FORENSIC MEDICINE

JUNVIL A. INSONG
MSCRIM; LLB; CSP

1
.
Forensic Medicine
is a branch of medicine which deals an applies
the medical science in medico-legal cases. It is
then a science which concerns with the medical
aspects of problems that confronts the court. In
practice, it is synonymous with legal medicine,
although Forensic Medicine applied in the
solution of various problems in courts and legal
proceedings

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Legal Medicine
is the branch of medicine that is applied to law
and justice whether to elucidate legal problems
or not.

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Scope of Forensic Medicine

 Internal Medicine -Sudden or mysterious death

 Orthopedic Surgery -sprain; fracture and

dislocation

 Toxicology - poisoning belong

 Pathology or Surgery -wounds and other

physical injuries

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Gynecology and Obstetrics. -abortion and
injuries of the genital organs in rape and other
sexual crimes

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History of Forensic Medicine in the Philippines

• 1858- The first textbook in legal Medicine

and its practice by Dr. Rafael Genard Y Mas,
Who is a Spanish chief army physician was
published and is entitled “Manual de Medicina
Domistica.”

• 1895- A medico-legal laboratory was

established in Manila to handle medico-legal
cases

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• December 10, 1937- The creation of the
Division of Investigation under the Department of
Justice was done by the commonwealth Act 181 in
which a medico-legal sec. was under the division with
Dr. Gregorio T. Lanten as the head.

• June 19, 1947- The Bureau of Investigation was

created by the RA 157. Then, the Bureau of
Investigation was made the National Bureau of
Investigation by the Executive Order from the
President of the Phils. The medico-legal sec. was
created under the National Bureau of Investigation
with its head Dr. Enrique V. de los Santos
•

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The Medical-Legal System

• A. Medico-legal Office System

Medico-legal system used in the Phils. at present
which is handled by a medical Jurist or Medico-legal
Officer who is a registered physician duly qualified to
practice medicine in the Phils. The NBI, Manila Police
Department and the PC had their own medico-legal
officers with their own respective Medico-legal officers.

The Medico-legal officer is the one who investigates

medico-legal cases of death, physical injuries, rape and
other sexual crimes. His duty is to examine the victim or
assailant, to make a report and to appear in court as expert
witness when summoned by the proper authorities.
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• B. Medical Examiner System - The Medical
Examiner System is handled by the Chief Medical
Examiner who is a Doctor of Medicine and
appointed by the Mayor from the classified lists
compiled by the civil service on the basis of
competitive examination..

The duty of the Medical Examiner is to

investigate the cause of death especially violent
death or other circumstances leading to the death of
the victim.

During trial, the Medical Examiner will then

present his medical report to the court.

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• C. Coroner System - The name “Coroner” is
probably derived from the title “Custodes
Placitorum Coronae” or “Keeper of the King’s
Pleas”
• The coroner system is handled by country
coroner or a borough coroner who maybe a
barrister, solicitor or legally qualified medical
practitioner of not less than five years standing in
his profession and is elected by the county
council or borough council.

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• coroner is a government official who confirms
and certifies the death of an individual within
a jurisdiction. A coroner may also conduct or
order an investigation into the manner
or cause of death, and investigate or confirm
the identity of an unknown person who has
been found dead within the coroner's
jurisdiction.

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1. Principle of stare Decisis -The principle of
law, that, when the court had once laid down the
principle of law as applied to a certain state of
facts, it will adhere to that principle and apply it
to all future cases where the facts are
substantially the same.

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• 2. “Ignorancia legis nominem excusat” meaning
Ignorance of the law excuses no one from
compliance therewith (Art. 3, civil code)
•
• The main reason for the rule is to prevent
ignorance of the law as a means of defense or alibi
for violation of the law. Otherwise mere ignorance
in fact of the law would furnish immunity form
punishment for violation of the Penal Code and
immunity from liability for actual loss for violation
of personal and property right.
•
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3. Laws shall have no retroactive effects
unless the contrary is provided. (art. 4, civil
code)

In general, all laws follow a prospective

effect. It will be unjust if a law will be given a
retroactive effect because it impairs vested rights
and not in accord with sound legislation or with
social compact.

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Exceptions: A law may be having retroactive effect
in the following instances:

a. When the law provides the contrary (art. 4, civil

code)
b. Penal laws should have retroactive effect if
favorable to the accused who is not a habitual
delinquent. (art. 22, revised Penal code)
c. When the statute is remedial in nature because
there is no vested right in the rules of procedure and
evidence
d. When the law creates new substantive rights

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MEDICAL EVIDENCE
• Evidence is the means, sanctioned by law, of
ascertaining in a judicial proceedings the truth
respecting a matter of fact. (Rules of court, rule 128,
sec. 1)

Physical evidence is a part of evidence which

includes any and all objects, living or inanimate,
solid, liquid or gas, and the relationships between all
such objects as they pertain to the problem in
question
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MEDICAL EVIDENCE
• Medical evidence- is a kind of evidence,
sanctioned by law, of ascertaining in a judicial
proceeding the truth respecting a matter of fact
wherein scientific medical knowledge will be
used.

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Forms of Medical Evidence
• 1. Real Evidence or Autoptic evidence or
Object evidence- It is an evidence that is made
known or address to the senses of the court. It
maybe the person itself or the articles. Ex, human
skeleton maybe permitted to be brought inside the
courtroom to show the fracture on the skull or other
bones.
• The probative value of real evidence is that it
is the best and highest form of proof. The scope of
real evidence extends to all senses of man.

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• Testimonial evidence – A form of evidence
either oral or written taken the witness who
may be asked about the question of issue.

A physician is an expert witness who

maybe asked by the counsels of parties or
presiding officer of the court about the crime in
dispute.
The statement of the physician and other
witnesses is considered as testimonial evidence.

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• . Experimental evidence– A form of evidence
extracted after an experiment was performed in
court to prove a certain matter of fact. The
experiments maybe permitted in court but also
with limitations as in real evidence.

Ex. An experimental animal maybe permitted

to be brought inside the courtroom and then a
questionable substance was injected to prove the
poisonous effect of such substance.

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• . Documentary evidence- A written evidence
presented to the court by an expert witness
about the subject matter in dispute and not
excluded by the rules of court. The
documentary evidence presented by the
physician is a medical evidence and maybe
important to the court.

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A. Written medical report
1.) Physical examination report

2.) Laboratory report

3.) Autopsy report
4.) Examination report

5.) Medical examination report

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b. Medical certificates
1.) Certificate of sickness
2.) Certificate of physical and mental health
3.) Birth certificate

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 Dying declaration – or Ante-mortem
statement

The statement made by a dying or seriously ill

person afraid of an impending death and then
transcribed in written by the physical and other
bedside witnesses about the crime in dispute.
Usually, a person about to die will tell the truth
or reveal the secret of crime and even pinpointed
a person by uttering his name as the criminal.

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MEDICO-LEGAL INVESTIGATION

Criminal Investigation – It is an art of gathering and

acquiring information thru interview and other means
from the cooperative subject about the crime in dispute.

Medico-legal Investigation - It is an investigation about

the question of issue by the use of the medical techniques
in its procedure and operation.

Interview – It is simple questioning of a person who is

usually cooperating with the interviewer to acquire the
necessary information.
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Criminal Interrogation – It is an intensive and
vigorous questioning between the reluctant
subject and the interrogator about the crime in
dispute. This procedure involved the use of
psychological and neurological techniques in the
manner of interrogation.

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Kinds of Offender
A. Emotional Offender
An individual who commits crime in the heart
of passion, anger, bated, revenge or by accident.
This is an offender who usually commits crime for
the first time and who had a feeling of depression,
repentance, metal anguish or compaction after the
commission of the act. The person may not be able
to sleep or eat because he is usually bothered by his
conscience and had a sense of moral guilt.

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B. Non-emotional offender
An offender, usually a recidivist or
professional criminal, who commits crimes for
financial gain or personal reasons without due
regards to the other aggrieved persons.

The only concern of a professional criminal is

for, monetary consideration as payments for his act,
to elude arrest or escape from the law enforcement
agent after the crime and to resist aggression from
other people.

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Kinds of Confession
A. EXTRA-JUDICIAL CONFESSION- A confession made
outside the court during preliminary investigation before
trial.

1. Voluntary extra-judicial confession – A confession outside

the court and before trial is said to be voluntary when the
accused person made the declaration of guilt in his own
freewill, without the influence of others or given not as a result
of force or intimidation, violence, threat or promise of reward
or leniency. This confession is voluntary and naturally
admissible in court as evidence.

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2. Involuntary extra-judicial confession – This
is the confession done outside the court or
before trial wherein the accused person made the
statement which is not of his own freewill of
influence by other persons or given as a result of
force or intimidation, violence, threat or promise
of reward or leniency. This confession is not
admissible in court as evidence because it is not
reliable to be true an done in a manner which
violates the human rights of person to speak
freely.
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B.JUDICIALCONFESSION – A confession made
inside the court during trial. It is usually
voluntary and therefore an admissible evidence
of high degree.

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Blood
• The human blood is a reddish liquid portion of
the body within the blood vessels and
containing formed elements such as red blood
cells, white blood cells, platelets and plasma
which is the liquid portion.

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 Plasma
• The liquid component of blood is called
plasma, a mixture of water, sugar, fat, protein,
and salts. The main job of the plasma is to
transport blood cells throughout your body
along with nutrients, waste products,
antibodies, clotting proteins, chemical
messengers such as hormones, and proteins
that help maintain the body's fluid balance

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 Red Blood Cells (also called erythrocytes or
RBCs)
Red cells contain a special protein called
hemoglobin, which helps carry oxygen from
the lungs to the rest of the body and then
returns carbon dioxide from the body to the
lungs so it can be exhaled

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Red cells are the most abundant cell in the
blood, accounting for about 40-45 percent of
its volume. The shape of a red blood cell is a
biconcave disk with a flattened center - in
other words, both faces of the disc have
shallow bowl-like indentations (a red blood
cell looks like a donut).

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 White Blood Cells (also called leukocytes)

White blood cells protect the body from

infection. They are much fewer in number
than red blood cells, accounting for about 1
percent of your blood.

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 Platelets (also called thrombocytes)

Unlike red and white blood cells, platelets are

not actually cells but rather small fragments of
cells. Platelets help the blood clotting process
(or coagulation) by gathering at the site of an
injury, sticking to the lining of the injured
blood vessel, and forming a platform on which
blood coagulation can occur.

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• Serum is a light-yellow fluid which separates
when blood coagulates.

A normal healthy Filipino has about 16-18

glasses of blood (an average glass of 200 cc.)

loss of six glasses of blood means loss of

life, while loss of three glasses will cause
anemia.

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 GAIT
It refers to a person's manner of walking.
They are usually due to diseases or injuries to
the legs, feet, brain, spinal cord, or inner ear.

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 Some walking abnormalities have been given
names:
• Propulsive gait -- a stooped, stiff posture with
the head and neck bent forward
• Scissors gait -- legs flexed slightly at the hips
and knees like crouching, with the knees and
thighs hitting or crossing in a scissors-like
movement

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• Spastic gait -- a stiff, foot-dragging walk caused
by a long muscle contraction on one side
• Steppage gait -- foot drop where the foot
hangs with the toes pointing down, causing
the toes to scrape the ground while walking,
requiring someone to lift the leg higher than
normal when walking
• Waddling gait -- a duck-like walk that may
appear in childhood or later in life

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 MEDICOLEGAL DEATH

DEATH - It is defined as the absence of life in a living

matter.

In medico-legal death, it refers to the death

which involves in crime or medico-legal cases to
prove or disprove that a play has been done.

Usually death from sickness in the hospital or

at home is a natural death and therefore is not
classified medico-legal death because there is no
foul play or crime involved.
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Signs of Death

1. Cessation of respiration
2. Cessation of heart beating and circulation
3. Cooling of the body (algor mortis)

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Algor mortis (Latin: algor—coldness; mortis—of
death) is the reduction in body temperature
following death. This is generally a steady
decline until matching ambient temperature,
although external factors can have a
significant influence.

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 Kinds of death
1. Somatic death-Clinical death
It is a complete, continuous, persistent
cessation of respiration, circulation and almost
all brain function of an organism. It is usually
pronounced by a physician or other members
of the family.

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 Clinical types of death
a. Sociologic death
It is a type of death wherein the
withdrawal and separation from the patient
by others producing a sense of isolation and
abandonment. Sociologic death can last for
patient is abandoned by the family, unvisited
and left alone to die.

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b. Psychic death

The condition of death wherein the patient

regresses gives up or surrenders, accepting
death prematurely and refuses to continue
loving. Psychic death occurs prematurely if the
patient has excessive fear of his illness and
views it as lending to immediate death.

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c. Biologic death
The type of death characterized by the
absence of cognitive function or awareness,
although artificial support system may
maintain organ functioning.

d. Physiologic death
A type of death when all the vital organs
have ceased to function.

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2. Molecular death-Cellular death

It is the cessation of life individual cells in the

body which occurs one at a time after somatic
death. The cells die after varying periods of time
depending upon the ability to function without
food supply. The blood contains die earlier about 5
minutes after somatic death while muscle cells live
longer until the onset of rigor mortis which is about
2-6 hours.

Thus the tissues of the organism die in bits

and pieces after somatic death.

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3. Apparent death – “State of suspended Animation”

It is a state of temporary cessation of vital activities

of the body or the vital processes were depressed to the
minimum compatible with life. This condition is not
actually death although classified under the kinds of death
because the person or organism is still alive although it
seems that there no signs of life.

Apparent death maybe seen in diseases or

conditions like catalepsy, uremia, hysteria, drowning,
electrocution and sometimes in newborn infants

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 Stages of Muscular change

1. Stage of primary flaccidity

It is the stage of muscular change upon death
characterized by relaxation of muscles and loss of their
natural tone so that the jaw or the head drops down; the
thorax collapse and the limbs becomes flaccid; the iris
assumes a midposition and the sphinster relaxes

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2. Stage of Post-mortem Rigidity or Rigor Mortis

This is the stage of muscular change which

occurs 2-6 hours after death and is
characterized by hardening of the muscles due
to biochemical changes of the muscle

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 Conditions Simulating Rigor Mortis

1. Heat Stiffening
A condition characterized by hardening of the muscles
due to coagulation of muscle proteins when the dead body is
exposed to intense hint as by burning or immersion in a hot
liquid.

2. Cold Stiffening
A condition characterized by hardening of the muscles
due to solidification of facts, muscle and fluid when the dead
body is exposed to extremely cold or freezing temperature.

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3. Cadaveric Spasm or Instantaneous Rigor
It is the instant stiffening of a certain group of muscles
which occurs immediately at the moment of death and although
its cause is unknown is associated with violent death due to
extreme nervous tension, fatigue and injury to the nervous
system.

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c. Stage of secondary flaccidity
A muscular change characterized by the softness and
flaccidity of the muscles in which no longer responds to
mechanical or electrical stimulation due to dissolution of the
muscle proteins that have been previously coagulated during the
stage of rigor mortis.

This stage is the onset of putrefaction and occurs after

many hours in rigor mortis.

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 Putrefaction

Its is the process of dissolution of tissues by the digestive

action if its enzymes and bacteria that result to softening and
liquefaction of tissues and usually accompanied by the liberation
of foul-smelling gases and change of color of the tissues.

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 Special forms of putrefaction
A. Mummification
A Condition where there removal of the body fluid
before decomposition sets in that resulted to shrunkening and
preservation of the dead body. If the dead body is buried or
exposed to a dry, hot, sandy soil and warm environment with
considerable air movement, the body will not decomposed but
instead becomes dried and be preserved for an indefinite period
of time.

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Mummify

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B. Saponification – Adipocere formation
It is the formation of a soft, friable
and brownish-white greasy substance
in a soft fatty tissues of the body after
death.

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 C. Maceration
It is a condition of a dead body usually the
foetus characterized by softening and
discoloration of tissues as well as the formation
of blisters in the skin due to action of autolytic
enzymes in the absence putrefactive bacteria.

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 Maceration

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 Kinds of Post-mortem Lividity

1. Hypostatic lividity
It is the lividity when the discoloration is
due to the blood pooled in the most dependent
areas of the body.

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2. Diffusion lividity
It is a fixed or permanent discoloration
when the blood clotted inside the blood vessels
or has diffused to different parts of the body.

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3. Cadavaric spasm
In violent death, the attitude of the parts of
the body may infer position on of the spasm of
the muscles as exemplified in drowning and
suicide wherein the materials maybe grasped
tightly by the hands.

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 Basis in Estimating the Time of Death

1. General physical changes

A warm supple body with moist, transparent cornea and moist
lips as will as the absence of post-mortem lividity in the most
dependent portion of the body is a condition of recent death in a
person.

2. Post-mortem Lividity – Livor Mortis

The onset of the post-mortem lividity is 20-30 minutes in the
most dependant portions of the body and is completed in about 12
hours when the blood has already clotted or diffused to different parts
of the body wherein the discoloration is darker and permanent.

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• Livor mortis (Latin: livor—"bluish color," mortis—
"of death"), postmortem
lividity (Latin:postmortem—"after
death", lividity—"black and
blue"), hypostasis (Greek: hypo, meaning "under,
beneath"; stasis, meaning "a standing"[1][2])
or suggillation, is one of the signs of death. Livor
mortis is a settling of the blood in the lower
(dependent) portion of the body, causing a
purplish red discoloration of the skin. When the
heart stops functioning and is no longer agitating
the blood, heavy red blood cells sink through
the serum by action of gravity.

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Livor mortis starts twenty minutes to three
hours after death and is congealed in the
capillaries in four to five hours. Maximum
lividity occurs within 6–12 hours.

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3. Post-mortem Rigidity – Rigor Mortis
Onset – 2-6 hours after death and is completed
in about 12 hrs
Duration – 24-48 hours in the Philippines and
other tropical countries
36-48 hours during summer in the Philippines
and other tropical countries

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Rigor mortis (Latin: rigor "stiffness", mortis "of
death") is one of the recognizable signs of
death, caused by chemical changes in
the muscles after death, causing the limbs of
thecorpse to stiffen after death.

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4. Onset and stage of decomposition
In tropical countries, the onset of
decomposition is 1-2 days after death and then
finally the dead body becomes skeleton in a
month’s time considering the factors that
influence the
rate of putrefaction.

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 Methods of Judicial Death
• Death by lethal Injection

• Death by electrocution

• Death by Musketry – firing squad

• Death by Gas Chamber

• Death by Hanging

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 Classification of Wound or Physical Injury

• Mortal wound

• Non-mortal wound

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 Application of force and the location of injury:

1. Coup injury – It is the physical injury which is

found at the site of the application of force.

2. Contre coup injury – It is the physical injury

which is found not at the site but opposite the site
of the application of force
.
3. Coup contre coup injury – It is the physical injury
which is found at the site and
the opposite site of the application of force.

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4. Locus minoris resistancia – It is the physical
injury which is found not at the site or opposite
the site of the application of force but in some
areas offering the least resistance to the force
applied.

5. Extensive injury – It is the physical injury

involving the greater area beyond the site of
force.

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Fracture – It is a break or solution in the continuity of the
bone tissue resulting from violence or from some
existing pathology.

Kinds of Fracture:
– Simple Fracture – It is an injury where there is the line of
fracture but the alignment of the bones are still intact.

– Compound fracture – It is where there is a break in the

bone and loss of alignment of the affected bones.

– Comminuted fracture – It is a fracture where there is a

break in the bones, loss of alignment of the affected bones
and separation of fragments of bones.

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Simple, compound & Comminuted

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Dislocation – It is the displacement of the articular
surfaces of the bones forming the joints usually
secondary to trauma.

Kinds of dislocation:
– Simple dislocation – A dislocation where there is
displacement of the bones but without external
wound.
– Compound dislocation – A dislocation where there
is displacement of the bones and accompanying
break or wound in the skin.

Cerebral concussion – It is a condition of the brain

resulting from a sudden jarring or stunning of the brain
which follows a blow on the head and is characterized
by headache or dizziness; unconsciousness or semi-
consciousness;

Internal hemorrhage – It is bleeding usually in the cavity

or organs inside the body.

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 Cerebral concussion

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Simple compound

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Abrasion – It is an open wound characterized by the removal of
the epithelial

• Types of abrasion

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Imprint abr. Friction abr

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Grazes scratches

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 Incised wound Lacerated wound

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Splitting lacerated wound overstretch lacerated wounds

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Grinding compression wound tearing wound

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Cut laceration laceration Puncture

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Stab wounds

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 Sexual Offense and Deviation
Virginity is a condition of a woman or female
who have not experienced sexual intercourse
or whose genital organs had not been altered
by coitus.

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 virginity

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 Defloration is the rupture or laceration of the hymen in woman
due to sexual intercourse.

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 Kinds of Virginity
• 1.Moral Virginity - It is a state of virginity wherein a
female is not physically matured or still not conscious
about sex and had not experienced sexual intercourse.
It sex organs have not yet been fully developed.
•
• 2. Physical Virginity – A condition of virginity
wherein a woman is already conscious about sex and
had already developed the sexual organs and sex
characteristics but have not yet experience sexual
intercourse.
•

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• 3. Demi-virginity – This is a virginity wherein the
woman had some sexual act with either man or
woman but with the exception of sexual intercourse or
rupturing of the hymen. The sexual acts maybe
exhibitionism or partialism.
•
•
• 4. Virgo-intacta - This is actually not virginity because
the woman had one or more sexual intercourse with
another man but had not borne a child yet.
•
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 Labia majora and labia minora

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Vaginal canal
– It is a musculo-membranous canal used as a female copulatory organ and covered by
hymen externally. The lining of the vaginal canal formed numerous transverse ridges.

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Fourchette and Perineum
The Fourchette is the V-shape structure formed by the union of the
labia minora posteriorly and below the vaginal orifice.

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Hymen
The hymen is a thin fold of mucous membrane attached around the vaginal
orifice. Its shape and structure may determine the appearance of the vaginal orifice.

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Breast
– the breast are two mass of fleshy tissues at the region of the chest with its nipple at the center
and surrounded by pinkish-brown areola.

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 Six (6)Breast Shape
1. Archetype Breast Shape

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This archetypical breast shape is just that – the
standard. The breasts are full and round
coming to a small point at the nipple

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 2.Uneven Breast Shape

Uneven breasts mean your two breasts are not of equal size

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3. Conical Breast Shape

The base of the breast is typical, but the breast shape is more cone-like
than round with the conical breast shape

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4. Thin Breast Shape

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Thin breasts are where the base of the breasts
have a smaller circumference than standard
breasts. Also called tuberous breasts, this
smaller breast circumference causes the
breast shape to appear slim and long

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5. Omega Breast Shape

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The Omega breast shape (named after an
upside-down omega symbol) occurs with
mostly large cup-sized breasts (D cup or
larger). Also known as “ball-shaped breasts” it
is a shape that occurs over time due to
improper bra wearing

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6. Reduced Projection Breast Shape

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Breasts with reduced projection have a
traditional breast base circumference, but the
breasts themselves do not have adequate
breast tissue to fully fill out a bra’s cups.

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 Thank you!!!

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