Notes on Legal Medicine

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

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:

- 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 3rd 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]

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.
1.
2.
3.
4.
5.

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.

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Notes on Legal Medicine

respiration is being assisted, with your heart
beating on its own.

What you should not do:

1.
2.
3.
4.
5.
6.

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

If theres irreversible unconsciousness, with

spontaneous respiration and heartbeat, 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.

June 28

Brain death follows a stage:

1. The cerebral cortex or that part of the brain
with higher functions die first.
2.
The cerebellum (the part of the brain
thats for keeping your balance and
coordination) follows.
3. 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.

DEATH
A person is alive because of the 3 main parts of the
body:
1. The brain;
2. The respiratory center; and
3. 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.

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.

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:

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

Stages of Death:
1. Clinical or somatic death
2. Brain death
3. Biological death
4. 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

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.

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

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Notes on Legal Medicine

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 doesnt mean
that just because the person stops breathing and his
heart is not beating, hes dead. Its 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 theyre very immature, the very old because
of the wear and tear. They dont have defenses
anymore so they can die really fast. If youre very thin,
if youre malnourished, if you have all these diabetes
and heart problems, your death will be faster. Or
environmental factors (good thing it doesnt snow
here). If youre sickly and its cold outside, youre not
wearing anything, or youre malnourished, youre going
to die fast.
So its the physician who
what you call the point of
breached. And when is that?
that the point of irreversibility

pronounces death when

irreversibility has been
When does a doctor say
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.
1.

2.

3.

4.

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 its
fibrillating? Imagine a bag of live worms. You look at
the outside. Its 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, youre not going to hear it so youre going to
say hes dead. But applying defibrillators can still
revive the heart. Thats why its very importantif any
of you witness a person who may be undergoing a
heart attackto just have to call the emergency
medical services. Here we have ERUF. They have
defibrillators just to get your heart to start pumping
immediately.
Theres what you call for a person who needs a heart
transplant. They have what you call assisted devices

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Notes on Legal Medicine

(not a pacemaker). Its 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.

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:

But we have a problem whereinbecause of modern

resuscitation technology, even if all brain functions will
have ceased except for the cardiac and respiratory
centersyour 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?

(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

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.
a. Unreceptivity and unresponsiveness
meaning theres a total unawareness of
externally-applied stimuli, pain stimuli,
etc.
There
must
be
complete
unresponsiveness despite application
of painful stimuli.
b. 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.
c. No reflexes
d. 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 lets 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:

(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 authorizationwho 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,
theres 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 drivers
license, its indicated if you want to donate your body
or a part of your body, and automatically, youll be sent
to the hospital and the hospital will harvest your
organs. Of it could be anybodysomebody 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:

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Notes on Legal Medicine

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:
o 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.
o 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.
o

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

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Notes on Legal Medicine

we can say he asphyrated and that is the cause of his
death.

hours. If it is cold and flaccid up to secondary flaccidity,

therefore, more than 36 hours.

Rigor mortis. The temperature dependent physicochemical changes or chemical reactions occur within
motor cells as a result of lack of oxygen.

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.

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

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.

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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.

Page 7 of 23

Notes on Legal Medicine

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 officersthe 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.

Page 8 of 23

Notes on Legal Medicine

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

Page 9 of 23

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)

Notes on Legal Medicine

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
fingerprints.

with

the

use

of

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

fingerprint even twins

Cannot be altered by time or injury

Can be extracted in any surface they

come into contact with.

Three Types

the

same

Patent prints

Plastic pri

-left when a foreign substance on

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

-left when a
malleable s

-visible prints
-no need for enhancements

Page 10 of 23

-visible prints

Notes on Legal Medicine

Tissue and cell samples: blood type,

protein complexes, blood enzyme systems,
- no need for enhancements
etc

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 antemortem data

Facial reconstruction: soft tissue thickness

of the skull

Photo superimposition: photo of possible

individual is overlaid with a photographic
transparency of the skull which has been
scaled down to the eyes

DNA profiling: used in exclusion and

identification thru body fluids, hair strands;
DNA analysis can yield a positive identity

Principles
o

no two persons have the same

DNA
pattern
except
for
identical twins or clones

each part of your

contains the same DNA

body

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.

Page 11 of 23

Notes on Legal Medicine

There are
sequences.

ways

of

determining

DNA
Use of DNA evidence in courts:

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
mother, child
father.

DNA testing:
and probable

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

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.
1.

2.

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.

Page 12 of 23

Notes on Legal Medicine

3.

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.

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.

Statistical analysis will estimate significance of the

match:
Abrasion
1.

2.

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

Contusions, bruises (ecchymosis, hematoma)

-

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

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.

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)

Page 13 of 23

Notes on Legal Medicine

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

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.

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

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?

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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, maldevelopment 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,

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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 child-sensitive interview is done using the
appropriate language depending on the childs age,
non-leading 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 nonaccidental. (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

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metal (usually lead). Some projectiles will fragment
inside the target while others do not.
Two basic types of firearms:
1. Artillery (usually the big ones)
2. Firearms - very portable and has a range of
accuracy of less than one mile.
a. riffled weapon which is a pistol and a
riffle
b. shot gun

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.

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.

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.

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.

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.

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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:
1. is there projectile present? Where?
2. projectile fragments present? Where?
3. type of weapon or ammunition?
4. 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

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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 (unoxygenated 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

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Motorcyle injuries
3 GROUPS OF VICTIMS
Pedestrian, passengers, cyclists or motorcyclists

TRANSPORT 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

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

Different things

20-60 km/hr victim may fall on the hood and

head may strike windshield

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?

60-100 km/hr victim may fly up in the air and

he can fall on the car or beyond the car.

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.

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:
1.
2.
3.
4.

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

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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
a. You struggle, you may find bruises in
your chest and shoulders
b. You get tired and you sink
c. 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
d. Cough vomit, loss of consciousness.
Convulsions. Involuntary respiratory
movements and we keep inhaling
water.
e. 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:

1.

was the person dead or alive when he entered

the water

2.
3.
4.
5.
6.
7.

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:

1.
2.

3.

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?

1.
2.
3.
4.
5.
6.
7.
8.

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

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Tests for error of coordination:
1.
2.

3.
4.
5.
6.
7.

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:

1.

2.

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.

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-

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-yearold is more inward-looking as compared with a 9year-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 pear-pressure.
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.

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