsy will consist of an external examination. Examine the whole body on the outside.
Collect and trace evidence especially under the nails, on the mouth, etc. After conducting an
external examination taking all the necessary pictures and documentation of the injuries
including sizes and location of all those injuries an internal examination is done where the body
is cut up, each internal organ is removed, weighed and dissected, injuries are looked for, signs
of a natural disease are looked for. Anything thats abnormal there are looked for. Part of the
autopsy is a laboratory examination wherein tissues, fluids, any weapon fragment bullets or
whatever are collected and examined. Autopsy includes gross observations and microscopic
examination of all the tissues. That medico legal autopsy must determine the cause of death.

Cause of death: It is the disease process or injury responsible for initiating the train of events
whether their brief or prolonged using the fatal end results. Its that which starts the event.
Mechanism of death: The physiologic or biochemical derangement produced by the above
cause which is incompatible with life that is how the disease or the injury leads to death.
Manner of death: The fashion or mode in which the cause of death came into being. It may be
natural, accident, suicide, homicide, it can be unclassified whether if it is due to alcohol or
drug. It could be undetermined. In the homicide classification of death, this is used to classify
the kind of death. It is not used to imply criminal intents. Criminal intent is left to the police
investigators, into the legal process not in the doctors. It is only used here that the person died
because of a volitional act of somebody. Undetermined cause or manner of death it could be
like there are so many manners of death that could have happened and its very hard to
determine which one weighed more in killing that person. Example: if youre a person who
loves to drink a lot of alcohol, eat a lot especially pork, smoke so youre prone to have high
blood cholesterol level so you will develop a coronary artery disease. Coronary artery disease
can cause two problems in your heart: electrical disturbance and heart failure. Because of the
block in your coronary artery theres not enough blood supplying the heart, so it could be that
the nerves of your heart or the lethical wires of the heart are not well supplied by blood. So its
not going to pump regularly and rhythmically. Fibrillation or a fibrillating heart, like a bag of
worms, so that heart is not pumping blood at all. Its not pumping blood out. Every time your
heart pumps out of its chamber it will also supply blood to the heart muscles. A heart failure is
caused by poor oxygenation because of poor blood flow to the heart muscles. If a part of your
heart muscle is weak, its not gonna pump blood. Your hearts gonna have an ineffective pump
so youre gonna have a heart attack. When you die, the manner of death is classified as
natural. When you are stabbed, youll lose a lot of blood, thats the mechanism. Hanging,
suicide, strangulation, the mechanism there is asphyxia, a lack of oxygen in the system.
The medico legal report must show these three information. Unfortunately, our system of
death, according to Doctor Fortun, is not scientific based and is haggled by the policy of no
aggressive complainant, no case and the practice of relying mostly on witnesses. If theres no
complaint, theres no case.
Here is a case of a girl who died in a Monday morning. She was apparently well 4 days prior to
her death. The following day she did not feel well, she complained of vague abdominal pain.
She stayed in bed and ate what was fed to her. Two days before she died, she refused to eat
and continued to complain of abdominal pain. Her mother noted that her abdomen was
becoming distended. She still refused to eat the next day. And because of that the mothers live
in boyfriend beat her with an electric wire. The child still didnt eat and died the following day.
The mothers live in boyfriend was arrested and was charged with for violating RA 7610, the
Anti-Child Abuse Law. The autopsy report concluded that the child died of pneumonia. As to the
manner of death, there was no report. Based on the request of the mother this child was
exhumed. This is the case where Doctor Fortun felt an abnormality in the childs rib. The child
had bruises. The police were saying that she died of beating. Doctor Fortun found out that her
intestines had telescope unto itself (the smaller part will enter into the bigger part) there will
be intestinal obstruction. The cause of death is intussusception. The mechanism of death is the
biological and physiological changes in the body; youre not eating, youre starving, youll have
lactic acidosis and your heart is going to stop beating if its in an acidic medium. The manner of
death is homicide because the mothers live in boyfriend refused to bring the child to the
hospital even when the mother pleaded to bring the child to the hospital. But maybe its
unintentional because he probably just did not know.

July 26
IDENTIFICATION OF THE LIVING AND THE DEAD
Medical reasons for establishing the identity of a living person and a dead body:

a person is comatose

infant

person who has mental defect

there is language barrier

the person may tell false information regarding his identity

even if details is known but personal details are needed to be confirmed for
purposes of immigration or inheritance

for paternity and filiations for proper support, inheritance and parental authority

for investigation of the death especially if it involves mass disaster for purposes of
inheritance, insurance, retirement, immigration, etc
You need the help of experts or forensic people like forensic pathologist, orthodontologist,
anthropologist when the dead bodies are severely injured or severely mutilated, decomposed
or skeletized.
The identity of a person is established by comparing or matching the parameters that can be
measured with the parameters of another person which is suspected to belong to the body
being measured. The best feature on how to identify a person is his specific features that are
matched to one that is known to a certain person.
METHODS OF IDENTIFICATION:

Morphological characteristics. This is a method of identifying criminals thru

height, weight, general physique, hair color and length, presence of beard and
mustache, skin pigmentation and other facial appearances, eye color, shape of the lips,
and chin. These can differentiate one person from another (e.g. race).

Picture: get the frontal and the side view shot (more often than not, your left profile
is different from the right profile)

To determine the age: white thing around the eye, teeth only up to age 25 and a
range is given, x-ray (oxification centers, bone growth)

Clothing and jewelry.

Tattoos.

Other marks: Striae, pimples, cleft lip, tribal marks, body piercing.

Health records (scar, disease)

Vertillian system of identification.

Get 11 measurements from the person

Write down and describe all the persons individual markings and personal
characteristics

It is flawed, it does not take into account changes with age

Was replaced with the use of fingerprints.

Fingerprints

Three main patterns: loops, whirls and arches or a combination of any of these
three.

Used to ascertain a positive ID of a person

No two persons have the same fingerprint even twins

Cannot be altered by time or injury

Can be extracted in any surface they come into contact with.

Three Types

Patent prints

Plastic prints

Latent prints

-left when a foreign

substance on the
skin of a finger
comes in contact
with
the
smooth
surface of another
object

-left when a finger

touches
a
soft
malleable surface

-impressions
secreted
in
a
surface or an object
that is invisible to
the eye, the result
from
perspiration
from
the
sweat
pores found on the
ridges
of
sweat
pores
-invisible to the eye

-visible prints
-no
need
enhancements

for

-visible prints
no
need
enhancements

for

-needs
enhancement
dusting)

(e.g.

No less than 16 points of similarity before declaring prints to be identical

The investigating agency must already have a file of fingerprints for comparison

For decomposed or damaged bodies: use specialized technique from a

fingerprint expert; can be obtained from despomated skin of the underlying epidermis
after shedding the stratum corneum (the fisrt layer) when it comes to prolonged
submersion; using the surface below the stratum corneum

Palm prints and sole prints it is believed that people do not have the same

Lip crease pattern

Ear-shape

Vein pattern in the dorsal part of the hands

Bite mark

Bones: sex, age only up to age 25, height, race, personal identiy: dependent on

ante-mortem data

Facial reconstruction: soft tissue thickness of the skull

Tissue and cell samples: blood type, protein complexes, blood enzyme systems,

Photo superimposition: photo of possible individual is overlaid with

photographic transparency of the skull which has been scaled down to the eyes

etc

DNA profiling: used in exclusion and identification thru body fluids, hair strands;
DNA analysis can yield a positive identity

Principles

no two persons have the same DNA pattern except for identical twins or clones

each part of your body contains the same DNA

If the DNA pattern left at the scene of the crime does not match the suspects DNA
pattern, the suspect was never in that scene. If it matches the suspects DNA pattern, it
puts the suspect in the vicinity of the scene of the crime but does not necessarily mean
that he is guilty of the crime.
The DNA molecule consists of two strands of sugar and phosphate molecules that
link to one another to form a double helix.
Ten percent of the molecule is used for genetic coding and the rest are silent. These
silent zones repeat themselves, meaning, there is only 10 percent of the billions of
molecules in the body and only a few percent is specific to you alone but the distribution
is unique for each one of us, the sequencing is different.
The DNA is found in the nucleus and it is a double helix. It is very stable but the
specimen that contains the DNA that is to be analyzed can easily be contaminated by
the collector.
DNA typing is a well-established means of identifying human remains and is a
powerful tool resorted to when traditional methods of identification are not helpful.
DNA fingerprinting is the last resort in identifying people. Its used for healthcare,
pharmaceutical research, evolution and forensic.

There are 3 ways of determining DNA sequences.

Types of samples needed for DNA analysis: it must have nucleus (white blood cells,
hair root, spermatozoa). Get a buckle smear from the side of your mouth, vaginal swabs
and anal swabs to determine presence of semen or Y chromosome within 72 hours
placed in a ref right away, blood. Semen on clothing can stay for a year.

Half of our chromosomes come from our father and the other half from our mother.

Blood groups can only be used for exclusion in paternity or maternity testing; not
accurate like that of DNA analysis.
If the childs blood type is O and the mothers blood type is O, the fathers could be
A or B.

Samples for DNA testing: mother, child and probable father.

In paternity exclusion, if theres none matching profiles in at least two DNA locations
it can constitute conclusive proof that the alleged father is not the biological father.
In child sexual abuse cases, it does not necessarily exonerate the suspect from the
abuse charges; it just means that the abuse did not impregnate the child.
In paternity inclusion, complete matches in the DNA profiles of the child and the
alleged father will not necessarily establish paternity. The strength of the matches is
determined statistically.

JULY 31 (SATURDAY)

IDENTIFICATION OF LIVING AND DEAD

Use of DNA evidence in courts:

Important to use DNA- allowable for ID and testing of parentage
SC said DNA can be used as corroborative evidence together with other evidences
Find out how sample collected, handled, possibility of contaminating samples, standard
procedure followed in analysis, proper standards followed in conducting tests and qualifications
of the analysts who conducted the DNA tests (questions that should be answered when you
present evidence in court)
By itself DNA cannot establish the guilt of an individual (powerful corroborative evidence)
only DNA experts can say that the DNA samples belong to the suspect
DNA experts are the most appropriate persons to answer questions regarding DNA forensic
process. Find out his professional qualifications, how reliable is their DNA testing process and
the laboratory itself.
Expert witness will interpret the DNA results and will explain the match or exclude a suspect
as a possible source of the DNA.
DNA report contains:

what were the samples tested

the controls used
DNA profile of sample consistent with that of the suspects
Statistics of the probability that the evidence sample came from the suspect
Conclusion based on the results of their test

How are these interpreted?

Independent DNA profiles of the victim (sexually assaulted kid) and the reference samples are
compared. The results are either inconclusive or theres an exclusion or an inclusion.

Inconclusive - DNA testing did not produce info that would include or exclude the suspect.
May result from improper collection, handling or storage and can occur when quantity of intact
DNA is insufficient or sample contains complex mixture from several individuals (do not
contaminate!)
Exclusion - if the DNA profile from the sample does not match the profile of the suspects
DNA reference sample. Suspect excluded as a source of the DNA but does not equate to
innocence and does not automatically absolve suspect of the crime because he may have
committed the crime but did not leave any DNA samples. May indicate involvement of another
person.
Inclusion DNA sample from the suspects DNA reference sample matches the DNA profile
of the sample taken from the victim or scene of the crime. Suspect is included as a potential
source of the DNA but does not automatically determine the suspects guilt. You have to
present other evidences to prove if hes guilty or not.
Statistical analysis will estimate significance of the match:

random match probability - probability that an innocent individual who is unrelated to

the suspect and chosen randomly from the population will match the DNA profile taken from
the crime scene
Likelihood ratio ratio of the probability that the DNA profile in the evidence sample
came from the suspect and the probability that the DNA sample came from a random unrelated
person. Ratio of the probability of the match given that the defendant is guilty to the
probability of a match that the defendant is innocent.
> 1, 000 = very strong evidence to prove that this DNA belongs to defendant
INJURIES - from blunt and sharp forces

Wounds/ injuries tissue damage from mechanical force or from non mechanical forces;
breach in the skin; caused by outside objects or force either physical or chemical
- Results from accident, act of self-harm (self-inflicted) or from action of a third party

How caused?
1. Kinetic caused by application of mechanical or physical force
Mechanical force causes two types of trauma: blunt and sharp
Blunt force trauma causes abrasions, contusions and lacerations
Sharp force trauma leads to incised wound or stab wound

2. Non-kinetic injuries come from non-motion trauma like thermal, chemical, electrical,
radiation or exposure to atmospheric pressure

Important when describing the wound how it looks like, what kind? Demand from doctor, you
have to know whether blunt or sharp force, what are the dimensions, positions, etc.

Abrasion

 superficial type; involves epidermis; no bleeding involved; e.g. scratch; deep abrasions can
have bleeding because of blood vessels
Tangential glancing impact (something falls on your body) crushing; size and shape will
depend on the kind of object which comes into contact with the skin
Linear abrasion, broad, crushed.

Contusions, bruises (ecchymosis, hematoma)

breakage or rupture of blood vessels cause escape of blood from blood vessels to the
dermis resulting to discoloration
External bruising and internal bruising (bruises on internal organs)
The greater the force the greater the bruising
the site of bruising does not necessarily reveal the site of trauma because blood is not
static, can move by gravity
initially reddish / purplish to yellowish or brown (d/t breakdown of hemoglobin)
The usual guide in determining the age of the bruises has been discarded. It was discovered
that some bruises will only appear later on when there was already bruising in the muscles for
a long time.
depends on the site and how bad was the bleeding
they do not accurately reflect the object causing them but there are some patterns that
indicate the type of weapon used
often associated with abrasions and lacerations less associated with incised/stab wounds
because in stab wounds the blood is allowed to escape/ seep under the skin
more prominent if force applied on bony areas so if you see bruise on abdomen greater
force was applied for a bruise to result
Can occur after death since blood vessels are easily broken when dead. Found on areas on
the dependent part of the body (by gravity)
Lacerations
result of blunt force overstretching the skin and there will be a split of the full thickness of
the skin
deep and will bleed
important to look for bridging fibers (remain intact in lacerations and will not be cut)
skin can be compressed within the applied force and the underlying bone
rare in soft fleshy areas of the body
margins are always ragged
if caused by thin sharp object, the wound is sharply defined and may be mistaken for
incision but under the microscope there could be abrasions and contusions on the edges and
bridging fibers in the laceration
Sharp force injuries:

1. Incised wounds
also caused by objects with sharp and cutting edge and distinguished from a stabbed
wound by being longer than deep
Edges will give indication of the sharpness of the object used. Very sharp objects will not
leave bruising on the edges, no bridging fibers.
rarely life threatening unless it cuts deep into a tissue like your jugular artery
2. Stab wounds

 wounds that are deeper than they are longer

Depth of the injury will make it fatal because of the bleeding
Any object with a point or a tip can cause it, edge need not be sharp.
Pressed into the skin with enough force to overcome the natural elasticity of the skin
Appearance does not necessarily mimic the cross-sectional shape of the object used.
Contraction of the elastic fibers of the skin will distort a slit like wound after removing the
weapon
Shape of the wound can tell you if it was a single edged weapon or double edged knife
Pushing the edges of the wound together is not an effective way of measuring the size of
the wound and determining the size of the weapon
Size of the wound will depend on the shape of the blade and how it was inserted. Movement
of the knife in the wound will change the shape and can enlarge the wound opening
If knife fully inserted bruising might result d/t the hilt of the weapon or by the hand of the
assailant
Mechanism of Injury

3 ways of infliction of a wound

1. accident
2. self-infliction
3. action of a third party

By looking at the injuries alone it is very difficult to determine which of these three caused a
wound. You have to look at circumstances. Get a history on how it was incurred.

Bite marks in a child is pathognomonic and the child was definitely abused. To identify the
teeth marks you need a dentist and you need to get an impression of the suspects teeth and
compare. It can also be a source for DNA collection.

DEFENSE WOUNDS
Found in victims who are trying to defend themselves from an attack so it will depend on the
kind of weapon used

Areas : Underside or posterior sides of the arms and hands

Self-inflicted injuries - no definite characteristics that define these. But a person who wants
to hurt himself prefer stab or incised or gunshot wounds. In areas that can be reached, unusual
areas include the eyes, lips, nipple and genitalia. Blunt force injuries are rarely self-inflicted.

Survival:
If theres a lot of bleeding the body has a mechanism to prevent shock called Compensated

shock. But if he will not get any medical attention and body cant maintain it, body will go to
uncompensated shock and will lead to death.

Aug 2
Violence against women. RA 9262. When do violence against women and their children occur?
Violence according to the WHO: the intentional use of physical force or power, threatened or
actual against ones self or another person (here were talking about another person) that
results in or has a highlight resulting in injury, death, psychological harm, mal-development or
deprivation. The intentionality is always associated with the committing of the act itself
irrespective of the outcome of the violence. If somebody hurts another person or threatens to
hurt another person that in itself, the intentionality is there already. There must be a
relationship wherein one person perceives himself or herself as more powerful than the other
person. So this would include threats, intimidation, neglect acts of omission or all types of
physical, sexual and psychological abuse. Such an abuse could also happen within a marriage.
It does not necessarily lead to injury, disability or death but it will pose substantial burden on
individuals, families, communities, healthcare systems worldwide and this consequences can
either be immediate, latent or can lasts for years after the initial abuse. The consequences
such as psychological harm do not expect it to happen immediately all the time.
RA 9262 is gender based. According to the UN Declaration on the elimination of violence
against women, its a gender based violence performed by a husband or an intimate partner. In
the US, most of the recorded incidents of injuries in women are from violence of their intimate
partners. It occurs everywhere. It refers to any behavior within in an intimate relationship that
causes physical, psychological, sexual harm, to those in the relationship. And the term battery
issues the abuse occurs repeatedly in the same kind of relationship.
Different forms: physical aggression, psychological abuse, economic abuse.
Factors: the man grew up in an abusive atmosphere, witnessing domestic violence by children,
couple married very young, the man is alcoholic abuse/substance abuse, economic stress, no
support fort the family in the community, if culture accepts that men have the right to hit
women.
Two types of violence: the severe and escalating form of violence and the moderate form of
violence. Traditionally, mans beating is a consequence the mans right to inflict physical
punishment on his wife. There are many cultures that believe that a wife is a mans property.
What are the events that trigger partner violence? Woman refuses to have sex. Not preparing
the food. Woman asks where the money goes. A lot of men have no work. It is essentially about
power and control. But women still stay in the relationship.
Cycle of violence. First, tension building. Second, honeymoon stage. Back again to the tension
building.
Excuses of the batterers: I only pushed her; I did not hit her; Its her fault; Shes
hysterical; she bruises easily
Women in a violent relationship try to protect their children. They try to adopt in such a way
that the children will be protected from harm. Witnessing domestic abuse by children is an
abuse in itself.
Consequences: they keep complaining of pain everywhere in their body even if there is nothing
wrong with them, they may end up smoking, overeating, or they will stay idle, they become
depressed
Myths about domestic violence: it is not a common occurrence; women are just as violent as
men; men are brought up to be the aggressive person; women are brought up to be the
submissive group; alcohol abuse causes domestic violence (alcohol inhibits your actions so you
are braver to hit the other person); domestic violence is usually a one-time domestic
occurrence; men who batter are often good fathers.

40 to 70 percent of men who hit their wives abuse their own children either physically, sexually
or psychologically. When there is violence in the family all members are participating in the
dynamics, therefore, all must change to stop the violence. Battered women are machuchisyic
and provoke the abuse they must like it or they would leave. HITTING IS NOT DISCIPLINING.
Battered woman syndrome. It refers to a scientifically defined pattern of psychological and
behavioral symptoms found in women living in battery relationships as a result of cumulitative
abuse. It is the psychological, emotional, behavioral reactions and deficits of victims and their
inability to respond effectively to repeated physical and psychological violence. It is a state of a
woman in a highly abusive relationship resorts to murder or aggravated result of her spouse as
a result of her belief that it is the only way to save her from death.
When a person is under chronic stress, there will be abnormal secretion of cortisol and because
of that the brain becomes hyper-alert for danger and the woman now will be focused more on
surviving to the point that she will forget about trying to maintain her healthy cognitive and
social skills. Thinking properly becomes disrupted. Socially, she will not know to relate with her
children and she may be even become abusive to her children, she will not know how to relate
to her neighbors because all that shes trying to do is survive. Because of so much fear other
parts of the brain will wear out. She may either create permanent memories of what has been
happening to her and she may foresee that everything will just keep happening. There could
also be extreme anxiety. Depression. Difficulty forming attachment to other people. In a way,
she isolates herself. She can have sleep problems. She can be a very impulsive person. They
will appear helpless. Exposure to a remand of earlier trauma to perceive threats or to
generalize reminders will make either respond anxiously, shes gonna start to become panic,
aggressive may even provoke threatening behaviors from others.
There could be a post traumatic stress disorder. Any intrusive recollections of the traumatic
events will create hyper-arousal or hyper-vigilance. Theres avoidance behavior, emotional
longing, disrupted interpersonal relationship, body image distortion and sexual intimacy issues.
When the cycle of violence becomes worse it may come to a point where she could kill the man
when he is asleep or is drunk because that is the time that she is stronger, or she herself will
end up dying.
The medical evidences should include the interview of the woman as to what had happened. A
social workers interview and investigation is also needed. What the doctor can add to that
interview will the physical examination and documentation of the injuries, the laboratory
examination, and psychological or psychiatric evaluation will also be good if the woman intends
to file a case and other evidence that should include crime scene investigation, accounts from
witnesses, and a social workers investigation also.
Physical abuse. WHO: Child abuse or maltreatment that consists of all forms of physical, and/or
emotional maltreatment, sexual abuse, neglect or negligent treatment of commercial or other
exploitation resulting in the actual or potential harm to the childs health, survival,
development or dignity in the context of the relationship of responsibility, trust and power. For
medical evaluation we have to include the comprehensive medical history or child-sensitive
forensic interview, physical and laboratory examination. We treat that patient and we do crisis
interventions and referrals. The purpose of our evaluation is to evaluate the medical problems,
gather evidences, and give the child a therapy by making sure that the child is safe and
protected. In the US, it is the interviewer who tells the court what the child told her. The childsensitive interview is done using the appropriate language depending on the childs age, nonleading questions are asked initially and when the child starts to disclose everything down to
the specifics thats when we ask specific questions but make sure not to ask yes or no
questions and make sure that the story comes from the childs mouth. Take into consideration
the language development of the child. Children do not keep time. Children jump from one
event to another.
Physical abuses are acts of commission by a caregiver. There has to be a relation of trust,
power and authority. In RA 7610, although child abuse refers to infliction of physical injury,
physical injury in RA 7610 includes but is not limited to lacerations, fractured bones, burns,
internal injuries, severe injuries suffered by a child. It does not say who inflicts this injury, it
doesnt say whether its intentionally inflicted kind of injury which WHO adds the word
intentional.

One. The injury is not only inflicted but its non-accidental. (The three mechanisms of injury:
accidental, self-inflicted and action of a third party.) The pattern of injuries fit a biomechanical
model of trauma that is considered. A lot of injuries have been scientifically studied and there
have been conclusions are made wherein they said that it can only be caused by an abusive
act of another person. The pattern of injuries may correspond to infliction with an instrument in
a manner that would not occur through play or natural environmental interactions.
Shaken baby syndrome. When the baby is shaken he will have subdural hematoma, thats
bleeding within the brain, retinal hemorrhages, without any evidence of external injuries. The
babys head is bigger than that of the body. The neck muscles are weak. The baby can present
sudden seizures, stop breathing, vomiting, and poor feeding.
Another injury that can happen is rib fractures. Chest compression in CPR does not cause this
kind of fractures. Another problem that can happen is cervical cord injury wherein the baby
stops to breathe. When you shake the babys head, it will cut the nerve connections in the
brainstem (it is where your respiratory and circulatory centers are, it is what you call the
cervical cord), it is known as diffused axional injury, no time for bleeding to happen. Retinal
hemorrhage is a bleeding at the back of the eye. From a lot of short falls (short falls-falls less
than 4 feet), majority of children do not have serious head injuries because the extremities hit
the ground first. Medical evidences will be the medical history, family and social history,
investigation of the childs environment, physical and laboratory examination.
Questions that you have to ask:
When did it happen? Where did the injury occur? Who witnessed at the time of possible injury?
What did the caregiver do after the injury? In formulating our impression we have to ask these
questions. Does the history reasonably explain the injury? Was there any explanation given as
to how the child incurred the injuries? Is the statement given consistent with the development
capabilities of the child? Is there any delay in seeking medical care? Is the history vague?
Medico legal principles: we can only offer an opinion of the presence of an abuse because we
want to put the child in a safe place after. We cannot give you an opinion about the guilt of an
alleged perpetrator nor can we give you an opinion of his intents.
August 9
INJURIES FROM FIREARMS
Firearm - weapon that fires single or multiple projectiles propelled at high velocity by gases
produced through rapid confined burning of a propellant.
Projectile any object that is sent through space by the application of force. For firearms, the
projectile is called a bullet or a pellet or a shot which is made of metal (usually lead). Some
projectiles will fragment inside the target while others do not.
Two basic types of firearms:
Artillery (usually the big ones)
Firearms - very portable and has a range of accuracy of less than one mile.
riffled weapon which is a pistol and a riffle
shot gun
Handgun or pistol the smallest of all firearms, fired from the hand, it has a riffled barrel. You
can have a revolver wherein after the bullet is fired a brass case which contains the explosive
remains in the cylinder unlike an automatic when it is fired the empty cartridge case falls on
the ground.
Riffle - its a long barrel, with a high muzzle velocity, a riffled barrel, and built for accuracy and
long range (1.6 km) and you have to aim to hit your target
Shotgun firearm with a smooth bored barrel designed to fire multiple pellets that will come
out from the barrel and to be fired from the shoulder. It is designed to quickly hit a moving
target. You dont need to aim, just point and shoot

The other types are machine guns and submachine guns.

Ammunition or projectile its called a round or a cartridge. The cartridge packages the
bullet, the gun powder into a single metallic case precisely made to fit the firing chamber of a
firearm. The cartridge case expands and seals the chamber against rearward escape of gases.
The primer explodes on compression igniting the propellant. There are two types of primer: the
center fire and the ring fire. The propellant is within the cartridge. This propellant burns to
produce large volumes of gases under pressure. The tip is the bullet (either lead or metal
jacketed), which is the part of the cartridge that leaves the muzzle.
Projectile from a shotgun - shotgun shell. Cylindrical cartridge of a plastic or cardboard tube
with a brass base. Contains tiny lead shots. Bottom of the cylinder is the explosive powder and
the center is your detonator. Leaves the barrel as a composite missile becoming approximately
300 individual shots as the missile moves further down the barrel. Trigger is squeezed, the
firing pin will strike primer and ignite the powder within the cartridge and the burning powder
will create the pressure which will push the bullet out of the muzzle.
Important to know these things to identify whether the bullet wound is from close contact or
distant contact. If close contact you will not only see the bullet wound but also some of the
gasses, gunpowder residue on the victims body as compared to distant contact, bullet entry is
the only thing evident.
Wound ballistics study of projectile penetration. Wounding effect of a projectile is actually
produced by the transfer of kinetic energy from the projectile to the tissues. The greater the
kinetic energy or the velocity the greater the wounding potential. If projectile does not exit the
body then the energy in that projectile will be projected within the body causing further
damage. If it exits the body then only some of the kinetic energy is transferred to the tissues.
Mechanisms by which projectile disrupts tissue: direct laceration of the tissue drilling
effect, it just goes through the tissues. Main mechanism in a low velocity weapon. Permanent
cavity is produced. On the other hand a temporary cavity is produced by the shockwave or the
other pressures that come along with the firing of the gun. Can be produced surrounding the
permanent cavity where the bullet passes by. But if it exceeds the natural elasticity of the
tissue, that tissue can rupture and it becomes a permanent cavity.
In a description of a GSW (gunshot wound) it is important that the doctor will describe the
wound and its location to determine circumstances of the shooting.
Permanent cavity - where the projectile passed through the skin
Abraded margin around the wound- like an abrasion or contusion ring or bruise; cause is the
forward motion of the bullet upon entering the skin abrading the margin of the entry wound
Microtears- tiny lacerations on the edge of the wound from high velocity center fire rifle bullet
Graying lubricant or debris of the bullet wiped off the wound edge, smudging or blackening
deposition of soot from partially burned gasses.
Tattooing (Stippling) burning grains imbedding the skin; if it is seen it means immediate or
close range distance
Branding or burning from the hot gasses of the muzzle at close range
Muzzle contusion caused by the skin impact against muzzle (close range) (e.g. muzzle
imprint)
Contact range wounds muzzle to target distance: in contact with the body or only a few
centimeters away from the body. Edges of GSW seared by the gasses, blackened by soot and
propellant, and there is concentric blackened zone. Metal fragments may be found within the
wound. Gun placed over bony areas, GSW can come out in a stellate (x-shape) or lacerated
appearance.

Muzzle to target distance is greater than 10 feet all you will see is the GSW entry.
Exit wounds (in rifle wounds) will have inverted flaps because the bullet will go out. Bigger
than an entrance wound. You may not see any stippling or soot.
SHOTGUN WOUNDS
- large contact entrance hole with significant damage to the margins + gun residue deposits
Close range (less than 5 ft from muzzle to target) can produce single large defect which will
approximate the weapon bore.
Intermediate range (5 to 10 ft) central defect produced by the shot and the wadding with
surrounding wounds because of the tiny pellets. Once ammunition leaves muzzle, pellets will
start to separate. Not only central defect can be seen but also tiny defects coming from
individual pellets.
Long range whole thing breaks out. You still see tiny concentric defects from individual
pellets.
Exit wounds rarely seen if fired in the chest and abdomen. Can be seen if fired in the head,
mouth of huge rugged appearance.
How are they supposed to be investigated?
Body must be handled as little as possible to avoid loss of evidence
Hands must be paperbagged (not plastic) because in plastic moisture can develop. Body
transported in a body bag to preserve trace evidence and avoid contamination
During autopsy, MD must take an x-ray and look for metal fragments in the body. Medical
Examiner plus expert must recover residues with 10% nitric acid and swab the area, not a
paraffin test. Paraffin test is obsolete.
They must describe the wounds in detail
Ff.

questions must be answered:

is there projectile present? Where?
projectile fragments present? Where?
type of weapon or ammunition?
path of projectile?

Firearms investigation is a comparative investigation. Done macroscopically and

microscopically.
Bullets are compared and matched to specific firearms. As well as, accurately determine the
distance of the shooting. Bullets will have rifling of the FA that was used. Rifled FA will leave a
mark on bullets. Each FA has a unique rifling pattern. If no marks on the bullet then gun used
has smooth barrel without any rifling.
ACCIDENT, SUICIDE OR MURDER?
Suicide no notes are left in majority of cases. Wound site within the range of the deceased.
Usually contact wounds. Sites of the wound usually include the head, chest and abdomen.
Unusual location, think homicide. Weapon should be present at the scene of the crime. May not
be near the victim since he may have moved if he did not die instantly. If suicide ruled out it
could either be accident or homicide so look at the circumstances. Multiple FA wounds suggest
homicide.
Sept 6
INJURIES FROM EXPLOSIVES
Explosive. A mixture of an oxidizing agent and fuel.

Two parts:
1. Low explosives exert a throwing effect in a factory or people nearby of any object
2. High explosives they can explode between 1 thousand to 8, 500 meters per second causing
more shattering and devastating effects in a farther distance
Explosion. A result of endothermic chemical reaction wherein there is a generation of huge
amount of gas with the release of vast amount of heat that occurs very quickly.
Different types of bombs:
1. General purpose
2. Fragmentation
3. Penetration bombs
4. Cluster bombs
Mechanisms:
Blast caused by tremendous dynamic over pressures generated by recoillation of
a high explosives. Half of the total energy generated will cause the bomb casing to swell
1.5 times its normal size before it will erupt into small fragments and that energy will
send the fragments flying out in all directions. The remaining energy is expended in the
compression of air surrounding the bomb producing the blast effect. Destroys the skin or
muscle even to the point of amputation.
Damaging effects: fragmentation, crater-ring effect, fire, pure blast (caused by gas)
Secondary effects: burns, missile injuries, pepper, all types of injuries from collapse of a
building and destruction of a vehicle
Exchange principle: When any two objects come into contact there is always transference of
material from each object onto the other.
Paraffin test. A test that determines the presence of nitrates and nitrites that may have come
from a gun powder or primer inside the bullet casing that ignites when a gun is fired.
It has to be warm to open the pores of the skin (because the gun powder is embedded into the
skin) so that the nitrate compounds will go out and will be left in the paraffin wax.
Presence of nitrite or nitrate in the wax glove (with the use of an acid) produces specks of
violet-blue colors.

ASPHYXIA. Absence of pulse. It describes a range of conditions for which the lack of oxygen is
considered the cause.
Mechanism: obstructive or non-obstructive
The obstructive type is medico-legally significant.
Classical Features:
It is not diagnostic. Not definite signs of asphyxia like: facial congestion, facial edema, facial
cyanosis, petechial hemorrhages in the skin and in the eye, star dose spots
Conditions/causes
1. Suffocation
Lack of oxygen in the inspired air
Example: Putting plastic bags on the head of prisoners
There is quick death and minimal signs of asphyxia except for pallor in the face
Not struggling to breath; there is low external pressure
2. Smothering
The victim struggles

 May experience cyanosis and congestion

Bruises and abrasions on the face, on the lips, or inside the mouth
Non-struggling victims: may not see any of the signs; difficult to diagnose
3. Choking or gagging
Internal obstruction of the upper airway passages by an object or substance
impacted in the pharynx or larynx
Mucus membranes swell or congest if you breathe thru your nose
There will be respiratory distress, can become cyanosis and congested face and
neck up
4. Strangulation or hanging
Three forms of prime forensic importance
Manual strangulation
Ligature strangulation use of band around the circumference of the neck
Hanging pressure of the ligature on the neck produced by the weight of the body
Can result into two effects: classical asphyxia signs the person died a slow death;
no asphyxia signs there was sudden cardiac arrest
The effects and events depends on the method used, size of the pressure, and the
force with which the pressure is applied

Jugular veins drain venous blood (un-oxygenated blood) from the head. If there is
obstruction, the blood will remain in the head. The person will swell, congest or become
cyanotic. The arterial veins will rupture causing petechial hemorrhages underneath the
skin.

Obstruction in the carotid artery (carries oxygenated blood) causes cerebral skemia
and the person will collapse because of lack of oxygen in the brain.

Stimulation of the barrow nerve endings in the neck will bring about the slowing of
the heart.
External signs: abrasions and bruises in the neck area, laryngeal damage,
5. Traumatic asphyxia (restricting the movement of the chest)
External pressure is put on the chest thereby restricting respiration

Classic signs: very congested from face and neck up, person becomes very blue or
red, extensive petechia
Blood from above the chest cannot return to the heart, its just like obstructing the
jugular veins
6. Postrial asphyxia
Disabled or unconscious person lies with the upper half of the body lower than the
rest of the body
There is pressure in the abdomen that does not allow the diaphragm to move; its
like traumatic asphyxia where there is restriction of chest movement
Commonly seen on persons arrested, they are pushed to the ground
Hemoglobin carries oxygen but it prefers carbon monoxide.
Failure of oxygen utilization will paralyze the chest muscle.
HYPOXIA. Partial lack of oxygen.
ANOXIA. Complete lack of oxygen.

Sept 13

TRANSPORT INJURIES, DROWNING, ALCOHOL

3 GROUPS OF VICTIMS
Pedestrian, passengers, cyclists or motorcyclists

TRANSPORT INJURIES:

Primary injuries
from the direct contact of the vehicle
Primary injuries are recognizable and may take the pattern of the bumper for e.g..
Wherever the injury is thats the point where the pedestrian was hit.
Clues as to the speed on the car:
< 20 km/hr thrown off the hood either forward or sideways
20-60 km/hr victim may fall on the hood and head may strike windshield
car.

60-100 km/hr victim may fly up in the air and he can fall on the car or beyond the

Secondary injuries
from the contact of other objects or the ground after contact with the vehicle
Often more serious and potentially lethal than primary injuries (e.g. head and spinal
injuries)
Car occupant
The injuries suffered will depend on the kind of impact
Vehicle hit from behind called acceleration impact

Side impact and rollovers least common

From the front - there will be acceleration then deceleration. Deceleration impacts without
restraint (no seatbelts) and youre accelerating with the car and the car hits another car your
body is still accelerating; your head can hit the windshield or your chest the dashboard and
other injuries on the upper part of the body. There could also be injuries on the lower part of
the body, in the ankles, hips or knees. Organs in your body also accelerate and in the act of
deceleration pulmonary veins, aortic veins attached to the body can be torn off so theres
internal bleeding. You may also sustain injuries within your brain since the brain moves in your
skull. you may have concussions and contusions.
Motorcyle injuries
due to falls from the machine
you can have abrasions, injuries in the head
bicycles more milder forms since lower speeds but the problem is when they are hit by
other vehicles
wear appropriate safety gears
IMMERSION AND DROWNING

Different things

Bodies recovered from water could have died from natural causes before entering the water.
Determine WON victim died of natural causes before entering the water or while in the water
having entered it either voluntarily or accidentally. Did he die of unnatural causes before
entering the water? Did he die from exposure or hypothermia while in the water? Died of
injuries after entering water? Did he die of submersion or drowning?

Submersion just actually being in the water. A person who drowns can have signs of being
submerged but a person who was submerged in water does not necessarily mean he drowned.
If you died before you were placed in the water you are submerged.

S/Sx of Submersion:
washerwomans fingers/hand
macerations and skin will peel off after weeks of immersion
decomposition
Eventually your body will float. The only time body wont float is when youre submerged in
very cold water.
How do we know if these injuries are post-mortem or ante-mortem?
Injuries must be seen under the microscope and if theres inflammatory reaction seen then
you know injuries are before death since there are no inflammatory reactions if you got injured
after you died.
DROWNING
you die of suffocation because of water within your lungs and you have to be immersed in
water
Effect depends whether you drowned in fresh or sea water. Fresh water is absorbed into our
circulatory system resulting to volume overload and hemodilution, eventually leading to cardiac
arrest.
Sea water more concentrated than blood, so fluid in our blood will go out into our lungs
and theres pulmonary edema or congestion resulting to hypoxia, respiratory arrest, cardiac
failure and cardiac arrest
Post mortem findings variable and cause of death hard to prove
5 stages
You struggle, you may find bruises in your chest and shoulders
You get tired and you sink
You dont want to breathe in water so you stop breathing. Because we hold our breath
carbon dioxide goes up so respiratory centers in our body say breathe so we breathe in water
Cough vomit, loss of consciousness. Convulsions. Involuntary respiratory movements and
we keep inhaling water.
Respiratory arrest and cardiac arrest.
You could drown within 10 minutes
In 10-20% of the victims laryngospasm can happen and since larynx remains closed water
cannot enter lungs = dry drowning
The rest theres relaxation of the airway and water enters the lungs
There can be blood tinged froth in the mouth and nostrils which is more common in
seawater drowning.
Sand, silt, seaweed may be found in the lungs sign of life before immersion
BUT Finding of foreign material in stomach weighs heavier than finding them in the lungs

because theres a sphincter of some sort in the stomach which does not relax when youre
dead unlike airways which can relax so water may flow freely.
Mechanism of death as a Result of Submersion is not always classical drowning because most
of them die quickly and the result is usually cardiac arrest.

No universally accepted laboratory test to confirm drowning. If they find diatoms in the blood or
lungs its just corroborative evidence of drowning. Forensic pathology - if theres water in the
lungs victim was alive when he entered the water and if theres no water in the lungs it can be
dry drowning or death prior to submersion. Pathologist must determine if theres laryngospasm.

Questions to answer in an investigation:

was the person dead or alive when he entered the water
is the cause of death drowning? If not what is the cause of death?
why did the victim enter the water?
why was the victim unable to survive in the water? Did this victim have other health
problems or he was already injured?
what were the circumstances preceding death? very important to identify the body.
what were the circumstances when the body was recovered?
autopsy findings
#s 1 and 2 are very important because these will have to be correlated with autopsy
findings and if theres concurrence between the two then pathologist can make the findings.
ALCOHOL
Alcohol abuse usually encountered in child abuse and rape cases.
Its a drug and addictive. Makes one prone to accidents and an underlying cause of
misdemeanor, assault and homicide.

S/Sx of alcohol intoxication:

Excitement - lack of inhibition or self-control, feelings of well-being
Incoordination and Confusion loss of nervous control of your body, blunting of perceptions,
no muscular corrdination, nausea, vomiting, cardiac and respiratory symptoms
Narcossis or Coma deep sleep, slow breathing, paralysis of cardiac and respiratory centers
which can lead to death
Males cannot say that they could not have raped a girl because they were drunk because
erection can happen in the excitement stage. On the other hand, they take advantage of girls
when the girls get into the incoordination and confusion stage (Drug facilitated sexual abuse)

How do we diagnose drunkenness?

alcoholic smell of breath or vomitus

dry tongue
excessive salivation
irregular behavior

bloodshot eyes
thickness of speech
tremors, error of coordination and orientation
Best tests: blood alcohol content (BAC), urine test for alcohol and breath analyzer test

Tests for error of coordination:

Romberg test
eye movements - place a pen in front of his eyes and theres nystagmus and place the
object on the side of the eyes and theres jerky movements
walk and turn test walk in a straight line heel to toe 9 steps then do a quick turn
One leg stand
finger to nose test
let him pick a small object from the floor without falling off
may also be asked to do some tasks like recite the alphabet in a rapid fashion
BAC Normal below 0.5% (? Maybe Maam meant 0.05), .1-.15 % - impaired faculties, not fit to
drive vehicles, if = 0.15% and non-habitual drinkers intoxicated to the point of staggering,
0.2% habitual drinkers at the second stage and 0.5% stage of Coma.

Factors that affect absorption of alcohol:

weight- the heavier you are, the more water content and since alcohol is soluble in water,
alcohol is easily absorbed in the water content of our body so a person with more water
content does not easily get drunk as a person with less water content or weight
Fatty foods delay alcohol absorption. Alcohol is absorbed in the small intestine but you can
delay absorption if alcohol stays in stomach.
Sept. 20
Understanding the Child
Child development:
Continuous process that starts from birth to maturity, and goes to define stages and
phases. Before you can go to the next phase, the child must master first the previous stage.
Now the skills and the complexities as he grows older centers all in the physical, mental,
social, and emotional function of that person. It affects cognitive development, emotional
development, and social development.
I. First 3 to 4 years of baby:
Neurons start to connect with one another. And the only way these neurons get connected
with one another is if the baby is stimulated at the time when he is born.
Experience leads to neural changes in the brain.
Visual stimulation should happen in the first 6 months for the necessary neural pathway to
develop.
You are now developing communication with the baby. If you meet the needs of the child,
that child will learn to trust you and will develop an attachment to you as a caregiver.
If you need the baby to master a certain task, he must be stimulated at the right time,
given the right experience. Example, a 6-month-old baby, you cant teach that baby to walk,
since he has not developed the muscles to support his own body to walk or stand on his own or
balance himself.
They learn to recognize their father and mother. When looking at objects and you hide it
right away, they will think the object is no longer existing. They dont know the object is there
and eventually as they grow older, peek-a-boo is an important game for babies, because they
will learn you are still there actually.

 Touching is very important for children. For children who are not touched at all, when they
grow up they dont want to be touched, since its strange for them to be touched.
These babies are learning to be autonomous, they are learning how to toilet train and how
to be independent and if you dont allow them to toilet train themselves, learn new skills, they
will not develop self-esteem.
They now have the ability to symbolize. In the beginning, they know the mental image of
what an apple is. By the time they are 1 or 3 years old, now they can say this is an apple.
So they are ready to play with other people. They will only do things for the approval of a
parent, they will do things not to be punished. Thats all what they care about for the first 3
years of life.
The sexual behavior at this stage is more on touching and looking. These are just learning.
Sexual behavior at this age is merely knowing about the difference between the vagina and
penis.
As early as two years of age, they already learn the concept of right and wrong. It has
nothing to do about pleasing the parents or they are being punished. Moral control is
internalized by age 6 through consistent parental monitoring, praising of good behavior,
identification of parental values, etc.
Impact of abuse at this stage:
For babies, as they grow, anything the parents do is correct, so if the babies sees the father
and mother quarreling, they would see that as a normal thing to happen.
When they are abused at this age, especially when it comes to corporal punishment, they
will only understand the pain; they dont understand the reason for the punishment.
These children are egocentric in thinking. Everything is I, me mine. They cannot relate
themselves to the outside world. Its up to the parents to teach the child to relate with the
outside world by allowing the child to play, to converse and talk with him, to interact with his
environment, to do things on his own.
Children have immature reasoning. They think everything that happens is their fault. If they
get physically abused, the child thinks, Its my fault.
In court, lawyers should argue objections out of the childs hearing. The child will think its
his fault: My lawyer is shouting at me because I probably did something wrong.

II. Preschool:
May signal the start of mental and behavioral problems. The child grows older, learns new
skills, learns to be industrial, etc. If the child doesnt learn new things, she will learn not to take
any initiative at all and not develop self-esteem.
Morally, they will do things to please the other people other than the parents. Now they
have a conscience and are aware of social norms.
A 4-year-old victim will say, Hindi ako magsasabi kahit kanino kasi yan ang sabi nila. Or
Hindi naman ito bad kasi ginawa ni tatay. Hindi naman masakit, nakakakiliti nga.
A 9-year-old victim will say, Bastos tong ginagawa ko. Kung magsumbong ako, kawawa
naman si tatay, baka makulong din siya. A 4-year-old is more inward-looking as compared with
a 9-year-old.
Impact of abuse at this stage:
Research shows that those with multiple personalities disorders and other forms of
disassociation suffered abuse prior to 8 or 9 years old.

III. Adolescence
The offset of adolescence for girls is at 10-14, boys 13-14. Theyre now learning how to
think abstractly, but their thinking is still egocentric. They cannot handle hypothetical
situations yet.
They now follow rules and the values of society, but they may not understand the concept
of values and rules. But here, theyre finally learning who they are.
Initially, it was thought that the brain develops only in the first 4 years of life, when all the
neural connections are being made. It was found that during the adolescent stage, a lot of the
neuron pathways that were hardly used got pruned away and new pathways are being created.

Another thing that they learned was that the development of the brain is from the least
complex to the most complex, which is up in front.
The frontal lobe, where you have what is called the neo-cortex, develops, the area that
regulates our emotions, abstract thinking, and helps us do our executive functioning. In
teenagers, this is the area thats most developed. The frontal cortex reaches full maturity
around 20 years old. Its the area for planning, reasoning, impulse control, regulation of
emotions, learning from experiences, and weighing risks and rewards. This is the last part of
the brain that develops. Some studies have shown that this is completed at the age of 25 for
males, earlier in females.
The child has preference for physical activity.
The person has difficulty holding back or controlling emotions. Theres still no adequate
control from the pre-frontal cortex to the amygdala. (Mood swings! Try to remember your
teenage years.)
Studies show that, although the intellectual activity develops at 16 to 17, psycho-socially,
hes still not mature until hes 25.
The adolescent brain is a reward-seeking brain, this is where theyre susceptible to pearpressure. At the age of 14, they tend to commit crimes.
So the adolescent is actually still egocentric. They believe that they alone have difficulties,
no one else can understand or sympathize. They believe that nothing can harm them.
Morality:
Ability to differentiate between right and wrong and understand how to make choices. This
is discernment. Again, the childs physical, intellectual, emotional, and mental skills, as well as
his environment will influence the development of his morality. So you have to look into his
background.
IV. 16 20 years old (Young adulthood)
They continue to develop, emotionally, physically, and morally. Now they get into
relationships. When it comes to sex, its more on experimentation in the early stages. But as
they go into 17-19thats what you call late adolescenceits already more for being in a
relationship. This is part of normal development. Its up to you to guide your children.
Distinguish between occasional experimentation and enduring patterns of troublesome
behaviors. These are usually harmless experimentation. Seemingly behavioral problems are not
enduring problems. We have to distinguish those problems that arise during adolescence and
those that have roots in earlier periods. Most teens who have recurrent problems with the law
have problems at home and at school from an early age. (Hello, Joavan Fernandez! The
newspapers keep saying, the adopted son2x. Theyre just rubbing it in. He might not have
developed attachment as a child.) When does attachment develop? Before age 1.
Many of the problems adolescence experience are transitory in nature and are resolved at
the beginning of adulthood.
The effects of being abused are: It can affect their identity, their intimate relationships.
In young adulthood, you learn whom you care to be with. In adulthood, you learn what you
care to do and who you care to be, what and whom you take care of.