FORENSIC MEDICINE

By:

PROF. OSCAR GATCHALIAN SORIANO, LC

BSCrim., MSBA, MACrim., Ph.DCrim.
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General Considerations

Forensic Medicine is the branch of medicine that

deals with the application of medical knowledge for the
purpose of law and in the administration of justice. It
is the application of the basic clinical, medical and
paramedical sciences to elucidate forensic matters.

Originally the terms forensic medicine, legal

medicine and medical jurisprudence are synonymous, and
in common practice are used interchangeably. This
concept prevailed among countries under the Anglo-
American influence.

On the other hand, medical jurisprudence, juris-

law, prudence-knowledge, denotes knowledge of law in
relation to the practice of medicine. It concerns with
the study of the rights, duties and obligations of a
medical practitioner with particular reference to those
arising from doctor-patient relationship.

Scope of Forensic Medicine

The scope of forensic medicine is quite broad and

encompassing. It is the application of medical and
paramedical sciences as demanded by law and
administration of justice. The knowledge of the nature
and extent of wounds has been acquired in surgery,
abortion in gynecology, sudden death and effects of
trauma in pathology, etc., aside from having knowledge
of the basic medical sciences, like anatomy,
physiology, biochemistry, physics and other allied
sciences.

Nature of the Study of Forensic Medicine

Knowledge of forensic medicine means the ability

to acquire facts, the power to arrange those facts in
their logical order, and to draw a conclusion from the
facts which may be useful in the administration of
justice. Aside from being a preceptor of fact, he must
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possess the power to impart to others verbally or in

writing all those he has observed.

A physician who specializes or is involved

primarily with medico-legal duties is known as medical
jurist, medico-legal examiner, medico-legal officer,
and medico-legal expert. Inasmuch as administration of
justice is primarily a function of the state,
physicians whose duties are mainly medico-legal in
nature are mostly in the service of the government.

Health officers, medical officers of law

enforcement agencies and members of the medical staff
of accredited hospital are authorized by the law to
perform autopsies, as provided by Section 95, P.D. 856,
Code of Sanitation.

However, “it is the duty of every physician, when

called upon by the judicial authorities, to assist in
the administration of justice on matters which are
medico-legal in character, as provided by Section 2,
Art. III, Code of Medical Ethics of the Medical
Profession of the Philippines.

To be involved in medico-legal duties, a physician

must possess sufficient knowledge in pathology,
surgery, gynecology, toxicology and such other branches
of medicine germane to the issues involved.

Dis. Bet. Ordinary Physician & Medical Jurists

1. An ordinary physician examines the point of

view of treatment, while the medical-jurist sees injury
or disease on the point of view of cause.

2. The purpose of an ordinary physician in the

examination of a patient is to arrive at a definite
diagnosis so that appropriate treatment can be
instituted, while the purpose of the medical-jurist in
the examination of a patient is to include bodily
lesions in his reports and testify before the court or
before an investigative body, thus giving justice to
whom it is due.
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3. Minor or trivial injuries are usually ignored

by an ordinary physician inasmuch as they do not
require usual treatment, while the medical jurists must
record all bodily injuries even if they are small or
minor, because these injuries may be proofs to qualify
the crime or to justify the act.

Medical Evidence Defined

It is species of proof, or probative matter,

legally presented at the trial of an issue by the act
of the parties, and through the medium of witnesses,
records, documents, concrete objects, etc. for the
purpose of inducing belief in the minds of the court as
their contention. If the means employed to prove a fact
is medical in nature then it becomes medical evidence.

Preservation of Medical Evidence

The physical evidences recovered during medico-

legal investigation must be preserved to maintain their
value when presented as exhibits in court. Most medical
evidences are easily destroyed or physically or
chemically altered unless appropriate preservation
procedure is applied. This problem is further
compounded by the long space of the time the evidence
was recovered and its presentation in court.

From its recovery and from becoming a part of the

investigation report, a preliminary investigation will
be made by the prosecuting fiscal to prove that there
is a prima facie evidence to warrant the filing of
information of the case in court. While in court,
preferential trials of other cases, raisings of
prejudicial issues to higher courts, etc might be
experienced. In these instances, preservation of
evidence is indeed vital in medico-legal investigation.
Definition of Death

Death is the termination of life. It is the

complete cessation of all the vital functions without
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possibility of resuscitation. It is an irreversible of

the properties of the living matter. Dying is a
continuing process while death is an event that takes
place at a precise time. The ascertainment of death is
a clinical and not a legal problem.

Categories of Death

The following are the categories of death:

1. Brain Death

Death occurs when there is irreversible coma,

absence of electrical brain activity and complete
cessation of all the vital functions without
possibility of resuscitation.

2. Cardio-Respiratory Death

Death occurs when there is a continuous and

persistent cessation of heart action and respiration.
Cardio-respiratory death is a condition in which the
physician and the members of the family pronounced a
person to be dead based on the common sense and
intuition.

3. Others

Some countries or states provide both brain and

cardio-respiratory bases in an alternative or electric
way in the determination of the death.

Kinds of Death

Based on criterion used in it determination, death

maybe:

1. Somatic Death or Clinical Death

This is the state of the body in which there is

complete, persistent and continuous cessation of the
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vital functions of the brain, heart and lungs that

maintain life and health. It occurs the moment the
physician or other members of the family declare a
person has expired, and some of the early signs of
death are present. It is hardly possible to determine
the exact time of death.

2. Molecular or Cellular Death

About three to six hours, later, there is death of

individual cells. This is known as molecular or
cellular death. Its exact occurrence cannot definitely
ascertain because its time of appearance is influenced
by several factors, i.e., previous state of health,
infection, climatic condition, cellular nutrition, etc.

3. Apparent Death or State of Suspended Animation

This condition is not really death but merely a

transient loss of consciousness or temporary cessation
of the vital functions of the body on account of
disease, external stimulus or other forms of influence.
It may arise especially in hysteria, uremia, catalepsy
and electric shock.

Signs of Death

1. Cessation of Heart Action and Circulation

There must be an entire and continuous cessation

of the heart action and flow of blood in the whole
vascular system. A temporary suspension of the heart
action is still compatible with life. The length of the
time the heart may cease to function and life is still
maintained depends upon the oxygenation of blood at the
time of the suspension. As a general rule, if there is
no heart action for a period of five minutes, death is
regarded as certain.
2. Cessation of Respiration

Like heart action, cessation of respiration in

order to be considered a sign of death must be
continuous and persistent. A person can hold his breath
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for a period not longer than 31/2 minutes. In case of

electrical shock, respiration may cease for sometime
but may be restored by continuous artificial
respiration.

3. Cooling of the Body-Algor Mortis

After death the metabolic process inside the body

ceases. No more heat is produced, and the body loses
slowly its temperature by evaporation or by conductions
to the surrounding atmosphere.

4. Insensibility of Body and Loss of Power to Move

After death the whole body is insensible. No kind

of stimulus is capable of letting the body to have
voluntary movement. This condition must be observed in
conjunction with cessation of heartbeat and circulation
and cessation of respiration.

5. Changes in the Skin

1) Discoloration

After death the skin may be observed to be

pale and waxy-looking due to the absence of
circulation. Areas of the skin especially the most
dependent portions will develop livid discoloration on
account of the gravitation of blood.

2) Loss of Elasticity of the Skin

Normally when the body surface is compressed,

it readily returns to normal shape. After death,
application of pressure to the skin surface will make
the surface flattened. Application of pressure with the
fingertip will produce impression, like one observed in
edema.

3) Opacity of the Skin

Exposure of the hand of a living person to

translucent light will allow the red color of
circulation to be seen underneath the skin. The skin of
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a dead person is opaque due to the absence of

circulation.

4) Effect of the Application of Heat

Application of melted sealing wax on the

breast of a dead person will not produce a blister or
inflammatory reaction on the skin. In the living, an
inflammatory edema will develop about the wax.

6. Changes in and About the Eye

1) Loss of Corneal Reflex

The cornea is not capable of making any

reaction to whatever intensity of light stimulus.
However, absence of corneal reflex may also be found in
a living person, based on the following conditions:
general anesthesia, apoplexy, uremia, epilepsy,
narcotic poisoning, and local anesthesia.

2) Clouding of the Cornea

The normal clear and transparent nature of

the cornea is lost. The cornea becomes slightly cloudy
or opaque after death. If the cornea is kept moist by
the application of saline solution after death, it will
remain transparent. Opacity of the cornea may be found
in certain diseases, like cholera, and therefore is not
reliable sign of death.

3) Flaccidity of the Eyeball

After death, the orbital muscles lose their

tone making the intra-orbital tension rapidly fall. The
eyeball sinks the orbital fossa. Intra-orbital tension
is low.

4) The Pupil is in the Position of Rest

The muscle of the iris loses its tone. The

pupil cannot react to light. The size of the pupil
varies at the time of death. However, if constricted,
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it may be found in life in the following conditions:

action of drugs like atropine, uremia, tabes dorsails,
and apoplexy.

5) Opthalmoscopic Findings

(1) The optic disc is pale and has

appearance of optic atrophy.

(2) The retina becomes pale like the optic

disc.

(3) The remaining portion of the fundus may

have a yellow tinge which later changes to a brown-gray
or slate color.

(4) The retinal vessels become segmented, no

evidence of blood.

(5) The retinal vessels and arteries are

indistinguishable.

6) Tache Noir dela Sclerotique

After death a spot may be found in the

sclera. The spot which may be oval or round or may be
triangular with the base towards the cornea and may
appear in the sclera few hours after death. At the
beginning it is yellowish, but later it becomes brown
or black. This is believed to be due to the thinning of
the sclera thereby making the pigmented choroids
visible.

7. Action of Heat on the Skin

This test is useful to determine whether death

occurred before or after the application of heat. The
heat is applied to a portion of the leg or arm. If
death is real, only a dry blister is produced. The
epidermis is raised but on prickling the blister, no
fluid is present. There is no redness of the
surrounding

In the living, the blister contains abundant serum

and area vital reaction on the skin around is present.
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The following combination of signs shows that death has

occurred, i.e., loss of animal heat to a point not
compatible with life, absence of response of muscle to
stimulus, and onset of rigor mortis.

Changes in the Body Following Death

Hereunder are the changes of the body after death.

1. Changes in the Muscle

After death, there is complete relaxation of the

whole muscular system. The entire muscular system is
contractile for three to six hours after death, and
later rigidity sets in. Secondary relaxation of the
muscles will appear just when decomposition has set in.
The following are the stages of the entire muscular
tissue after death:

1) Primary Flaccidity or Post-Mortem Muscular

Irritability

Immediately after death, there is complete

relaxation and softening of all the muscles of the
body. The extremities may be flexed, the lower jaw
falls, the eyeball loses its tension, and there may
incontinence of urination and defecation. To determine
whether the muscles are still irritable, apply electric
current and note whether there is still irritability of
the muscles.

Normally during the stage of primary

flaccidity, the muscles are still contractile and react
to external stimuli, mechanical or electrical owing to
the presence of molecular life after somatic death. This
stage is usually lasts about three to six hours after
death. In warm places, the average duration is only one
hour and fifty minutes. Chemically, the reaction of the
muscle is alkaline and the normal constituents of the
individual muscle proteins are the same as life.
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2) Post-Mortem Rigidity or Cadaveric Rigidity or

Death Stiffening or Death Struggle of the Muscles or
Rigor Mortis

Three to six hours after death the muscles

gradually stiffen. It usually starts at the muscles of
the neck and lower jaw and spreads downwards to the
chest, arms, and lower limbs. Usually the whole body
becomes stiff after twelve hours. All the muscles are
involved-both voluntary and involuntary. In the heart
rigor mortis may be mistaken for cardiac hypertrophy.
Chemically, there is an increase of lactic acid and
phosphoric content of the muscle. The reaction becomes
acidic. There is no definite explanation as to how such
contraction of muscles occurs although it has been
proven that there is coagulation of the plasma protein.

In the medico-legal point of view, post-

mortem rigidity may be utilized to approximate the
length of time the body has been dead. In temperate
countries it usually appears three to six hours after
death, but in warmer countries it may develop earlier.
In temperate countries, rigor mortis may last for two
or three days but in tropical countries the usual
duration is twenty-four to forty-eight hours during
cold weather and eighteen to thirty-six hours during
summer. When rigor mortis sets in early, it passes off
quickly and vice-versa.

Conditions Stimulating Rigor Mortis

(1) Heat Stiffening

If the dead body is exposed to temperature

o
above 75 it will coagulate the muscle proteins and
cause the muscles to be rigid. The stiffening is more
or less permanent and may not be easily affected by
putrefaction. The body assumes the “pugilistic
attitude” with the lower and upper extremities flexed
and hands clenched because the flexor muscles are
stronger than the extensors.

(2) Cold Stiffening

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The stiffening of the body may be manifested

when the body is frozen, but exposure to warm
conditions will make such stiffening disappear. The
cold stiffening is due to solidification of fat when
the body is exposed to freezing temperature. Forcible
stretching of the flexed extremities will produce a
sound due to the frozen synovial fluid.

(3) Cadaveric Spasm or Instantenous Rigor

This is the instantaneous rigidity of the

muscles which occurs at the moment of death due to
extreme nervous tension, exhaustion and injury to the
nervous system or injury to the chest. It is
principally due to the fact that the last voluntary
contraction of muscle during life does not stop
after death but is continuous with the act of
cadaveric rigidity.

In case of cadaveric spasm, a weapon may be

held in the hand before death and can be removed with
difficulty. For practical purposes it cannot be
possible for the murderer or assailant to imitate the
condition. In cadaveric spasm, only group of muscles
are involved and they are usually not symmetrical.

The findings of weapon, hair, pieces of

clothing, weeds on the palms of the hands and firmly
grasped is a very important medico-legal point in the
determination whether it is case of suicide, murder or
homicide. The presence of weeds held by the hands of a
person found in water shows that the victim was alive
before disposal. Instantaneous rigor may also be found
following ingestion of cyanide but usually it is
generalized and symmetrical. Strychnine may produce the
same, but rigidity may appears sometime after
ingestion.

Distinction Bet. Rigor Mortis & Cadaveric Spasm

(1) Time of Appearance

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Rigor mortis appears three to six hours after

death, while cadaveric spasm appears immediately after
death.

(2) Muscles Involved

Rigor mortis involves all the muscles of the

body whether voluntary or involuntary, while cadaveric
spasm involves only a certain muscle or group of
muscles and are asymmetrical.

(3) Occurrence

Rigor mortis is a natural phenomenon which

occurs after death, while cadaveric spasm may or may
not appear on a person at the time of death.

(4) Medico-Legal Significance

Rigor mortis may be utilized by a medical

jurist to approximate the time of death, while
cadaveric spasm may be useful to determine the nature
of the crime.

3) State of Secondary Flaccidity or Secondary

Relaxation

After the disappearance of rigor mortis, the

muscle becomes soft and flaccid. It does not respond to
mechanical or electrical stimulus. This is due to the
dissolution of the muscle proteins which have
previously been coagulated during the period of rigor
mortis. The body while at the stage of rigor mortis, if
stretched or flexed to become soft will no longer be
rigid. This condition of the muscles is not secondary
flaccidity.

2. Changes in the Blood

1) Coagulation of the Blood

The stasis of the blood due to cessation of
circulation enhances the coagulation of blood inside
the blood vessels. Blood clotting is accelerated in
cases of death by infectious fevers and delayed in
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cases of asphyxia, poisoning by opium, hydrocyanic acid

or carbon monoxide poisoning.

The clotting of blood is a very slow process

that there is a tendency for the blood to separate
forming a red clot at the lower level and above it is a
white clot known as chicken-fat clot. Blood may remain
fluid inside the blood vessels after death.

2) Post-mortem Lividity or Cadaveric Lividity or

Post-Mortem Suggillation or Post Mortem Hypostasis or
Livor Mortis

The stoppage of the heart action and the loss

of tone of blood vessels cause the blood to be under
the influence of gravity. Blood begins to accumulate in
the most dependent portions of the body. The
capillaries may be distended with blood. The distended
capillaries coalesce with one another until the whole
area becomes dull-red or purplish in color known as
post-mortem lividity. If the body is lying on his back,
the lividity will develop on the back. Areas of bone
prominence may not show lividity on account of the
pressure.

If the position of the body is moved during

early stage of its formation, it may disappear and
develop again in the most dependent area in new
position assumed. But if the position of the body has
been changed after clotting or the blood has set in or
when blood has already diffused into the tissue of
the body, a change of position of the body will not
alter the location of the post-mortem lividity.

Ordinarily, the color of post-mortem lividity

is dull-red or pink or purplish in color, but in death
due to carbon monoxide poisoning, it is bright pink.
Exposure of the dead body to cold or hot may cause
post-mortem lividity to be bright-red in color. The
lividity usually appears three to six hours after death
and the condition increases until blood coagulates. The
time of its formation is accelerated in cases of death
due to cholera, uremia and typhus fever. Twelve hours
after death, the post-mortem lividity is already fully
developed. It also involved internal organs.
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Kinds of Post-Mortem Lividity

(1) Hypostasis Lividity

The blood merely gravitates into the most

dependent portions of the body but still inside the
blood vessels and still fluid in form. Any change of
the position of the body leads to the formation of the
lividity in another place. This occurs during the early
stage of its formation.

(2) Diffusion Lividity

This appears during the later stage of its

formation when the blood has coagulated inside the
blood vessels or has diffused into the tissues of the
body. Any change of position will not change the
location of the lividity.

3. Autolytic or Autodigestive Changes After Death

After death, protoelytic, glycolytic and lipolytic

ferments of grandular tissues continue to act which
lead to the autodigestion of organs. This action is
facilitated by weak acid and higher temperature. It is
delayed by the alkaline reaction of the tissues of the
body and low temperature. Their early appearance is
observed in the parenchymatous and glandular tissues.

Autolytic action is seen in the maceration of the

dead fetus inside the uterus. The stomach may be
perforated, glandular tissues become soft after death
due to auto-digestion and the action of autolytic
enzymes. Microscopic examination of the tissues under
the influence of autolytic enzymes shows
disintegration, swelling or shrinkage, vacuolization
and formation of small granules within the cytoplasm of
the cells. There is also a change in the straining
capacity and become desquamated from the underlying
layers.

4. Putrefaction of the Body

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Putrefaction is the breaking down of the complex

protein into simpler components associated with the
evolution of foul smelling gasses and accompanied by
the change of color of the body.

Tissue Changes in Putrefaction

1) Changes in the Color of the Tissues

A few hours after death there is hemolysis of

the blood within blood vessels and as a result of which
hemoglobin is liberated. The hemoglobin diffuses
through the wall of the blood vessels and stains the
surrounding tissues thereby imparting a red or reddish-
brown color.

While in the tissues, the hemoglobin

undergone chemical changes and various derivatives of
hemoglobin are formed. On account of these chemical
changes the tissue is gradually changed to greenish-
yellow, greenish-blue, or greenish-black color. The
earliest change is greenish in color of the skin seen
at the region of the right iliac fossa and it gradually
spreads over the whole abdominal wall. Blood after
extravasates into the cavities of the body.

The prominence of the superficial veins with

the reddish discoloration during the process of
decomposition that develops on both flanks of the
abdomen, root of the neck and shoulder and which makes
the area look like a marbled reticule of branching
vein. This is observed easily among dead persons with
fair complexion, this is called “marbolization”.

2) Evolution of Gases in the Tissues

One of the products of putrefaction is the

evolution of gases. Carbon dioxide, ammonia, hydrogen,
sulphurated hydrogen, phosphoresced hydrogen, and
methane gasses are formed. The offensive odor is due to
these gases, and also due to a small quantity of
mercaptans.

The formation of gasses causes the distention

of the abdomen and bloating of the whole body. Gases
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formed in the subcutaneous tissues and in the face and

neck cause swelling of the whole body. Small gas
bubbles are found in the solid visceral organs and give
rise to the “foamy” appearance of the organs.

Physical Changes During Putrefaction

Hereunder is the chronological order of the

external changes of the body during putrefaction:

1. Greenish discoloration over the iliac fossa

appearing after one to three days, and extension of the
greenish discoloration over the whole abdomen and other
parts of the body.

3. Marked discoloration and swelling of the face

with bloody froth coming out of the nostrils and mouth.

4. Swelling and discoloration of the scrotum or

of the vulva, distention of the abdomen with gases, and
development of the bullae in the face of varying sizes.

5. Bursting of the bullae and denudation of

large irregular surfaces due to the shedding of the
epidermis, and escape of blood-stained fluid from the
mouth and nostrils.

7. Brownish discoloration of the surface veins

giving an arborescent pattern on the skin, and
liquefaction of the eyeballs.

8. Increased discoloration of the body generally

and progressive increase of abdominal distention.

9. Presence of maggots, shedding of the nails

and loosening of hair, and conversion of the tissue
into semi-fluid mass.

10. Facial feature unrecognizable, bursting of

the abdomen and thoracic cavities, and progressive
dissolution of the body.
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Duration of Death

In the determination as to how long a person has

been dead from the condition of the cadaver and other
external evidences, the following points must be taken
into consideration.

1. Presence of Rigor Mortis

In warm countries like the Philippines, rigor

mortis sets from 2 to 3 hours after death. It is fully
developed in the body after 12 hours. It may last from
18 hours to 36 hours and its disappearance is
concomitant with the onset of putrefaction.

2. Presence of Post-Mortem Lividity

Post-mortem lividity usually develops 3 to 6 hours

after death. It first appears as a small petechia-like
red spots which later coalesce with each other to
involve bigger areas in the most dependent portions of
the body depending upon the position assumed at the
time of death.

3. Onset of Decomposition

In the Philippines like other tropical countries,

decomposition is early and the average time is 24 to 48
hours after death. It is manifested by the presence of
watery, foul-smelling froth coming out of the nostrils
and mouth, softness of the body and presence of
crepitation when pressure is applied on the skin.

4. Stage of Decomposition

The approximate time of death may be inferred from

the degree of decomposition, although it must be made
with extreme caution. There are several factors which
modify putrefaction of the body.

5. Entomology of the Cadaver

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In order to approximate the time of death by the

use of the flies present in the cadaver, it is
necessary to know the life cycle of the flies. The
common flies undergo larval, pupal and adult stages.
The usual time for the egg to be hatched into larva is
24 hours, so that by the mere fact that there are
maggots in the cadaver, one can conclude that death has
occurred more than 24 hours.

6. Stage of Digestion of Food in the Stomach

It takes normally 3 to 4 hours for the stomach to

evacuate its content after meal. The approximate time
of death may be deduced from the amount of food in the
stomach in relation to his last meal. This
determination is dependent upon the amount of food
taken and the degree of tonicity of the stomach.

7. Presence of Live Fleas in Drowning Cases

A flea can only survive for approximately 24 hours

submerged in water. It can no longer be revived if
submerged more than that period. In temperate
countries, people wear woolen clothes. If the body is
found in water, the fleas may be found in the woolen
clothing. The fleas recovered must be place in a watch
glass and observed if it is still living. If the fleas
still could move, then the body has been in water for a
period less than 24 hours. Revival of the life of the
fleas is not possible if they are in water for more
than 24 hours.

8. Amount of Urine in the Bladder

The amount of urine in the urinary bladder may

indicate the time of death when taken into
consideration; he was last seen voiding his urine.
There are several factors which may modify urination so
it must be utilized with cautions.

9. State of the Clothing

A circumstantial proof of the time of death is the

apparel of the deceased. If the victim is wearing
street clothes, there is more likelihood that death
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took place at daytime, but if in night gown or pajama,

it is more probable that death occurred at night time.

10. Chemical Changes in the Cerebro-Spinal Fluid

1) Lactic acid increase from 15 to 200 mg. per

100 cc.

2) Non-protein nitrogen increase from 15 to 40

mg.

3) Amino-acid concentration rises from 1% to 12%

following death.

11. Post-Mortem Clotting and Decoagulation of Blood

Blood clots inside the blood vessels in 6 to 8

hours after death. Decoagulation of blood occurs at the
early stage of decomposition. The presence of any of
these conditions may infer the approximate duration of
death.

12. Presence or Absence of Soft Tissues in Skeletal

Remains

Under ordinary condition, the soft tissues of the

body may disappear 1 to 2 year’s time after burial. The
disappearance of the soft tissues varies and is
influenced by several factors. When the body is found
on the surface of the ground, aside from the natural
forces of nature responsible for the destruction of the
soft tissues, external element and animals may
accelerate its destruction.

13. Conditions of the Bone

If all the soft tissues have already disappeared

from the skeletal remains, the degree of erosion of the
epiphyseal ends of long bones, pulverization of flat
bones and diminution of weight due to the loss of
animal matter maybe the basis of the approximation.
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Stages of Medico-Legal Investigation of Death

1. Crime Scene Investigation

The crime scene is the place where the essential

ingredients of the criminal act took place. This
includes the setting of the crime and also the
adjoining places of entry and exit of both offender and
victim. Not all crimes have a well-defined scene, like
estafa, malversation, continuing crimes, etc. However
where medical evidence may be present, like murder,
homicide, physical injuries, sex crime-crime scene is
almost invariably present.

Crime scene investigation includes appreciation of

its condition and drawing an inference from it. It also
includes the collection of the physical evidences that
may lead to the identity of the perpetrator, the manner
the criminal act was executed, and such other things
that may be useful in the prosecution of the case.
There are five (5) methods of crime scene search, i.e.,
strip search, double strip search or grid method,
spiral method, wheel method, and zone method.

2. Autopsy

An autopsy is a comprehensive study of a dead

body, performed by a trained physician employing
recognized dissection procedure and techniques. It
includes removal of tissues for further examination.
There are two kinds of autopsies, i.e., hospital or
non-official autopsy, and medico-legal or official
autopsy.

1) Hospital or Non-Official Autopsy

This is an autopsy done on a human body with

the consent of the deceased person’s relatives for the
purpose of:

(1) Determining the cause of death;

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(2) Providing correlation of clinical

diagnosis and clinical symptoms;

(3) Determining the effectiveness of

therapy;

(4) Studying the natural cause of disease

process; and

(5) Educating students and physicians.

2) Medico-Legal or Official Examination

(1) Determining the cause, mode, and time of

death;

(2) Recovering, identifying, and preserving

evidentiary material;

(3) Providing interpretation and correlation

of facts and circumstances related to death;

(4) Providing a factual, objective medical

report for law enforcement, prosecution, and defense
agencies; and

(5) Separating death due to disease from

death due to external cause for protection of the
innocent.

Causes of Death

1. Immediate or Primary Cause of Death

This applies to cases when trauma or disease kill
quickly that there is no opportunity for sequelae or
complications to develop. An extensive brain laceration
as a result of a vehicular accident is an example of
immediate cause of death.

2. Proximate or Secondary Cause of Death

The injury or disease was survived for a

sufficiently prolonged interval which permitted the
 23

development of serious sequelae which actually caused

the death. If a stab wound in the abdomen later caused
generalized peritonis, then peritonis is the proximate
cause of death.

Medico-Legal Classifications of Death

1. Natural Death

This is death caused by natural disease condition

in the body. The disease may develop spontaneously or
it might have been a consequence of physical injury
inflicted prior to its development. If a natural
disease developed without the intervention of the
felonious acts of another person, no one can be held
responsible for the death.

2. Violent or Unnatural Death

Violent deaths are those due to injuries inflicted

in the body by some forms of outside force. The
physical injury must be the proximate cause of death.
The death of the victim is presumed to be natural
consequence of the physical injuries inflicted, when
the following facts are established:

1) That the victim at the time of physical

injuries is inflicted was in normal health.

2) That the death may be expected from physical

injuries inflicted.

3) That death ensued within a reasonable time.

Pathological Classifications of Death
1. Death from Syncope

This is death due to sudden and fatal cessation of

the action of the heart with circulation included.

2. Death from Asphyxia

 24

Asphyxia is a condition in which the supply of the

oxygen to the blood or to tissues or to both has
reduced below.

3. Death from Coma

Coma is the state of unconsciousness with

insensibility of the pupil and conjunctivae, and
inability to swallow, resulting from the arrest of the
functions of the brain.

Medico-Legal Aspects of Physical Injuries

Physical injury is the effect of some forms of

stimulus on the body. The effect may only be apparent
when the stimulus applied is insufficient to cause
injury and the body resistance is great. It may be real
when the effect is visible.

The effect of the application of stimulus may be

immediate or may be delayed. A thrust to the body of a
sharp pointed and sharp edge instrument will lead to
the immediate production of a stab wound, while a hit
by a blunt object may cause the delayed production of a
contusion.

Physical Injuries Brought About by Violence

The effect of the application of physical violence

on a person is the production of wound.

A wound is de-solution of the natural continuity

of any tissues of the living body. It is the disruption
of the anatomic energy of a tissue of the body. In
several occasions, the word physical injury is used
interchangeably with wound.

However, the effect of physical violence may not

always results to the production of wound, but the
wound is always the effect of physical violence.
 25

Vital Reactions

It is the sum total of all reaction of tissue or

organ to trauma. The reaction may be observed
macroscopically and microscopically. The following are
the common reactions of a living tissue to trauma.

1. Rubor

Redness or congestion of the area due to an

increase of blood supply as a part of the reparative
mechanism.

2. Calor

Sensation of heat or increase in temperature.

3. Dolor

Pain on account of the involvement of the sensory

nerve.

4. Loss of Function

On account of the trauma, the tissue may not be

able to function normally.

Classifications of Wounds

1. As to Severity

1) Mortal Wound

Wound which is caused immediately after

infliction or shortly thereafter that is capable of
causing death.

Parts of the body where the wounds inflicted

are considered mortal.

(1) Heart and big blood vessels

 26

(2) Brain and upper portion of the spinal

cord.

(3) Lungs

(4) Stomach, liver, spleen and intestine

2) Non-Mortal Wound

Wound which is not capable of producing death

immediately after infliction or shortly thereafter.

2. As to the Kind of Instrument Used

1) Wound brought about by blunt instrument:

(1) Contusion

(2) Hematoma

(3) Lacerated wounds.

2) Wound brought about by sharp instrument:

(1) Sharp-edged instrument-incised wound.

(2) Sharp-pointed instrument-punctured

wound.

(3) Sharp-edged and sharp-pointed

instrument-stab wound

3) Wound brought about by tearing force-

lacerated wound.

4) Wound brought about by change of atmospheric

pressure-barotrauma.

5) Wound brought about by heat or cold-

frostbite, burns or scald.

6) Wound brought about by chemical explosion-

gunshot or shrapnel wound.
 27

7) Wound brought about by inflection.

3. As to the Manner of Infliction

1) Hit-bolo, blunt instrument, axe.

2) Thrust or stab-bayonet, dagger.

3) Gunpowder explosion-projectile or shrapnel

wound.

4) Sliding or rubbing or abrasion.

4. As regards to the Depth of the Wound

1) Superficial

When the wound involves only the layers of

the skin.

2) Deep

When the wound involves the inner structure

beyond the layers of the skin.

(1) Penetrating

One in which the wounding agent enters

the body but did not come out or the mere piercing of a
solid organ or tissue of the body. Penetrating wound is
a wound where the dimension of depth and direction is
an important factor in its description. It involves the
skin of mucous surface and deeper underlying tissues or
organs caused directly by the wounding instrument.
Punctured, stabbed, and gunshot wounds usually belong
to this type of wound.

(2) Perforating

When the wounding agent produces

communication between the inner and outer portion of
the hollow organs. It may also mean piercing or
traversing completely a particular part of the body
causing communication between the points of entry and
exit of the instrument or substance producing it.
 28

5. As Regards to the Relation of the Site of the

Application of Force and the Location of Injury

1) Coup Injury

Physical injury which is located at the site

of the application of force.

2) Contre-Coup Injury

Physical injury found opposite at the site of

the application of the force.

3) Coup Contre-Coup Injury

Physical injury located at the site and also

opposite the site of application of force.

4) Locus Minoris Resistencia

Physical injury located not at the site, nor

opposite the site of the application of force but in
some areas offering the least resistance to the force
applied. A blow on the forehead may cause contusion at
the region of the eyeball because of the fracture on
the papyraceous bone forming the roof of the orbit.

5) Extensive Injury

Physical injury involving greater area of the

body beyond the site of the application of force. It
has not only the wide area of injury but also the
varied types of injury. A fall from a height or a run-
over victim of vehicular accident may suffer from
multiple fractures, laceration of organs, and all types
of skin injuries.

When a stationary head is hit by moving

object, there is tendency for the development of
contusion on the brain at the site of impact. When the
moving head hits a firm, fixed and hard object, brain
contusion may develop at the opposite of the site of
impact. A coup-contre-coup location of brain injury may
 29

be found when a fixed head is hit with a moving object

and then falls on another hard object.

6. As to Regions or Organs of the Body

1) Head and Neck

2) Injuries in the Chest

3) Abdominal Injuries

4) Pelvic Injuries

5) Extremities

7. Special Types of Wounds

1) Defense Wound

Wound which is the result of a person’s

instinctive reaction of self-protection. Injuries
suffered by a person to avoid or repel potential injury
contemplated by the aggressor.

A person who is conscious that he is going to

be hit by a blunt instrument on the head may raised his
flexed forearms over his head, causing injuries to the
forearms.

If someone is going to stab another with a

sharp instrument the tendency of the potential victim
is to take hold of the instrument thus causing the
production of an incised stab wound on the palm of the
hand.

2) Patterned Wound

Wound in the nature and shape of an object or

instrument and which infers the object or instrument
causing it.

Impact of the face on the radiator grill of a

car may cause imprint of the radiator grill on face. A
person run-over by a wheel of a car, tire marks are
shown on the body.
 30

Due to hanging, the nature of the abrasion

mark on the neck may infer material used. Contusion
produced by belt, branch of tree, metallic rod etc. may
have the shape of the wounding instrument.

3) Self-Inflicted Wound

Self-inflicted wound is a wound produced on

oneself. As distinguished from suicide, the person has
no intention to end his life.

Types of Wounds

1. Closed Wounds

There is no breach of continuity of the skin or

mucous membrane.

1) Superficial

When the wound is just beneath the layers of

the skin or mucous membrane.

(1) Petechiae

This is a circumscribed extravasation of

the blood in the subcutaneous tissue or underneath the
mucous membrane. The cause of passage of blood from
capillaries may be due to the increase intra-capillary
pressure or increased permeability of the vessel. The
hemorrhage maybe small or pinhead sized but several
petechiae may coalesced to form a bigger hemorrhagic
area. Mosquito or other insect bites may cause the
formation of a circumscribed hemorrhages.

Petechiae is not always a product of

trauma. Petechial hemorrhage may be a post-mortem in
death by hanging. There is gravitation of blood into
the most dependent part of the body which eventually
leads to rupture of over-distended capillaries seen at
the region of the leg.
 31

(2) Contusion

Contusion is the effusion of blood into

the tissues underneath the skin on account of the
rupture of the blood vessels as a result of the
application of blunt force or violence. When a blunt
force is applied, it momentarily compresses the blood
vessels at the point of contact, thereby temporarily
forcing the blood out of the area and setting up a
fluid wave under pressure. When the pressure exceeds
the cohesive force of the cells forming the capillary,
arteriole, or venule wall, the vessel ruptures.

Inasmuch as it used to take more time

for the blood to get out of the blood vessels,
contusion does not immediately develop after the
application force. It may develop after a lapse of
minutes or even hours after the application force. The
variation depends on the part of the body injured,
tenderness of the tissues affected, condition of the
blood vessels involved, and natural disease. Women are
much more easily bruised than men while boxers are less
prone to suffer contusion despite of heavy punishment.

The size of the contusion is usually

greater than the size of the object causing it. The
location of the contusion may not always indicate the
site of the application of the force. For instance, a
blow of the forehead may cause black-eye or contusion
around the tissues of the eye-ball, or a kick on the
leg may cause appearance of contusion at the region of
the ankle on account of the gravitation of the effusion
between muscles and fascia.

On the medico-legal viewpoint, a

contusion as indicated by its external pattern may
correspond to the shape of the object or weapon used to
produce it; its extent may suggest the possible degree
of violence applied; and its distribution may indicate
the character and manner of injury as in manual
strangulation around the neck. It may infer grave
complications and consequences on account of serious
injuries of the underlying tissues.

(3) Hematoma
 32

Hematoma is the extravasation or

effusion of blood in a newly formed cavity underneath
the skin. It usually develops when the blunt instrument
is applied in part of the body where bony tissues is
superficially located, like the head, chest and the
anterior aspect of the legs. The force applied causes
the sub-cutaneous tissues to rupture on account of the
presence of a hard structure underneath. The
destruction of the sub-cutaneous will lead to the
accumulation of blood causing it to elevate.

2) Deep

(1) Musculo-Skeletal Injuries, i.e., sprain

- partial or complete disruption in the continuity of a
muscular or ligamentous support of a joint. It is
usually caused by a blow, kick or torsion force;
dislocation - displacement of the articular surface of
bones entering into the formation of a joint; fracture
- dissolution of continuity of bone resulting from
violence or from existing pathology, strain - the over-
stretching, instead of an actual tearing or the rupture
of a muscle or ligament which may not be associated
with the joint, and subluxation - incomplete or partial
dislocation.

(2) Internal Hemorrhage

Rupture of blood vessel which may cause

hemorrhage may be due to the following, i.e., traumatic
intracranial hemorrhage, rupture of parenchymatous
organs, and laceration of other parts of the body.

(3) Cerebral Concussion-Commotion Cerebri

Cerebral concussion is the jarring or

stunning of the brain characterized by more or less
complete suspension of its functions, as a result of
injury to the head, which leads to some commotion of
the cerebral substance.

Cerebral concussion is much more severe

when the moving or mobile head struck a fixed object as
 33

compared when the head is fixed and struck by a hard

object moving.

2. Open Wounds

There is a breach of continuity of the skin or

mucous membrane.

1) Abrasion-Scratch, Graze, Impression Mark,

Friction Mark

It is an injury characterized by the removal

of the superficial epithelial layer of the skin caused
by a rub or friction against a hard rough surface.
Whenever, there is forcible contact before friction
occurs, there may be contusion associated with
abrasion. The shape varies and the raw surface exudes
blood and lymph which later dries and forms a
protective covering known as scab or crust.

Forms of Abrasions

(1) Linear

An abrasion which appears as a single

line. It may be a straight or curved line. Pinching
with the fingernails will produce a linear curved
abrasion, while sliding the point of a needle on the
skin will produce a straight linear abrasion.

(2) Multi-Linear

An abrasion which develops when the skin

is rubbed on hard rough object thereby producing
several linear marks parallel to one another. This is
frequently seen among victims of vehicular accident.

(3) Confluent

An abrasion where the linear marks on

the skin are almost indistinguishable on account of the
severity of the friction and roughness of the object.

(4) Multiple
 34

Several abrasions of varying sizes and

shapes may be found in different parts of the body.

Types of Abrasions

(1) Scratch

This is caused by a sharp-pointed object

which slides across the skin, like a pin, thorn or
fingernail. The injury is always parallel to the
direction of the slide. The commencement and
termination are well defined, and the depth depends on
the pressure applied. The fingernails scratch maybe
broad at the point of commencement and may terminate
with a tailing.

(2) Graze

These usually caused by forcible contact

with rough hard object resulting to irregular removal
of the skin surface. The nature of injury is dependent
upon the degree of roughness of the object and the
amount of pressure in the course of the sliding. The
course will be indicated by a clean commencement and
tags on the end.

(3) Impact or Imprint Abrasion, Patterned

Abrasion, Stamping Abrasion-Abrasion A La Signature

Those whose pattern and location

provides objective evidence to show cause, nature of
the wounding material or instrument and the manner of
assault or death.
(4) Pressure of Friction Abrasion

Abrasion caused by pressure accompanied

by strangulation. The spiral strands of the rope may be
reflected on the skin of the neck. The lesion may dry
up and assume a papyraceous or parchment-like
consistency.

2) Incised Wound-Cut, Slash, Slice

 35

This is produced by a sharp-edged-cutting or

sharp-linear edge of the instrument, like a knife,
razor, bolo, edge of oyster shell, metal sheet, glass,
etc. It may be an impact cut when there is forcible
contact of the cutting instrument with the body
surface, or slice cut when cutting injury is due to the
pressure accompanied with movement of the instrument.

When the wounding instrument is a heavy

cutting instrument, like axe, big bolo, the wound
produced is called chopped or shacked wound. The injury
is quite severe; edges may or may not be contused
depending on the nature of the edge of the instrument
used.

Characteristics of the Incised Wounds

(1) Edges are clean-cut and both extremities

are sharp, except in areas where the skin is loose or
folded at the time of infliction.

(2) The wound is straight and may be

shelving if inflicted with the wounding instrument
applied with an acute angle to the surface of the body
involved.

(3) Usually the wound is shallow near the

extremities and deeper at the middle portion.

(4) Because the blood vessels involved are

clean cut, profuse hemorrhage is invariably a feature.

(5) Gaping is usually present due to

retraction of the edges but its presence and degree of
retraction depends on the direction of the incised
wound with the line of cleavage-Langer’s Line.

(6) If the incised wound is located in parts

of the body covered with clothes, the clothing
itself will show clean-cut of its texture.

(7) In the absence of complication and/or

when there is no deeper involvement present, healing is
relatively fast and the scar may not or may develop
conspicuously.
 36

(8) Incised wound caused by broken edge of

glass may be irregular and may appear like a punctured
or stab wound. Fragments of the glass may be removed
from the incised wound.

It May be Suicidal, Homicidal or Accidental

(1) Suicidal

Located in peculiar parts of the body,

like the neck, flexor surfaces of the extremities,
i.e., elbow, groin, knee, wrist, and accessible to the
hand in inflicting the injury. The most common
instrument used is the barber’s razor blade with an
improvised handle.

There are usually superficial tentative

cut-hesitation cuts, and the direction varies with the
location of the hand—left or right used in inflicting
the injuries. The most common site of suicidal incised
wounds is on the wrist with involvement of the radial
artery and the neck.

(2) Homicidal

The incised wounds are deep, multiple

and involve both accessible and non-accessible parts
of the body to the hands of the victim. Defense and
other forms of wounds may be present. Clothing is
always involved.

(3) Accidental

Multiple incised wound is commonly

observed on the passengers and driver of vehicular
accidents on account of the broken windshield and glass
parts of windows. Stepping on oyster shell, broken
glasses, sharp-edges of metal sheets are common causes
of incised wound on the sole of the foot.
 37

Those associated in the use of kitchen

knives in the preparation of food, carpenters and
handicraft workers who use sharp edged instruments are
frequent victims of accidental incised wounds.

3) Stab Wound

Stab wound is produced by the penetration of

a sharp-pointed and sharp edge instrument, like a
knife, saber, dagger, or scissors. It may involve the
skin or mucous surface. If the sharp edge portion of
the wounding instrument is the first to come in contact
with the skin, the wound produced is an incised wound,
but if the sharp-pointed portion first’s come in
contact, then the wound is a stab wound. As a general
rule, like an incised wound, the edges are clean-cut,
regular and distinct.

The surface length of a stab wound may

reflect the width of the wounding instrument. It may be
smaller when the wound is not so deep inasmuch as it is
only caused by the penetration of the tapering portion
of the pointed instrument. It may be made wider if
the withdrawal is not on the same direction as when it
was introduced or the stabbing is accompanied by a
slashing movement. In the latter case, the presence of
an abrasion from the extremity of the skin is in line
with direction of the slashing movement.

The extremities of stab wound may show the

nature of the instrument used. A double-bladed weapon
may cause the production of both extremities sharp. A
single bladed instrument may produce as one of its
extremities rounded and contused. This distinction may
not be clearly observed if the instrument is quite
thin.

The direction of the surface defect may be

useful in the determination of the possible relative
position of the offender and the victim when the wound
was inflicted. As to whether the wound is a slit-like
or gaping depends on the looseness of the skin and the
direction of the wound to the line of cleavage—Langer’s
Line.
 38

The depth may be influence by the size and

sharpness of the instrument, area of the body involved,
and the degree of force applied. Involvement of the
bones may cause clean-cut fracture on it. A portion of
the wounding instrument, usually the tapering part, may
remain in the body. X-ray examinations may be needed to
reveal its location. Hemorrhage is always the most
serious consequence of stab wound. This is due to the
severance of blood vessels or involvement of bloody
organs.

Evidence Showing Intent to Kill the Victim

(1) There are more than one stab wounds.

(2) The stab wounds are located in different

parts of the body or on parts of the body where vital
organs are located.

(3) Stab wounds are deep.

(4) Stab wound with serrated or zigzag

borders infers alternative thrust and withdrawal of the
wounding weapon to increase internal damages.

(5) Irregular or stellate shape skin defects

may be due to changing direction of the weapon with
portion of the instrument at the level of the skin as
the lever.

Different measurement of the stab wounds may

possibly be produced by one weapon if it is tapering
towards the sharp point. Withdrawal of the instrument
not on the same direction as when it was introduced may
increase the length of the skin defect.

A sharpened three-cornered file-tres cantos,

when used as a stabbing weapon will produce three-
cornered-extremities, skin defect. The most common
immediate cause of death is hemorrhage particularly
when located in the chest or abdomen.

Accidental stab wounds are quite rare and are

usually caused by falling against a projecting sharp
 39

object like broken pieces of glass or flattened and

pointed iron bars.

4) Punctured Wound

Punctured wound is the result of a thrust of

a sharp pointed instrument. The external injury is
quite small but the depth is to a certain degree. It is
commonly produced by an icepick, needle, nail, spear,
pointed stick, thorn, fang of animal and hook. The
nature of the external injury depends on the sharpness
and shape of the end of the wounding instrument.

Contusion of the edges may be present if the

end is not so sharp. The opening may be round,
elliptical, diamond-shape or cruciate. An accurate
cross-section nature of the wounding object may be well
appreciated when there is involvement of flat hard
parts of the body especially the skull.

External hemorrhage is quite limited although

internal injuries may be severe. However, direct
involvement of blood vessels and bloody organs may
cause fatal consequences unless appropriate medical
intervention is applied.

The site of the external wound can be easily

sealed by the dried blood, serum or clotted blood so
that introduction of pathogenic microorganism which
does not require the presence of air in its growth and
multiplication may find the place favorable, and may
produce fatal consequences. Punctured wound is usually
accidental but in rare instances it may be homicidal or
suicidal.

Characteristics of Punctured Wounds

(1) External hemorrhage is limited although

internally it may be severe.

(2) The opening on the skin is very small

and may become unnoticeable because of clotted blood
and elasticity of the skin.
 40

(3) Sealing of the external opening will be

favorable for the growth and multiplication of
anaerobic microorganism like bacillus tetani.

Evidence that Tend to Show it is Homicidal

(1) It is multiple and usually located in

the different parts of the body.

(2) The wounds are deep.

(3) There are defense wounds on the victim.

(4) There is disturbance in the crime scene—

sign of struggle.

Proof to Show it is Suicidal

(1) Located in areas of the body where the

vital organs are located.

(2) Usually singular but may be multiple and

located in one area of the body.

(3) Parts of the body involved are

accessible to the hands of the victim.

(4) Clothing usually is not involved.

(5) Wounding is made by the weapon while the

victim is in sitting or standing position.

(6) No disturbance of the crime scene.

(7) Presence of suicide note.

(8) Wounding instrument found near the body

of the victim.

5) Lacerated Wound-Tear, Rupture and Stretch

Lacerated wound is a tear of the skin and the

underlying tissues due to forcible contact with blunt
instrument. It may be produced by a hit with a piece of
wood, iron bar, fist blow, stone, butt of firearm, or
other objects which are not sharp objects.
 41

If the force applied to a tissue is greater than its

cohesive force and elasticity, the tissue tears and a
laceration is produced.

Since the skin is composed of several types

of tissues, namely: epidermis, connective tissue, fat,
blood vessels, nerves, glandular cells, etc. each
having its own breaking point, the laceration will be
irregular and having strands of tissues bridging. The
rupture of continuity may only extend deeper to the
stronger layer like that of the galea aponeuritica in
case of scalp injury.

Characteristics of Lacerated Wounds

(1) The shape and size of the injury do not

correspond to the wounding instrument, the tear on the
skin is rugged with extremities irregular and ill-
defined, the injury developed is at the site where the
blunt force is applied, and the borders of the wound
are contused and swollen.

(5) It is usually developed on the areas of

the body where the bone is superficially located, like
the scalp, malar region of the face, front part of the
leg, dorsum of the foot, etc.

(6) Examination with the aid of the hand

lens show bridging tissue joining the edges and hair
bulbs intact, bleeding is not extensive because the
blood vessels are not severed evenly, and healing
process is delayed and has more tendencies to develop
scar.
Classifications of Lacerated Wound

(1) Splitting caused by crushing of the skin

between two hard objects - this is best seen in
laceration of the scalp caused by a hit of a blunt
instrument, cut eyebrow of boxer and laceration of the
chin of motorcyclist.

(2) Overstretching of the skin - when

pressure is applied on one side of the bone, the skin
over the area will be stretched up to breaking point to
cause laceration and exposure of the fractured bone. In
 42

avulsion, the edges of the remaining tissue are that of

laceration.

(3) Grinding compression - the weight and

the grinding movement may cause separation of the skin
with the underlying tissue.

(4) Tearing

This may be produced by a semi-sharp

instrument which causes irregular edges on the wound,
like hatchet and choppers. Laceration wounds may
involve deeper tissues like laceration of the muscles
and fracture of bones depending upon the degree of
force applied in causing it.

It may be homicidal or accidental but

rarely, it is suicidal. An insane person may hit his
head on a concrete wall but when loss of consciousness
develops he will not be able to continue further his
act of self-destruction.

6) Gaping of Wound

The separation of the edges especially in

deep wound may be due to the following:

(1) Mechanical Stretching

The presence of a mechanical device on

the edges to prevent coaptation will cause separation.
The presence of canula in tracheostomy, drain gauze in
an incised abscess, or a retractor during surgical
operation are examples of this type of gaping.

(2) Loss of Tissue

Separation of the edges of a wound may

be on account of loss of tissue bridging them. The loss
of tissue may be due to, i.e., destruction by pressure,
infection, celllysis, burning or chemical reaction,
avulsion or physical or mechanical stretching resulting
to separation of a portion of the tissue, and trimming
of the edges.
 43

Debridment of the skin which come in

contact with the bullet at the gunshot wound of
entrance and the removal of the necrotic material in an
infected wound may cause separation of the edges.

(3) Retraction of the Edges

Underneath the skin are dense networks

of fibrous and elastic connective tissue fibers running
on the same direction and forming a pattern more of
less present in all persons. This pattern of fiber
arrangement is called cleavage direction or lines of
cleavage of the skin and their linear representation on
the skin is called Langer’s Line. These lines of
cleavage are different in different parts of the body.

If an incised wound or stab wound was

inflicted wherein the long axis of the wound is
parallel or on the same directions as the cleavage line
of the part of the body involved, the wound will appear
narrow or slit-like because the edges of the wound will
not be subjected to the lateral pull of the severed
connective tissue fibers.

If the long axis of the wound is

perpendicular to or with an angle with the lines of
cleavage, the tendency of the borders of the wound is
to separate on account of the retraction of the severed
fibers.

Complications of Trauma or Injury

1. Shock

Shock is the disturbance of fluid balance

resulting to peripheral deficiency which is manifested
by the decreased volume of blood, reduced volume of
flow, hemo-concentration and renal deficiency. It is
clinically characterized by severe depression of the
nervous system. Three major factors operate in the
production of shock and all are likely to be associated
together as the condition develops.
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Kinds of Shock

1) Primary Shock

This is caused by immediate nerve impulse set

up at the injured area which are conveyed to the
central nervous system. The impulse may also whelm the
vital centers in the medulla thereby shock develops
within a short time due to vasomotor collapse. If the
reaction is not intense, the patient may live longer or
may recover completely from the effect of the shock.

2) Delayed or Secondary Shock

Patient shows signs of general collapse which

develop sometime after the infliction of injury. It is
characterized by a low blood pressure, subnormal
temperature, and cold clammy perspiration. The shock
may be severe to produce death or the patient may
recover completely from its effect.

2. Hemorrhage

Hemorrhage is the extravasation or loss of blood

from the circulation brought about by wounds in the
cardio-vascular system. The degree and nature of
hemorrhage depends upon the size, kind and location of
the blood vessel cut.

Kinds of Hemorrhage

1) Primary Hemorrhage

It is the bleeding which occurs immediately

after the traumatic injury of the blood vessel.

2) Secondary Hemorrhage

This occurs not immediately after the

infliction of the injury but sometime thereafter on or
near the injured area.

3. Infection
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Infection is the appearance, growth and

development of micro-organisms at the site of injury.

How Injury or Trauma Acquires Infections

1. From the instrument of substance which

produces the injury, and from the organs involved in
the trauma applied.

2. As indirect effect of the injury which

creates a local area of diminished resistance causing
the invasion and multiplication or microorganism.

3. Injury may depress the general vitality,

especially among the aged and the young children and
makes the patient succumb to terminal disease.

4. Deliberate introduction of microorganisms at

the site of injury.

4. Embolism

This is a condition in which foreign matters are

introduced in the blood stream causing sudden block to
the blood flow in the finer arterioles and capillaries.

Determination Whether the Infliction of Wounds

1. Hemorrhage

As a general rule, hemorrhage is more profuse when

the wound was inflicted during the lifetime of the
victim. In wounds inflicted after death, the amount of
bleeding is comparatively less if at all bleeding
occurred. This is due to the loss of tone of the blood
vessels, absence of heart action and post-mortem
clotting of blood inside the blood vessels. Violence
inflicted on a living body may not show the formation
of a bruise until after death.

2. Sings of Inflammation
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There may be swelling of the area surrounding the

wound, effusion of lymph or pus and adhesion of the
edges. Other vital reactions are present whenever the
wound was inflicted during life, although it may be
less pronounced when resistance of the victim is
markedly weakened. The vital reaction may also indicate
the time of infliction of the wound. Post-mortem wounds
do not show any manifesting signs of vital reactions.

3. Signs of Repair

Fibrin formation, growth or epithelium, scab or

scar formation conclusively shows that the wound was
inflicted during life. But the absence of signs of
repair does not show that injury was inflicted after
death. The tissue may not have been given ample time to
repair itself before death took place.

4. Retraction of the Edges of the Wound

Owing to the vital reactions of the skin and

contractility of the muscular fibers, the edge of the
wound inflicted during life retract and cause of
gaping. On the other hand, in the case of the wound
inflicted after death, the edges do not gape and are
closely approximated to each other because the skin and
the muscles have lost their contractility.
Medico-Legal Aspects of Sex Crimes

Virginity is a condition of a female who has not

experienced sexual intercourse and whose genital organs
have not been altered by carnal connection. A woman is
“virtuous female” is her body is pure and if she has
never had any sexual intercourse with another, though
her mind and heart is impure. The presumption of a
woman’s virginity arises whenever it is shown that she
is single and continuous until overthrown by proof to
be contrary. A woman is presumed to be a virgin when
unmarried and of good reputation.

Kinds of Virginity

1. Moral Virginity
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The state of not knowing the nature of sexual life

and not having experienced sexual relation. Moral
virginity applies to children below the age of puberty
and whose sex organs and secondary sex characters are
not yet developed.

2. Physical Virginity

A condition whereby a woman is conscious of the

nature of the sexual life but has not experienced
sexual intercourse. The term applies to women who have
reached sexual maturity but have not experienced sexual
intercourse.

Kinds of Physical Virginity

1) True Physical Virginity

A condition wherein the hymen is intact and

the edges distinct and regular and the opening small to
barely admit the tip of the smaller finger of the
examiner even if the thighs are separated.

2) False Physical Virginity

A condition wherein the hymen is unruptured

but the orifice is wide and elastic to admit two or
more fingers of the examiner with lesser degree of
resistance. The hymen may be laxed and distensible and
may have previous sexual relation. In this particular
instance the physician may not be able to make
convincing conclusion that the subject is virgin.

3. Demi-Virginity

This term refers to a condition of a woman who

permits any form of sexual liberties as long as they
abstain from rupturing the hymen by sexual act. The
woman may be embraced, kissed, may allow her breast to
be fondled, her private organ to be held and other
lascivious acts. The woman allows sexual intercourse
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but only “inter-femora” or even “inter-labia” but not

to the extent of rupturing the hymen.

4. Virgo Intacta

Literally the term refers to a truly virgin woman;

that there are no structural changes in her organ to
infer previous sexual intercourse and that she is
virtuous woman. Inasmuch as there are no conclusive
evidences to prove the existence of such condition,
liberal authorities extend the connotation of the term
to include women who have had previous sexual act or
even habitually but had not given birth.

Determining the Conditions of Virginity

1. Breasts

The breasts are functionally related to the

reproductive system since they secrete milk for
nourishment of the young child. At their inner
structures are 15 to 20 lobes of glandular tissues
supported by connective tissue framework with variable
amount of adipose tissue. The condition of the breast
is not a reliable evidence to determine virginity. The
size, shape and consistency of the breast may be
hormonal or hereditary. The advent of artificial
feeding makes it possible for parturient women to
preserve the condition of the breast.

2. Vaginal Canal

As a general rule, the vaginal canal of a virgin

is tight and the rugosities are sharp and prominent.
Insertion of a finger or instrument may show certain
degree of resistance. The wall of the vagina is
composed of smooth muscle and fibroelastic connective
tissue so that its tightness and degree of resistance
on insertion of a finger or an instrument depends on
the integrity of its wall, as well as on the potency of
its lubricating secretion.
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The sharpness of the wall’s rugosities may be

diminished by insertion of foreign bodies, passage of
clotted blood, self-manipulation, etc. and not by
sexual intercourse. The canal may be inherently lax and
rugosities not prominent since birth.

3. Labia Majora and Labia Minora

The labia majora is firm, elastic and plump and

its medial borders are usually in close contact with
each others so as to cover the labia minora and the
clitoris. The labia minora is soft, pinkish in close
contact with one another, and its vestibule is narrow.
Entry of the male organ may cause the labia to gape due
to stretching of their borders.

The condition of both labias is not a reliable

basis in determining virginity. A woman may be a virgin
but with gaping labia, while others might have had
previous delivery but the labia are still coaptated.
The condition of the labia is much more related to the
general physical condition of the woman rather than the
absence or the presence of previous sexual intercourse.
A stout woman usually can preserve the plump, coaptated
and firm labia while skinny women usually have gaping
labia.

4. Fourchette

The fourchette present a V-shape appearance as the

two labia unite posteriorly. After severe distention,
the sharpness of the acute angle may become rounded
with retraction of the edges. The rounding of the
fourchette and the retraction of the edges can be a
consequence of so many causes. Stretching apart of the
thighs, instrumentation, horse or bicycle riding may
produce the condition other than sexual intercourse.

5. Hymen

Physicians give much attention in the examination

of the hymen in the determination of virginity.
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Defloration Defined

Defloration is the laceration or rupture of the

hymen as a result of sexual intercourse. All other
laceration of the hymen which is not caused by sexual
act is not considered as defloration.

Determining Determine Defloration

1. Condition of the Vulva

Normally the labia majora and minora are in close

contact with one another covering almost completely the
external genetalia. After defloration, the labia may
gape exposing the introitus vulvae. The finding may not
be relied upon because some female may have inherently
gaping labia, especially, asthenic women although there
is no history of previous sexual act, while others may
preserve the coaptated labia even if there has been
previous sexual act.

2. Fourchette

The normal V-shape of the fourchette is lost on

account of the previous stretching during insertion of
the male organ. Withdrawal of the stretching force will
cause retraction of its wall with rounding base.
Retraction of the fourchette is not a good sign of
defloration inasmuch as it can be due to other causes.
Ballet dancing, separation of the thighs, tree climbing,
cycling, horse riding, insertion of foreign body, etc.
may cause retraction of the fourchette without previous
sexual act. The fourchette, together with the perineum
and lower portion of the posterior vaginal wall, may be
lacerated by sexual act or some other causes.

3. Vaginal Canal

After repeated sexual acts, there is diminution of

the sharpness or obliteration of the vaginal rugosities.
There will be laxity of its wall so that the insertion
of a medium size tube during the medical examination can
be done with slight resistance. The changes in the
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vaginal rugosities or the laxity of its wall cannot be

relied upon as a proof of defloration because
instrumentation during medical examinations,
masturbation or insertion of foreign bodies or other
similar or related acts will cause the development of
such condition. The vaginal wall, together wit the
vulva, may suffer injury during defloration or some
other causes.

4. Hymen

The hymen is lacerated during the initial sexual

act. However, it is not always the case. Some hymens are
thick, elastic and fleshy such that they can resist
certain degree of distention without causing laceration.
Some women may inherently have lacerated hymen probably
on account of previous trauma during the early age. The
fact the hymen is intact does not prove absence of
previous sexual intercourse and the presence of
laceration does not prove defloration.

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