Legal Medicine_OCR by Pedro Sous

Chapter I

GENERAL CONSIDERATION

ÊGALM^DIClNllis a branch of medicine which deals with the application of medical knowledge to the purposes of law and in the administration of justice. It is the application of basic and clinical, medical and paramedical sciences to elucidate legal matters.

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

The concept and practice of legal medicine in the Philippines is of Spanish origin. In modern times, especially in continental European countries, legal medicine has a similar meaning as the term forensic medicine, although, strictly speaking, legal medicine is primarily the application of medicine to legal eases while forensic medicine concerns with the application of medical science to elucidate legal problems. On the other hand, .medical jurisprudence (j'uris-law, prudentia-knowledge) denotes knowledge"of lawT 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.

According to the Rules of Court (Sec. 5, Rule 138) Medical Jurisprudence is one of the subjects in the law course before admission to the bar examination. This is based on the original concept but actually it must be the study of legal medicine as it was the intention and practice in the past.

v Scope of Legal Medicine: The scope of legal 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 Legal Medicine: A knowlege of legal medicine means the ability to acquire facts,

the power to arrange those facts in their logical order, and to draw a

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conclusion from the facts which may be useful in the administration of justice.

Aside from being a perceptor of fact, he must 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 medicolegal duties is known as medical jurist, (meoical examiner, medicolegal officer, 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 Jaw enforcement agencies and members of the medical staff of accredited hospital are authorized by law to perform autopsies (Sec. 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" (Sec. 2, Art. Ill, Code of Medical Ethics of the Medical Profession of the Philippines).

To be involved in medico-legal duties, a physician must possess sufficient knowledge of pathology, surgery, gynecology, toxicology and such other branches of medicine germane to the issues involved.

/Distinction Between an Ordinary Physician and a Medical Jurist:

1. An ordinary physician sees an injury or disease on the point of view of treatment, while a medico-jurist sees injury or disease on the point of view of cause.

2. The purpose of an ordinary physician examining a patient is to arrive at a definite diagnosis so that appropriate treatment can be instituted, while the purpose of the medical jurist in examining a patient is to include those bodily lesions in his report and testify before the court or before an investigative body; thus giving justice to whom it is due.

3. Minor or trivial injuries are usually ignored by an ordinary clinician inasmuch as they do not require usual treatment. Superficial abrasions, small contusion and other minor injuries will heal without medication. However, a medical jurist 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.

Examples: a. The presence of physical injuries of a victim of sexual abuse may be presumptive proof that force was applied in the commission thereof, hence the crime committed must be rape.

GENERAL CONSIDERATION 3

b. The presence of physical injuries on the offender of the crime of physical injuries may be a proof that the victim acted in self-defense.

Other Definitions: yjl. Law is a rule of conduct, just, obligatory, laid by legitimate power

for common observance and benefit. It is a science of moral laws founded on the rational nature of man which regulates free activity for the realization of his individual and social ends under the aspect of mutual demandable independence. (1 S.R.)

The word "law" includes regulations and circulars which are issued to implement a law and have, therefore, the effect of law.

^Characteristics of Law: a. It is a rule of conduct; b. It is dictated by legitimate power; and c. Compulsory and obligatory to all (Civil Code by Padilla).

Forms of Law: ' a. Written or Statutory Law (Lex Scripta):

This is composed of laws which are produced by the country's legislations and which are defined, codified and incorporated by the law-making body.

/ Example: Laws of the Philippines, ^ b . Unwritten or Common Law (Lex non Scripta):

This is composed of the unwritten laws based on immemorial customs and usages. It is sometimes referred to as case law, common law, jurisprudence or customary law. Example: Laws of England

J 2. Forensic: It denotes anything belonging to the court of law or used in

court or legal proceedings or something fitted for legal or public argumentations (Black's Law Dictionary, 4th ed.)

i 3. Medicine: Medicine is a science and art dealing with prevention, cure and

alleviation of disease. It is that part of science and art of restoring and preserving health.

The term medicine is also applied to a science and art of diagnosing, treating, curing and preventing disease, relieving pain, and improving the health of a person,

z 4. Legal: Legal is that which pertains to law, arising out of, by virtue of

or included in law. It also refers to anything conformable to the letters or rules of law as it is administered by the court.

4 LEGAL MEDICINE

5. Jurisprudence: It is a practical science which investigates the nature, origin,

development and functions of law. It is a science of giving a wise interpretation of the law and making just application of them to all cases as they arise.

Judicial decisions applying or interpreting the laws shall form a part of the Philippine jurisprudence. The decisions contemplated are those rendered by the Supreme Court which is the final arbiter on legal issues. However, the decisions of the Court of Appeals may serve as precedent for inferior courts on points of facts.

Principle of Stare Decisis: A principle that, when the court has once laid down a principle of

law or intepretation as applied to a certain state of facts, it will adhere to and apply to all future cases where the facts are substantially the same.

The principle is one of policy, grounded on the theory that security and certainty require that accepted and established legal principles, under which right may accrue, be recognized and followed, though later found to be not legally sound, but whether previous holding of court shall be adhered to, modified or overruled is within the court's discretion under the circumstance of the case before it (Black's Law Dictionary, 4th ed.).

Branches of Law Where Legal Medicine may be Applied: 1. Civil Law — Civil law is a mass of precepts that determines and

regulates the relation of assistance, authority, and obedience between members of a family and those which exist among members of a society for the protection of private interest (Sanchez Roman).

Our civil laws are scientifically and systematically compiled in the Civil Code of the Philippines (Republic Act No. 386).

In civil law, knowledge of legal medicine may be useful on the following: a. The determination and termination of civil personality (Art. 40

and 41), b. The limitation or restriction of a natural person's capacity to

act (Art. 23 and 39); c. The marriage and legal separation (Book I, Title III & IV); d. The paternity and filiation ^Book I, Title VIII); and e. The testimentary capacity of a person making a will (Book III,

Title IV).


2. Criminal Law — Criminal law is that branch or division of law which defines crimes, treats of their nature and provides for their punishment.

It is a body of specific rules regarding human conduct which have been promulgated by political authority, which apply uniformly to all members of the classes to which the rules refer, and which are enforced by punishment administered by the state (Sutherland-Cressey, Criminology, 7th ed„ p. 4).

Penal laws and those of public security and safety shall be obligatory upon all who live or sojourn in the Philippine territory, subject to the principles of public international law and to treaty stipulations (Art. 14 Civil Code).

The Philippine criminal law is codified in the Revised Penal Code and may also be found in the penal provisions of the special laws.

Legal medicine is applicable in the following provisions of the penal code: a. Circumstances affecting criminal liability (Title I); b. Crimes against person (Title VIII), and c. Crimes against chastity (Title XI).

3. Remedial Law — Remedial law is that branch or division of law which deals with the rules concerning pleadings, practices and procedures in all courts of the Philippines.

It is the law which gives a party a remedy for a wrong. It is intended to afford a private remedy to a person injured by the wrongful act. It is a designed law, which redresses an existing grievance or introduces regulation conducive to public good (Black's Law Dictionary, 4th ed.).

Our remedial law is embodied in the Rules of Court of the Philippines and also in the remedial provision of Special Laws.

Legal Medicine may be applied in the following provisions of the Rules of Court: a. Physical and mental examination of a person (Rule 28); b. Proceedings for hospitalization of an insane person (Rule 101);

and c. Rules on evidences (Part IV).

4. Special Laws: a. Dangerous Drug Act (R.A. 6425, as amended) b. Youth and Child Welfare Code (P.D. 603) c. Insurance Law (Act No. 2427 as amended) d. Code of Sanitation (P.D. 856)

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e. Labor Code (P.D. 442) f. Employee's Compensation Law

Some Bask Principles Governing Application and Effects of Laws: 1. Ignorance of the law excuses no one from compliance therewith

or "ignorantia legis nominem excusat" (Art 3, Civil Code): The main reason for the provision is to prevent ignorance of

the law as a means of defense for violation of the law. The provision refers to all kinds of domestic laws on grounds of expediency, policy and necessity.

"Ignorance of the law" may refer to the literal wordings of the law and also to the meaning or interpretation given to the law. But the rule is not inflexible. It may only be applied when it is clearly manifested and inexcusably ignorant of the law.

Mere ignorance of the facts of the law would furnish immunity from the punishment for violation of the penal code and immunity from the liability for actual loss for violation of personal or property right.

2. Laws shall have no retroactive effect, unless the contrary is provided (Art. 4, Civil Code):

A law can only be applied to cases after its promulgation arid must not be given retroactive application.

A law, however, may be given retroactive effects in the following instances: a. When the law provides the contrary (Art. 4, Civil Code). b. Penal laws shall be given retroactive effect if favorable to the

accused who is not habitually 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.

d. When the law creates a new substantive right. 3. Rights may be waived, unless the waiver is contrary to law, public

order, public policy, morals or good customs, or prejudicial to a third person with a right recognized by law (Art. 6, Civil Code):

A right is the power, privilege, faculty which entitles a man to have, or to do, or to receive from another within the limits prescribed by law. Waiving is the intentional or voluntary relinquishment, abandonment or throwing away, renunciation, surrendering of a known right.

The rights granted to a person by law may be waived but in the following cases, the law does not allow such waiver: a. When such waiver will be contrary to the existing law.


b. When it is against public order, public policy, morals and good customs.

c. When in so waiving it is prejudicial to a third person with a right recognized by law.

4. Customs which are contrary to law, public order or public policy shall not be countenanced (Art. 11, Civil Code). A custom must be proved as a fact according to the rules of evidence (Sec. 12, Civil Code):

Custom is a usage or practice of the people, which by common adoption and acquiescence and by long and unvarying habit, has become compulsory and has acquired the force of a law with respect to the place and subject-matter to which it relates (Black's Law Dictionary, 4th ed.).

Customs constitute sources of supplementary law in default of specific legislation.

However, if the custom is contrary to the existing law or to ' public order and policy, the law must prevail.

5. Laws are repealed only by subsequent ones, and their violation or non-observance shall not be excused by disuse, custom or practice to the contrary.

When the court declares a law to be inconsistent with the constitution, the former shall be void and the latter shall govern.

Administrative or executive acts, orders and regulations shall be valid only when they are not contrary to the laws or the constitution (Art. 7, Civil Code):

The constitution is the fundamental law of the land. All acts, administrative or executive orders contrary to the provision of the constitution shall be deemed void.

Any existing law which is inconsistent with a subsequent law is deemed repealed by the latter law.

Administrative or executive acts, orders and regulations are considered valid when they are not in contravention with the existing laws.

BRIEF HISTORY OF LEGAL MEDICINE

1. IN WORLDWIDE SCALE: The earliest recorded medico-legal expert was Imhotep (2980

B.C.). He was the chief physician and architect of King Zoser of the third dynasty in Egypt and the builder of the first pyramid. That time was the first recorded report of a murder trial written on clay tablet.

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The Code of Hammurabi, the oldest code of law (2200 B.C.) included legislation on adultery, rape, divorce, incest, abortion and violence.

Hippocrates (460-355 B.C.) in Greece discussed the lethality of wounds. Aristotle (384-322 B.C.) fixed animation of fetus at the 40th day after conception.

About 300 B.C. the Chinese materia medica gave information on poison including aconite, arsenic and opium. Hashish was said to have been used as a narcotic in surgery about 200 B.C.

That bodies of all women dying during confinement should immediately be opened in order to save the child's life was promulgated during the reign of Numa Pompilius in Rome (600 B.C.).

The first "police surgeon" or forensic pathologist was Antis-tius. Julius Caesar (100-44 B.C.) was murdered and his body was exposed in the forum and Antistius performed the autopsy. He found out that Julius Caesar suffered from twenty-three wounds and only one penetrated the chest cavity through the space between the first and second ribs.

Justinian (483-565 A.D.), in his Digest, made mention that a physician is not an ordinary witness and that a physician gives judgment rather than testimony. This led to the recognition of expert witness in court.

The first textbook in legal medicine was included in the Constitute Criminalis Carolina which was promulgated in 1532 during the reign of Emperor Charles V in Germany.

Pope Innocent III (1209) issued an edict providing for the appointment of doctors to the courts for the determination of the nature of wounds.

Pope Gregory IX, in 1234, caused the preparation of Nova Compilatio Decretalium which concerned medical evidence, marriage, nullity, impotence, delivery, caesarian section, legitimacy, sexual offenses, crime against persons and witchcraft.

In the 14th century, Pope John XXII expressed the need of experts in the ecclesiastical courts, in the diagnosis of leprosy and many medico-legal documents.

In China, the Hsi Yuan Lu (Instructions to Coroner) was published. It is a five volume book dealing with inquest, criminal abortion, infanticide, signs of death, assault, suicide, hanging, strangling, drowning, burning, poisoning and antidotes, and examination of the dead.


In 1575, Ambroise Pare considered legal medicine as a separate discipline and he'discussed in his book, abortion, infanticide, death by lightning, hanging, drowning, feign diseases, distinction between ante-mortem and post-mortem wound and poisoning by carbon monoxide and by corrosives.

Paulus Zacchias (1584-1659), a papal physician, is regarded as the "father of forensic medicine." He published Questiones Medico-legales which dealt with the legal aspects of wounds and the first two chapter dealt with the detection of secret homicide.

In 1598, Severin Pineau published in Paris a work on virginity and defloration. He confirmed the existence of the hymen and that it may not rupture during sexual intercourse. -

Orfila (1787-1853) introduced chemical methods in toxicology. In his Traite' des Poison, he mentioned mineral, vegetable and animal poison in relation with physiology, pathology and legal medicine. He was considered later as the founder of modern toxicology.

The period thereafter is characterized by an appreciable increase in available publication on the subject dealing with modem innovative findings and procedures related to medical progress and changes in the laws.

2. IN THE PHILIPPINES: In 1858, the first medical textbook printed including per

tinent instructions related to medico-legal practice by Spanish physician, Dr. Rafael Genard y Mas, Chief Army Physician, entitled "Manual de Medicina Domestica."

In 1871, teaching of legal medicine, included as an academic subject in the foundation of the School of Medicine of the Real y Pontifica Universidad de Santo Tomas.

On March 31, 1876 by virtue of the Royal Decree No. 188, of the King of Spain, the position of "Medico Titulares" was created and made in charge of public sanitation and at the same time medico-legal aid in the administration of justice.

In 1894, rules regulating the services of those "Medico Titular y Forences" was published.

In 1895, medico-legal laboratory was established in the City of Manila and extended at the same time its services to the provinces.

In 1898, American Civil Government preserved the Spanish forensic medicine system.

In 1901, Philippine Commission created the provincial, insular and municipal Board of Health (Act Nos. 157, 307 and 308) in the Philippines and assigned to the respective inspectors and pres-

10 LEGAL MEDICINE

idents of the same, medico-legal duties of the "Medico Titulares" of the Spanish regime. The Philippine Legislature maintained the pre-existing medico-legal system in full force in the Administrative Code.

In 1908, the Philippine Medical School incorporated the teaching of Legal Medicine, one hour a week to the fifth year medical students.

In 1919, the University of the Philippines created the Department of Legal Medicine and Ethics with the head having the salary of 4,000.00 pesos per annum, half-time basis, with Dr. Sixto de los Angeles as the chief.

On January 10, 1922, the head of the Department of Legal Medicine and Ethics became the Chief of the Medico-Legal Department of the Philippine General Hospital without pay.

On March 10, 1922,-the Philippine Legislature enacted Act. No. 1043 which became incorporated in the Administrative Code as Section 2465 and provided that the Department of Legal Medicine, University of -the Philippines, became a branch of the Department of Justice.

On December 10, 1937, Commonwealth Act. No. 181 was passed creating the Division of Investigation under the Department of Justice. The Medico-Legal Section was made as an integral part of the Division with Dr. Gregorio T. Lantin as the chief.

On March 3, 1939, the Department of Legal Medicine of the College of Medicine, University of the Philippines was abolished and its functions were transferred to the Medico-Legal Section of the Division of Investigation under the Department of Justice.

On July 4, 1942, President Jose P. Laurel consolidated by executive order all the different law-enforcing agencies and created the Bureau of Investigation on July 8,1944.

In 1945 immediately after liberation of the City of Manila, the Provost Marshal of the United States Army created the Criminal Investigation Laboratory with the Office of the Medical Examiner as an integral part and with Dr. Mariano Lara as Chief Medical Examiner.

On June 28, 1945, the Division of Investigation, under the Department of Justice was reactivated.

On June 19, 1947, Republic Act. No. 157 creating the Bureau of Investigation was passed. The Bureau of Investigation was created by virtue of an executive order of the President of the Philippines. Under the bureau, a Medico-Legal Division was created with Dr. Enrique V. de los Santos as the Chief.


There exists a Medico-Legal Division in the Criminal Laboratory Branch of the G-2 of the Philippine Constabulary. All provincial, municipal and city health officers, physicians of hospitals, health centers, asylums, penitentiaries and colonies are ex-officio medicolegal officers.

In remote places where the services of a registered physician was not available, a "Cirujano Ministrante" may perform medico-legal work. However, after the approval of Republic Act 1982 on June 15, 1954 which provided for the creation of rural health unit to each municipality composed of municipal health officer, a public nurse, a midwife and a sanitary inspector virtually abolished the appointment of Cirujano Ministrante thereby making qualified physicians to perform medico-legal functions.

June 18, 1949, Republic Act 409 which was later amended by Republic Act 1934 provides (Sec. 38) for the creation of the office of the Medical Examiners and Criminal Investigation Laboratory under thej^jice Department of the City of Manila.

On December 23, 1975, Presidential Decree 856 was promulgated and Sec. 95 provides:

A. Persons authorized to perform autopsies: 1. Health officers 2. Medical officers of law enforcement agencies 3. Members of the medical staff of accredited hospitals

B. Autopsies shall be performed in the following cases: 1. Whenever required by special laws; 2. Upon order of a competent court, a mayor and a provin

cial or city fiscal; 3. Upon written request of police authorities, 4. Whenever the Solicitor General, provincial or city fiscal

deem it necessary to disinter and take possession of the remains for examination to determine the cause of death;

5. Whenever the nearest kin shall request in writing the authorities concerned to ascertain the cause of death.

Evidence is the means, sanctioned by the Rules of Court, of ascertaining in a judicial proceeding the truth respecting a matter of fact (Sec. 1, Rule 128, Rules of Court).

It is the species of proof, or probative matter, legally presented at the trial of an issue by the act of the parties and through the medium

and

V MEDICAL EVIDENCE

12 LEGAL MEDICINE

of witnesses, records, documents, concrete objects, etc., for the purpose of inducing belief in the minds of the court as to their contention (Black's Law Dictionary, 4th ed.).

If the means employed to prove a fact is medical in nature then it becomes a medical evidence.

Same rules in all cases — The rules of evidence shall be the same in all courts and on all trials and hearings, whether civil or criminal (Sec. 2, Rule 128, Rules of Court).

Admissibility of evidence — Evidence is admissible when it is relevant to the issue and is not excluded by these rules (Sec. 3, Rule 128, Rules of Court).

It is considered relevant when it has the tendency to prove any matter of fact. It is something which by the process of logic, an inference may be made as to the existence or non-existence of a fact at issue.

Relevancy of evidence (collateral matters) — Evidence must have such a relation to the fact in issue as to induce belief in its existence or non-existence; therefore, collateral matters shall not be allowed, except when they tend in any reasonable degree to establish the probability or improbability of the fact at issue (Sec. 4, Rule 130, Rules of Court).

Collateral matters are those different from those or do not correspond with the matters in issue. Types of Medical Evidence:

. /I. Autoptic or Real Evidence: This is an evidence made known or addressed to the senses of the

court. It is not limited to that which is known through the sense of vision but is extended to what the sense of hearing, taste, smell and touch is perceived.

Sec. 1, Rule 130, Rules of Court — View of an object — Whenever an object has such a relation to the fact in issue as to afford reasonable ground of belief respecting the latter, such object may be exhibited to or viewed by the court, or its existence, situation, condition, or character proved by witnesses, as the court in its discretion may determine.

The court may require the physician to present the skeleton of the victim of a criminal act exhumed and examined for the judge to see the presence and degree of the ante-mortem fracture. Limitations to the Presentation of Autoptic Evidence: a. Indecency and Impropriety — Presentation of an evidence may

be necessary to serve the best interest of justice but the notion of decency and delicacy may cause inhibition of its presentation.


The court may not allow exposure of the genitalia of an alleged victim of sexual offense to show the presence and degree of the genital and extra-genital injuries suffered by the victim. There are other ways for the court to know the facts other than actual exhibition.

b. Repulsive Objects and those Offensive to Sensibilities — Foul smelling objects, persons suffering from highly infectious and communicable disease, or objects which when touch may mean potential danger to the life and health of the judge may not be presented.

However, if such evidence is necessary in the adjudication of the case, the question of indecency and impropriety or the fact that such evidence is repulsive or offensive to sensibilities, it may be presented. This will depend on the sound discretion of the court.

-2. Testimonial Evidence: A physician may be commanded to appear before a court to

give his testimony. While in the witness stand, he is obliged to answer questions propounded by counsel and presiding officer of the court. His testimony must be given orally and under oath or affirmation.

A physician may be presented in court as an ordinary witness and/or as an expert witness:

a. Ordinary Witness: A physician who testifies in court on matters he perceived

from his patient in the course of physician-patient relationship is considered as an ordinary witness.

Sec. 18, Rule 130, Rules of Court — Witnesses. Their qualification — Except as provided in the next succeeding section, all persons who, having organs of sense, can perceive, and perceiving, can make known their perception to others, may be witnesses. Neither parties nor other persons interested in the outcome of a case shall be excluded; nor those who have been convicted of crime; nor any person on account of his opinion on matters of religious belief.

One of theêxceptions to the ordinary witness rule is the privilege j>fcommunication (confidential) between physician and patient. Although the physician perceived something through his organ of sense and has the power to transmit to others what he perceived, he is not allowed to disclose those informations to others as regards to matters he perceived from his patient during the physician-patient relationship.

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Sec. 21(c), Rule 130, Rules of Court — Privileged communication — A person authorized to practice medicine, surgery or obstetrics cannot in a civil case, without the consent of the patient, be examined as to any information which he may have acquired in attending such patient in a professional capacity, which information was necessary to enable him to act in that capacity, and which would blacken the character of the patient.

A medical witness can only testify on matters derived by his own perception. Hearsay informations are as a rule not admissible in court. Hearsay evidences are those not proceeding from the personal knowledge of the witness but from mere repetition of what he has heard others say. It is a, "second hand" evidence which rest mainly on the veffdty and competence of its source.

Sec. 30, Rule 130, Rules of Court — Testimony generally confined to personal knowledge — A witness can testify only to those facts which he knows of his own knowledge; that is, which are derived from his own perception, except as otherwise provided in these ruje:

One of the exceptions to the non-admissibility of hearsay evidence is dying declaration. The declaration of a dying person under the consciousness of his impending death as regards circumstance regarding his impending death is admissible in spite of the fact that it is a hearsay, it is made so because of necessity and it is trustworthy.

Exceptions to the hearsay rule. Sec. 31, Rule 130, Dying declaration — The declaration of a dying person, made under a consciousness of an impending death, may be received in a criminal case wherein his death is the subject of inquiry, as evidence of the cause and surrounding circumstances of such death.

Physicians are frequent recipients of dying declaration in the medical clinics and emergency rooms of hospitals. To be admissible it must be shown that the declarant was conscious of his impending death, that the declaration must be with regards to his impending death; that the declarant was in full possession of his mental faculties when he made the declaration; and that such evidence is presented in court in a case of homicide, murder or parricide wherein the declarant was the victim,

b. Expert Witness: A physician on account of his training and experience can

give his opinion on a set of medical facts. He can deduce or


infer something, determine the cause of death, or render opinion pertinent to the issue and medical in nature.

Sec. 42, Rule 130, Rulesof^Court — Opinion Rule — General Rule — The opinion of^witness is not admissible, except as indicated in the following section.

Sec. 43, Rule 130, Rules of Court — Expert Evidence — The opinion of a witness regarding a question of science, art or trade, when he is skilled therein, may be received in evidence.

The probative value of the expert medical testimony depends upon the degree of learning and experience on the line of what the medical expert is testifying, the basis and logic of his conclusion, and other evidences tending to show the veracity or falsity of his testimony.

3. Experimental Evidence: A medical witness may be allowed by the court to confirm his

allegation or as a corroborated proof to an opinion he previously stated.

The issue as to how long a person can survive, after the administration of lethal dose of poison can be shown by the administration of the said poison to experimental animals within the view of the court.

4. Documentary Evidence:

A document is an instrument on which is recorded by means of letters, figures, or marks intended to be used for the purpose of recording that matter which may be evidentially used. The term applies to writings, to words printed, lithographed or photographed; to seals, plates or stones on which inscriptions are cut or engraved; to photographs and pictures; to maps or plans (Black's Law Dictionary, 4th ed.).

Medical Documentary Evidence may be: a. Medical Certification or Report on:

(1) Medical examination. (2) Physical examination. (3) Necropsy (autopsy). (4) Laboratory. (5) Exhumation. (6) Birth. (7) Death.

b. Medical Expert Opinion. c. Deposition — A deposition is a written record of evidence

given orally and transcribed in writing in the form of questions

16 LEGAL MEDICINE

by the interrogator and the answer of the deponent and signed by the latter.

5. Physical Evidence: These are articles and materials which are found in connection

with the investigation and which aid in establishing the identity of the perpetrator or the circumstances under which the crime was committed, or in general assist in the prosecution of a criminal.

The identification, collection, preservation and mode of presentation of physical evidence is known in modern parlance as criminalistics. Criminalistics is the application of sciences such as physics, chemistry, medicine and other biological sciences in crime detection and investigation.

On the investigator's viewpoint, the following are the different types of physical evidences: a. Corpus Delicti Evidence — Objects or substances which may be

a part of the body of the crime. The body of the victim of murder, prohibited drugs recovered from a person, dagger with blood stains or fingerprints of the suspect, stolen motor vehicle identified by plate number and by body or engine serial numbers are examples of corpus delicti evidence.

b. Associative Evidence — These are physical evidences which link a suspect to the crime. The offender may leave clues at the scene such as weapon, tools, garments, fingerprints or foot impression. Broken headlights glass found at the crime scene in "hit and run" homicide may be associated with the car found in the repair shop. Wearing apparel of the offender and other articles of value may be recovered where the crime of rape was committed.

c. Tracing Evidence —These are physical evidences which may assist the investigator in locating the suspect. Aircraft or ship manifest, physician's clinical record showing medical treatment of suspect for injuries sustained in an encounter; blood stains recovered from the area traversed by the wounded suspect infer direction of the movement are examples of tracing evidence.

Preservation of Evidences: The physical evidences recovered during medico-legal investi

gation 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 are applied. This problem is further compounded by the long space of time the evidence was recovered and its presentation in court. From its recovery and from becoming a part of the inves-


tigation report, a preliminary investigation will be made by the prosecuting fiscal to prove that there is a prima facie evidence to warrant filing of the case in court. While in court, the case further suffers delays because of postponement of the hearings, preferential trials of other cases, raising of prejudicial issues to higher courts, etc. Preservation of evidence is indeed vital in medico-legal investigation.

-Methods of Preserving Evidences: 1. Photographs, audio and/or video tape, micro-film, photostat,

xerox, voice tracing, etc. Photography is considered to be the most practical, useful and

reliable means of preservation. a. Photo-camera are available in many places. b. The object preserved is reduced in size in the picture propor

tionately with other objects adjacent or near it. c. An unlimited number of copies can be reproduced, each of

which is identical to one another. In colored photographs variation may occur in the choice

of the kind of film and printing paper used. Identification of voice from the recording instrument may

sometimes be difficult. Audio-recording may be dependent on the speed, volume, pitch and timbre which may be changed by the instrument used in the recording and replaying.

2. Sketching — If no scientific apparatus to preserve evidence is available then a rough drawing of the scene or object to be preserve is done. It must be simple, identifying significant items and with exact measurement.

-Kinds of Sketch: a. Rough Sketch — This is made at the crime scene or during

examination of living or dead body. On the latter, an anatomic figure of the front, back and side part of the body must be made and the bodily lesions indicated.

b. Finished Sketch — A sketch prepared from the rough sketch for court presentation.

J Essential Elements to be Included in a Sketch: a. Measurement must be accurate. b. Compass direction must always be indicated to facilitate proper

orientation in the case of crime scene. A c. Essential item which has a bearing in the investigation mus. oe

included. d. Scale and proportion must be stated by mere estimation.

18 LEGAL MEDICINE

e. There must be a title and legend to tell what it is and the meaning of certain marks indicated therein.

3. Description — This is putting into words the person or thing to be preserved. Describing a thing requires keen observation and a good power of attention, perception, intelligence and experience. It must cause a vivid impression on the mind of the reader, a true picture of the thing described.

The following are the minimum standard requirements which must be satisfied in the description of the person or thing to make it complete: a. Skin Lesion — kind, measurement, other descriptive infor

mation of the lesion itself, location, orientation. b. Penetrating Wound (Punctured, Stab or Gunshot) — kind,

shape, other information from the wound itself, location, orientation, direction, other structures involved, complications and foreign elements that may be present.

c. Hymenal laceration — location, degree, duration, complication. d. Person — those requirement in portrait parle (see p. 53 supra).

4. Manikin Method — In a miniature model of a scene or of a human body indicating marks of the various aspects of the things to be preserved. An anatomical model or statuette may be used and injuries are indicated with their appropriate legends. Although it may not indicate the full detail of the lesion, it is quite impressive to the viewer as to the nature and severity of the trauma.

5. Preservation in the Mind of the Witness — A person who perceived something relevant for proper adjudication of a case may be a witness in court if he has the power to transmit to others what he perceived. He would just have to make a recital of his collection.

Principal drawbacks of preserving evidence in the mind of the witness: a. The capacity of a person to remember time, place and event

may be destroyed or modified by the length of time, age of the witness, confusion with other evidences, trauma or disease, thereby making the recollection not reliable.

b. The preservation is co-terminus with the life of the witness. If the witness dies, then the evidence is lost.

c. Human mind can easily be subjected to too many extraneous factors that may cause distortion of the truth. Other persons

./£may influence a witness to serve the interest of another or state untruthful facts to justify an end.

6. Special Methods — Special way of treating certain type of evidence may be necessary. Preservation may be essential from the time it


is recovered to make the condition unchanged up to the period it reaches the criminal laboratory for appropriate examination. Preservation may be needed for the remaining portion of the evidence submitted for future verification and/or court presentation. Some of the Special Ways of Preservation are: a. Whole human body — embalming. b. Soft tissues (skin, muscles, visceral organs) — 10% formalin

solution. c. Blood — refrigeration, sealed bottle container, addition of

chemical preservatives. d. Stains (blood, semen) — drying, placing in sealed container. e. Poison — sealed container.

Kinds of Evidence Necessary for Conviction: 1. Direct Evidence:

That which proves the fact in dispute without the aid of any inference or presumption. The evidence presented corresponds to to the precise or actual point at issue.

2. Circumstantial Evidence: The proof of fact or facts from which, taken either singly or

collectively, the existence of a particular fact in dispute may be inferred as a necessary or probable consequence. When is circumstantial evidence sufficient to produce conviction? a. When there is more than one circumstance; b. When the facts from which the inferences are derived are

proven; and c. When the combination of all the circumstances is such as to

produce a conviction beyond reasonable doubt (Sec. 4, Rule 123, Rules of Court).

Weight and Sufficiency of Evidence: Rule 133, Rules of Court:

Section 1. Preponderance of evidence, how determined. — In civil cases, the party having the burden of proof must establish his case by a preponderance of evidence. In determining where the preponderance or superior weight of evidence on the issues involved lies, the court may consider all the facts and circumstances of the case, the witnesses' manner of testifying, their intelligence, their means and opportunity of knowing the facts to which they tire testifying, the nature of the facts to which they testify, the proba

20 LEGAL MEDICINE

bility or improbability of their testimony, their interest or want of interest, and also their personal credibility so far as the same may legitimately appear upon the trial. The court may also consider the number of witnesses, though the preponderance is not necessarily with the greatest number.

From the foregoing provision of the Rules of Court, the following factors must be considered which party's evidence preponderate.

a. All the facts and circumstances of the case. b. The witnesses' manner of testifying, their intelligence, their

means and opportunities of knowing the facts to which they are ' testifying.

c. The nature of the facts to which the witnesses testify. d. The probability and improbability of the witnesses' testimony. e. The interest or want of interest of the witnesses. f. Credibility of the witness so far as the same may legitimately

appear upon the trial. g. The number of witnesses presented, although preponderance is

not necessarily with the greatest number. Section 2 — Proof beyond reasonable doubt — In a criminal case,

the defendant is entitled to an acquittal, unless his guilt is shown beyond reasonable doubt. Proof beyond reasonable doubt does not mean such a degree of proof as, excluding possibility of error, produces absolute certainty. Moral certainty only is required, or that degree of proof which produces conviction in an unprejudiced mind.

It is presumed that a person is innocent of a crime until the contrary is proven beyond reasonable doubt. The doubt, the benefit of which an accused is entitled in a criminal case, is a reasonable doubt, and not a whimsical or fanciful doubt, based on imagined and wholly improbable possibilities and unsupported by evidence.

Chapter II

^'fjECEPTION DETECTION

The knowledge of the truth is an essential requirement for the administration of criminal justice. The success or failure in making decisions may rest solely on the ability to evaluate the truth or falsity of the statement given by the suspect or witness. The task for its determination initially lies on the hand of the investigator.

Modern scientific methods have been devised utilizing knowledge of physiology, psychology, pharmacology, toxicology, etc. in determining whether a subject is telling the truth or not. Although the scientific methods of deception detection have not yet attained legal recognition to have their results admissible as an evidence in court, they have been considered very useful as aids in criminal investigation.

1 Methods of deception detection which are currently being used or applied by law enforcement agencies may be classified as follows: 1. Devices which record the psycho-physiological response:

a. Use of a polygraph or a lie detector machine b. Use of the word association test c. Use of the psychological stress evaluator Use of drugs that try to "inhibit the inhibitor": a. Administration of "truth serum'' b^Narcoanalysis or narcosynthesis c. Intoxication

3. Hypnotism 4. By observation 5. Scientific interrogation jo. Confession

i I. RECORDING OF THE PSYCHO-PHYSIOLOGICAL RESPONSE

The nervous control of the human body includes the central nervous system (the brain and the spinal cord) and the autonomic or regulating nervous system (sympathetic and parasympathetic). The central nervous system primarily controls the motor and sensory functions that occur at or above the threshold. It may be voluntary. The autonomic nervous system acts as a self-regulating autonomic response of the body.

21

22 LEGAL MEDICINE

The autonomic nervous system is composed of two complimentary branches: the sympathetic and the parasympathetic nervous system, acting opposite each other. The fibers of both enervate are all organs where self-regulation is essential.

When a person is under the influence of physical (exertion) or emotional (anger, excitement, fear, lie detection, etc.) stimuli, the sympathetic will dominate and over-ride the parasympathetic, thus, there will be changes in the heart rate, pulse rate, blood pressure, respiratory tracing, psychogalvanic reflexes, time of response to question, voice tracing, etc. The parasympathetic nervous system works to restore things to normal when the conditions of stress have been removed. It is the dominant branch when the condition is normal and the subject is calm, contented and relaxed. «/ The recording of some of the psycho-physiological reaction of a

subject when he is subjected to a series of questions, and the scientific interpretation by trained experts are the basis of the tests.

A. Use of a Lie Detector or Polygraph: It is not appropriate to call a lie detector a polygraph. A lie

detector records physiological changss that occur in association with lying in a polygraph. It is the fear of detection of the subject which allows the determination. The fear of the subject when not telling the truth activates the sympathetic nervous system to a series of automatic and involuntary physiological changes which are recorded by the instrument.

The instrument (lie detector) is like an electrocardiogram or electroencephalogram with recording stylets making tracings on moving paper at the rate of 6 inches per minute.

The test must be made in a room especially built for the purpose. It must be quiet, private, sound-proof and free from any disturbances and distractions. Extrenuous noises, like blowing of horns, ringing of bells or telephone and loud conversations of persons must be avoided.

The subject is seated on a chair beside a table where the instrument is located. The pneumograph tubes are placed around the chest and abdomen, the blood pressure cuff around the upper right arm, and the electrodes are attached to the two fingers of the other hand. The back of the chair is equipped with an inflatable rubber bladder for the purpose of recording the muscular contraction and pressure. All the gadgets attached are connected to the recording instrument. The subject must be placed in. a position so that he looks straight ahead.

The subject is instructed to remain as quiet as possible, to answer all questions by "yes ' or "no", and to refrain from other

DECEPTION DETECTION 23

verbal responses during the test. If any explanations are to be made, the subject is instructed to wait until the termination of the test.

Phases of the Examination: 1. Pre-test interview 2. Actual interrogation and recording through the instrument 3. Post-test interrogation 1. Pre-test interview:

Before the actual testing is done, the examiner must first make an informal interview of the subject which may last from 20 to 30 minutes, a. Purpose of the interview:

(1) To determine whether the subject has any medical or psychiatric condition or has used drugs that will prevent the testing;

(2) To explain to the subject the purpose of the examination; (3) To develop the test questions, particularly those of the

types to be asked; (4) To relieve the truthful subject of any apprehension as

well as to satisfy the deceptive subject as to the efficiency of the technique;

(5) To know any anti-social activity or criminal record of the subject.

2. Actual interrogation and recording: With all the gadgets attached to the body of the subject, the

instrument will start running by applying pressure on a button. The subject then will be asked to answer the following standard test questions:

a. Irrelevant questions — These are questions which have no bearing to the case under investigation. The question may refer to the subject's age, educational attainment, marital status, citizenship, occupation, etc. The examiner asks these types of questions to ascertain the subject's normal pattern of response by eliminating the feeling of apprehension.

b. Relevant questions — These are questions pertaining to the issue under investigation. They must be unambiguous, unequivocal and understandable to the subject. They must all be related to one issue or one criminal act. It is equally important to limit the number of relevant questions to avoid discomfort to the subject. Relevant questions must be very specific to obtain an accurate result.

24 LEGAL MEDICINE

Examples of relevant questions are "Did you shoot to death Mr. "X''? "Did you take the ring, wrist watch, and wallet of Mr. "X" after his death? "

c. Control questions — These are questions which are unrelated to the matter under investigation but are of similar nature although less serious as compared to those relevant questions under investigation.

If someone is being investigated for murder by shooting, the control questions may be "Have you ever used or fired a gun? ", "Do you have a gun? ", "Have you killed someone with a gun? ", etc.

In practice, the relevant — irrelevant question technique is used. The responses to the two types of questions are compared, if there is no significant difference between the relevant and irrelevant questions, the subject is reported to be truthful. However, if the subject responds more to the relevant questions, he is considered as not telling the truth.

The use of control questions is considered by many poly-graphists to be the most reliable and effective questioning technique. These are usually asked if there is doubt in the interpretation of the subject's response to relevant and irrelevant questions.

3. Post-test interrogation: The purposes of further questioning after the test are: a. To clarify the findings; b. To learn if there are any other reasons for the subject's

responding to a relevant question, other than the knowledge of the crime;

c. To obtain additional information and an admission for law enforcement purposes, if the results suggest deception.

4. Supplementary tests: Aside from the standard tests described above, the following

special tests may be performed and incorporated as a part of the standard procedure or may be used as supplementary tests depending upon the result of the standard test in order to draw a better conclusion. a. Peak-of-tension test — The subject may be given this test if

he is not yet informed of the details of the offense for which he is being interrogated by the investigator, or by other persons or from other sources like the print media.

The examiner will prepare several questions, about seven, and one of them has a specific bearing on the matter under investigation. The specific question must refer to some


details of the incident which could not have been known to the subject.

A truthful subject, not aware of any question referrable to the subject of investigation, will respond by not building up tension. However, when the question which refers to a detail of the incident is asked, a guilty subject will develop a ''peak of tension'' which will be recorded in the tracing.

b. Guilt complex test — This test is applied when the response to relevant and control questions are similar in degree and consistency and in a way that the examiner cannot determine whether the subject is telling the truth or not.

The subject is asked questions aside from the irrelevant, relevant and controlled questions; a new series of relevant questions dealing with a real incident and that which the subject could not have committed. If the subject does not respond to the added relevant questions, it indicates that the subject was being deceptive as to the primary issue under investigation. However, no conclusion can be drawn if the response to the added guilt complex question is similar to the real issue questions.

c. Silent answer test — This test is conducted in the same manner as when relevant, irrelevant and control questions are asked, but the subject is instructed to answer the questions silently, to himself, without making any verbal response. This test is effective when the subject's verbal response causes distortion in the tracing such as sniff or clearing of the throat. (Modern Legal Medicine, Psychiatry and Forensic Sciences by William Curran, Louis McGarry & Charles Petty, F. A. Davis Company, Philadelphia, 1980 p. 1187-1205).

Reasons for the Inadmissibility To the Court of the Result of Polygraph Examination: 1. The polygraph techniques are still in the experimental stage and

have not received the degree of standardization of acceptance among scientists.

In a series of decisions of the state supreme courts in the United States (Fyre v. U.S., State v. Bonner (Wis.), People v. Becker (Mich.), People v. Forte, State v. Cole (Mich., (Beech v. State (Neb.), People v. Wechnick (Calif.), etc.), non-admis-sibility of the lie detector test was uniformly ruled. The common reason given was that, according to physiological and psychological authorities, the test has not gained a degree of development beyond the experimental stage. Until it is es-

2« LEGAL MEDICINE

tablished that reasonable certainty follows from such a test, it would be an error to admit the results as evidence. The test is useful in the investigation of a crime but it has no place In the courtroom.

2. The trier of fact is apt to give almost conclusive weight to the polygraph expert's opinion.

3. There is no way to assure that a qualified examiner administered the test. The polygraph is capable of a high degree of accuracy only when conducted under controlled conditions by an examiner who is highly qualified due to his ability, experience, education and integrity.

"The important areas that may affect the accuracy of the reported test result. . . .would be (1) his polygraphy training (2) the extent of his experience with respect to the years and number of tests he has conducted, (3) the operation of the polygraphy instrument itself (4) the accuracy of the polygraph technique. In addition, special consideration should be given to the number of tests and the number of questions asked during the test. . . (Modern Legal Medicine, Psychiatry and Forensic Sciences, by Curran, et. al, p. 1203).

4. Since the polygraph involves a certain unconscious quality of the examinee, he may unwittingly waive his or her right against self-incrimination. It becomes necessary to determine the scope of the defendant's waiver if he voluntarily submits to the test. (Am. J. of Trial Advocacy, Vol. 4, p.593).

5. The test itself cannot be relied upon because it has many errors.

The factors that are responsible for the 26% errors of the lie detector are as follows:

1. Nervousness or extreme emotional tension experienced by a subject who is telling the truth regarding the offense in question but who is nevertheless affected by:

a. Apprehension induced by the mere fact that suspicion or accusation has been directed against him;

b. Apprehension over the possibility of an inaccurate lie-detector test result;

c. Over-anxiety to cooperate in order to assure an accurate test result;

d. Apprehension concerning possible physical hurt from the instrument;

e. Anger resentment over having to take a lie-detector test; f. Over-anxiety regarding serious personal problems unrelated

to the offense under investigation;


g. Previous extensive interrogation, especially when accompanied by physical abuse; and

h. A guilt-complex or fear of detection regarding some other offense which he had committed.

2. Physiological abnormalities such as: a. Excessively high or excessively low blood pressure; b. Diseases of the heart; and c. Respiratory disorder.

3. Mental abnormalities such as: a. Feeblemindedness, as in idiots, imbeciles and morons; b. Psychosis or insanities, as in manic-depressives, paranoids,

schizophrenics, paretics, etc. c. Psychoneurosis and psychopathia, as among the so-called

"peculiar" or "emotionally stable" persons — Those who are neither psychotic or normal, and those from the borderline between these two groups.

4. Unresponsiveness in a living or guilty subject, because of: a. No fear of detection; b. Apparent inability to consciously control response by means

of certain mental sets of attitudes; c. A condition of "sub-shock" or "adrenal exhaustion" at the

time of the test; d. Rationalization of the crime in advance of the test to such an

extent that lying about the offense arouses little or no emotional disturbance.

e. Extensive interrogation prior to the test. 5. Attempt to "beat the machine" by controlled breathing or by

muscular flexing. 6. Unobserved application of muscular pressure which produces

ambiguities and misleading indications in the blood pressure tracing (Lie Detection and'Criminal Interrogation by Fred Imbau and John Reid, The Williams & Wilkins Co., p. 65). However, the results of the lie detector test may be admissible if

there is a stipulation of the parties and counsels that they will accept said results. The reason is that if the defendant agrees to the admission of the polygraph result, then he should not be able to object if the subsequent result turns out to be unfavorable to him (State v. Valdez, 91 Ariz. 274, 371 p. 2d 894 (1962). The judge may have the discretion as to whether it is to be admitted or not. For example, it may not be admitted if done by an incompetent polygrapher. Can a person be compelled to be subjected to the lie-detector test?

28 LEGAL MEDICINE

Inasmuch as the test requires the subject to answer the questions either by "yes" or "no", it infers the use of intelligence and attention or other mental faculties which is self-incriminatory. Therefore, a person cannot be compelled to be subjected to the test.

B. Use of the Word Association Test: A list of stimulus and non-stimulus words are read to the sub

ject who is instructed to answer as quickly as possible. The answers to the questions may be a "yes" or a "no". Unlike the lie detector, the time interval between the words uttered by the examiner and the answer of the subject is recorded.

When the subject is asked questions with reference to his name, address, civil status, nationality, etc. which has no relation to the subject-matter of the investigation, the tendency is to answer quickly. But when questions bear some words which have to do with the criminal act the subject allegedly committed, like knife, gun or hammer which was used in the killing, the tendency is to delay the answer.

The test is not concerned, with the answer, be it a "yes" or "no". The important factor) is the time of response in relation to stimulus or non-stimulus words.

Like the use of the lie detector, the subject cannot be compelled to be subjected to the test without his consent.

C. Use of the Psychological Stress Evaluator (PSE):

When a person speaks, there are audible voice frequencies, and superimposed on these are the inaudible frequency modulations which are products of minute oscillation of the muscles of the voice mechanism. Such oscillations of the muscles or micro tremor occur at the rate of 8 to 14 cycles per second and controlled by the central nervous system.

When a person is under stress as when he is lying, the micro-tremor in the voice utterance is moderately or completely suppressed. The degree of suppression varies inversely to the degree of psychologic stress in the speaker.

The psychological stress evaluator (PSE) detects, measures, and graphically displays the voice modulations that we cannot hear.

/ When a person is relaxed and responding honestly to the questions, those inaudible frequencies are registered clearly on the instrument. But when a person is under stress, as when he is lying, these frequencies tend to disappear.


1. Procedure: a. The examiner meets the requesting party to determine the

specific purpose of the examination and to begin formulation of relevant questions.

b. A pre-test interview is conducted with the subject to help him or her feel at ease with the examiner, to provide an opportunity to specify matters, to eliminate outside issues, and to review questions that will be asked.

c. An oral test of about 12 to 15 "yes* or "no" questions is given which is recorded on a tape recorder. The questions are a mixture of relevant and irrelevant questions.

d. Immediately following the test or at a later time, the tape is processed through the Psychological Stress Evaluator for analysis of the answers.

e. If stress is indicated, the subject is given opportunity to provide additional clarification. A retest is given to verify correction and clarification (Legal Medicine 1980, Cyril Wecht, ed. p. 58).

2. Advantages of Psychological Stress Evaluator over the Lie Detector Machine: a. It does not require the attachment of sensors to the person

being tested. b. The testing situation need not be carefully controlled to

eliminate outside distraction; and c. Normal body movement is not restricted.

/ II. USE OF DRUGS THAT "INHIBIT THE INHIBITOR"

A. Administration of Truth Serum: The term "truth serum" is a misnomer. The procedure does not

make someone tell the truth and the thing administered is not a serum but is actually a drug.

In the test, hyoscine hydrobromide is given hypodermically in repeated doses until a state of delirium is induced. When the proper point is reached, the questioning begins and the subject feels a compulsion to answer the questions truthfully. He forgets his alibi which he may have built up to cover his guilt. He may give details of his acts or may even implicate others. j The drug acts as depressant on the nervous system. Clinical evidence indicates that various segments of the brain particularly the cortex and diencephalon are selectively depressed in the reversed order of their evolutionary development.

The use of drugs for the purpose is not without the element of danger and should not be attempted except by a physician who

30 LEGAL MEDICINE

has had experience in using the drug. Scopolamine may sometime cause psychotic reactions.

Statements taken from the subject while under the influence of truth serum are evolutionarily obtained hence they are not admissible as evidence. Because of the potential risks involved in the application of the procedure, it is seldom used by law-enforcement agencies.

B. Narcoanalysis or Narcosynthesis: This method of deception detection is practically the same as

that of administration of truth serum. The only difference is the drug used. Psychiatric sodium amytal or sodium p'enthotal is administered to the subject. When the effects appear, questioning starts. It is claimed that the drug causes depression of the inhibitory mechanism of the brain and the subject talks freely.

The administration of the drug and subsequent interrogation must be done by a psychiatrist with a long experience on the line.

Like the administration of truth serum, the result of the test is not admissible in court. I

C. Intoxication with alcohol: The apparent stimulation effect of alcohol is really the result of

the control mechanism of the brain, so alcohol, like truth serum, and narcoanalytic drugs "inhibit the inhibitor".

The ability of alcohol to reveal the real person behind the mask which all of us are said to wear ("mask of sanity") is reflected in the age-old maxim, "In vino Veritas" ("In wine there is truth"). (Pathology of Homicide by Lester Adelson, Charles Thomas, 1974, p. 895).

The person whose statement is to be taken is allowed to take alcoholic beverages to almost intoxication. At this point the power to control diminishes and the investigator starts pounding questions and recording answers.

The questioning must start during the excitatory state when the subject has the sensation of his well-being and when his action, speech and emotions are less strained due to the lowering of the inhibition normally exercised by the higher brain centers. When the subject is already in the depressive state due to the effect of alcohol, he will no longer be able to answer any question.

Confessions made by the subject while under the influence of alcohol may be admissible if he is physically capable to recollect the facts that he has uttered after the effects of alcohol have disappeared. 3ut in most instances, the subject cannot recall everything that he had mentioned or he may refuse to admit the truth of the statement given.


III. HYPNOSIS

Hypnosis is the alteration of consciousness ^nd concentration in which the subject manifests a heightened of suggestibility while awareness is maintained.

Not all persons are susceptible to hypnotic induction. Subjects who are compulsive-depressive type, strong-willed like lawyers, accountants, physicians and other professionals are usually non-hypnotizable. Reasons Why Deception Detection Obtained Through Hypnosis Is Not Admissible in Court: 1. It lacks the general scientific acceptance of the reliability of

hypnosis per se in ascertaining the truth from falsity; 2. The fear that the trier of fact will give uncritical and absolute

reliability to a scientific device without consideration of its flaw in ascertaining veracity.

3. The possibility that the hypnotized subject will deliberately fabricate;

4. The prospect that the state of heightened suggestibility in which the hypnotized subject is suspended will produce distortion of the fact rather than the truth; and

5. The state of the mind, skill and professionalism of the examiner are too subjective to permit admissibility of the expert testimony (Am. J. of Trial Advocacy, 1981, p. 603).

Confession while under hypnotic spell is not admissible as evidence because such "psychiatric treatment" is involuntary and mentally coersive (Leyra v. Demro, 347 U.S. 556, 74 S. Ct. 716, 98, 948 (1954).

Although hypnosis may not yield admissible evidence it may be of some use during investigation as a discovery procedure.

IV.^SERVATION

A good criminal investigator must be a keen observer and a good psychologist. A subject under stress on account of the stimulation of the sympathetic nervous system may exhibit changes which may be used as a potential clue of deception. And since just one or a combination of the following signs and symptoms is not conclusive or a reliable proof of guilt of the subject, their presence infers further investigation to ascertain the truth of the impression.

Physiological and Psychological Signs and Symptoms of Guilt: 1. Sweating — Sweating accompanied with a flushed face indicate

anger, embarrassment or extreme nervousness. Sweating with a

32 LEGAL MEDICINE

pallid face may indicate shock or fear. Sweating hands indicate tension.

2. Color cnange — If the face is flushed, it may indicate anger, embarrassment or shame. A pale face is a more common sign of guilt.

3. Dryness of the mouth — Nervous tension causes reflex inhibition of salivary secretion and consequently dryness of the mouth. This causes continuous swallowing and licking of the lips.

4. Excessive activity of the Adam's apple — On account of the dryness of the throat aside from the mouth, the subject will swallow saliva from the mouth and this causes the frequent upward and downward movement of the Adam's apple. This is observed in many guilty subjects.

5. Fidgeting — Subject is constantly moving about in the chair, pulling his ears, rubbing his face, picking and tweaking the nose, crossing or uncrossing the legs, rubbing the hair, eyes, eyebrows, biting or snapping of fingernails, etc. These are indicative of nervous tension.

6. "Peculiar feeling inside" — There is a sensation of lightness of the head and the subject is confused. This is the result of his troubled conscience.

7. Swearing to the truthfulness of his assertion — Usually a guilty subject frequently utters such expression. "I swear to God I am telling the truth" or "I hope my mother drops dead if I am lying", "I swear to God". . . etc. Such expressions are made to make forceful and convincing his assertion of innocence.

8. "Spotless past record" — "Religious man" — The subject may assert that it is not possible for him to do "anything like that" inasmuch as he is a religious man and that he has a spotless record.

9. Inability to look at the investigator "straight in the eye" — The subject does not like to look at the investigator for fear that his guilt may be seen in his eyes. He will rather look at the floor or ceiling.

10. "Aror that I remember" expression — The subject will resort to the use of "not that I remember" expression when answering to be evasive or to avoid committing something prejudicial to him.

V. SCIENTIFIC INTERROGATION Interrogation is the questioning of a person suspected of having

committed an offense or of persons who are reluctant to make a full disclosure of information in his possession which is pertinent to the investigation. It may be done on a suspect or a witness.


1. A suspect is a person whose guilt is considered on reasonable ground to be a practical possibility.

2. A witness is a person, other than the suspect, who is requested to give information concerning the incident. He may be a victim a complainant, an accuser, a source of information, an observer of the occurrence, a scientific specialist who has examined physical evidence or a custodian of official document.

Attitude and Conduct of an Investigator: In the course of an interrogation of a suspect or witness, the inter

rogator must observe the following: 1. The interrogator should avoid creating an impression that he is an

investigator seeking a confession or conviction. It is better for him to appear in the role of one who is merely seeking the truth.

2. Such realistic words or expressions as "kill", "steal", "confess" your crime, etc. should not be used by the interrogator. It is more desirable, from the psychological standpoint, to employ a milder terminology like "shoot", "take", "tell the truth", etc.

3. The interrogator should sit fairly close to the subject and between the two, there should not be a table or other pieces of furniture.

4. The interrogator should avoid pacing about the room. To give an undiverted attention to the person being interrogated, make it as such that will be more difficult for him to evade detection of deception or conceal his guilt-

5. The interrogator should avoid or at least minimize smoking, and he should also refrain from fumbling with a pencil, pen or other room accessories, for all these tend to create an impression of lack of interest or confidence.

6. The interrogator should adapt his language to that used and understood by the subject himself. In dealing with an uneducated and ignorant subject, the interrogator should use simple words and sentences.

7. Since the interrogator should always occupy a fearless position with regards to his subject and to the condition and circumstances attending the interview, the subject should not be handcuffed or shackled during his presence in the interrogation room. The interrogator should face the subject as "man to man" and not as policeman to prisoner.

For Purposes of Investigation the Following are the Different Types of Criminal Offenders: 1. Based on behavioral attitude:

a. Active aggressive offenders — They are persons who commit crime in an impulsive manner usually on account of their

34 LEGAL MEDICINE

aggressive behavior. Such attitude is clearly shown in crimes of passion, revenge or resentments,

b. Passive inadequate offenders — Persons who commit crimes because of inducement, promise or reward. They are gullible and easily persuaded to perform acts in violation of the penal laws.

2. Based on the state of mind: a. Rational offenders — Those who commit crime with motive or

intention and with full possession of their mental faculties. Example: Killing with evident premeditation.

b. Irrational offenders — They commit crime without knowing the nature and quality of his act. Example: Mad killer.

3. Based on proficiency: a. Ordinary offenders — These are the lowest form of criminal

career. They are only engaged in crimes which require limited skill. They lack the capacity to avoid arrest and conviction.

a. Professional offenders — They are highly skilled and able to perform criminal acts with the least chance of being detected. They commit crimes which require special skill rather than violence.

Example: Pick-pocketing, shop-lifting. 4. Psychological classification:

a. Emotional offenders— These are persons who commit crimes in the heat of passion, anger, or revenge, and also who commit offenses of accidental nature. Emotional offenders usually have feeling of remorse, mental anguish or compunction as a result of their acts. They have the sense of moral guilt. Their conscience "bother" them and they have difficulty resting or sleeping because of their feeling of guilt. The most effective interrogation approach to use for them is based upon sympathetic consideration regarding their offense and present difficulty.

b. Non-emotional offenders — These are persons who commit crimes for financial gain and are usually recidivist or repeaters. Sympathetic approach is not effective. The interrogator should make a factual analysis of the suspect's predicament and appeal to his common sense and reasoning rather than to his emotion.

Requirement for the Admissibility of Evidence Obtained Through Interrogation: Sec. 20 Art. IV, Bill of Rights, Philippine Constitution:

No person shall be compelled to be a witness against himself. Any person under investigation for the commission of an offense


shall have the right to remain silent and to counsel, and be informed of such right. No force, violence, threat, intimidation, or any other means which vitiates the free will shall be used against him. Any confession obtained in violation of this section shall be inadmissible in evidence.

In compliance with the above provision of the constitution and the decision of the U.S. Supreme Court, in Miranda v. Arizona, 384 U.S. 436 (1966) safeguards were established for the interrogation of suspected (accused) person. If a person is to be interrogated, he must first be warned and advised that:

a. He has the right to remain silent; b. Anything he says can be used against him in court of law; c. He has the right to consult with an attorney and to have the

attorney present during the questioning; and d. If he cannot afford an attorney, one will be appointed for him

prior to any questioning if he so desires. After such warning and in order to secure a waiver, the following

questions should be asked. An affirmative answer to each question constitutes a waiver to the rights:

a. Do you understand each of these rights I have explained to you?

b. Having these rights in mind, do you wish to talk to us now?

Some Techniques of Interrogation: The choices of methods of questioning depend on the personal

and psychological evaluation of the subject by the interrogator, the nature of the crime under investigation, previous criminal record, and the social and educational background of the subject. 1. Emotional appeal — The interrogator must create a mood that is

conducive to confession. He may be sympathetic and friendly to the subject. The subject may be willing to disclose more information if he is treated in a kind spirit.

2. Mutt and Jeff technique — In this technique there must be at least two investigators with opposite character; one (Mutt) who is arrogant and relentless who knows the subject to be guilty and will not waste time in the interrogation, and the other (Jeff) who is friendly, sympathetic and kind. When Mutt is not present Jeff will advice the subject to make a quick decision and plea for cooperation.

3. Bluff on split-pair technique — This is applicable where there are two or more persons who allegedly participated in the commission of a crime. All of them are interrogated separately and the results of their individual statements are not known to one another. While one of them is under interrogation, the interrogator may

36 LEGAL MEDICINE

claim that the subject was implicated by the author and that there is no use for him to deny participation.

4. Stern approach — The questions must oe answered clearly, and the interrogator utilizes harsh language. Immediate response from the subject is demanded.

5. The subject is given the opportunity to make a lengthy, time-consuming narration. There may be a moment when the subject becomes confused and desists from making further statement for fear of contradicting his previous statement.

Basis of the Investigator's Inference that the Subject is Not Telling the Truth: 1. The subject's statement have many improbabilities and gaps on

its substantial parts. 2. The subject's statements are inconsistent with the material facts. 3. The subject's statements are incoherent, conflicting with one

another.

VI. CONFESSION

Confession is an expressed acknowledgment by the accused in a criminal case of the truth of his guilt as to the crime charged, or of some essentials thereof.

Confession is different from admission, although admission includes, as one of its species, confession. Confession is a statement of guilt while admission is usually a statement of fact by the accused which does not directly involve an acknowledgement of guilt of the accused.

The defendant stated in the preliminary investigation that he had inflicted upon the deceased the wounds -in question. It was held that such statement was not a confession of guilt but only an admission, inasmuch as the defendant might have inflicted the wound in self-defense (U.S. v. Team, 23 Phil. 64).

An admission by one accused of rape that he had carnal intercourse with the complaining witness at the time and place mentioned in the information is not a confession of guilt of the crime charged unless he further admits that he cohabited with the woman without her consent, or by the use of force or threat (U.S. v. Flores, 26 Phil. 262).

Kinds of Confession: 1. Extra-judicial Confession:

This is a confession made outside of the court prior to the trial of the case.

LEGAL MEDICINE 37

Sec. 3, Rule 133, Rules of Court — Extra-judicial confession, not sufficient ground for conviction:

An extra-judicial confession made by an accused, shall not be sufficient ground for conviction, unless corroborated by evidence of corpus delicti.

Qbrpus delicti means the body of the crime or fact of specific loss or injury sustained. It may not necessarily be the body of the crime but may consist of facts and circumstances tending to corroborate the confession.

The reason for the above rule is to guard against conviction based upon false confession of guilt. It is possible that a person might have confessed his guilt regarding an offense which someone has committed and when asked of his victim on the nature of the injuries inflicted by him, it does not coincide with the identity or nature of the injuries received by the victim.

a. Extra-judicial confession may be: / ( l ) Voluntary extra-judicial confession:

L The confession is voluntary when the accused speaks on his free will and accord, without inducement of any kind, and with a full and complete knowledge of the nature and consequence of the confession, and when the speaking is so free from influences affecting the will of the accused, at the time the confession was made that it renders it admissible in evidence against him.

(2) Involuntary extra-judicial confession: lA ^ C A W * * V A M -

' Confessions obtained through force, threat, intimi-?

dation, duress or anything influencing the voluntary act of the confessor.

Confessions obtained from the defendant by means of force and violence is null and void, and cannot be used against him at the trial. (U.S. v. Lozada, 4 Phil. 266; U.S. v. Felipe, 5 Phil. 333).

If a confession was made when a threat or promise was made by, in the presence of a person in authority, who has, or is supposed by the accused to have power or opportunity to fulfill the threat or promise, then the confession of the accused will be presumed to be the exclusive effect of inducement and therefore inadmissible (Early v. Com., 86 Va. 921).

A confession made under the influence of spiritual advice or exhortation is not admissible.

38 LEGAL MEDICINE

A confession made under the influence of parental sentiment is not admissible (People v. Martinez, 42 Phil. 853).

In confession through a "third degree", the duty of the physician is to determine the presence and extent of physical injuries on the subject.

A physician must be cautious concluding that if physical injuries are present, they were inflicted in the course of a "third degree". It could be possible that the subject has self-inflicted those wounds in the guise that the confession was not voluntary.

Maltreatment of Prisoners for the Purpose of Exhorting Confession or To Obtain Some Information is a Crime. Art. 235, Revised Penal Code — Maltreatment of prisoners:

The penalty of arresto mayor in its medium period to prision correccional in its minimum period, in addition to his liability for the physical injuries or damaged caused, shall be imposed upon any public officer or employee who shall overdo himself in the correction or handling of a prisoner or detention of a prisoner under his charge, by the imposition of punishments not authorized by the regulations, or by inflicting such punishments in a cruel and humiliating manner.

If the purpose of the maltreatment is to extort a confession, or to obtain some information from the prisoner, the offender shall be punished by prision correccional in its minimum period, temporary special disqualification, and a fine not exceeding 500 pesos, in addition to his liability for the physical injuries or damage caused.

Elements of the crime: 1. The offender is a public officer or employee; 2. The offender has under his charge a (convicted) prisoner or a de

tention prisoner; 3. The offender maltreats the prisoner in any of the following way:

a. By overdoing in the correction or handling of prisoner, either by (1) imposition of punishment not authorized by the regulation, or (2) by inflicting such punishment in a cruel and humiliating manner; or

b. By maltreating such prisoner to extort a confession or to obtain some information from the prisoner.

THE TOKYO DECLARATION The Tokyo Declaration which was endorsed by the World Medical

Association in 1975 contains guidelines to be observed by physicians concerning torture and other cruel, inhuman, and degrading treatment or punishment in relation to detention and imprisonment.


Preamble It is the privilege of the medical doctor to practice medicine in

the service of humanity, to preserve and restore bodily and mental health without distinction as to persons, to comfort and ease the suffering of his or her patients. The utmost respect for human life is to be maintained even under threat, and no use made of any medical knowledge contrary to the laws of humanity.

For the purpose of this Declaration torture is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason. Declaration 1. The doctor shall not countenance, condone or participate in the

practice of torture or other forms of cruel inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs for motives, and all the situations, including armed conflict and civil strife.

2. The doctor shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment.

3. The doctor shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment is used or threatened.

4. A doctor must have complete clinical independence in deciding upon the care for a person for whom he or she is medically responsible.

The doctor's fundamental role is to alleviate the distress of his or her fellow men, and no motive — whether personal, collective or political — shall prevail against his higher purpose.

5. Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgment concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgement should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner.

6. The World Medical Association will support, and should encourage the international community, the national medical associations and fellow doctors, to support the doctor and his or her family in

40 LEGAL MEDICINE

the face of threats or reprisals resulting from a refusal to condone the use of torture and other forms of cruel, inhuman or degrading treatment.

(The New Police Surgeon by S.H. Burgress, pp. 134-136; JAMA Vol. 255, No. 20 May 23,1986, p. 2800) 2. Judicial Confession:

This is the confession of an accused in court. It is conclusive upon the court and may be considered to be a mitigating circumstance to criminal liability.

A plea of guilty when formally entered on arraignment is sufficient to sustain a conviction of any offense, even a capital one, without further proof. Sec. 2, Rule 129, Rule of Court — Judicial admissions:

Admissions made by the parties in the pleadings, or in the course of the trial or other proceedings do not require proof and can not be contradicted unless previously shown to have been made through palpable mistake.

Chapter III

MEI31G0-LEGAL ASPECTS OF IDENTIFICATION

- identification is the determination of t h e ind iv idua l i ty nt ajTimn or thing.

importance of Identification of Person: 1. In the prosecution of the criminal offense, the identity of the

offender and that of the victim must be established, otherwise it will be a ground for the dismissal of the charge or acquital of the accused.

2. The identification of a person missing or presumed dead will facilitate settlement of the estate, retirement, insurance and other social benefits. It vests on the heirs the right over the properties of the identified person.

If identity cannot be established, then the law on presumption of death (Art. 390, Civil Code) must be applied which requires the lapse of seven years before a person can be presumed dead. In special instances, the seven years period may be reduced to four years (Art. 391, Civil Code).

3. Identification resolves the anxiety of the next-of-kin, other relatives and friends as to the whereabouts of a missing person or victim of calamity or criminal act.

4. Identification may be needed in some transactions, like cashing of check, entering a premise, delivery of parcels or registered mail in post office, sale of property, release of dead bodies to relatives, parties to a contract, etc.

Rules in Personal Identification: 1. The greater the number of points of similarities and dissimilarities

of two persons compared, the greater is the probability for the conclusion to be correct. This is known as the TJIW of Multiplicity of Evidence in Identification.

2. The value of the different points of identification varies in the formulation of conclusion. In a fresh cadaver, if the fingerprints on file are the same as those recovered from the crime scene, they will positively establish the identity of the person while bodily marks, like moles, scars, complexion, shape of nose, etc. are merely corroborative. Visual recognition by relative or friends may be of lesser value as compared with fingerprints or dental comparison.

41

42 LEGAL MEDICINE

3. The longer the interval between the death and the examination of the remains for purposes of identification, the greater is the need for experts in establishing identity. The process of taking fingerprints and its examination under a magnifying lens requires the services of an expert. When putrefaction has set in, the external bodily marks useful in identification might be destroyed so that it is necessary to resort to an anatomical or a structural examination of the body which requires knowledge of medicine' and dentistry.

4. Inasmuch as the object to be identified is highly perishable, it is necessary for the team to act in the shortest possible time specially in cases of mass disaster.

5. There is no rigid rule to be observed in the procedure of identification of persons.

Methods of Identification: l.By comparison — Identification criteria recovered during investi

gation are compared with records available in the file, or postmortem finding are compared with ante-mortem records. Examples: a. Latent fingerprints recovered from the crime scene are com

pared with the fingerprints on file of an investigating agency. b. Dental findings on the skeletal remains are compared with the

dental record of the person in possession of the dentist. 2. By exclusion — If two or more persons have to be identified and

all but one is not yet identified, then the one whose identity has not been established may be known by the process of elimination.

/ IDENTIFICATION OF PERSONS The bases of human identification may be classified as:

X- Those which laymen used to prove identity — No special training or skill is required of the identifier and nc instrument or procedure is demanded.

2<JPhose which are based on scientific knowledge — Identification is made by trained men, well-seasoned by experience and observation, and primarily based on comparison or exclusion.

V L ORDINARY METHODS OF IDENTIFICATION Points of Identification Applicable to the Living Person Only: 1. Characteristics which may easily be changed: (j^ Growth of hair, beard or mustache — This may easily be shaved

or grown within a short time. Arrangement may be changed.

MEDICO-LEGAL ASPECTS OF IDENTIFICATION

artificial hair may be worn or ornamentation may be placed to changed its natural condition.

^b^Clothing — A person may have special preference for certain form, texture, or style. Certain groups of people are required to have specific cut, color or design, as in uniforms, worn by students, employees of commercial or industrial establishment, or groups of professionals.

/c.^'requent place of visit — A person may have a special desire or ^"nabi t to be in a place if ever he has the opportunity to do so.

"Sari-sari" stores, barber shops, coffee shops, beer gardens and recreation halls are common venues of visit of certain class of people. A wanted criminal may suddenly prevent himself from going to the place he used to visit for fear that he may be apprehended.

^^Grade of profession — A medical student of the upper clinical year may be recognized by the stethoscope; a graduate or student nurse by her cap, a mechanic by his tools, a clergyman by his robe, etc. A change of grade, trade, vocation or profession may be resorted to as a means of concealing identity.

(eJBody ornamentations — Earrings, necklaces, rings, pins, etc. ^-ûsually worn by persons may be points to identify a person

from the rest.

2.\£haracteristics that may not easily be changed: a. Mental memory — A recollection of time, place and events

may be a clue in identification. Remembering names, faces and subjects of common interest may be initiated during interview to see how knowledgeable a person is.

b. Speech — A person may stammer, stutter or lisp. However, if the manner of talking is due to some physical defects, like harelip and cleft palate, that have been corrected by surgery, there may be a change in his manner of speech.

The manner of talking and the quality of the voice are dependent on the vocal cavities (throat, mouth, nose and •inuses) and his manner of manipulating the lips, teeth, tongue, soft palate, and jaw muscles. The chances of two or more persons having the same size of vocal cavities and the same manner of articulation are remote and unlikely. Whispering, muffling and nose-holding do not change the speech characteristic. The speech may be recorded and preserved in a good tape recorder. A known standard may also be recorded for purposes of comparison. Identification can be achieved through the sound spectrographs analysis.

LEGAL MEDICINE

c. Gait — A person, on account of disease or some inborn traits, may show a characteristic manner of walking.

(1) Ataxic gait — A gait in which the foot is raised high, thrown forward and brought down suddenly is seen in persons suffering from tabes dorsalis.

(2) Cerebellar gait — A gait associated with staggering movement is seen in cerebellar diseases.

(3) Cow's gait — A swaying movement due to knock-knee.

(4) Paretic gait — Gait in which the steps are short, the feet are dragged and the legs are held more or less widely apart.

(5) Spastic gait — A gait in which the legs are held together and move in a stiff manner and the toes dragged.

(6) Festinating gait — Involuntary movement in short accelerating steps.

(7) Frog gait — A hopping gait resulting from infantile paralysis.

(8) Waddling gait — Exaggerated alternation of lateral trunk movement similar to the movement of the duck.

In the normal process of walking the rear portion of the heel is placed on the ground. This is subsequently followed by the other parts of the heel and the sole of the foot is pressed on the ground. The toes are the last to be pressed followed by the lifting of the foot making another step forward. The pressure at the rear portion of the heel and in the region of the toes is the most forceful, hence the impression is the most.

During the process of running the foot marks are less distinct because of the slipping of the foot and the sand or soil thrown into the marks by the pressure of the tip of the toes.

Gait Patterns: A scientific investigation of the gait pattern may be useful

for purposes of identification and investigation of the crime scene. Gait pattern is the series of foot marks by a person walking or running. Examination of the gait includes the direction line, gait line, foot angle, principal angle and the length and breadth of the steps.

MEDICO-LEGAL ASPECTS OF IDENTIFICATION 45

at.. Gait pattern. A: direction line; B: gait line; C: foot line; D: foot angles;

E: principal angle; F: length of step; G: breadth of step.

(A) Direction line — Expresses the path of the individual. (B) Gait line — The straight line connecting the center of the

succeeding steps. It is more or less in zigzag fashion especially when the legs are far apart while walking. Stout, elderly people and those who want stability while walking have a more zigzag gait line.

(C) Foot line — The longitudinal line drawn on each foot mark. There may be a difference in the foot line of the left and right foot.

(D)Foot angle — The angle formed by the foot line and the direction line. In normal walking the foot angle is very characteristic of a person and cannot be altered immediately. However, it may be altered when a person is running, carrying a heavy weight or moving on a rugged terrain.

(E) Principal angle — The angle between the two succeeding foot angles.

(F) Length of step — When the distance between the center points in two successive heel prints of the two feet exceeds 40 inches, there is a strong presumption that the person is running.

(G) Breadth of step — The distance between the outer contours of two succeeding foot marks or steps. The more apart the legs are while walking, the greater is the breadth of the step. (Crime Detection by Ame Svensson & Otto Wendel, p. 58)

dr.'Mannerism — Stereotype movement or habit peculiar to an individual. It may be: (1) Way of sitting. (2) Movement of the hand. (3) Movement of the body. (4) Movement of the facial muscles. (5) Expression of the mouth while articulating. (6) Manner of leaning.

46 LEGAL MEDICINE

e. Hands and feet — Size, shape and abnormalities of the hands and feet may be the bases of identification. Some persons have supernumerary fingers or toes far apart with bony prominence. Some fingers or toes are with split nails.

Foot or hand marks found in the investigation of the crime scene may be:

(1) Foot or hand impression — This develops when the foot or hand is pressed on mouldable materials like mud, clay, cement mixture, or other semi-solid mass. The impression can be preserved by making a cast of it with plaster of Paris.

(2) Footprint or handprint — This is a footmark or handmark on a hard base contaminated or smeared with foreign matters like dust, flour, blood, etc.

t. Complexion — Complexion can be determined when the whole body is exposed preferably to ordinary sunlight. Dark complexion may be found fair with the use of bleaching chemicals, while fair complexion may temporarily be made dark with the use of an ointment with a dark pigment. Exposed parts of the body usually appear darker than those covered with clothing.

g. Changes in the eyes — A person identified because he is nearsighted, far-sighted, color blind, astigmatic, presbyopic, or crosseyed. The eye may have arcus senilis, artificial pupils, irregular marks of the spectacles or cataract. Color of the iris, shape of the eyes, deformity of the eyeball and the presence of disease are useful bases of identification.

h. Facies — There are different kinds of facial expressions brought about by disease or racial influence.

(1) Hippocratic facies— The nose is pinched, the temple hollow, eyes sunken, ears cold, lips relaxed and skin livid. The appearance of the face is indicative of approaching death.

(2) Mongolian facies — Almond eyes, pale complexion, prominence of cheek bones.

(3) Facies Leonine — A peculiar, deeply furrowed, lion-like appearance of the face. This may be observed in leprosy, elephantiasis and ,leontiasis ossia.

(4) Myxedemic facies — Pale face, edematous swelling which does not pit on pressure, associated with dullness of intellect, slow monotonous speech, muscular weakness and tremor.


Base up Base down

Triangular face

The face may be round, oval, triangular or slightly square.

Distinct identifying marks may be present on the face, such as, peculiarly attractive scars, moles, hair, nose and condition of the skin which an identifier may specially notice,

i. Left— or right-handedness — The preferential use of one hand with skill to the other in voluntary motor acts. Ambidextrous people can use their right and left hands with equal skill.

The best way to determine whether a person is left— or right-handed or ambidextrous is to observe him during his unguarded moments.

j. Degree of nutrition — The determination must be in relation to the height and age. A person may be thin, normal or stout. This point of identification easily changes by refraining from

/ intake of fatty foods. Some persons are inherently skinny / inspite of heavy intake of nutritive food.

^Points of Identification Applicable to Both Living and Dead before -Ouaul of Lrecomposition:

lÔeeupatirnttl Marfrff — Certain occupations may result in some characteristic marks or identifying guides:

48 LEGAL MEDICINE

a. A shoemaker develops depressed sternum. b. Painters have stains on the hands and fingernails. c. Engineers and mechanics may have grease on their hands. d. A dressmaker develops multiple punctured marks on finger

tips. e. Baker and miller may have flour dust on their clothings and

on their bodies. f. Mason have callosities on the palms of the hands. g. Scars caused by burns produced by scales or sparks or red hot

iron may be seen at the back of the hands of blacksmiths. h. Involuntary tattooing of particles of coal may be seen on the

hands of miners. i. Chemical stains may be present on the hands of dyers, photo

graphic developers and printers. 2. Race — In the living, race may be presumed in: *â. Color of the skin:

Caucasian — Fair Malayan — Brown Mongolian — Fair Negro — Black

b. Feature of the face: Caucasian — Prominent sharp nose Malayan — Flat nose with round face Mongolian — Almond eyes and prominent cheek bone Negro — Thick lips and prominent eyes

c. Shape of the skull: Caucasian — Elongated skull Malayan — Hound head Mongolian — Round head Ked Indians and Eskimos — Flat head

d. Wearing apparel — Casual and customary wearing apparel may indicate race as well as religion, nationality, region and custom.

3. Rtntiijp - A person ceases to increase in height after the age of "25. There is apparent shrinkage in height after a long standing debilitating disease. There is actual shrinkage in old age on account of the compression of the inter-vertebral and also the curvature of the spinal column. The growth of a person rarely exceeds five centimeters after the age of 18.

The rate of growth is variable but it is most active from 5 to 7 and from 13 to 16 years of-age. When the rate of growth is increased, the horizontal growth is relatively retarded.


Methods of Approximating the Height of a Person: If the body is complete the height can be determined by actual

measurement. Sometimes some part of the body is missing and the actual measurement may not be possible. The following are the methods to be used to approximate the height: a. Measure the distance between the tips of the middle fingers of

both hands with the arms extended laterally and it will approximately be equal to the height.

b. Two times the length of one arm plus 12 inches from the clavicle and 1.5 inches from the sternum is the approximate height.

c. Two times the length from the vertex of the skull to the pubic symphysis is the height.

d. The distance between the supra-sternal notch and the pubic symphysis is about one-third of the height.

e. The distance from the base of the skull to the coccyx is about 44% of the height.

f. The length of the forearm measured from the tip of olecranon process to the tip of the middle finger is 5/19 of the height.

g. Eight times the length of the head is approximately equal to the height of the person.

4. Tattoo marks — Introduction of coloring pigments in the layers _ 1 , of the skin by multiple puncture. Tattoo marks may be in the

form of initials, names, images or views.

Tattoo marks

so l e g a l medicine

Importance of Tattoo Mark: a. It may help in the identification of the person. The image

inscribed may reflect the name, date of birth, language spoken, religion, name of spouse, etc.

b. It may indicate memorable events in his life. c. It may indicate the social stratum to which the person belongs.

Generally, tattooing is practiced by the members of the lower economic class.

d. Lately, the presence of tattoo implies previous commitment in prison or membership in a criminal gang.

Factors Responsible for the Permanency of Tattoo: a. Whether the punctures are superficial or deep to reach the true

skin;

b. Nature and solubility of the pigment used. Ordinary pen ink disappears in a short time while carbon introduced to the true skin layer is usually permanent. Soluble pigments easily disappear and may be seen in the lymph glands.

Methods of Removing Tattoos: a. By surgical excision - Shallow tattoo may disappear by simple

rubbing or superficial incision and may leave no scar. Deep-seated tattoo may be excised and usually leaves a scar.

b. By electrolysis — The needle is inserted into the tattoo mark in a sufficient number of times using a current of 5 to 8 milliam-peres. This forms a superficial eschar, which drops off in a week or so taking the pigment with it and leaving a superficial scar.

c. By application of caustic substance — The caustic substance is applied to the tattoo mark and the pigment is removed with the eschar after inflammatory reaction.

h.Wejghtr— This is not a good point of identification for it is """"easily changed from time to time. 6. Deformities — Congenital or acquired — deformities may cause

^-Peculiar way -of walking, body movement, facial expression, mannerisms, etc. Deformity like clubfoot, harelip, cleft palate, cystic conditions, bony prominence, etc., may be corrected surgically.

Acquired deformities in the form of amputation, improper union of bones, depressed fracture, deforming scars may be the bases for identification.

T_Birth marks — Birth marks may be a spot naevi, port wine, or a Mongolianblue spot. They may be removed by carbon dioxide snow, electrocautery, or by excision. The marks must be des-


cribed as to shape, location, dimension, color and degree of pigmentation. rnj»riv>fl leaving permanent results — Amputation, improper union of fractured bones.

Q M o f g « — Ordinari ly they are permanent but can be removed by '""""electrolysis, by radium or by carbon dioxide snow. 10^Jfcgc--==--A-^maining mark after healing of the wound. The

fibrous tissue takes the place of the original tissue which has been injured or destroyed. A scar is devoid of specialized tissues so it does not contain pigment, sweat or sebaceous glands. Its number, exact location, size and shape, and whether it is elevated or depressed should be noted.

Faint scars may be made visible by making the surrounding skin red upon applying friction with hand or by heat.

Scar which develops after a secondary infection is usually marked.

Scar increases in size in proportion with the growth of the person.

Age of the Scar — A recently formed scar is slightly elevated, reddish or bluish in color, and tender to touch.

In a few weeks to two months, the scar has inflammatory redness and it is soft and sensitive.

Two to six months later, it becomes brownish or coppery red in color, free from contraction and corrugation, and soft.

When the scar is white, glistening, contracted and tough, it is not less than six months.

The period of scar formation may be delayed by sepsis, poor vascularity of the part involved, age, depth of the wound, mobility, presence of foreign body and health condition of the victim. Scar may or may not develop if the wound is small, superficial and healed by first intention.

Characteristics of the scar may show the cause of the previous lesion: a. Surgical operation — Regular form and situation with stitch

marks. b. Bums and scald — Scars are large, irregular in shape, and may

be keloid. Scar of scald may show stippled surface. c. Gunshot — Disc-like, depressed at center and may be adherent

to the underlying tissue. d. Tuberculosis sinus — Irregular in shape furrowed, with edges

hardened and uneven.

52 LEGAL MEDICINE

e. Flogging — Fine white lines diagonally across back, depressed small spot at interval.

f. Gumma — Depressed scar following loss of tissue. g. Lupus — Bluish-white scar. h. Venesection — At bend of elbow, on dorsum of foot, or on

temporal region. i. Wet cupping — Short parallel scars on lower part of the back

and loin. 11. Tribal marks — Marks on the skin by tattooing or branding. In CliiratrdtngTheated metal is pressed on the skin and during the

healing process a scar develops as a mark. The tribal marks are placed in the exposed parts of the body and used to identify person or membership of a tribe or social group.

12. Sexual orggjL=.Male organ may show previous circumcision. In lale"the uterus and breasts may show signs of previous preg

nancy. Previous gynecological operation may be seen in the abdomen.

13. Blood examination — Blood type, disease, parasitic infection or -to~xic substances piesent may be utilized to distinguish one person from another.

/ ^ IHROPOMETRV (Bertitton Systemy

Alphonse Bertillon, a French criminologist, devised a scheme utilizing anthropometrical measurement of the human body as the basis of identification.

Basjs'of the Bertillon System of Identification: l.X'he' human skeleton is unchangeable after the twentieth year. The

igh bone continues to grow somewhat after the period, but this 'is compensated by the curving of the spine which takes place at aboia the same age. /

2. It/is impossible to find two Jjuman beings having bones exactly like.

3/The necessary measurement can easily be taken with the aid of a simple instrument.

Information Included in the System: 1. Descriptive data — Color of the hair, eyes and complexion, shape „<of the nose, ear, etc;

Igdymarks — moles, scars, tattoo marks, deformities, etc. 3 .An thropoineti ivul measu remen ts:

"a.~Sotfy Mrasuromentii - H e i g h t ^ width of outstretched arms, and sitting height.


Side-view shapes of noses

b. Measurement of the head — Length and breadth of head, bizy-f—gouiatkal diameter, and length of the right ear.

the left middle and left little fingers, and length of left arm and hand from the elbow to the tip of the oustretched middle

In many instances an investigator does not have a picture of the wanted or missing person. The only way to have an idea of the prominent physical features is for the witnesses or someone who has knowjeiig£_af-±h*jdentity to tell him. <^Portrait parte' (spoken picture) is a verbal, accurate and pictures-

queoescTlptioii o t the person identified. „ Such information may be given by the witness, relatives, or other persons who are acquainted with the physical features of the person to be identified.

The following basic requirements must be included in the verbal description:

1. General impression: type, personality, apparent social status 2. Age and sex 3. Race or color 4. Height 5. Weight 6. Built — Thin, slender, medium or stout 7. Posture — Erect, slouching, round shoulder 8. Head — size, shape 9. Hair — Color, length, baldness

10. Face — General impression a. Forehead — High, low, bulging or receding b. Eyebrows — Brushy or thin, shape

"of the left foot, length of

finger.

54 LEGAL MEDICINE

c. Mustache — Length, color, shape d. Ears — Size, shape, size of lobe, angle of set e. Eyes — Small, medium or large; color; eyeglasses f. Cheeks — High, low or prominent medium cheek bones; flat or

sunken. g. Nose — Short, medium or big; or long; straight, aquiline or

flat or pug. h. Mouth — Wide, small or medium; general impression i. Lips — Shape; thickness; color j. Teeth — Shade, condition, defect; missing elements k. Chin — Size, shape, general impression 1. Jaw — Length, shape, lean, heavy or medium

11. Neck — shape, thickness, length; Adam's apple 12. Shoulder — Width and shape 13. Wrist — Size, shape 14. Hands — Length; size; hair; condition of the palms 15. Fingers — Length; thickness; stains; shape of nails; condition

of the nails. 16. Arms — Long, medium or short; muscular; normal or thin;

thickness of the wrist. 17. Feet — Size, deformities

If a skilled investigative illustrator is available, a picture of the person to be identified may be drawn or sketched. As a check to the sketch or drawing made, it must be shown to the person(s) who gave the information to see whether it tallies with the person to be identified.

If available, the investigator may look at what is commonly called rougue's galary or photographic files of wanted or missing persons for comparison with the cartographic sketch.

EXTRINSIC FACTORS IN IDENTIFICATION

1. Ornamentations — Rings, bracelet, necklace, hairpin, earrings, lapel pin, etc.

2. Personal belongings — Letters, wallet, driver's license, residence certificate, personal cards, etc.

3. Wearing apparel — Tailor marks, laundry mark, printed name of owner, size, style, and texture, footwear, socks.

4. Foreign bodies — Dust in clothings, cerumen in the ears, nail scrapping may show occupation, place of residence or work, habit, etc.

5. Identification by close friends and relatives.


6. Identification records on file at the police department, immigration bureau, hospitals, etc.

7. Identification photograph.

LIGHT AS A FACTOR IN IDENTIFICATION

1. Clearest moonlight or starlight: Experiments have shown that the best known person cannot be

recognized by the clearest moonlight at a distance greater than 16 to 17 yards and by starlight any further than 10 to 13 yards. a. Broad daylight:

A person can hardly recognized another person at a distance farther than one hundred yards if the person has never been seen before, but persons who are almost strangers may be recognized at a distance of twenty-five yards.

b. Flash of firearm: Although by experiment, letters of two inches high can be

read with the aid of the flash of a caliber .22 firearm at a distance of two feet it is hardly possible for a witness to see the assailant in case of a hold-up or a murder because: (1) Usually the assailant is hidden. (2) The assault is unexpected and the attention of the person or

witness is at its minimum. c. The flash of lighting produces sufficient light for the identifi

cation of an individual provided that the person's eye is focused towards the individual he wishes to identify during the flash.

d. In case of artificial light, the identity is relative to the kind and intensity of the light. Experiments may be made for every particular artificial light concerned.

/ JH. SCIENTIFIC METHODS OF IDENTIFICATION

Aspects o t Identification Requiring Scientific Knowledge:

^printing jS^Denfal Identification

.^^Handwriting .

Dudentification of Skeleton

E<^5etefmination of Sex .

F/f5e^0rfmnation of Age ,

Gîaentiflcation of Blood and Blood Stains

H. Identification of Hair and Fibers

56 LEGAL MEDICINE

A. FINGERPRINTING

Fingerprinting is considered to be the most valuable method of identification. It is universally used because: 1. There are no two identical fingerprints:

Fingerprints show unlimited and infinite varieties of form. Two or more fingerprints may grossly appear to be seemingly alike but under a microscope or the magnifying lens, the difference may be proven. The chances of two fingerprints being the same are calculated to be 1 to 64,000,000,000 which is ten times the number of fingers existing in the world.

2. Fingerprints are not changeable: Fingerprints are formed in the fetus in the fourth month of

pregnancy. During the latter stage of pregnancy as well as after birth, the pattern enlarges, but no changes take place in the number and arrangement of the friction ridges.

The finger may be wounded or burned, but the whole pattern with all its details will reappear when the wound heals. If the injury is deep or beyond the layers of the skin and scar develops, it will not deter identification. On the contrary, the scar will make a much deeper impression of the pattern. It can be said that fingerprints are an indelible signature which a person carries from the cradle to the grave.

* Practical Uses of Fingerprints:

•fTHelp establish identity in cases of dead bodies and unknown or missing persons.

2. Prints recovered from the crime scene associate person or weapon. 3. Prints on file are useful for comparative purposes and for the

knowledge of previous criminal records. Among illiterates, right thumbprint is recognized as a substitute for signature on legal documents. Countries differ as to which finger is used for the purpose. India uses the left thumb, Spain uses the right pointing finger.

^ / Dactylography is the art and study of recording fingerprints as a means of identification.

f Dactyloscopy is the art of identification by comparison of fingerprints. It is the study and utilization of fingerprints.

f -^Poroscopy is the study of the pores found on the pappillary or friction ridges of the skin for purposes of identification.

¥fW>LfgAt^peert of IOETWIC^TiON 57

Advantages of Using Fingerprinting as a Means of Identification:

1. Not much training is necessary for a person to take, classify and compare fingerprints.

2. No expensive instrument is required in the operation. 3. The fingerprint itself is easy to classify. 4. Actual prints for comparative purposes are always available and

suspected errors can easily be checked.

Methods of Producing Impressions: r Jt. Plain method — The bulbs of the last phalanges of the fingers and

thumb are pressed on the surface of the paper after pressing them /on an ink pad or ink plate with printing ink.

^ Rolled method — The bulbs of the thumb and other fingers are rolled on the surface of the paper after being rolled on an ink pad or ink plate with printing ink.

A Kinds of Impressions: 1. Real impression — Impression of the finger bulbs with the use of

^printing ink on the surface of the paper. Other coloring materials may be used but they are less visible and indelible.

k 2. Chance impression — Fingerprints which are impressed by mere chance without any intention to produce it. Chance impression maybe:

o

A Fingerprint

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a. Visible print — Impression made by chance and is visible with-out previous treatment. Impression made by the fingers smeared with some colored substances, like black ink, vegetable juice, may be visible immediately after impression.

b. Plastic print — Impression made by chance by pressing the finger tips on melted paraffin, putty, resin, cellophane, plastic tape, butter, soap, etc.

c. Latent print — Prints which are not visible after impression but made visible by the addition of some substances. Latent prints develop because the fingers are always covered with colorless residue of oil and perspiration which when pressed on smooth and non-absorbent material will cause the production of the prints.

ir How to Develop Latent Prints: (1) Application of fine powder — The choice of substance to

be used to make the latent prints visible depends upon the texture and color of the material where the suspicious prints are located. The color of the substances to be used must be in contrast with that material.

Characteristics of a good powder: (a) It should be adhesive to the extent that it clings readily

to the edges of the fingerprints. (b) It should not absorb water. (c) It should provide good contrast to the place where the

latent print is impressed.

The following substances are commonly used to make latent prints visible: (a) Graphite for spraying (b) Aluminum powder (c) Plaster of Paris (d) Copper powder for latent prints on leather (e) Metallic antimony

(2) Chemical development by fuming and immersion: Fuming by iodine or arsenic acid or immersion in a

solution of silver nitrate may develop latent prints.

How to Get Fingerprint Impressions on Dead Bodies: In cases of fresh dead bodies, the fingers are unclenched and each

one is inked individually with the aid of a small rubber roller. The paper where the print will be impressed will be placed in a spoon-shaped piece of wood and slowly and evenly rolled over the pattern. If the fist is too tightly clenched, a small incision may be made at


the base of the fingers. The contraction may also be overcome by dipping the hands in hot water.

If the so-called washerwoman's skin is not too marked on the fingerprints of dead bodies recovered shortly from bodies of water (floaters), the fingers may be dried off with a towel and glycerin is injected with a syringe under the skin of the finger tips in order to smoothen the surface. The fingerprints are then taken like that of a fresh dead body.

If the "floater" has been in a body of water for a longer time and the friction ridges have disappeared, the skin of the fingertips is cut away. This area of skin from each finger is placed in a small labelled test tubes containing formaldehyde solution. If the papillary ridges are still preserved on the outer surface, the person taking the prints places a portion of the skin on his right index finger protected by a rubber glove and then takes the print after inking the finger tip.

The same procedure as described may be applied to putrefied or burned bodies according to circumstances.

^Fypes of Fingerprint Patterns: 1. Arches — The ridges go from one side of the pattern to another,

never turning back to make a loop. a. Plain arches — The ridges on one side of the impression and

flow or tend to flow out the other side with rise or wave in the center.

b. Tented arch — One or more ridges at the center to form a definite angle of 90 degrees or less than 45 degrees from the horizontal plane.

2. Loops — One or more ridges enter on either side, recurves and terminate or tend to terminate on the same side from which it entered. a. Ulnar loop — Recurves towards the ulnar side of the hand or

little finger. b. Radial loop — Recurves towards the radial side of the hand or

thumb. 3. Whorls — Patterns with two deltas and patterns too irregular in

form to classify: a. Simple whorls — Consist of two deltas with a core consisting of

circles, ellipses, or spiral turning to the right or left. b. Central pocket loop- — It is like simple loop but in the core, one

may find one ridge which forms a convex towards the opening of the loop.

c. Lateral pocket loops — There are at least two loops opening at the same side.

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Four Primary Types of Fingerprint

> Whorl 4 Composite

d. Twin loop — There are at least two loops opening at the different sides.

e. Accidentals — There are no rules that can be made in this pattern. They are rare and often with more than two deltas.

/Poroscopy (Locard's method of identification): Examination of the ridges of the hands and fingers reveal to be

studded with minute pores which are the openings of ducts or sweat glands. These pores are permanent as the ridges are and differ in number and shape in a given area in each person. Poroscopy, as a means of identification, is applied when only a part of the fingerprint is available for proper means of identification.

Can fingerprints be effaced? John Dillinger, a notorious gangster and a police character at

tempted to erase his fingerprints by burning them with acid, but as time went by, the ridges were again restored to its "natural" feature. The acid he applied temporarily destroyed the epidermis of the bulbs of his fingers.

As long as the dermis of the bulbs of the finger is not completely destroyed, the fingerprints will always remain unchanged and indestructible.


Can fingerprints be forged? There is a considerable controversy regarding the possibility of

forging fingerprints or making a simulated impression or a perfect replica of impression of fingers. Various experiments were conducted by authorities and although they could almost make an accurate reproduction, still there is no case on record known or have been written that forgery of fingerprints has been a complete success. The introduction of modern scientific equipment, new techniques and up-to-date knowledge in crime detection will always foil the attempt. /

The role of the teeth iri human identification is important for the following reasons: 1. The possibility of two persons to have the same dentition is quite

remote. An adult has 32 teeth and each tooth has five surfaces. Some of the teeth may be missing, carious, with filling materials, and with abnormality in shape and other peculiarities. This will lead to several combinations with almost infinite in number of dental characteristics.

2. The enamel of the teeth is the hardest substance of the human body. It may outlast all other tissues during putrefaction or physical destruction.

3. After death, the greater the degree of tissue destruction, the greater is the importance of dental characteristics as a means of identification.

4. The more recent the ante-mortem records of the person to be identified, the more reliable is the comparative or exclusionary mode of identification that can be done. In order to make an accurate dental record available for purposes

of comparison with that of the person to be identified, Presidential Decree No. 1575 was promulgated, requiring practitioners of dentistry to keep records of their patients. It provides the following:

"Whereas, the identification of persons is a necessary factor in solving crimes and in settling disputes such as claims for damages, insurance, and inheritance; _

Whereas, in these cases where the identification of persons cannot be established through the regular means, identification through dentition has been proven to be necessary and effective;

Whereas, however, records of dentition of persons are often not available due to the lack of systematic recording of dental practitioners of the dental history of their patients.

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NOW, THEREFORE, I, FERDINAND E. MARCOS, President of the Philippines, by virtue of the powers vested in me by the Constitution, do hereby order and decree the following:

Section 1. It shall be obligatory upon all practitioners of dentistry to keep and maintain an accurate and complete record of the dentition of all their patients which shall include a history and description of the patient's dentition and the treatment made thereon.

Section 2. Upon the lapse of ten years from the last entry, dental practitioners shall turn over the dental records of their patients to the National Bureau of Investigation for record purposes: Provided, that the said practitioner may retain copies thereof for their own files.

Section 3. Any violation of the provisions of this Decree shall be punishable by a fine of not less than one hundred pesos but not more than one thousand pesos.

Section 4. This Decree shall take effect immediately. Done in the City of Manila, this 11th day of June, in the year of

Our Lord, nineteen hundred and seventy-eight." However, the absence of dental records will not absolutely negate

dental identification. Members of the family, close associates and friends may be witnesses to prove identity of dentition.

Causes of Unreliability of the Dental Records: An ante-mortem dental record may be available but may be in

sufficient, and in some instances unreliable for purposes of comparison with the post-mortem findings because: 1. The dentist, in the course of diagnosis and treatment of the

patient, may only concern himself with the affected teeth and may not care to have a detailed examination of the other teeth.

2. There may be no uniformity in nomenclature of the location and condition in the charting of the teeth.

3. Although there may be a law obliging dentists to have a record of their patient, the law does not mention the agency which will enforce it.

4. The dentist may have a record but may no longer be reliable on account of the lapse of time. There may be changes in the teeth which are not seen by the dentist.

For purpose of uniformity, the following are the description of location for dental identification: 1. Teeth position:

a. Anterior — From cuspid to cuspid inclusive (it includes cuspid, lateral and central incissor).


b. Posterior — All bicuspid and molar teeth.

2. Surface:

Occlosal — O — Surface which is in contact with the opposing teeth when jaws are in occlusion (closed).

Mesial — M — Surface in direct contact with the adjacent tooth towards the midline.

Distal — D — Surface in direct contact with the adjacent teeth away from the midline.

Buccal — B — Surface facing the lip or cheek.

Lingual — L — Inward directed surface of the teeth.

3. Restoration: Amalgam (silver filling), gold inlay, gold foil, silicate, acrylic,

temporary cement, crown.

4. Prosthesis: a. Fixed prosthesis — bridge b. Removable prosthesis:

(1) Complete denture (2) Partial denture

5. Root canal treatment (endodentia).

Dental Features Which May Be Included in the Description for Identification:

1. Malposition, overlapping, crowding and spacing teeth.

2. Number and location of deciduous or permanent teeth.

3. Missing (unerupted or extracted) or supernumerary teeth.

4. Peculiar shape, size, direction of growth of individual teeth.

5. Missing piece or fragment due to decay or trauma.

6. Restoration, prosthesis (surface, morphology, configuration and material).

7. Root canal therapy on x-ray examination.

8. Bone pattern on x-ray examination.

9. Complete denture (type, shade and material).

10. Relationship of bite.

11. Oral pathology (tore, gingival hyperplasia, etc.).

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Dental Chart

c - Caries AB - Bridge Abutment X — Indicated for Extraction P Pontic

RF — Retained Root Fragment -

Gold Clasp AM — Amalgam Filling Gl - Gold Inlay

S - Silicate Filling M - Missing due to Extraction CG — Gold Crown U N - Unerupted

Other Aspects of Identification Which May Be Reflected in Dentition:

1. Personal, occupational and cultural traits:

a. Cigarette smokers may have smoke marks mainly on the lingual surface of the anterior upper teeth.

b. Seamstress, carpenter, cobblers may hold pins or nails between incissors and may cause formulation of groove.

c. Wind instrument musicians may have altered position of their teeth due to mouth formation necessary for playing the instrument.

d. Pipe smokers may develop an oval-shape notch at the occlusal surface or irregular gaps located at the angle of the mouth.

e. Sandblasters and stone mason may cause abrasions on the labial or occlusal surface of their teeth.

f. Poor oral hygiene, with many decayed teeth and no restorations infers individual of low economic status. Extracted teeth are also not replaced by bridgework.

g. Excessive fruit juice drinker or carbonated drinks may cause dissolution of the enamel structure of the front teeth.

h. Mutilation of teeth by filing or inlaying with precious metals or stone, not done professionally, may indicate tribal customs and cultural peculiarities.


2. Age 9 yrs 12 permanent teeth (8 incisors and 4 molars). 11 yrs 20 permanent teeth (8 incisors, 8 premolar

and 4 molar). 13 yrs 28 permanent teeth and no deciduous teeth. 8 to 10 yrs Calcification begin at the 3rd molar. 25 yrs Root-ends of 3rd molar completely calcified. Beyond 25 yrs. . . . Ends of the root of the 3rd molar have been

completely calcified. After 30 yrs Carries frequently develop at the cementum.

There may be gingival recession, decay attack of the root surface.

3. Sex Examination for the presence of Barr bodies from palatal

scrappings. j

y/C. HANDWRITING

A person may be identified through his handwriting, handprinting and handnumbering. Sec. 23, Rule 132, Rules of Court — Handwriting, how proved:

The handwriting of a person may be proved by any witness who believes it to be the handwriting of such person, and has seen the person write, or has seen writing purporting to be his upon which the witness has acted or been charged, and has thus acquired knowledge of the handwriting of such person. Evidence respecting the handwriting may also be given by a comparison, made by the witness or the court, with writings admitted or treated as genuine by the party against whom the evidence is offered, or proved to be genuine to the satisfaction of the judge.

The genuiness of any disputed writing may be proven by any of the following ways:

JL. Acknowledgement of the alleged writer that he wrote it; Statement of witness who saw the writing made and is able to identify it as such; By the opinion of persons who are familiar with the handwriting of the alleged writer, or

4r By the opinion of an expert who compares the questioned writing with that of other writings which are admitted or treated to be genuine by the party against whom the evidence is offered.

Sec. 44, Rule 130, Rules of Court — Opinion of ordinary witnesses: The opinion of a witness regarding the identity of handwriting of

a person, when he has knowledge of the person or handwriting; the opinion of a subscribing witness to a writing; the validity of which is

6 6 LEGAL MEDICINE

Some Practical Uses of Handwriting Examination: (^Financial crimes (bogus checks, cr'xlit card fraud, embezzlement).

/fjDeath investigation (suicide notes, hotel registration cards, letter af explanation),

obberies (pawnshop notes, cashing of stolen checks), idnapping with ransom (demand note, threatening letter).

'Anonymous threatening letters. Falsification of documents (deeds of conveyance, receipts).

A \Bibliotics is the science of handwriting analysis. It is the study of documents and writing materials to determine its jgerqjineness or authorship. One who had acquired special knowledge of the science of handwriting for purposes of identification is known as JZibliotisl or more commonly known as handwriting expert or qualified question document examiner.

<A Graphology is the study of handwriting for the purpose of determining the writer's personality, character and aptitude. It is a pseudo-science and merely explains the characteristics of the handwriting reflecting the character, weakness, personal idiosyncracies, mannerisms and ambition of the writer. It must not be confused with bibliotics.

Handwriting is a complex interaction of nerves, memory and muscular movement. It is influenced by several factors and may be changed or modified during the life-span of a person.

Writing is a conscious act, but on account of a repeated act it becomes habitual and unconscious. The writer concentrates more on the subject-matter of the writing than on the way the letter are formed which make up the writing.

.Worry, anxiety, anger, fegling of insecurity, a g e , and drunkenness may cause variation of a person's handwriting. ~

k Movements in Writing: 1. Finger movement — The letters are made entirely by the action of

the thumb, the pointing and middle fingers. Such is found among

in dispute, respecting the mental sanity of the signer; and the opinion of an intimate acquaintance respecting the mental sanity of a person, the reason for the opinion being given, may be received as evidence.

In order for an ordinary witness to be qualified to express his opinion, it must be shown that he has some familiarity with the handwriting of the person in a way recognized by law.


children, illiterates and those to whom writing is an unfamiliar process.

2. Hand movement — The letters are produced by the action of the hand as a whole with the wrist as the center of action and with some action of the fingers. Most of the illegible, scratchy and angular writings of women are produced by such movement.

3. Arm movement — The movement in writing is made by the hand and arm supported with the elbow at the center of the lateral swing. Many of the good writings are written in this manner. There is more speed, rhythm and freedom in this way of writing.

4. Whole arm movement — The action is produced by the entire arm without any rest. The source of motion comes from the shoulder. Writing on a blackboard is a good example of whole arm movement.

The Form, Style and Characteristics of the Handwriting of a Person are Basically Determined By: A.Primary factors:

1. Survival of the letters are formed when a person begins to write. Children who were under the same tutelage during their initial period of learning how to write have the tendency to develop similar writing habits.

2. Inclusion of some characteristics due to admiration of a peculiar design in writing.

3. Identifying characteristics may be the result of the great volume of writing done.

4. The presence or absence of physical abnormalities or defects originating from illness, injury, psychological variations and other similar conditions.

B. Secondary factors: 1. The position of the writer, e.g. sitting, standing, lying, arm

high or low, and other similar variations not normally observed in his ordinary writing habit.

2. Temporary physical or psychological disturbances, such as excitement, fear, pain, exhaustion, injury to thd hand or arm, etc.

3. Other external temporary variables, such as writing without glasses, bad lighting, irregular surface, external interference.

4. Physical and chemical factors: a. Writing instrument:

(1) Ballpen — It. usually leaves rounded line showing no tip separation even when pressed heavily. Smudge may be deposited on the line. The ink, not being a true liquid,

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does not flow into the fibers and spread in the same way as fluid ink does.

(2) Fountain pen — The lines are more or less round but when pressure is increased there is separation of the nib which is easily detected. There is evenness in the flow of ink.

(3) Steel pen — There is unevenness in the flow of ink and leaves a scratchy appearance.

(4) Pencil — Lead of pencils is compose of graphite and clay with kaolin as binder. Soft pencils have greater proportion of graphite while hard ones have relatively more clay. Cheap quality pencils have frequently gritty impurities which scratch the paper, while high-grade pencils are free from such grit.

Paper: (1) Color — Color can be well appreciated with a good light.

Dirt, stain or fading condition may not show the true color of the paper.

(2) Surface appearance — It may be smooth or rough. The surface may be damaged or wrinkled.

(3) Watermarks - Exposure of the paper to a strong light may reveal the watermarks of the manufacturer or the type of paper.

(4) Weight and thickness — The thickness may be measured by means of the paper micrometer. Papers are designated in weight which is in turn related to the thickness of the sheet.

Ink: (1) Iron gallotannate ink — Commonly used in "blue-black"

ink and still the basis of the greatest number of commercial ink. The changes in the paper may provide some indications of the age of the writing.

(2) It may be a solution of a single or a mixture of dyes. This is a common constituent of "washable" inks.

(3) Logwood ink — Made of logwood extract with salts of iron, copper, or chromium.

(4) Carbon ink — It is a fine suspension in water of carbon with stabilizing agent. India ink is an example of this type of ink.

(5) Ballpoint ink — A thick suspension of dye in a liquid which is usually a drying oil (Crime Investigation, Physical Evidence and the Police Laboratory by Paul L. Kirk, p. 446).


Instruments Necessary in Questioned Document Examination: l j Photographic instruments are primarily used to view the writing

in sufficient magnification for detail examination and preparation of evidence for presentation in an investigative or judicial body.

2^Magnifying lens and stereoscopic binocular microscope — These two instruments are useful to determine line quality, quaver, uncertainty, patching, over-writing, crowding, and other unusual appearances of writing. Presence of obvious obliteration, erasure or alteration may become more visible.

3JUltraviolet lamp and infra-red radiaton — Chemical erasures may be made visible, invisible ink, writing may be made legible, identification of paper and resealing of the envelopes with different mucilage can be seen through these instruments, feasuring caliper,

lighting facilities.

>se of Handwriting Examination: LUWhether the document was written by the suspect. [2) Whether the document was written by the person whose signature

it bears. 3JWhether the writing contains additions or deletions.

^Whethe r the document such as bills, receipts, suicide notes or checks are genuine or a forgery.

Points to be Considered in Questioned Document Examination: Size, slant, spacing, proportion of the letters, speed and rhythm in

writing, shading and change of position in pen hold, pressure, pen-lift, initial and terminal strokes, alignment, etc.

Inasmuch as handwriting examination is basically comparative, the standard for such comparison must be suitable and sufficient. The greater the variation in a way of writing, the greater is the amount of standard writing needed to form a reliable impression.

Handwriting examination done by comparison with known standards: To determine whether a certain instrument or document has been

written by a certain person, it is necessary to compare the writings on such instrument or document with some standard writings of the same person for the purpose of comparison and determine the similarities.

The standard (exemplar) writings with which the questioned writing has to be compared are of two types: 1. Collected (procured) standards — These consist of handwriting

by the person who is suspected to have written the questioned document. It may be found in the private or public records of

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the person or from other possible sources. Provided it is clear and sufficient, it is the most appropriate standard.

2. Requested standard — These are standards made by the alleged writer of the document in question upon request of the examiner or the persons interested in the examination. Inasmuch as one of the characteristics of good exemplar is that it must be contemporaneous with the date the questioned document was made, the use of the requested standards is applicable only to recently


written questioned documents, like extortion letter, "poison" notes, letter of threat or ransom, etc.

Considering that it is a request from a suspected maker of the questioned document, there is a strong possibility for it to be written in a disguised way.

Steps to be Undertaken to Minimize Conscious Efforts to Disguise the Requested Standard: 1. The writer should be allowed to write sitting comfortably at a

desk or table and without distraction. 2. The suspect should not, under any condition, be shown the

questioned document or be provided with instructions on how to spell certain words or what punctuation to use.

3. The suspect should be furnished with a pen and a paper similar to those used in the questioned document.

4. The dictated text may be the same as the contents of the questioned document, or at least should contain many of the same words, phrases, and letter combinations found in the document. In handwriting cases, the suspect must not be given any instruction on whether to use upper-case (capital) or lower-case lettering.

5. Dictation of the test should take place at least three times. If the writer is making a deliberate effort to disguise his writing, noticeable variations should appear between the three repetitions. Discovering this, the investigator must insist upon continued repetitive dictation of the text.

6. Signature exemplars can best be obtained when the suspect is required to combine other writings with a signature. For example, instead of compiling a set of signatures alone, the writer must be asked to completely fill out twenty to thirty separate checks or receipts, each of which includes a signature.

7. Before requested exemplars are taken from the suspect, a document examiner should be consulted and shown the questioned specimens (Criminalistics by Richard Saferstein, p. 336).

Handwriting Characteristics of Illiterates: 1. They seldom follow any rule or baseline although at the beginning

a position above the baseline is taken which continues in an ascending or descending course. Baseline is the ruled or imaginary line upon which the writing rests.

2. The tendency of the writing is to be raised involuntarily in the last letters of the word made by the extension of the fingers while the hand is being held in a fixed position.

3. The loop letters are often slanted too much because the upstrokes are made too long or nearly straight.

72 LEGAL MEDICINE

4. Very unlikely to produce facsimile signatures in size, arrangement and proportion of parts.

5. The writing is not rhythmic, but made up of disconnected unskilled movement impulses which are not likely to be related in an exactly identical way.

6. Tremor or involuntary trembling is seen due to inability to control the pen in motion because of not being familiar with and self-conscious to the process of writing.

7. Formation and angle of letters are irregular and definitely show lack of knowledge of size and proportion.

8. Same speed is utilized from beginning to end and seldom is the pen raised to get a new adjustment.

9. Illiterate pencil-writing is usually produced with much pressure and may show the habit of wetting the pencil lead frequently.

10. In anonymous writing, illiteracy is indicated by faulty arrangement of words, lines, paragraphs and pages.

11. Combination of script forms and Roman capitals, or pen or pencil printing, containing freak forms, abbreviations or punctuation marks are individual creations.

Handwriting Characteristics of Old Aged Persons: X^Due to lack of muscular control, the handwriting will not usually

show fine lines continuously but the strokes are mostly rough and made with considerable pressure.

2^With the presence of tremor, the changes of direction are numerous and omission of parts of letters of strokes are common.

Z. The concluding parts are often made with a nervous haste and carelessness and they may be much distorted.

A\ Even with much tremor, the handwriting will usually show free connecting and terminal strokes made by the momentum of the hand.

J£ Often shows very uneven alignment and may disregard entirely a line near which they are written.

-o. Usually shows an unusual and erratic departure from its intended movement, particularly in the downward strokes.

"7. There is a loss of individual departure from its intended movement, particularly in the downward strokes.

,-8TThere is a loss of individual rhythm as indicated by malformation and irregularity of speed in the writing of small letters.

Disguised Writing: Disguised writing is the deliberate attempt on the part of the

writer to alter his writing habit by endeavoring to invent a new writing style or by imitating the writing of another person.

MEDICO-LEGAL ASPECTS OF IDENTIFICATION 7 3

Physical Methods of Disguising Handwriting: a. By changing the direction of the slant. The forger may employ

a backhand slant, instead of the usual forehand slant. b. By increasing or decreasing the speed in writing. c. By deliberate carelessness that will produce inferior style of

writing. d. By making the letters unusually large or small. e. The forger may use the left hand instead of the right hand. f. Hand printing may be substituted for script.

Characteristics of Disguised Writing: a. Inconsistent slant b. Inconsistent letter formation c. Change of capital letters d. Lack of free-flowing movement e. Lack of rhythm f. Unnatural starts and stops g. Irregular spacing h. Writing with unaccustomed hand (Criminalistics by Richard

Saferstein, p. 692).

Signature forgery: Signature forgery examination is the most common activity of a

questioned document examiner. A signature may be found on a document which appears that a person has participated in its execution and the person denied that he had signed it. Such signature may be found in checks, deeds of conveyance, anonymous letters, receipts, etc.

Classification of Signature Forgery: a. Traced forgery — The outlining of a genuine signature from one

document onto another where the forger wishes it to appear. Traced forgery is basically drawing and consequently lacks free natural movement inherent in a person's normal writing. Ways of Achieving Traced Forgery * (1) The paper wherein the signature is to be copied is placed

on top of the document containing the signature. By means of a strong light underneath, the forged signature is traced from the genuine, either directly or lightly by a pencil outline and then over-writing the pencil outline.

(2) By placing the paper to receive the signature tracing underneath the document bearing the genuine signature and by indented outline on the underneath page, or by interweaving the documents with carbon paper to produce a carbon outline on the forged paper.

7 4 LEGAL MEDICINE

b. Simulated forgery — An attempt to copy in a freehand manner the characteristics of a genuine signature either from memory of the signature or from a model. It is accomplished without outline.

The quality of the simulated signature varies with the writer's skill as a penman, the difficulty of the signature being imitated, the writer's ability to recognize and incorporate the details, his ability to concentrate on the important feature of the signature and his ability to discard all of his own natural habit of writing.

c. Spurious forgery — One prepared primarily in the forger's own handwriting wherein little or no attempt has been made to copy the characteristics of the genuine writing. (Modern Legal Medicine, Psychiatry and Forensic Medicine by W. Curran et ai, p. 1235).

The principle of identification of handwriting is also applicable to handprinting and handnumbering.

Typewriter Identification: The identification of the typing machine used in a questioned

document, like that in ballistics examination, may be on the basis of: 1. Class characteristics — those characteristics which serve to dis

tinguish it from any other machine, such as: a. Manufacturer's characteristics b. Size and design of the type c. Line and letter spacing

2. Individual characteristics: a. Defects in the type face — Unusual manner of letter formation

due to factory defect, misuse of the machine or wear and tear. b. Defects in the alignment — Malpositioning, spacing and align

ment may be modified by loosening of the hinges and positioning of the letters on account of wear and tear and changes in the spring pressure.

c. Other machine defects: (1) Skipping space (2) Irregular margin stops (3) Improper letter spacing (4) Improper ribbon actions

A typewriter has 44 keys with 88 characters, each operating independently of one another and each being capable of damage or having inherent defects. Consequently, a variety of combinations of these defects may be the basis of typewriter identification.

The questioned document may be compared with those made by the suspected typewriters.

Examination of Bones — Complete lay-out of the bones to determine duplicity

Vi and missing ones.

D. IDENTIFICATION OF THE SKELETON Occasionally, before a physician is called to examine a dead body,

the soft tissues have already disappeared and only the skeletal system remains. Ail the external identifications have already disappeared. In this particular case we resort to the study of bones. hi the examination of bones, the following points can be determined approximately: 1. Whether the remains are of human origin or not. 2. Whether the remains belong to a single person or not. 3. Height. 4. Sex. 5. Race. 6. Age. 7. Length of interment or length of time from date of death. 8. Presence or absence of ante-mortem or post-mortem bone injuries. 9. Congenital deformities and acquired injuries on the hard tissues

causing permanent deformities. How to Determine Whether the Remains Are of Human Origin or Not:

The shape, size and general nature of the remains, especially that of the head, must be studied. The oval or round shape of the skull and the less prominent lower jaw and nasal bone are suggestive of

76 LEGAL MEDICINE

human remains. A complete lay-out of the whole bones found and placing each of them on their corresponding places in the human body will be helpful. The presence of dental fixtures, rings on the fingers, earrings in the case of women, hair and other wearing apparels, together with the remains are strong presumption of human remains.

How to Determine Whether the Remains Comes from a Single Individual or Not:

A complete lay-out of the bones on a table in their exact locations in the human body is necessary. Any plurality or excess of the bones after a complete lay-out denotes that the remains belong to more than one person. However, congenital deformities as supernumery fingers and toes must not be forgotten. The unequality in sizes, especially of the limbs may be ante-mortem.

Height: Several formulae using different constants have been forwarded in

the approximation of the height of a person by measuring the long bones of the body. A. Actual measurement of the skeleton — To the actual length of the

skeleton add 1 to 1-1/2 in. for the soft tissue. •, B. Pearson's Formulae for the reconstruction of the living stature of

long bones, whose animal matters have disappeared and which are in a dry state.

Males Females S = 81.306 plus 1.880 F S = 72.844 plus 1 .945 F

= 70.641 plus 2.894 H = 71.475 DIUS 2 . 754 H = 78.664 plus 2.376 T = 74.774 plus 2 . 3 5 2 T = 89.925 plus 3.271 R = 81.224 plus 3 . 3 4 3 R

S = Stature F = Femur H = Humerus T = Tibia R = Radius

Remarks: 1. The femur is measured from the head to the apex of the inner

condyle. If the femur has been measured in the oblique position and not straight, add 0.23 for male and 0 . 3 3 for female to the length before using the above formulae.

2. The tibia is measured from the upper articular surface to the tip of the malleolus. If the tiDia has been measured with, and not without, the spine, subtract 0.96 for male, and 0 .87 cm. for female, from the length before using the above formulae.


3. The humerus and radius are measured in their greatest length. (Taylor's Principles and Practices of Medical Jurisprudence, S. Smith, 10th ed., Vol 1, p. 155).

4. Inasmuch as the formulae for male and female skeletons are different, it is necessary to determine the sex of the skeleton before the formulae may be applied.

C. Stature from bone:

Dupertuis and Hadden's General Formulae For Reconstruction of Stature From Lengths of Dry Long Bones Without Cartilage (Constant Terms in Metric and Adapted to English System)

Constant term to be added after calculations in previous column

Stature-bone length armula coefficient(s) Centimeters Inches

Male

(a) 2.238 (femur) 69.089 27.200 (b) 2.392 (tibia) 81.688 32.161 (c) 2.970 (humerus) 73.570 28.965 (d) 3.650 (radius) 80.405 31.655 (e) 1.255 (femur + tibia) 69.294 27.281 (f) 1.728 (humerus + radius) 71.429 28.112 (g) 1.422 (femur) + 1.062 (tibia) 66.544 26.198 (h) 1.789 (humerus) + 1.841 (radius) 66.400 26.142 (i) 1.928 (femur) + 0.568 (humerus) 64.505 25.396 (k) 1.442 (femur) + 0.931 (tibia)

+ 0.083 (humerus) + 0.480 (radius) 56.006 22.050

Female (a) 2.317 (femur) 61.412 24.178 (b) 2.533 (tibia) 72.572 28.572 (c) 3.144 (humerus) 64.977 25.581 (d) 3.876 (radius) 73.502 28.938 (e) 1.233 (femur + tibia) 65.213 25.674 (f) 1.984 (humerus + radius) 55.729 21.941 (g) 1.657 (femur) + 0.879 (tibia) 59.259 23.330 (h) 2.164 (humerus) + 1.525 (radius) 60.344 23.757 (i) 2.009 (femur) + 0.566 (humerus) 57.600 22.677 (k) 1.644 (femur) + 0.764 (tibia)

+ 0.126 (humerus) + 0.296 (radius) 57.495 22.636

78 LEGAL MEDICINE

(From: Forensic Medicine by Keith Simpson, 7th ed., p. 25.) D.Topinard and Rollet, two French anatomists devised a formula fo'

the determination of the height for males and females. Male Female

Length of Femur x 3.66 or 3.71 equals height Length of Humerus x 5.06 or 5.22 equals height Length of Tibia x 4.53 or 4.61 equals height Length of Radius x 6.86 or 7.16 equals height

(These formulae do not hold good in mixture of races.)

E. Humphrey's Table:

Humphrey made a table of the different height of bones for different ages and their corresponding statures.

F. Lacassagne made the following coefficient for the determination of height:

Bone Male Female Femur 3.66 3.71 Tibia 4.53 4.61 Fibula 4.58 4.66 Humerus 5.06 5.22 Radius 6.86 7.16 Ulna 6.41 6.66

E.Manouvrier made a formulae based on length of tibia, fibula, radius and ulna for the determination of height.

MANOUVRIER'S STATURE TABLE FOR FEMALES

ftbula Tibia Femur Cadaver Length

Humerus Radius Ulna

Mm. Mm. Mm. Cm. Mm. Mm. Mm. 283 284 363 / 140.0 263 193 203 288 289 3 6 8 ^ 142.0 266 195 206 293 294 , 373 144.0 270 197 209 298 299 378 145.5 273 199 212 303 304 383 147.0 276 201 215 307 309 388 148.8 279 203 217 311 314 393 149.7 282 205 219 316 319 398 151.3 285 207 222 320 324 403 152.8 289 209 225 325 329 408 154.3 292 211 228 330 334 415 155.6 297 214 231 336 340 422 156.8 302 218 235 341 346 429 158.2 307 222 239


346 352 436 159.5 313 226 243 351 358 443 161.2 318 230 247 356 364 450 163.0 324 234 251 361 370 457 165.0 329 238 254 366 376 464 167.0 334 242 258 371 382 471 169.2 339 246 261 376 388 478 171.5 344 250 264

Coefficients for smaller bone lengths than given above. x4.88 x4.85 x3.87 x5.41 x7.44 x7.00

Coefficients for greater bone lengths than given above. x4.52 x4.42 x3.58 x4.98 x7.00 x6.49

MANOUVRIER'S STATURE TABLE FOR MALES

Fibula Tibia Femur Cadaver Humerus Radius Ulna Length

Mm. Mm. Mm. Cm. Mm. Mm. Mm. 318 319 392 153.0 295 213 227 323 324 398 155.2 298 216 231 328 330 404 157.0 302 219 235 333 335 410 159.0 306 222 239 338 340 416 160.5 309 225 243 344 346 422 162.5 313 229 246 349 351 428 163.4 316 '232 249 353 357 434 164.4 320 236 253 358 362 440 165.4 324 239 257 363 368 446 166.6 328 243 260 368 373 453 167.7 332 246 263 373 378 460 168.6 336 249 266 378 383 467 169.7 340 252 270 383 389 475 171.6 344 255 273 388 394 482 173.0 348 258 276 393 400 490 175.4 352 261 280 398 405 497 176.7 356 264 283 403 410 504 178.5 360 267 287 408 415 512 181.2 364 270 290 413 420 519 183.0 368 273 293

Coefficient for smaller bone lengths than given above. x4.82 x4.80 X3.92 . . . x5.25 x7.11 x6.66

Coefficients for greater bone lengths than given above. x4.37 x4.32 x3.53 . . . x4.93 x6.70 x6.26

(From: Medical Jurisprudence by Gordon, Turner and Price, 3rd ed., pp. 354-355.)

80 LEGAL MEDICINE

F. Estimations of Total Foetal Length from One or More Bones (C.H. length)

Diaphysis of femur x 6.71 = Total height Diaphysis of tibia x 7.63 = Total height Diaphysis of humerus x 7.6 = Total height Diaphysis of radius x 9.2 = Total height Diaphysis of clavicle x 11.3 = Total height Diaphysis of lower jaw x 10.0 = Total height

(The lower jaw is measured from the symphysis menti to the tip of the condyle, the whole breadth of the mandibular symphy-seal surface placed flat along the blade of the calipers; Smith, 1943).

These ratios have been checked against the material recently obtained and have been found useful; they are not accurate during the early stage of embryonic life (Practical Forensic Medicine by Camp and Purchase, 1957, p. 29).

Determination of the Sex of the Skeleton: In determining the sex of the skeleton, the following bones must

be studied: A. Pelvis D. Femur B. Skull E. Humerus C. Sternum

A. Pelvis:

Differences Between a Male and a Female Pelvis:

Male 1. Heavier construction wall

more pronounced. 2. Height greater and flays off

its wall more pronounced. 3. Pubic arch narrow and less

round. 4. Diameter of the true pelvis

less. 5. Curve of the iliac crest

reaches a higher level. 6. Narrow greater sciatic notch. 7. Body of the pubis narrow. 8. Iliopectineal line sharp. 9. Obturator foramen egg-

shaped. 10. Sacrum short and narrow.

Female 1. Lighter construction wall less

pronounced. 2. Height lesser and flays off its

wall less pronounced. 3. Pubic arch wider and

rounder. 4. Diameter of the true pelvis

greater. 5. Curve of the iliac crest is of

the lower level. 6. Wide greater sciatic notch. 7. Body of the pubis wider. 8. Iliopectineal line rounded. 9. Obturator foramen tri

angular. 10. Sacrum long and wide.


B. Sternum: Length of body

Length of manubrium x 100 = 46.2 (male and 54.3 (female)

C. Femur: Pearson and Bell made a study of the sex difference in the

femur: Male Female

Right Left Right Left 1. Bicondylar width 80.147 79.404 70.123 69.886 2. Vertical diameter

of head 47.059 46.769 41.123 40.765 3. External condyle

oblique length 61.846 61.048 55.804 55.176 4. Vertical diameter

of neck 33.849 34.337 29.337 29.520 D. Humerus:

Dwight gives the following measurement for male and female bones (humerus):

Male Female 1. Vertical diameter of head 48.7 42.6 2. Transverse diameter of head 44.6 38.9

E. Cranium: Male Female

1. Less curve of shaft. 1. More curve of shaft. 2. Mastoid process larger. 2. Predominance of cranial roof

over cranial base Mastoid process smaller.

3. Cranium placed horizontally 3. Cranium placed horizontally rests on mastoid process. rests on the occipital and

maxilliary bones. 4. Styloid process shorter. 4. Styloid process longer and

slender. 5. Forehead higher and more 5. Forehead less high and more

oblique. vertical. 6. Superciliary ridges less sharp 6. Superciliary ridges sharper,

or more rounded. 7. Zygomatic arches and frontal 7. Zygomatic arches and frontal

sinuses more prominent. sinuses less prominent. 8. Lower jaw larger and wider. 8. Lower jaw narrower and

lighter and chin not projecting.

82 LEGAL MEDICINE

9. Face larger in proportion to 9. Face smaller in proportion to the cranium. t n e cranium.

Determination of the Race of the Skeleton: It is becoming more difficult to determine the race because of the

amalgamation of races. For practical consideration there is hardly no race that is absolutely pure.

The following points may be used in determining the race in the remains of a person:

A. Extrinsic Factors: 1. Color of the skin 2. Facial features 3. Nature of the hair 4. Mode of dressing

B. Indices: 1. Skull:

Maximum width of the skull „ - n n

a. Cephalic Index = M axunum length of the skuLl X 1 0 0

Below 70 — Hyperdolico-cephalic 70 — 74.9 — Dolico-cephalic — Semato — Caucasian 75 — 79.0 — Mesaticephalic — Mongolian 80 — 84.9 — Brachycephalic — Malayan

u o u-4. i T A Height of the orbit b. Orbital Index = w,.T..—ttt x 100 Width of the orbit Above 89 — Megasemes — Mongolian 84 — 89 — Mesosemes — Semato-Caucasian Below 84 — Microsemes — Malayan

, T , Breadth of the base , n n c. Nasal Index = • —r—r *~ x 100 Length of the nose

Above 53 — Platyrrhine — Malayan 48 — 53 — Mesorrhine — Mongolian Below 48 — Leptorrhine — Semato — Caucasian

TT0;„uf T„ . Height of the skull , A _ Height Index = z—~———.—.—_ x 100 Length of the skull

2. Pelvis:

Pelvic Index = Anteroposterior diamete^ x 1 Q Q

Transverse diameter Below 85 — Platypellic — Semato — Caucasian 86 — 95 — Dolicopellic — Malayan Above 95 — Mesopellic — Negroes


Other Differential Racial Characteristics of Skeletons:

1. Skull 2. Forehead 3. Face

4. Upper Extremity

5. Lower Extremity

Caucasian Elongated Raised Proportionately small

Small

Normal

Mongolian Square inclined Small

Small

Small

Negro Narrow and elongated Small and compressed Malar bones and jaw projecting; teeth set obliquely Long in proportion to body; forearm large in proportion to arm; hand small

Leg6 large in proportion to thighs; feet wide and flat, heel-bones projecting backwards.

AGE: Aside from the size of the bones and dental examination, the age

of the person to whom the skeleton belongs may be determined by:

, T L . . . T , Pubis length x 100 b. Ischium-pubis Index = —=—— :——— Ischium length

Caucasians (200 cases): <90=Male; 90-95=Sex?; > 95= Female Negroes (100 cases): < 84= Male; 84-88=Sex? ; > 88= Female. (GradwohVs Legal Medicine by Camps, Lucas & Robinson, 3rded.,p. 112).

3. Extremities: , , Length of the lower leg .. _ r t

a. Crural Index = 7 — * . .. r x 100 Length of the upper leg

95 — 98 — Semato-Caucasian 98 —102 — Mongolian and Malayan

, , _ Length of humerus + length of radius x 100 b. IntermembralIndex = — — — — 7 7 — — — — . . . . .

Length of femur + Length of tibia (Modi p. 22) Indian — 67.27 European - 70.4 Negroes —70.3

, t j Length of humerus 1 „„ c. Humero-femoral Index = -=— . . x 100

Length of femur

84 LEGAL MEDICINE

1. Appearance

1 year

2 years

3 years

4 years

5 years

6-7 years

8-9 years

10-11 years

12-14 years

of the ossification centers: External cuneiform, capitate, hamates heads of humerus, femur, tibia. Lower epiphysis of tibia, lower epiphysis of fibula, capitulum of humerus, first four metacarpal heads. Internal cuneiform, tarsal, navicular, triquetrum phalanges, patella. Midcuneiform, lunate, upper end of fibula, greater trochanter of femur. Scaphoid, trapezium, carpal, navicular, greater tubercle of the humerus, lower end of the fibula. Upper end of the radius, lower end of ulna, trapezoid, scaphoid. Internal epicondyle of the humerus, rami of ischium and pubis, olecranon. Epiphysis of os calcis, pisiform, trochlea of humerus, lesser trochanter of femur. External epicondyle of the humerus, patella complete. Acromion, iliac crest. Tuber ischia. Inner clavicle.

Textbook of Medical Jurisprudence Toxicology by 39).

14-16 years 17-19 years 20-21 years

(A Simplified C.K. Parikh, p.

2. Union of Bones and Epiphyses: Anterior fontanelles should be closed. The condylar portion of the occipital bone fuses with the squama; the metopic suture also closes. The greater tubercle fuses with the head of the humerus. The condylar portion of the occipital bone fuses with the basi-occiput. The ilium, pubes and ischium should meet in the acetabulum, rami of ischium and pubis fuse. Ilium and pubes should be united but still separable on maceration. The epiphysis of os calcis (calcaneum) joins the bone; the coracoid should be united to the scapula. The olecranon should be united to the ulna. The head of the radius and the lower end of the humerus should be joined to their respective shaft. The internal condyle should be united to the humerus.

1-1/2 years

CO

years

4 years

5 years

9 years

13 years

15 years

16 years 16-17 years

17-18 years


18-20 yean The head of the femur should have joined diaphysis; the epiphysis of long bones of the hand and foot should have united to the diaphyses; the basi-occiput should be fused with the basisphenoid.

20 years The epiphyses of the fibula should be united to the diaphysis. Distal radius unites.

22 years The inner (secondary) epiphysis of the clavicle fuses. 25 years The crest of the ilium and the articular facts of the

ribs should be united, if all the epiphysis have united, the person is above 25 years of age.

(A Simplified Textbook of Medical Jurisprudence & Toxicology by C.K. Parikh, p. 40).

3. Dental Identification (supra p. 61)., 4. Obliteration of cranial sutures (see illustration).

4U-50 20-3Q

MOLAR root calcification more important than eruption

Approximate time of closure of cranial sutures. The inner aspect closes several years before the outer as a rule. Molar tooth root calcification is also noted.

Determination of the Duration of Interment: The period from the time of death up to the time of examination

may be determined by the nature and presence of the soft tissues and the degree of erosion of the bones. Ordinarily, all the soft tissues in a grave disappear within a year. However, it is influenced by several factors.

86 LEGAL MEDICINE

Fragmentation and erosion of bones after a long burial

The Bases of the Estimate for Duration of Interment are: 1. Presence or absence of soft tissues still adherent to the bones. 2. Firmness and weight, brittleness, dryness of the bones. 3. The degree of erosion of the surface of the bones. 4. The changes in the clothings, coffin, and painting. Determination of the Presence or Absence of Ante-Mortem or Postmortem Injuries:

Individual bones must be examined in detail for possible fractures. Importance must be laid on whether these injuries in the bones occurred during life or in the process of exhumation. Note the presence of vital reaction, principally the signs of repairs. Superimposed Photography:

This is a special method of determining the person to whom the skull belongs. The negatives of the picture of the skull and the suspected individuals are superimposed and printed. This will show whether the contour of the skull fits the contour of the face of the suspected person.

E DETERMINATION OF SEX / Legal Importance of Sex Determination: 1. As an aid in identification:

Habit, social life, manner of dressing, physical features and


inclination are generally dependent on the sex. These points are useful in identification.

2. To determine whether an individual can exercise certain obligations vested by law to one sex only:

3. Marriage or the union of a man and a woman: Any male of the age of sixteen years or more, and any female

at the age of fourteen years or more, not under any of the impediments mentioned in articles 80 to 84, may contract marriage (Art. 54, Civil Code).

4. Rights granted by law are different io different sexes: Majority commences upon the attainment of the age of twenty-

one years (Art. 402, Civil Code). Notwithstanding the provisions of the preceding article, a

daughter above twenty-one but below twenty-three years of age cannot leave the parental home without the consent of the father or mother in whose company she lives, except to become a wife, or when she exercises a profession or calling, or when the father or mother has contracted a subsequent marriage (Art. 403, Civil Code).

5. There are certain crimes wherein a specific sex can only be the offender or victim: a. In rape (Art. 335, Revised Penal Code), seduction (Art. 337 &

338, Revised Penal Code), abduction (Art. 342 & 343, Revised Penal Code) or abuse against chastity (Art. 245, Revised Penal Code) a woman is the victim.

b. In case of prostitution, the offender must be a woman: For purposes of this article, women who, for money or

profit, habitually indulge in sexual intercourse or lascivious conduct, are deemed to be prostitutes (Art. 202, No. 5, Revised Penal Code).

c. In adultery the offender is a married woman and in concubinage the offender is a husband.

Differences in the social role of the sexes used to be clearly marked but now they are less than they used to be. Dress, hairstyle, general bodily shape provide an immediate and accurate answer to the vast majority of cases.

V

above, ÂA^H

(sts to Determine the Sex: pocial test:

88 LEGAL MEDICINE

Genital test: The presence of penis indicates a male, its absence and the

presence of a vaginal opening, indicates a female. We may look for the testes in the scrotum and if they are absent we must not conclude that the individual is not a male. They may be in the abdomen or inguinal canal undescended.

3. Gonadal test: Presence of testes in male and ovary in female. This will in

volve exploration of the abdomen and in some cases a histological examination of the gonad to see whether its microscopic structure is characteristically ovarian or testicular.

4. Chromosomal test: f^-^t* *~W-cT Shortly after the war, Barr noticed that there was a difference

between cells derived from men and women suitably stained and examined under the microscope. The nucleus of the cells is a densely staining area in the cell itself and Barr noticed that there was a small part of nucleus which stained deeply than the rest in woman's cells but not in cells from men. He observed this in white cells from the blood and cells obtained by scraping the mucous membrane of the mouth. This is called Barr bodies. (Medico-Legal Journal, Part 3, Vol. 40, p. 79).

Problems in Sex Determination: Sex determination may be possible and can scientifically be

distinguished on account of the biological structure differences; however, in the following instances there will be no way to determine the sex: 1. Gonadal agenesis — Sex organs (testes or ovaries) have never devel

oped. 2. True hermaphrodism — A state of bisexuality. The gonads of both

sexes are present which may be separated or combined as ovotestis.

<fc Evidences of Sex: 1. Presumptive evidences: (a) General features and contour of the face. cK^Presence or absence of hair in some parts of the body. @ Length of the scalp hair. Generally, the female has long hair in

the scalp than that of the male. (ji/Clothes and other wearing apparel, but not in a transvestite.

Transvestism is a form of sexual deviation characterized by an overwhelming desire to assume the attire and be accepted as a member of the opposite sex.

f eJ Figure — Females have prominent pelvis, while those of the males are slender.


(P Habit or inclination — Pseudohermaphrodite* are persons who have the gonadal tissue of one sex and the behavior of the opposite sex,

g} Voice and manner of speech.

The Important Distinguishing Presumptive Characters between the Two Sexes are as follows:

Female a. Hips are broader in rela

tion to shoulders. b. Generally smaller build. c. Breasts developed.

d. Adam's apple (Thyroid cartilage) not prominent.

e. Striae present on breasts, abdomen and buttocks in ladies who have borne children.

f. Pubic hair straight and stop short above the mons-veneris.

g. Hair absent on face, abdomen and chest.

h. Female skull is smaller h lighter, and has thin bones and smooth,

i- Trunk abdominal segment i larger.

j . Thighs conical. j

(From: Handbook of Forensic Medicine Chadha, IVth ed., p. 68).

Male Shoulders are broader than hips. Larger build. Generally not developed, very rarely and may be developed in cases like gynaecomazia. Adam's apple prominent.

e. Striae absent.

Pubic hair thick, curved upward extending up to umbilicus. Hair present on chest and face moustaches, beard, etc. Male skull is longer, heavier and of thick bones.

g

Trunk abdominal segment smaller. Thighs cylindrical.

and Toxicology by Dr. P. V.

2. Highly probable evidences of sex:

(a^Possession of vagina, uterus and accessories in female, and penis , in male.

( j p Presence of developed and large breasts in female. c. Muscular development and distribution of fat in the body.

3. Conclusive evidence: aJ Presence of ovary in female and testis in males. ( p i

90 LEGAL MEDICINE

Evidence of Sex in Mutilated or Decomposed Body: 1. General physical and muscular development. 2. Hairiness of the scalp, face, chest, pubes and other parts of the

body. 3. Prominence of the Adam's apple. 4. Amount of subcutaneous fat in specific parts of the body. 5. Presence of linea albicantes, enlarged nipple, cutex in fingernails

and lipstick or coloring materials. 6. Presence of prostate gland in male or uterus and ovary in female.

If in doubt, a microscopic examination must be made on the suspicious ovarian or testicular tissue.

F. DETERMINATION OF AGE ^

Legal Importance of Determination of Age: jtAs an aid to identification:

Mention of the age of the wanted or missing person will create an impression of the physical characteristics, social life and psychic and mental behavior of that person. Although it may only be presumptive, it may be useful in identification.

'^Determination of criminal liability: Art. 12, Revised Penal Code — Circumstances which exempt

from criminal liability — The following are exempted from criminal liability:

1 2. A person under nine years of age. 3. A person over nine years of age and under fifteen, unless he

has acted with discernment, in which case, such minor, shall be proceeded against in accordance with the provisions of article 80 of this code.

^Di Determination of right of suffrage: Suffrage shall be exercised by citizens of the Philippines not

otherwise disqualified by law, who are eighteen years of age or over, and who shall have resided in the Philippines for at least one year and in the place wherein they propose to vote for at least six months preceding the election. No literacy, property, or other substantive requirement shall be imposed on the exercise of suffrage. The Batasan Pambansa shall provide a system for the purpose of securing the secrecy and sanctity of the vote (Art. VI, Sec. 1, Philippine Constitution as amended in 1984).

Ji. Determination whether a person can exercise civil rights: Majority commences upon the attainment of the age of twenty-

one years.

MEDICOLEGAL ASPECTS OF IDENTIFICATION

The person who has reached majority is qualified for all acts of civil life, save the exceptions established by this Code in special cases. (Art. 402, Civil Code).

^.Determination of the capacity to contract marriage: Any male of the age of sixteen years or upwards, and any

female of the age of fourteen years or upwards, not under any of the impediments mentioned in articles 80 to 84 may contract marriage (Art. 54, Civil Code).

<As a requisite to certain crimes: ArRape — Rape is committed by having carnal knowledge of a

woman under any of the following circumstances:

1. By using force or intimidation;

2. When the woman is deprived of reason or otherwise unconscious; and — ^

3. When the woman is under/twelve years of agej even though neither of the circumstanceTm^ntioned in the two preceding paragraphs shall be present (Art. 335, Revised Penal Code).

Înfanticide — The penalty provided for parricide in article 246 and for murder in article 248 shall be imposed upon any person who shall kill any child less than three days of age (Art. 255, Revised Penal Code). ^ », JLIH^

prSeductions:

(lyGualified seduction — The seduction of a virgin over twelve years and under eighteen years of age, committed by any person in public authority, priests, house-servant, domestic, guardian, teacher, or any person who, in any capacity, shall be entrusted with the education or custody of the woman seduced, shall be punished by prision correccional in its minimum and medium periods (Art. 337, Revised Penal Code).

(2împle seduction — The seduction of a woman who is single or a widow of good reputation, over twelve but under eighteen years of age, committed by means of deceit, shall be punished by arresto mayor (Art. 338, Revised Penal Code.

d. Consented abduction — The abduction of a woman victim over twelve and under eighteen years of age, carried out with her consent and with lewd designs shall be punished by the penalty of prision correccional in its minimum and medium period (Art. 343, Revised Penal Code).

I LEGAL MEDICINE

' Determination of the Age of the Fetus: 1. Application of the Hess's Rule or Haase's Rule:

a. For fetus of less than 25 cm. long (Crown-feet length) — Get the square root of the length in centimeter and the result is the age of the fetus in months.

Example: If the length of the fetus is 16 cm., the age is 4 months.

b. For fetus 25 centimeters or more — Divide the length of the fetus by 5, and the result is the age in month.

Example: If the length of the fetus is 40 cm., the age is 8 months.

(The age referred to in this rule is lunar month, not calendar month. One lunar month is equivalent to 28 days.)

2. Examination of the product of conception:

Age Nature of the product of conception 1 month — Ovum is about 1.0 cm. long, weighing about 2.6 gm.

The eyes are seen as two dark spots and limb buds present.

2 months — The ovum is about 4.0 cm. long and weighs about 10 gram. Eyes and nose are recognizable. Clavicle, mandible, ribs and vertebra show the center of ossification. Anus is seen as a dark spot.

3 months — Length is 8 cm. weighing 30 gms. Nails begin to appear as thin membrane on the fingers and toes. Fiacenta is formed. Sex organs have appeared Ossification has begun in most of the bones.

4 months — Length is 13 cm. weight 204 gm. Sex can be distinguished; Skull is partly ossified, with wide sutures and f ontanelles. Lanugo hair is visible on the body. Convolution of the brain begins to appear.

5 months —

6 months —

Length is 23 cm. and weight is 450 gm. Skin begins to be covered with vernix caseosa. Ossification center in os calcis. Dental gum appears at the mandible.

Length is about 30 cm.; weight is about a kilo. Skin is still wrinkled but subcutaneous fat is beginning to form. Hair appears on the head. The eyebrows and eyelashes are beginning to form. The eyelids are adherent. The testicles lie close to the kidneys. Meconium is seen in the upper part of the large


intestine. The centers of ossification are seen in the four divisions of the sternum. Length is 18 cm. Weight is 1.5 kg. Eyelids are open. Testicle is beginning to descend into the scrotum. Nails do not reach the tips of the fingers. Lanugo hair is disappearing from the face. Primary center of ossification of talus has appeared. Body is dark red and plump, with hair on the scalp. The child is viable (28 weeks). Length is 42 cm. Weight is 2 to 2-1/5 kg. Skin is only slightly wrinkled and flesh-colored. Lanugo hair is beginning to be shed. Testicle is generally in the scrotum. Nails reach the end of fingers. Convolutions of the brain are more distinct. Pappillary membrane disappears. The skin is red but not wrinkled. The length is about 45 to 50 cm. and weighs about 3 to 3.5 kg. Skin is with slight wrinkles. Scalp is covered with dark hair. Nails have grown over finger tips. Testes have descended to the scrotum. Vemix caseosa present over flextures of joints and neck folds. Meconium is seen at the end of the large intestine. Ossification center appears at the lower end of the femur. Signs of maturity is present.

Age Determination During Infancy: 1. Age based on height or weight:

a. Height: New bom full term child — 50 cm. After 6 months — 60 cm. After one year — 68 cm. After 4 years — Double the birth height (one

meter) b. Weight:

Newly born full term child — 2.5 to 3 kg. Roughly a child increases in weight by 0.5 kg. per month. At the end of 6th month — Child doubles the birth weight. At the end of one year — Child weighs three times the

birth weight. The estimation of the age utilizing the weight and/or the height

is not quite useful inasmuch as there is a difference in the rapidity of growth not only in children of different sex, but also in children of the same sex.

2. Physical characteristics of infant: Newly bom — Skin covered with vernix caseosa and red.

Meconium present in the rectum.

7 months —

8 months —

9 months —

94 LEGAL MEDICINE

Lanugo hair almost disappeared. Limbs and body plump. Scalp hair about 2 inches long ( 5 cm.).

After 24 — Skin firm and less red. hours Umbilical cord shrivelled, soft and bluish in

color. Lungs more or less distended with air. 2nd to 3rd — Skin with yellowish tinge. day Skin sometimes with cracks and with sepa

ration of the scales. Umbilical cord brown and dry.

3rd to 4th —Skin becomes more yellow. Umbilical cord day brownish-red, flattened, semi-transparent and

twisted. 4th to 6th — Umbilical cord separates from abdomen, day Foramen ovale partly close. 6th to 12th — Cicatrization of the umbilical cord.

Ductus arteriosus close.

Age Determination in Childhood and Adulthood:

1. Age based on the eruption of teeth:

a. Temporary (deciduous or milk) teeth: Central incisor (lower) 6th month Central incisor (upper) 7th month Lateral incisor (upper) 9th month Lateral incisor (lower) 1 Oth month First molars 12th month Canines 18th month Second molars 2nd year

b. Permanent teeth: First molar 6th year Central incisors 7th year Lateral incisors 8th year First bicuspid 9th year Second bicuspid 10th year Canines 11th year second molars 11th-12th year Third molars 17th-18th year or at

any period later

2. Appearance of ossification centers (Supra p. 84).

3. Union of epiphysis with shaft of bones (Supra p. 84).

4. Obliteration of cranial sutures (Supra p. 85).


Other Points to Consider in the Determination of Age: 1. Growth of pubic hair, beard and mustache:

The pubic hair begins to appear at the age of 13 in female and 14 in male. The growth of thick dark hair is well marked on the pubes, scrotum and in the axillae at about 16 to 17 years of age. Mustache and beard begin to appear in male at the age of 16 to 18.

2. Changes of the breast in female: The development of the breast in female commences at the

age of 13 to 14. The degree and the commencement of development may be influenced by habit and social environment.

3. Development of the voice: Males develop low tone voice between the age of 16 to 18,

while females change their voice on the same period. Males become low pitch while females become high pitch.

4. Changes in color of the hair: The black color of the hair becomes gray after forty. Silvery-

white color may be seen in advanced old age. Sometimes gray hair appears in younger people or may appear suddenly after extreme terror, grief or shock. Localized areas of gray hair may be due to neuralgia or other diseases of the fifth cranial nerve. Pubic hair may turn gray at the age of 50.

5. Grade or year in school or college: Usually children enter the primary school at the age of 7.

They finish high school at the age of 17. Graduation in a collegiate course depends on the number of years required for the course.

6. Menstruation in women: Menstruation usually commence at the age of 12 but in warm

countries it may start at an earlier age. 7. Degree of mental development. 8. Manner of dressing, self-beautification and social life. 9. Atheromatous changes of blood vessels, opacity of the lens

and cornea (arcus senilis). 10. Wrinkleness of the skin usually appears after forty.

IDENTIFICATION OF BLOOD AND BLOOD STAINS

Legal Importance of the Study of Blood: Y^For disputed parentage (maternity nnd paternity):

a. Disputed paternity may arise: (1) When the wife committed adultery and the husband denied

to be the father of the child.

96 LEGAL MEDICINE

{2) When a child was born out of lawful wedlock and the mother claimed someone to be the father but he vehemently denied it.

(3]T In a claim for support or right of succession of the alleged illegitimate child,

b. Disputed maternity may arise: fflTTn case of allegation of jnterchange of children in a hospital

or nursery home, either accidentally or deliberately. (•2ffn cases of wayward or stray children being claimed by two

or more women. (-SfFor ownership of dead fetus or newly born child found in

street trash. tSC'vrcumstantial or corroborative evidence against or in favor of the

perpetrator of a crime: Example:

"A" was found dead with a deep stab wound on the chest. "B" was found with a kitchen knife in his hand stained with blood. Examination of the weapon showed that the stain was blood of human origin and belonging to the same group as that of the deceased "A". With such result of the examination, the investigating authorities have a very strong presumption that " B " was the one who committed the crime.

^Determination of the cause of death: The amount of blood or blood stains found in the scene of the

crime or found inside the body of the deceased outside the blood vessels may imply that the cause of death of the person is hemorrhage.

^Determination of the direction of^ escape of the victim or the assailant:

The shape of the blood or blood stains will give the investigator an idea on the direction of the source of blood. Usually, in small drops, the tapering end of the blood spot is towards the direction of the moving source of blood.

^Determination of the approximate time the crime was committed: Although there are variations as to the color and soluble

changes as to regards the age of the stain, we can only say that when there is too much change, it is not very recent.

•^Determination of the place of commission of the crime. ^Determination of the presence of certain diseases.

Problems to be Answered in the Examination of Blood: -tTDetermine whether the stain is due to blood. Aril due to blood, determine whether it is of human origin or not.


3flf it is of human origin, to what group does it belong? 4rDoes it belong to the person in question? grThe manner, degree and condition of the article which have been

stained. fVAge of the stain.

PRELIMINARY OR GROSS EXAMINATION OF THE STAIN: 1. Determine the material, make, color of the article stained. 2. Note which surface has been stained and the color of stain. Recent

blood stains are dark-red. 3. Study the direction of the origin of the blood stain. The spot of

blood is usually tapering towards the direction of the source. A fall will give a splash appearance.

4. For small and discolored stains, the use of a lens or ultra-violet light may be useful.

5. Determine the amount by the degree of soaking, size and intensity of color.

PHYSICAL EXAMINATIONS: 1. Solubility test:

Recent blood shed is soluble in saline solution and imparts a bright red color.

Stains which have been exposed to air become dry; hemoglobin is transformed to meth-hemoglobin or hematin. If the stain has been kept in damp places for a long time; hemoglobin is transformed to hematin.

2. Heat test: Solution of the blood stain when heated will impart a muddy

precipitate. 3. Luminescence test:

Stains on dark fabric mixed with mud, paint, etc. emit bluish-white luminescence in a dark room when sprayed with one of the two solutions: a. 3-amino-phthalic-acid-hydrazide-HCL 1 gram

Sodium peroxide 5 grams Distilled water 1,000 cc.

b. 3-amino-phthalic-acid-hydrazide-HCL 1 gram Sodium carbonate 50 grams Hydrogen peroxide (10 Vol.) 50 grams Distilled water 1,000 cc. The substance responsible for the reaction is hematin. Older

stains therefore react better than new ones. Although the solutions are said not to interfere with further

tests, unsprayed specimen of the material must be kept for the

98 LEGAL MEDICINE

serologic test. (Lyon's Medical Jurisprudence for India by S.P.S. Greval, 1953, p. 303).

CHEMICAL EXAMINATIONS: 1. Saline extract of the blood stain plus ammonia will give a brown

ish tinge due to the formation of alkaline hematin. 2. Benzidine test:

A piece of white filter paper is pressed firmly on the suspected stain. Benzidine reagent is dropped on the paper, then followed by drops of active hydrogen peroxide. A positive result will show blue color. A positive result is not conclusive, because an oxidizing agent will give a positive blue color reaction. Benzidine test has the sensitivity up to 1:300,000 dilution. Benzidine reagent:

Benzidine sulphate is dissolved in glacial acetic acid to form 10% solution.

3. Guaiacum test (Van Deen's Dyas' or Schombein's Test): To a white filter paper pressed and rubbed on the surface of the

stain, the solution of the alcoholic tincture of guaiacum is added and then hydrogen peroxide or ozonic ether is applied by drops. If blood is present, a blue color is imparted by the mixture. It is not conclusive like the benzidine test because potato skin, iron rust, cheese, blue and indigo may give a positive reaction to the test. The guaiacum test is positive up to 1:5,000 dilution.

4. Phenolphthalein test (Kastle-Meyer Test): A drop of the Kastle-Meyer's reagent is dropped on a white

filter paper with the stain and left for at least ten seconds. A positive result will show a pink color after the addition of hydrogen peroxide. This test is not conclusive but sensitive up to 1:80,000,000 dilution. This test proves only the presence of peroxidase. Kastle-Meyer's reagent:

5. Leucomalachite Green test: This test which was recommended by Adler in 1904 is quite

useful, but it is not so sensitive as the benzidine test. It depends upon the fact that leucomalachite green is oxidized to malachite green with a bluish-green or peacock-blue color by hydrogen peroxide solution. The reaction occurs also with a solution of the blood pigment previously boiled. On the other hand, the reaction is negative when iron is removed from hemoglobin forming hematoporphyrin.

Phenolphthalein Potassium hydroxide Distilled water

. .2 grams

.20 grams 100 cc.


MICROSCOPIC EXAMINATIONS: Saline extract of the stain is examined under the microscope.

Note the presence of red blood cells, leucocytes, epithelial cells and microorganisms. The presence of red blood cells will conclusively show that the stain is blood. By microscopic examination, we can differentiate the origin or the part of the body it came from. Menstrual blood will show abundance of vaginal epithelial cells and Doe-derlein's bacilli.

MICRO-CHEMICAL TESTS: 1. Hemochromogen crystal or Tokayama test:

A fragment of the suspected material is placed on a slide glass and a drop of hemochromogen reagent is added. A cover glass is placed on top and heated gradually for a time, then examined under the microscope. Crystals varying from salmon color to dark brown and pink and which are irregular rhomboids or in clusters, may be seen. This test is positive to any substance containing hemoglobin. Hemochromogen solution:

Sodium hydroxide (10%) 3 cc. Pyridine 3 cc. Glucose (saturated solution).. .3 cc. Distilled water 7 cc.

Hemochromogen crystals hemin crystal*

100 LEGAL MEDICINE

2. Teichmann's blood crystals or Hemin crystals test: On the microscopic slide is placed fragments of the stain and a

drop of water with trace of sodium chloride added. Add glacial acetic acid and evaporate to dryness under a cover slip. Dark Drown rhombic prisms of chloride of hematin are formed. This is considered as the best of the micro-chemical test.

3 . Acetone-haemin of Wagenhaar test: A particle of dried stain or a fiber of the stained fabric is placed

on a glass slide and covered with a cover slip with a needle interposed to prevent direct contact of the cover slip with the slide. A drop of acetone is run under the cover slip so that the material is surrounded and a drop of diluted oxalic or acetic acid is then added. When examined under high power microscope, small dark, dichroic acicular crystals of acetone-haemin are seen.

SPECTROSCOPIC EXAMINATIONS: This examination depends on the principle that blood pigments

have the power to absorb light of certain wave length and produce certain characteristic absorption bands on the spectrum. By means of the spectroscope we can determine the presence of the following substances: 1. From fresh blood stains:

a. Oxyhemoglobin b. Hemoglobin c. Reduced hematin or hemochrogen

2. From older stains: a. Methemoglobin b. Alkaline hematin c. Hematoporphyrin d. Reduced hematin

3. Other blood preparations: a. Acid hematin b. Alkaline hematin c. Carboxyhemogiobin d. Hematin

BIOLOGIC EXAMINATIONS: 1. Precipitin test:

This test is to determine whether the blood is of human origin or not. Principle of the test:

By injecting an animal, usually, a rabbit, with defibrinated blood of unrelated animal, an anti-serum is produced in the blood of the animal injected. The serum of this animal injected is capable


specifically of precipitating the serum of the unrelated animal whose blood serum has been injected. However, closely related animals may also give the same response. Preparation of the anti-human serum:

A dose of 1.5 cc. to 2.0 cc. per kilogram body weight of human defibrinated blood is injected intravenously in the marginal vein of the rabbit's ear. The dose is then repeated every third day with three or five injections. The titre of the rabbit serum is tested with the human serim. If the anti-human rabbit serum has sufficient power to produce a ring of haziness at the junction of the two sera, then the titre is sufficient for the examination of the unknown.

Some biologists prefer combined intravenous and intraperitoneal injection of the serum but the result is the same.

If the titre is sufficiently strong the rabbit is bled to death and the serum is oollected for the examination of the unknown. Procedure of the test:

A normal saline extract must be made on the stain to be examined. The saline extract must be diluted from 1:10 up to 1:100,000. At least capillary glass tubes, clean and dry on a rack, are used in the examination. The following are the series of mixtures including the controls:

1. Extract 1:100,000 + Anti-human serum 2. Extract 1:10,000 + Anti-human serum 3. Extract 1:1,000 + Anti-human serum 4. Extract 1:100 + Anti-human serum 5. Extract 1:10 + Anti-human serum 6. Extract 1:100 + Normal Rabbit serum 7. NaCl + Anti-human serum 8. Substrate extract + Anti-human serum 9. Heterogenous blood 1:1,000 + Anti-human serum

^10. Known human 1:1,000 + Anti-human serum

s 6 to 10 are controls. Normally, there must be positive \readticm in No. 10 even if the rest are negative.

A\ positive reaction is manifested as an area of haziness in the form* of a white ring at the point of contact between the two solutions mixed. Animals of the allied specie may also give a positive reaction to sheep and goat.

Substances responsible for a false positive reaction: The following common substances, if present in the extract,

will precipitate the anti-serum and thus produce the semblance of a positive reaction:

102 LEGAL MEDICINE

a. Soap. This is of special importance in washed stains. b. Rancid oil is found sometimes in pillow cases and head dresses.

The soluble fraction of the oil prevents frothing yet the extract gives a sharp and quick reaction. Two errors are introduced, namely: (1) False positive reaction from the rancid oil itself. (2) Failure of foam test and danger of group reaction — mon

key blood in high concentration will act like human blood. c. Alum. This is used as a household remedy in gargles and mouth

washes and may stain any article. d. Tannin and allied substances derived from vegetable tissue. The

stain of saliva of the betel chewer not only looks like bloodstain but by virtue of the tannin present in most of the constituents of the prepared betel it also acts on the antisera. Stains on leather and plant tissue should be removed by applying moist filter paper to the surface (leather contains tannin). (From: Lyon's Medical Jurisprudence for India, S.P.S. Greval, 10 in ed., 1953, p. 315)

Substances responsible for a false negative reaction: a. Mineral acids b. Corrosive sublimate c. Chloride of lime d. Sulfate of copper and iron e. Bisulphide of carbon and sodium f. Nitrate of silver g. Thymol h. Permanganate of potassium Value of the precipitin test:

If positive result is obtained, we can tell in a more or less conclusive way that the blood stain is of human origin; although anthropoid ape may give the same result.

The same test and technique may be made to determine whether muscles, secretions, bones and other body fluids are of human origin or not.

Certain materials like alcohol, formaldehyde, corrosive sublimate, lysol, creoline, carbolic acid, acids and alkalies destroy the property of blood to react with precipitin.

2. Blood grouping: Principle of the test:

All human beings have their blood belonging to any of the four principal blood groups. A normal suspension of human red blood cells when mixed with its own serum or serum of a similar group


will make the red blood cells suspension remain even. But if suspended in the serum of another group, the red blood cells clump with one another and this is called agglutination. The red blood cells contain agglutinogens and the serum contains agglutinins. Procedure of the test:

Two methods may be utilized and both should be employed in the examination:

a. Detection of agglutinins b. Detection of agglutinogens

a. Detection of agglutinins: A saline extract is made on the stain. The solution is then

mixed on a slide glass with A, B, and O cell suspensions. The results should be examined after agitation for several hours until a decisive reading is possible.

b. Detection of agglutinogens: Agglutinogens cannot be detected in dried stains since the

red blood cells lose this power on drying, but the presence may be shown by their ability to absorb agglutinins A and B and their power to inhibit the action of the sera containing these agglutinins from the test sera. When these are subsequently tested against known test corpuscles, the absorption which has taken place will become apparent. Corresponding absorption will result if only agglutinogen A' or B is present in the stain. The portion of stained material should be mixed with Group O serum. (Medical Jurisprudence and Toxicology by Glaister, 8th ed., p. 308).

Value of the test: It may solve disputed parentage (paternity or maternity). A

positive result is not conclusive that the one in question is the offspring, but a negative result is conclusive that he is not the child of the alleged parents.

Inheritance Patterns of ABO Blood Groups: Group of Group of Exclusion Parents Children Cases O x O O A, B, AB O x A O.A B, AB O x B 0 , B A, AB A x A O, A B, AB A x B O, A, B, AB

B, AB

B x B O, B A, AB O x AB A, B 0 , AB Ax AB A, B, AB 0

104 LEGAL MEDICINE

Bx AB ABx AB

A, B, AB A, B, AB

Inheritance of M—N type

O O

Parents MxM MxMN M x N

Possible Children M

M, MN MN

MN x N N x N

MN x MN M, N, MN MN, N

N Grouping is true not only with blood but also with other fluids

of the body like saliva, vaginal secretion, seminal fluid, milk, urine and others. Age of the Blood Stains:

When blood is exposed to the atmosphere or some other influences, its hemoglobin is converted to meth-hemoglobin or hematin. The color is changed from red to reddish-brown. The presence of acid accelerates the formation of hematin. These changes take place in warm weather within 24 hours. Blood of one week old and that of six weeks may not present a difference in physical and chemical properties.

Differential Characteristics of Blood from Different Sources: 1. Arterial Blood:

a. Bright scarlet in color. b. Leaves the blood vessel with pressure. c. High oxygen contents.

2. Venous Blood: a. Dark red in color. b. Does not spill far from the wound. c. Low oxygen content.

3. Menstrual Blood: a. Does not clot. b. Acidic in reaction owing to mixture with vaginal mucous. c. On microscopic examination, there are vaginal epithelial cells. d. Contains large number of Deoderlein's bacillus.

4. Man's or Woman's Blood: There is no method differentiating a man's blood from a wo

man's blood. Probably, the presence of sex hormone in female blood may be a point of differentiation.

5. Child's Blood: a. At birth, it is thin and soft compared with that of adult. b. Red blood cells are nucleated and exhibit greater fragility. c. Red blood cells count more than in adult.


H. IDENTIFICATION OF HAIR AND FIBERS How the Hair and Fibers Change Color: 1. Addition of a substance that will coat the outer surface of the

hair so as to impart a different color. Example: Salts of bismuth, lead, silver and pyrogallic acid.

2. Addition of substances which bleach or change the natural color of the fiber or hair.

Example: Hydrogen peroxide, chlorine and diluted nitric acid.

Characteristics of the Different Kinds of Fibers: 1. Cotton Fibers:

Flattened, twisted fibers with thickened edges. Irregularly granulated cuticle. No transverse markings. Fibers show spiral twist. Fibers swell in a solution of copper sulphate and sodium carbonate dissolved in ammonia. It is insoluble in strong sodium hydroxide but soluble in strong sulfuric acid and partially dissolved in hot strong hydrochloric acid.

2. Flax Fibers: > Apex tapering to fine point. Transverse sections are polygonal

and show a small cavity. The fibers consist of cellulose and give blue or bluish-red color

when treated with a weak solution of potassium iodide saturated in iodine and sulfuric acid.

The fibers which show transverse lines and are usually seen in group formation, dissolve in a solution composed of copper sulphate and sodium carbonate in ammonia.

3. Hemp Fibers: Fibers show transverse lines and consist of cellulose. Large oval cavities are seen in transverse sections. The end is

usually blunt, and there is often a tuft of hair at the knots. Stains are bluish-red with phloroglucin, and yellow with both

aniline sulphate and weak solution of potassium iodide saturated in iodine with sulfuric acid.

4. Abaca Fibers: Fibers are smooth without transverse or longitudinal markings. The cavities are large and uniform. The walls are lignified. The tips are fine points.

5. Jute Fibers: Fibers are quite smooth without either longitudinal or transverse

markings.

106 LEGAL MEDICINE

The fibers have typical large cavities which are not uniform but vary with the degree of contraction of the walls of the fibers which are lignified.

The ends are blunt. The fibers are stained red with phloroglucin and yellow with

aniline sulphate, also with iodine and sulfuric acid. 6. Wool Fibers:

These fibers can easily be distinguished from vegetable fibers since the former show an outer layer of flattened cells and imbricated margins.

The interiors are composed of fibrous tissues but sometimes the medulla is present.

They do not dissolve in a solution composed of copper sulphate, sodium carbonate and ammonia.

Stain is yellow with iodine and sulfuric acid and also with picric acid.

Do not dissolve in sulfuric acid. Smell of singeing on burning.

7. Silk Fibers: Manufactured silk is almost structureless, microscopically. Fibers stain is brown with iodine and sulfuric acid and yellow

with picric acid. They dissolve slowly in a mixture of copper sulphate, sodium

carbonate and ammonia. 8. Linen Fibers:

Fibers are straight and tapering to a point. Cortical area shows transverse lines which frequently intersects,

simulating a jointed appearance. The medullary region shows a thin dense line. They do not dissolve in concentrated sulfuric acid. If placed in 1% alcoholic solution of fuchsin and then in a

solution of ammonium hydroxide, they assume a bright red color (Medical Jurisprudence and Toxicology by Glaister, 8th ed„ P. 110).

The Vegetable and Animal Fibers may be Differentiated as Follows: 1. Ignition test:

a. Animal fibers — Burn and fuse; smell of burnt hair, fused and globular; fume turns red litmus to blue.

b. Vegetable fibers — Rapid combustion, end charred and break sharply; smell of burning wood; vapor turns blue litmus to red.


2. Chemical tests: Use of concentrated nitric acid: a. Animal fibers — Turn yellow. b. Vegetable fibers — No change in color.

3. Picric acid test: a. Wool and silk — Yellow. b. Cellulose — No change.

4. Millon's Reagent test: a. Wool and silk — Turn brown. b. Cellulose fibers — Turn black.

5. Soaked in tannic acid: a. Wool and silk — No change. b. Cellulose fibers — Black.

6. Heated with 10% NaOH: a. Wool and silk — Dissolve. b. Cellulose — Not affected. Once the fibers are found to be of animal origin, the next step

is the examination to determine whether these fibers are human hair or hair of other animals:

Parts of the Hair: 1. Cuticle — The outer layer of the hair. 2. Cortex or middle layer — Consists of longitudinal fibers bearing

the pigment. 3. Medulla or core — Contains air bubbles and some pigments.

Differences Between Hair Forcibly Extracted and Naturally Shed Hair:

If a hair-root has been extracted forcibly, the bulb is irregular in form due to rupture of the sheath and shows an undulating surface, together with excrescences of different shapes and sizes. A naturally shed bulb has a rounded extremity, a smooth surface, and most probably show signs of atrophic or fatty degeneration, especially in an elderly person (Medical Jurisprudence and Toxicology by Glaister, 8th ed., p. 99)

Distinctions between Human and Animal Hair

Human Animal Medulla

Air network in fine grains. Air network in forms of large or small sacks.

Cells easily visible. Cells invisible without treatment in water.

Value of I lower than 0.3. Fuzz without medulla.

Value of I higher than 0.6 Fuzz with medulla.

108 LEGAL MEDICINE

Cortex Looks like a thick muff.

Pigments in the form of fine grains.

Cuticle Thin scales not protruding, co

vering one another to about 4/5.

Looks lixe a fairly thin hollow cylinder.

Pigments in the form of irregular grains larger than that of human's.

Thick scales protruding, do not cover one another to the same degree as the human's.

Hair and blood in the victim's hand showing struggle

Note: Medullary index (I) is the relation between the diameter of the medulla and the diameter of the whole hair. (Soderman, p. 176).

The hair and fiber may be examined microscopically in its cross-section and longitudinal aspect.

Comparative study must be made to show similarity of the hair and fibers in question to the known where they are alleged to belong.

(From: — Modern Criminal Investigation by Harry Soderman, 4th ed., p. 191).


Differentiation Between Sections of Gorilla, Chimpanzee and Human Hair:

Gorilla Medulla very con

stantly present. Medulla of small

size.

Granular cortical pigment, central around medulla.

Cuticular margins regular, but less tnan in human

Chimpanzee Constantly present.

Small but slightly larger than human's or gorilla's.

Centrally placed.

Less regular than in human hair.

Human Very frequently ab

sent. Small size, slightly

smaller than gorilla's or chimpanzee's.

Granules less coarse, peripheral, near cuticular margins.

Cuticular margins, extremely regular.

hair. (From: Recent Advances in Forensic Medicine by Sydney Smith & Giaister,p. 109).

Other Points in the Identification of Hair:

1. Characteristics of the hair: Hair on body surfaces is fine while those from the beard,

mustache and scalp are very thick. Hair from the eyebrows and lashes is tapering gradually to fine

points. 2. Length of the hair:

Hair from the scalp grows 2.5 cms. a month. Beard hair grows at the rate of 0.4 millimeter a day.

3. Color of the hair: The color of the hair may be black, blonde or brunette. Hair from older persons may be white or gray. The hair may be artificially colored by bismuth, lead or silver

salts. It may be bleached by addition of hydrogen peroxide, chlorine or diluted hydrochloric or nitric acid. How to detect presence of coloring or bleaching material in hair: a. Examination of hair may show pigments at nodes. b. The new portion of the hair recently grown has a different color

from the treated part. c. The hair in other parts of the body may not correspond in

color. d. The scalp may be dyed. e. The texture of the hair may be altered.

110 LEGAL MEDICINE

4. Does the Hair Belong to a Male or a Female? In many instances it is quite impossible to state the sex from the

hair, but certain points may be worthy of mention: Ha& on the scalp of male are shorter, thicker and more wiry than

that of female's. Eyebrow hair of a male is generally long and more wiry than that

of a female's. (From: Recent Advances in Forensic Medicine by Sydney Smith and Glaister, p. 121).

Estimations of Age Based on the Hair:

This is quite difficult and the examiner hesitates in giving his opinion. However, there are some points of distinction:

Hair of children are fine, short, deficient of pigments and, as a rule, devoid of medulla.

At the adolescent age, hair may appear at the pubis. Hair on the scalp becomes long, wiry, and thick.

In the case of older persons, the color is usually white or gray, with marked absorption of pigments and degenerative changes.

Chapter IV ^

MEDICOLEGAL ASPECTS OF DEATH

Importance of Death Determination: £f P ^ * ^ yThe civil personality of a natural person is extinguished by death:

The civil personality is extinguished by death. The effect of death upon the rights and obligations of the deceased is determined by law, by contract and by will (Art. 42, Civil Code).

£ The property of a person is transmitted to his heirs at the time of death:

Succession is a mode of acquisition by virtue of which the property, rights and obligations to the extent of the value of the inheritance of a person are transmitted through his death to another or others either by will or by operation of law (Art. 774, Civil Code).

3<The death of a partner is one of the causes of dissolution of partnership agreement:

Dissolution (of a partnership) is caused. . . (5) by the death of any partner;. . (Art. 1830, Civil Code).

4\77ie death of either the principal or agent is a mode of extinguishment of agency:

Agency is extinguished. . . (3) By death, civil interdiction, insanity or insolvency of the principal or of the agent. . . (Art. 1919, Civil Code).

f/The criminal liability of a person is extinguished by death: How criminal liability is totally extinguished — Criminal liability

is totally extinguished: 1. By death of the convict, as to the personal penalties; and as

to pecuniary penalties, liability therefore is extinguished only when the death of the offender occurs before judgment. (Art. 89, Revised Penal Code).

The civil case for claims which does not survive is dismissed upon death of the defendant:

When the action is for recovery of money, debt or interest thereon, and the defendant dies before the final judgment in the court of the First Instance, it shall be dismissed to be prosecuted in the manner especially provided by these rules (Rule 3, Sec. 21, Rules of Court).

I l l

112 LEGAL MEDICINE

Notice to creditor to be issued by court — Immediately after granting letters, testamentary or of administration, the court shall issue a notice requiring all persons having money claims against the decedent to file them in the office of the clerk of said court (Rule 86, Sec. 1, Rules of Court).

ieath is the termination of life. It is the comrjjgte_cessation of all the vital functions without possibility of resuscitatioriJ It is an irreversible loss of the properties of 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.

Previously, complete and persistent cessation of heart action and respiration (cardio-respiratory) is the standard criteria in the determination of death, but the following events in the recent years led to the development of uncertainty of the moment of death: 1. The increasing use of mechanical resuscitative devices which can

maintain respiration and cardiac functions almost indefinitely. Heart vitality may be maintained by coronary perfusion or its rhythm by defibrillation or pace maker. Breathing can be sustained by a respirator or pulmonator.

2. There is an increasing demand of organs for transplantation. Vital organs can now be transplanted and the shorter the time space between the death of the donor and the transplantation process, the more is the chance of success of surgery. It becomes a problem as to when the donor dies for the immediate removal of the organ to be transplanted. The surgeon must see to it that the donor is dead before the organ to be transplanted is removed, otherwise he may be held liable if done prematurely.

3. Coma following administration of excessive doses of modern sedatives and hypnotics could be mistaken for death. Coma induced by barbiturates could be mistaken for death because it clinically appears to have eliminated breathing and heart action, chill the body and makes reflexes weak or totally non-existent.

Based on the Criterion Used in its Determination, Death may be: 1. Brain Death — Death occurs when there is deep-'Irreversible coma, âbsence 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>con-

tinuous 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 or intuition.

MEDICO-LEGAL ASPECTS OF DEATH 113

3. Some countries or states provide both brain and cardio-respiratory bases in an alternative or eclectic way in the determination of the moment of death. In 1970, the state of Kansas became the first to enact a statute which specifies more clearly the accepted alternatives for defining death. Section 1, Chapter 378 of the Kansas Statute provides the following:

"A person will be considered medically and legally dead if, in the opinion of a physician, based on ordinary standards of medical practice, there is the absence of spontaneous respiratory and cardiac function and, because of the disease or condition which caused, directly or indirectly, these functions to cease, or because of the passage of time since these functions ceased, attempts at resuscitation are considered hopeless; and, in this event, death will have occurred at the time these functions ceased.

Second, a person will be considered medically or legally dead if, in the opinion of a physician, based on ordinary standards of medical practice, there is the absence of spontaneous brain function; and if based on ordinary standards of medical practice, during reasonable attempts to either maintain or restore spontaneous circulatory or respiratory function in the absence of aforesaid brain function, it appears that further attempts at resuscitation or supportive maintenance will not succeed, death will have occurred at the time when these conditions first coincide. Death is to be pronounced before artificial means of supporting respiratory and circulatory function are terminated and before any vital organ is removed for purposes of transplantation."

Brain Death: Inasmuch as there are no universally accepted criteria yet to

establish a condition of brain death, the following proposal or recommendations are made by different committees or bodies: 1. According to the Harvard Report of 1968, the following are the

characteristics of "irreversible coma":

a. Unreceptivity and unresponsibility — There is a total unaware-ness to externally applied stimuli and inner need and complete unresponsiveness — our definition of irreversible coma. Even the most intense painful stimuli evoke no vocal or other response, not even a groan, withdrawal of his limb, or quickening of respiration.

b. No movements or breathing — Observations covering a period of at least 1 hour by physicians is adequate to satisfy the criteria of no spontaneous muscular movements or spontaneous respiration or response to stimuli such as pain, touch, sound, or

114 LEGAL MEDICINE

light. After the patient is on a mechanical respirator, the total absence of spontaneous breathing may be established by turning off the respirator for three minutes and observing whether there is any effort on the part of the subject to breath spontaneously. (The respirator may be turned off for this time provided that at the start of the trial period the patient's carbon dioxide tension is within the normal range, and provided also that the patient had been breathing room air for at least 10 minutes prior to the trial).

c. No reflexes — Irreversible coma with abolition of central nervous system activity is evidenced in part by the absence of elicitable reflexes. The pupil will be fixed and dilated and will not respond to a direct source of bright light. . . Ocular movement (to head turning and to irrigation of the ears with ice water) and blinking are absent. There is no evidence of postural activity (decerebrate or other). Swallowing, yawning, vocalization are in abeyance. Corneal and pharyngeal reflexes are absent. As a rule the stretch or tendon reflexes cannot be elicited, i.e. tapping the tendons of the biceps, triceps and pronator muscles, quadriceps and gastrocnemius muscles with the reflex hammer elicits no contraction of the respective muscles. Plantar or noxious stimulation gives no response.

d. Flat electro-encephalogram — Of great confirmatory value is the flat or iso-electric E.E.G. We must assume that the electrodes have been properly applied, that the apparatus is functioning normally, and that the personnel in charge are competent. All of these tests shall be repeated at least 24 hours later with

no change. It is emphasized that the patient be declared dead before any effort is made to take him off the respirator, if he is then on a respirator.

2. In 1969, the Ad Hoc Committee of Human Transplantation convened under the auspices of the Institute of Forensic Sciences, Duquesne University School of Law adopted the proposed criteria for the determination of death otherwise known as Philadelphia Protocol, and the following were considered: a. Lack of responsiveness to internal and external environment. b. Absence of spontaneous breathing movements for 3 minutes,

in the absence of hypocarbia and while breathing room air. c No muscular movements with generalized flaccidity and no

evidence of postural activity or shivering, d. Reflexes and response:

(1) Pupils fixed and dilated, non-reactive to strong stimuli.


(2) Corneal reflexes absent. (3) Supra-orbital or other pressure response absent (both pain

response and decerebrate posturing). (4) Absence of snouting or sucking response. (5) No reflex response to upper airway stimulation. (6) No reflex response to lower airway stimulation. (7) No ocular response to ice water stimulation of the inner

ear. (8) No deep tendon reflexes. (9) No superficial reflexes.

(10) No plantar responses.

e. Falling arterial pressure without support by drugs or other means.

f. Iso-electric electro-encephalogram (in absences of hypothermia, anesthetic agents and drugs intoxication) recorded spontaneously and during auditory and tactile stimulation.

It is further laid down that these criteria shall have been present for at least 2 hours and that death should be certified by two physicians other than the physician of a potential organ recipient (Gradwohrs Legal Medicine, Francis Camps, Ann Robinson & Bernard Lucas, ed. 3rd ed. p. 51-52).

Other Set of Criteria to Establish Brain Death:

1. Mohandas and Chou (1971) made a summary of the criteria of brain death which was accepted by the University of Minnesota Science Center.

2. The Ottawa General Hospital (1970) set up guidelines for the criteria of cerebral death.

3. In France (1968) the Council of Ministers published a decree which adopted the official definition of death on recommendation of the French Academy of Medicine.

Although the consideration of brain death is the most ideal criteria, the difficulty and practicability of its application is a problem. Electro-encephalogram which is the most reliable instrument to determine brain activities is not available in many places. Even if available, the number of competent persons to apply the instrument and the interpretation of the results is quite limited.

The use of the criteria of brain death may only be applied to those persons who are potential organ donors.

LEGAL MEDICINE

f A. KINDS OF DEATH ^ j j ^

)MATIC DEATH OR CLINICAL DEATH: This is the state of the body in which there is ^complete, per

sistent and continuous cessation of the vital functions of the brain, heart and lungs which maintain life and health^ It occurs the moment a physician or the 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.

Immediately after death the face and lips become pale, the muscles become flaccid, the sphincters are relax, the lower jaw tends to drop, the eyelids remain open, pupils dilate and the skin losses its elasticity. The body fluid tends to gravitate to the mostf dependent portions of the body and the body heat gradually assiimes the temperature of the surroundings.

(OLECULAR OR CELLULAR DEATH: After cessation of the vital functions of the body there is still

ânimal life among individual cells. This is evidence by the presence of/excitability of muscles and^ciliary movements and other functions of individual cells.

About three to six hours later, there is death of individual cells. This is known as molecular or cellular death. Its exact occurrence cannot be definitely ascertained because its time of appearance is influenced by several factors. Previous state of health, infection, climatic condition, cellular nutrition, etc. influence its occurrence.

ÂPPARENT DEATH" OR "STATE OF SUSPENDED ANIMATION": This condition is not really death but merely aCtransient 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.

It may be induced voluntarily as has been cited by foreign authors (Col. Townshend who could be able to pass into a state of pulselessness for half an hour). Involuntary suspension is shown in still-birth. A newly born child may remain at the state of suspended animation and may die unless prompt action is taken. A person who has been rescued from drowning may appear dead but life is maintained after continuous resuscitation.

It is important to determine the condition of suspended animation to prevent premature burial. There are records of cases wherein a person was pronounced dead, placed in a coffin and


later angrily rise from it and walk unaided. The relative has sent death notice and placed wreaths near his coffin (Daily Mail England, 1948).

ji B. SIGNS OF DEATHS ^XC^®

CESSATION OF HEART ACTION AND CIRCULATION: tl R C I ^ A " There must be anfentire 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 time the heart may cease to function and life is still maintained depends upon the length of time it is readily reestablished and 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^

Respiration ceases frequently before the stoppage of heart contraction and circulation. Usually the auricle of the heart contracts after somatic death for a longer period than the ventricle. And the auricle is the last to stop, hence called ultimen martens.

In judicial hanging, the heart continues to beat for twenty minutes or half an hour after the individual has been executed although its beating is irregular and feeble. In decapitation of criminals, heart beating is present for an hour after decapitation has taken place.

Methods of Detecting the Cessation of Heart Action and Circulation: a. Examination of the Heart:

(1) Palpation of the Pulse: Pulsation of the peripheral blood vessels may be made at

the region of the wrist or at the neck. The pulsation of the vessels is synchronous with the heart beat. Occasionally the pulsation is very imperceptible and irregular that the examiner experience much difficulty.

(2) Auscultation for the Heart Sound at the Precordial Area: The rhythmic contraction and relaxation of the heart is

audible through the stethoscope. Heart sound can be audible during life even without the aid of a stethoscope by placing the ear at the precordial area. Errors in the Method of Determining Heart Action: (a) The heart itself may, like other muscles, be in a state of

apparent and not real death. (b) The heart sound may not always be appreciable to the

ear even with the aid of the stethoscope.

118 LEGAL MEDICINE

Difficulties in Auscultation may be Encountered in: (a) Stout person. (b) Fatty degeneration of the heart. (c) Pericardial effusion.

(3) Flouroscopic Examination: Fluoroscopic examination of the chest will reveal the

shadow of the heart in its rhythmic contraction and relaxation. The shadow may be enlarged and the excursion made less visible due to pericardial effusion.

(4) By the Use of Electrocardiograph: The heart beat is accompanied by the passage of electri

cal charge through the impulse conducting system of the heart which may be recorded in an electrocardiograph machine. The electrocardiograph will record the heart beat even if it is too weak to be heard by auscultation. This is the best method of determining heart action but quite impractical,

b. Examination of the Peripheral Circulation: (1) Magnus'Test:

A ligature is applied around the base of a finger with moderate tightness. In a living person there appears a bloodless zone at the site of the application of the ligature and a livid area distal to the ligature. If such ligature is applied to the finger of a dead man, there is no such change in color. The color of the area where the ligature is applied will be the same as that one distal to it. There may be no appreciable change of color if a living person is markedly anemic.

( 2 ) Opening of Small Artery: In the living, the blood escapes in jerk and at a distance.

In a dead man, the blood vessel is white and there is no jerking escape of blood but may only ooze towards the nearby skin. When bigger arteries are cut, blood may flow without pressure continuously.

(3) Icard's Test: This consists of the injection of a solution of fluorescein

subcutaneously. If circulation is still present, the dye will spread all over the body and the whole skin will have a greenish-yellow discoloration due to flourescein. In a dead man, the solution will just remain at the site of the injection. This test should be applied only with the use of the daylight as the color is difficult to be appreciated with the use of artificial light.


(4) Pressure on the Fingernails: If pressure is applied on the fingernails intermittently,

there will be a zone of paleness at the site of the application of pressure which become livid on release. There will be no such change of color if the test is applied to a dead man.

(5) Diaphanous Test: The fingers are spread wide and the finger webs are

viewed through a strong light. In the living, the finger webs appear red but yellow in the dead. The finger webs may appear yellow in a strong light even if living in cases of anemia or carbon monoxide poisoning.

(6) Application of Heat on the Skin: If heated material is applied on the skin of a dead man,

it will not produce true blister. There is no sign of congestion, or other vital reactions. But if applied to a living person, blister formation, congestion, and other vital reactions of the injured area will be observed.

(7) Palpation of the Radial Pulse: Palpation of the radial artery with the fingers, one will

feel the rhythmic pulsation of the vessel due to the flow of blood. No such pulsation will be observed in a dead man.

(8) Dropping of Melted Wax: Melted sealing wax is dropped on the breast of a person.

If the person is dead, there will be no inflammatory edema y at the neighborhood of the dropped melted wax.

CESSATION OF RESPIRATION: Like heart action, cessation of respiration in order to be con

sidered as a sign of death must be continuous and persistent. A person can hold his breath for a period not longer than 3-1/2 minutes. In case of electrical shock, respiration may cease for sometime but may be restored by continuous artificial respiration.

In the following conditions there may be suspension of respiration without death ensuing. a. In a purely voluntary act, as in divers, swimmers, etc. but it

cannot be longer than two minutes. b. In some peculiar condition of respiration, like Cheyne-Stokes

respiration, but the apneic interval cannot be longer than fifteen to twenty seconds;

c. In cases of apparent drowning; d. Newly-born infants may not breathe for a time after birth and

may commence only after stimulation or spontaneously later.

120 LEGAL MEDICINE

Methods of Detecting Cessation of Respiration: a. Expose the chest and abdomen and observe the movement

during inspiration and expiration. b. Examine the person with the aid of a stethoscope which is

placed at the base of the anterior aspect of the neck and hear sound of the current of air passing through the trachea during each phase of respiration.

c. Examination with a Mirror: The surface of a cold-looking glass is held in front of the

mouth and nostrils. If there is dimming of the mirror after a time, there is still respiration. The dimming of the cold mirror is due to the condensation of the warm moist air exhaled from the lungs if respiration is still going on. However, it must not be forgotten that the dimming of the mirror may be due to the expulsion of the air from the lungs due to the contraction of the diaphragm in rigor mortis. Ordinarily there is no dimming of the mirror when the subject is dead.

d. Examination with a Feather or Cotton Fibers: Place a fine feather or a strip of cotton in front of the lips

and nostrils. If there is movement of the feather or cotton not due to external air, respiration is present. The feather or cotton fibers will be blown away during expiration and towards the nose and mouth during inspiration. This is not a reliable test as the slightest movement of outside air or nervousness of the observer will move the feather or cotton fibers.

e. Examination with a Glass of Water: Place a glass half full of water at the region of the chest. If

the surface of the water is smooth and stable, there is no respiration taking place, but if it waves or water movement is observed, then respiration is taking place. This is not a good test because of the difficulty of preventing movement of the place where the body lies.

f. Winslow's Test: There is no movement of the image formed by reflecting

artificial or sun light on the water or mercury contained in a saucer and placed on the chest or abdomen if respiration is not taking place. The reflection is utilized to magnify the

/ movement of the surface of mercury or water.

. COOLING OF THE BODY (ALGOR MORTIS): 'After death the metabolic process inside the body ceases, yj No

more heat is produced but the body loses slowly its temperature by evaporationJor by conduction to the surrounding atmosphere.

MEDICO-LEGAL ASPECTS OF DEATH i r |

The progressive fall of the body temperature is one of the most prominent signs of death. / '

The rate of cooling of the body is not uniform. It is rapid during the first two hours after death and as the temperature of the body gradually approaches the temperature of the surroundings, the rate becomes slower.

It is difficult to tell exactly the length of time the body will assume the temperature of the surroun Several factors influence the rate of fall of the body temperature.

The fall of temperature may occur before death in the following conditions: ( a. Cancer b. Phthisis c. Collapse

The fall of temperature of 15 to 20 degrees fahrenheit is considered as a certain sign of death.

Post-mortem Caloricity is the rise of temperature of the body after death due to rapid and early putrefactive changes or some internal changes. It is usually observed in the first two hours after death. Post-mortem caloricity may occur in the following conditions: a. Cholera. b. Yellow fever. c. Liver abscess. d. Peritonitis. e. Cerebro-spinal fever. f. Rheumatic fever. g. Tetanus. h. Smallpox. i. Strychnine poisoning. Factors Influencing the Rate of Cooling of the Body: a. Conditions that are connected with the body:

(1) Factors Delaying Cooling: (a) Acute pyrexia! diseases. (b) Sudden death in good health. (c) Obesity of person. (d) Death from asphyxia. (e) Death of the middle age.

(2) Factors Accelerating Cooling: (a) Leanness of the body. (b) Extreme age. (c) Long-standing or lingering illness. (d) Chronic pyrexial disease associated with wasting.

122 LEGAL MEDICINE

b. Conditions that are connected with the surroundings: (1) Factors Delaying Cooling:

(a) Clothings. (b) Want of access of air to the body. (c) Small room. (d) Warm surroundings.

(2) Factors Accelerating Cooling: (a) Unclothed body. (b) Conditions allowing the access of air. (c) Large room permitting the dissipation of heat. (d) Cooling more rapid in water than in air.

Methods of Estimating How Long a Person Has Been Dead From the Cooling of the Body: a. When the body temperature is normal at the time of death,

the average rate of fall of the temperature during the first two hours is one-half of the difference of the body temperature and that of the air.

During the next two hours, the temperature fall is one-half of the previous rate, and during the succeeding two hours, it is one-half of the last mentioned rate.

As a general rule the body attains the temperature of the surrounding air from 12 to 15 hours after death in tropical countries (Medical Jurisprudence and Toxicology by Modi, 12th ed.,p. 121).

b. To make an approximate estimate of the duration of death from the body temperature, the following formula has been suggested:

(Normal Temperature) 98.4°F — (Rectal Temperature)

Approximate number of hours after death

This formula is only applicable to cases where the rectal temperature has not yet assumed the temperature of the surroundings, otherwise, the result will be constant.

c. Chemical Method: Schourup's formula for the determination of the time of death

of any cadaver whose cerebro-spinal fluid is examined for the concentrations of lactic acid (L.A.), non-protein nitrogen (N.P.N.) and amino acid (A.A.) and whose axillary temperature has been taken at the time the cerebro-spinal fluid has been removed.

MEDICO- LEGAL ASPECTS OF DEATH 123

36— T + antilog, L.A. + N.P.N. — 15 + A.A. — 1 180 16.7 7.35

4

T — temperature 1 = axillary temperature

The lactic acid content of the cerebro-spinal fluid rises from 15 mg. to over 200 mg. per 100 cc. The rise is rapid during the first 5 hours following death.

The non-protein nitrogen (N.P.N.) increases from 15 to 40 mg. per 100 cc. during the first 15 hours. This test is modified by ante-mortem anemia and rapid cooling of the body.

Amino-acids (A.A.) increases from 1 mg. to 12 mg. percent during the first 15 hours, but the result is modified by rapid cooling of the body. Limitations of the Schourup's Formula: a. The method is only applicable to adults, as the rate of bio

chemical change in a child is far more rapid than in adult. It is the value to person over the age of 15 years.

b. The cerebrospinal fluid must be free of blood, the presence of which raises the lactic concentration.

c. Injuries must not have allowed the escape of cerebrospinal

d. Death must have occurred' within a period 15 hours prior to the withdrawal of the sample of cerebrospinal fluid, as after that time the changes in the concentration per time unit become irregular (Modern Trend in Forensic Medicine by Keith

. Simpson, 1953, pp. 83-84).

INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE:

After death the whole body is insensible. No kind of stimulus is capable of letting the, body have voluntary movement.

This condition must be observed in conjunction with cessation of heart beat and circulation and cessation of respiration.

The insensibility and loss of power to move may be present although living, in the following conditions: a. Apoplexy. b. Epilepsy. c. Trance. d. Catalepsy. e. Cerebral concussion. f. Hysteria.

fluid.

124 LEGAL MEDICINE

S ^ H A N MANGES IN THE SKIN: The following are the changes undergone by the skin after death: a. The skin may be observed to be-pale and vgaxy-looking due to

the absence of circulation. Areas of the skin specially the most dependent portions will develop livid discoloration on account of the gravitation of blood.

bsLoss 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 finger tip will produce fitting impression like one observed in edema.

Post-mortem Contact Flattening — On account of the loss of elasticity of the skin and of the post-mortem flaccidity of muscles, the body becomes flattened over areas which are in contact with the surface it rests. This is observed at the region of the shoulder blades, buttocks and calves if death occurs while lying on his back. Certain degree of pressure may be applied on the face immediately after death and may be mistaken for traumatic deformity.

c. ppacity 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 a dead person is opaque due to the absence of circulation.

d. Effect of the Application of Heat: Application of melted sealing wax on the breast of a dead

person will not produce 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: a. 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 the following conditions: (1) General anesthesia. (2) Apoplexy. (3) Uremia. (4) Epilepsy. (5) Narcotic Poisoning. (6) Local Anesthesia.


b. 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 a reliable sign of death.

c. Flaccidity of the Eyeball: After death, the orbital muscles lose their tone making the

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

d. The Pupil is in the Position of Rest: The muscle of the iris loses its tone. The pupil can not

react to light. The size of the pupil varies at the time of death, however, if contracted, it may infer poisoning by narcotic drugs. A relaxed iris may be found in life in the following conditions: (1) Action of drugs like atropine. (2) Uremia. (3) Tabes dorsalis. (4) Apoplexy.

e. Ophthalmoscopic Findings: (1) The optic disc is pale and has the appearance of optic

atrophy. (2) The remaining portion of the fundus may have a yellow

tinge which later changes to a brownish-gray or slate color. (3) The retina becomes pale like the optic disc. (4) The retinal vessels become segmented, no evidence of blood

The retinal veins and arteries are indistinguishable : f. ltTache noir de la 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 a 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 choroid 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

flow.

126 LEGAL MEDICINE

on pricking the blister, no fluid is present. There is no redness of the surrounding skin. In the living, the blister contains abundant serum and area of vital reaction (congestion) on the skin around is present. The Following Combinations of Signs Show Death has Occurred: a. Loss of animal heat to a point not compatible with life. b. Absence of response of muscle to stimulus. c. Onset of rigor mortis.

Ô^C. CHANGES IN THE BODY FOLLOWING DEATH

^l^CHANGES IN THE MUSCLE: p f £ • 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 Entire Muscular Tissue Passes Three Stages After Death: Stage of primary flaccidity (post-mortem muscular irritability):

The ^nuscles are relaxed and capable of contracting when stimulated^ The pupils are dilated, the sphincters are relaxed,

^-"Shd there is incontinence of urination and defecation. b. Stage of post-mortem rigidity (Cadaveric rigidity, or Death

struggle of muscles or Rigor Mortis): The^whole body becomes rigid due to the contraction of the

muscles."!This develops three to six hours after death and may last frorfftwenty-f our to thirty-six hours.

Jc. Stage of secondary flaccidity or commencement of putrefaction (Decay of the muscles):

The muscles become flaccid, noJonger capable of responding to mechanical or electrical stimulus and the reaction becomes alkaline. ~

/a. Stage of Primary Flaccidity or Period of 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 be 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 usually lasts about three to six hours after death. In warm places, the average duration is only one hour and fifty-one minutes (Mackenzie cited by Modi, p. 122).

Chemically, the reaction of the muscle is alkaline and the normal constituents of the individual muscle proteins are the same as in life.

b. Stage of Post-mortem Rigidity, or Cadaveric Rigidity, or Death Stiffening, or "Death Struggle of 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 view point, 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.

Factors Influencing the Time of Onset of Rigor Mortis:

(1) Internal Factors: (a) State of the Muscles:

Rigor mortis appears late and the duration is longer in cases where the muscles have been healthy and at rest before death, It has been observed that in the following deaths, the onset of rigor mortis is hastened:

i. Animal having been hunted to death. ii. Prolonged convulsion and lingering illness.

iii. Death from typhoid fever, typhus, cholera and phthisis.

128 LEGAL MEDICINE

(b) Age: Rigor mortis has early onset in the aged and new-born. The onset is delayed in good health and good muscular development.

(c) Integrity of the Nerves: Section of the nerve will delay onset of rigor mortis

as shown in paralyzed muscles. (2) External Factors:

(a) Temperature: The development of rigor mortis is accelerated by

high temperature but a temperature above 75°C will produce heat stiffening.

(b) Moisture: /

Rigor mortis commences rapidly but the duration is short in moist air.

^ Conditions Simulating Rigor Mortis: (1) Heat Stiffening:

If the dead body is exposed to temperatures above 75°C 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 the hands clenched because the flexor muscles are stronger than the extensors.

Heat stiffening is commonly observed when the body of a person is placed in boiling fluid or when the body is burned to death.

J@) Cold Stiffening: The stiffening of the body may be manifested when

the body is frozen, but exposure to warm condition will make such stiffening disappear. The cold stiffening is due to the 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.

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

J$) Cadaveric Spasm or Instantaneous Rigor:


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 only 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 a 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 appears

/^sometime after ingestion. /Distinctions Between Rigor Mortis and Cadaveric Spasm: ( if Time of Appearance: ^ i v t . K M ^ affiles-opY 1

Rigor mortis appears three to six hours after death, while cadaveric spasm appears immediately after death.

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.

Rigor mortis is a natural phenomena which occurs after death, while cadaveric spasm may or may not appear on a person at the time of death.

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.

Distinctions Between Muscular Contraction and Rigor Mortis:

{^Muscles Involved:

(3^0ccurrence:

(^Medico-Legal Significance:

Muscular Contraction Rigor Mortis (1) Contracted muscle is

more or less transparent, or rather translucent.

(2) It is very elastic, i.e.,

(1) Muscle in rigor mortis losses this translucency, and becomes opague.

(2) It has lost this elasti-

130 LEGAL MEDICINE

capable of restoration to its original form as soon as the distorting force has ceased to act.

(3) In reaction to litmus, it is either neutral or slightly alkaline, and any reduction in this alkalinity is very speedily removed.

(4) If the contraction be overcome by mechanical force, the muscles though they may remain for a time un-contracted, possess still their inherent power of contraction; they may then keep the limb fixed in a new position or allow a return to the old position.

city and readily maintains a distorted position.

(3) It is distinctly and constantly acid (until decomposi t ion is advanced) owing to the development of sarco-latic and other acid metabolites.

(4) If rigor mortis be overcome by mechanical force, absolute flaccidity corresponding in degree with the amount of mechanical movement, at once ensues, and there is no power to resume the old position nor any new one, except so far as gravity may cause a new position. This flaccidity is permanent till decomposition destroys the muscles.

(From: Taylor's Principles and Practice of Medical Jurisprudence, 11th ed.. Vol I, p. 179).

c. Stage 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.

This body while at the stage of rigor mortis, if stretched or flexed to become soft, will no longer be rigid. This condition

f the muscles is not secondary flaccidity.

CHANGES IN THE BLOOD: a. Coagulation of the Blood:

The stasis of the blood due to the 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 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 for (Ho 8 hours.

^distinctions Between Ante-mortem from Post-mortem Clot: Ante-mortem Clot

Post-mortem Clot (1) Firm in consistency.^- l ^ u ^ 1 ) S o f t i n consistency. (2) Surface of the blood"^ 0 ' (2) Surface of the blood

vessel raw after the ^"^-vessels smooth and clots are removed. p£v t l f *Thealthy after the clots

are removed. (3) Clots homogenous in (3) Clots can be stripped

construction so it can- off in layers. not be stripped into layers.

(4) Clot with uniform color. (4) Clot with distinct layer. bfPost-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 the early stage of its formation, it may disappear and develop again in the most dependent area in the 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 tissues 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

132 LEGAL MEDICINE

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 the 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.

Physical Characteristics of Post-mortem Lividity: (1) It occurs in the most extensive areas of the most dependent

portions of the body. (2) It only involves the superficial layer of the skin. (3) It does not appear elevated from the rest of the skin. (4) The Color is uniform but the color may become greenish

at the start of decomposition. (5) There is no injury of the skin.

Kinds of Post-mortem (Cadaveric) Lividity: Hypostatic 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 position of the body leads to the formation of the lividity in another place. This occurs during the early stage of its formation.

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.

Importance of Cadaveric Lividity: (1) It is one of the signs of death. (2) It may determine whether the position of the body has

been changed after its appearance in the body. (3) The color of the lividity may indicate the cause of death.

Example: a. In asphyxia, the lividity is dark. b. In carbon monoxide poisoning, the lividity

is bright pink. Hemorrhage, anemia — less marked. Hydrocyanic acid — bright red. Phosphorus — dark brown. Potassium chlorate, Potassium bichromate — chocolate or coffee brown.


c. If the body is found for considerable time in snow or ice the lividity is bright red.

(4) It may determine how long the person has been dead. (5) It gives us an idea as to the time of death.

Points to be considered which may infer the position of the body at the time of death: a. Posture of the body when found:

The body may become rigid in the position in which he died. Post-mortem lividity may develop in the assumed position. This condition may occur and is of value if the state and position of the body was not moved before rigidity and lividity took place.

b. Post-mortem Hypostasis (Lividity): Hypostatic lividity will be found in areas of the body which

comes in contact with the surface where the body lies. If there is already coagulation of blood or if blood has already diffused into the tissues of the body, a change of position will not alter the location of the post-mortem lividity.

c. Cadaveric Spasm: In violent death, the attitude of parts of the body may infer

position on account of the spasm of the muscles. Example: (1) In drowning, the victim may be holding the

sea weeds. (2) In suicide, the wounding weapon may be grasped

tightly by the hands.

Distinctions Between Contusion (Bruise) and Post-mortem Hypostasis:

Contusion (Bruise) Post-mortem Hypostasis a. Below the epidermis in the a. In the epidermis or in the

true skin in small bruises or cutis, as a simple stain or extravasations, below this in a showing through the epi-larger ones, and often much dermis of underlying en-deeper still. The reason is gorged capillaries, obvious, viz., that the epidermis has no blood-vessels to be ruptured.

b. Cuticle was probably abraded b. Cuticle unabraded, because by the same violence that pro- the hypostasis is a mere duced the bruise. In small sinking of the blood; there punctures, such as flea bites, is no trauma. ^ this is not observed.

134 LEGAL MEDICINE

c. A bruise appears at the seat of and surrounding the injury. This may or may not be a dependent part.

d. Often elevated, because the extravasated blood and subsequent inflammation swell the tissues.

e. Incision shows blood outside the vessels. This is the most certain test of difference, and can be observed even in very small bruises.

f. Colour variegated. This is only true of bruises that are some days old; it is due to the changes in the haemoglobin produced during life.

g. If the body happens to be constricted at, or supported on, a bruised place, the actual surface of contact may be a little lighter than the rest of the bruise, but will not be white.

Always in a part which for the time of formation is dependent, i.e., at a place where gravity ordains it. Not elevated, because either the blood is still in the vessels or, at most, has simply soaked into and stained the tissues. Incision shows the blood is still in its vessels; and if any oozing occurs drops can be seen issuing from the cut mouths of the vessels. Colour uniform. The well-known change in colour (green, yellow, etc.) produced in blood extravasted into living tissues does not occur in dead tissues with the same regularity. In a place which would otherwise be the seat of a hypostasis pressure of any kind, even simple support (the wrinkling of a shirt or necktie, garters, etc.) is sufficient to obliterate the lumen of venules and capillaries, and so to prevent their filling with blood. White lines or patches of pressure bordered by,the dark color of a hypostasis are produced and marks of floggings, strangulation, etc., are thus sometimes simulated.

(From: — Taylor's Principles and Practice of Medical Jurisprudence, 11th ed. 1949, Vol I, p. 175-176.

Internal Hypostasis in Visceral Organs: Post-mortem lividity also occurs in the internal organs. The

principal organs affected are the lungs, loops of the intestine and brain. It may in some instances be mistaken for disease.


Post-mortem hypostasis in the organs may have the pathological appearance in the visceral organs. In the heart, it may simulate coronary occlusion while in the lungs it may appear like pneumonic changes. The intestine may be reddened to appear like strangulation.

Differences between Post-mortem Lividity of Organs and Simple Congestion: a. Post-mortem staining in organs is irregular and occurs in the

most dependent parts, while congestion is generally uniform and found all over the organs.

b. The mucous membrane in post-mortem staining (lividity) is dull and lusterless, but not so in congestion.

c. In post-mortem staining (lividity) inflammatory exudate is not seen, and areas of redness alternating with pale areas will be found if a hollow viscus is stretched out and held in front of a light. This is not seen in cases of simple congestion.

Distinctions between Post-mortem Lividity from Hemorrhage of Scurvy, Phosphorus Poisoning, or Purpura: a. History Before Death:

History will reveal the presence of scurvy, phosphorus poisoning or purpura.

b. Time of Appearance: In cases of scurvy, purpura or phosphorus poisoning, the

skin lesion is present even before death, while in cases of postmortem lividity it only appears after death.

c. Location: In post-mortem lividity, it is only present in the most de

pendent portions of the body, while in purpura, scurvy or phosphorus poisoning, the lesions may be found and distributed all over the skin or organs.

Other Changes in the Blood: a. Hydrogen ion Concentration — After death the Ph of the blood

and tissues drops because of the terminal accumulation of C O 2 , glycogenolysis and glycolysis with accumulation of phosphoric acid and lactic acid, and splitting off of amino-acid and fatty acids.

After about 24 hours, the reaction become alkaline due to the production of ammonia from enzymatic protein breakdown and the rise of serum concentration of nonprotein nitrogenous components.

b. The breakdown of liver glycogen leads to the accumulation of dextrose in the inferior vena cava and right side of the heart.

136 LEGAL MEDICINE

c. There is a rise of non-protein nitrogen and free amino-acid. d. Chemical — The chloride in the plasma and red blood cells falls

due to the extravascular diffusion so that after 72 hours it is only 1/2 of its content.

Magnesium content increases as a result of diffusion from without.

Potassium increases owing to diffusion from the vascular endothelium.

3. AUTO LYTIC OR AUTODIGESTTVE CHANGES AFTER DEATH: After death, proteolytic, glycolytic and lipolytic ferments of

glandular 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 autodigestion 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 staining capacity and become desquamated from the underlying layers (Legal Medicine by Gradwohl, p. 135).

4. PUTREFACTION OF THE BODY: Putrefaction is the breaking down of the complex proteins 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: The following are the principal changes undergone by the soft

tissues of the body in the process of putrefaction:

a. Changes in the Color of the Tissue: A few hours after death, there is hemolysis of the blood

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

While in the tissues, the hemoglobin undergoes chemical changes and various derivatives of hemoglobin are formed. On account of these chemical changes the tissue color is gradually


changed to greenish-yellow, greenish-blue, or greenish-black color.

The earliest change is greenish color of the skin seen at the region of the right iliac fossa and it gradually spreads over the whole abdominal wall. Blood later extravasates into the cavities of the body.

Marbolization — It is the prominence of the superficial veins with reddish discoloration during the process of decomposition which 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 veins. This is observed easily among dead persons with fair complexion.

b. Evolution of Gases in the Tissues: One of the products of putrefaction is the evolution of gases.

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

The formation of gases causes the distention of the abdomen and bloating of the whole body. Gases formed in the subcutaneous tissues and in the face, and neck cause swelling of the whole body. Small gas bubbles are found in solid visceral organs and give rise to the "foamy" appearance of the organs. Effects of the Pressure of Gases of Putrefaction: (1) Displacement of the Blood:

There may be post-mortem bleeding in open wounds on account of the increased pressure inside the body brought about by the accumulation of gases. The post-mortem lividity may be shifted to other parts of the body. The heart may empty itself of blood.

(2) Bloating of the Body: On account of the accumulation of gas, the body is

blown-up and swollen. The eyes may be protruding from its sockets, the tongue may come out of the mouth, and the face is black with thick lips having the appearance of a negro (tete de negri).

( 3 ) Fluid Coming Out of Both Nostrils and Mouth: Fluid coming out of both nostrils and mouth is usually

in the form of froth. It is due to the putrefaction of the upper gastro-intestinal and respiratory tracts.

( 4 ) Extrusion of the Fetus in a Gravid Uterus: On account of the increased intra-abdominal pressure,

the contents of the gravid uterus may be expelled, but this

138 LEGAL MEDICINE

event is quite doubtful when the product of conception is nearing full term because of the difficulty of expulsion. There is more likelihood for the uterus to rupture inside the abdominal cavity.

(5) Floating of the Body: The specific gravity of a decomposed body is much less

as compared with a recently dead. This is brought about by the increase of gaseous content and increase in volume due to bloating without any increase in weight,

c. Liquefaction of the Soft Tissues: As decomposition progresses, the soft tissues of the body

undergo softening and liquefaction. The eyeballs, brain, stomach, intestine, liver and spleen putrefy rapidly, while highly muscular organs and tissues relatively putrefy late.

Decomposition in water with bloating of the whole body, blackening of the face and attitude of the extremities at the time of recovery.

Factors Modifying the Rate of Putrefaction: a. Internal Factors:

(1) Age: Healthy adults decompose later than infants. It may be

late in a newborn infant who have not yet been fed. Markedly emaciated person has the tendency to mummify.


(2) Condition of the Body: Those of the full-grown and highly obese persons decom

pose more rapidly than skinny ones. Bodies of still-born are usually sterile so decomposition is retarded.

( 3 ) Cause of Death: Bodies of persons whose cause of death is due to in

fection decompose rapidly. This is also true when the diseased condition is accompanied with anasarca. Bodies whose sudden death is not due to microorganism decompose late.

b. External Factors: (1) Free Air:

(a) Air — The accessibility of the body to free air will hasten decomposition.

(b) Moderate Moisture — Moderate amount of moisture will accelerate decomposition, but excessive amount will prevent the access of air to the body thereby delaying decomposition. Moisture is necessary for the growth and multiplication of bacteria, however, if the evaporation of fluid is marked, there will be mummification of the tissues and putrefaction will be retarded.

(c) Condition of the Air — If the air is loaded with septic bacteria, decomposition will be hastened.

(d) Temperature of the Air — The optimum temperature for specific decomposition is 70°F to 100°F. Decomposition does not occur at temperatures below 32°F or about 212°F.

(e) Light — The organism responsible for the putrefaction prefers more the absence of light.

(2) Earth: Dry absorbent soil retards decomposition while moist

fertile soil accelerates decomposition. ( 3 ) Water:

Decomposition in running water is more rapid than in still water. Bacteria-laden pools will accelerate decomposition.

( 4 ) Clothings: Clothings initially hasten putrefaction by maintaining

body temperature but in the later stage, clothings delay decomposition by protecting the body from the ravages of flies and other insects. Tight clothings delay putrefaction

140 LEGAL MEDICINE

due to the diminution of blood in the area on account of pressure.

Physical Changes of the Body during Putrefaction in Chronological Order: a. External Changes:

(1) Greenish discoloration over the iliac fossa appearing after one to three days.

(2) 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. (5) Distention of the abdomen with gases. (6) Development of bullae in the face of varying sizes. (7) Bursting of the bullae and denudation of large irregular

surfaces due to the shedding of the epidermis. (8) Escape of blood-stained fluid from the mouth and nostrils. (9) Brownish discoloration of the surface veins giving an

arborescent pattern on the skin. (10) Liquefaction of the eyeballs. (11) Increased discoloration of the body generally and progres

sive increase of abdominal distention. (12) Presence of maggots. (13) Shedding of the nails and lossening of the hairs. (14) Conversion of the tissue into semi-fluid mass. (15) Facial feature unrecognizable. (16) Bursting of the abdomen and thoracic cavities. (17) Progressive dissolution of the body.

b. Internal Changes: (1) Those which Putrefy Early:

(a) Brain. (b) Lining of the trachea and larynx. (c) Stomach and intestines. (d) Spleen. (e) Liver. (f) Uterus (if pregnant or in puerperal stage).

(2) Those which Putrefy Late: (a) Esophagus. (b) Diaphragm. (c) Heart. (d) Lungs. (e) Kidneys. (f) Urinary bladder.


(g) Uterus (if not gravid). (h) Prostate gland.

Organs rich in muscular tissues resist putrefaction longer than the parenchymatous organs with the exception of the stomach and intestines which by reason of their contents at the time of death decompose quickly.

Factors Influencing the Changes in the Body after Burial: a. State of the Body Before Death:

An emaciated person at the time of death will decompose slower as compared with well-nourished individual when placed under the same conditions and circumstances. Skinny person has more tendency to mummify, especially at the regions of the extremities.

b. Time Elapsed between Death and Burial and Environment of the Body:

If the temperature of the surroundings at the time of death is conducive for the growth and multiplication of bacteria, then the longer the time such body is exposed to such condition the faster is the decomposition. However, if the body has been frozen to death for quite a time, there will be retardation of body decomposition. The presence of filthy, pultaceous and organic materials in the surroundings coupled with the presence of light and optimum temperature will enhance the decomposition.

c. Effect of Coffin: The use of a coffin will delay decomposition if it is air

tight and hard. If soft and weak, water can easily percolate at the floor and top, thus it will not serve the purpose. The body in a coffin usually decompose later as compared with the body which is coffinless.

d. Clothings and Any Other Coverings on the Body when Buried: Clothings and other body coverings delay decomposition.

Most often the covered portions of the body are well preserved for sometime. The most probable reasons why clothings retard decomposition are: (1) It affords some protection from insects and aids adipocere

formation keeping the body under it continuously moist by absorbing water from the soil.

(2) The pressure of the clothings on the body. e. Depth at which the Body was Buried:

As a general rule, the greater the depth the body has been buried, the better is the preservation. There is aeration in

142 LEGAL MEDICINE

shallow grave and this is a conducive invitation for injects and other animals. The changes of temperature of the body on account of the changing weather conditions is more marked in shallow graves.

f. Condition and Type of Soil: Dry, arid and sandy soil promotes mummification of the

body. The presence of straw or other organic matters that will introduce more bacteria will accelerate decomposition.

g. Inclusion of Something in the Grave which will Hasten Decomposition:

Some organic materials, like food are sometimes included with the dead body inside the coffin because of their superstition that it will be utilized by the departed soul in its life hereafter. Its presence inside the coffin will accelerate putrefaction.

h. Access of Air to the Body After Burial: Air may hasten evaporation of the body fluid and promotes

mummification. Bacteria-laden air will promote decomposition. Humid air will enhance adipocere formation. However, accessibility of air means also accessibility of insects and other scavengers which will promote destruction of the soft tissues of the body.

i. Mass Grave: This is seldom seen, except in mass massacre, war and in

plane crash. There is relatively rapid decomposition of the bodies,

j. Trauma on the Body: Persons dying from infection decompose rapidly while those

dying of violent death decompose relatively slow. On account of the presence of several factors which modify

decomposition of the body after death, it is quite difficult to make an estimate as to the duration of death of a decomposed body without considering those different elements influencing it.

Chronological Sequence of Putrefactive Changes Occurring in Temperate Regions:

Putrefactive Changes Time a. Greenish discoloration over the

iliac fossae. The eyeballs are soft and yielding. 1 to 3 days after death.

b. Greenish discoloration spreading over the whole abdomen, external genitals and other parts of the


body. Frothy blood from the mouth and nostrils. Abdomen distended with gas. Cornea fallen in and concave. Purplish red streaks of veins prominent on the extremities. Sphincters relaxed. Nails firm. Body greenish-brown. Blisters forming all over the body. Skin peels off. Features unrecognizable. Scrotum distended. Body swollen up owing to distention. Maggots found on the body. Nails and hair loose and easily detached. Soft parts changes into a thick, semi-fluid black mass. Skull exposed. Orbits empty.

3 to 5 days after death.



2 to 5 months after death.

(Casper, Forensic Medicine, cited by Modi, Medical Jurisprudence and Toxicology, 12 ed., 157, p. 134).

Chronological Sequence Tropical Region: Time Since Death 12 hours

24 hours

48 hours

72 hours

One week Two weeks

One month

of Putrefactive Changes Occurring in

Condition of the Body Rigor mortis present all over. Hypostasis well-developed and fixed. Greenish discoloration showing over the caecum. Rigor mortis absent all over. Green discoloration over whole abdomen and spreading to chest. Abdomen distended with gases.

Ova of flies seen. Trunk bloated. Face discolored and swollen. Blisters present. Moving maggots seen. Whole body grossly swollen and disfigured. Hair and nails loose. Tissues soft and-discolored. Soft viscera putrefied. Only more resistant viscera distinguishable. Soft tissues largely gone. Body skeletonized.

144 LEGAL MEDICINE

(From: — Lambert's Medico-Legal Post-mortem in India, 2nd ed., p. 25).

Body decomposition in warm countries, according to Lambert, will reduce the whole body to a skeleton in a month's time when exposed to air. In water, putrefaction proceeds twice as slowly as it is in air. When the body is buried, the rate depends on the mode of burial. In deep burial with coffin, putrefaction proceeds from four to six times as slowly as compared with that one in air, but with shallow coffinless burial, it is very slightly retarded.

Decomposition - Soft tissues of the chest and head have disappeared while those of the abdomen and extremities are mummified.

Chronological Sequence of Putrefactive Changes When the Body Has Been Submerged in Water:

Putrefactive Changes Time a. Very little change if water is

cold. Rigor mortis may persist. First four or five days. b. The skin on the hands and feet

became sodden and bleached. The face appears softened and lias a faded white color. From five to seven days.

c. Face swollen and red. Greenish discoloration on the eyelids, lips, neck and sternum. Skin of the hands and feet wrinkled. Upper


surface of brain greenish in color. One to two weeks.

d. Skin wrinkled. Scrotum and penis distended with gas. Nails and hair still intact. Lungs emphysematous and covered the heart. Four weeks.

e. Abdomen distended, skin of hands and feet come off with nails like a glove. Six to eight weeks.

(Observation of Devergie, cited by Modi, Medical Jurisprudence and Toxicology, 12th ed. 1957, p. 138).

Factors Influencing the Floating of the Body in Water: a. Age:

Bodies of fully-developed and well-nourished newly-born infants float relatively rapid.

Women float sooner than men. This is due to the lightness of female bones and greater porportion of fat, hence lesser specific gravity.

c. Conditions of the Body: Stout persons float quicker than skinny, lean and thin

bodies. Bodies with loose clothings will soon come to the surface.

d. Season of the Year: The moist hot air of summer is very favorable for putre

faction. Putrefaction makes the body bloat on account of gas formation, hence it will accelerate floating of the body.

e. Water:

Dead body floats in a shallow and stagnant water of creeks or pond sooner than in deep water of running stream. The stagnant water has higher specific gravity than clear water, so it is easy for the dead body to overcome it by gas formation. Body floats sooner in sea than in fresh water on account of the high specific gravity of sea water.

f. External Influence: The presence of heavy-wearing apparel or the addition of

weight in the pockets or attached to the body by means of rope or string will delay the floating of the body.

Order of Putrefaction When the Body is in Water: a. Face and neck or sternum. b. Shoulders.

b. Sex:

146 LEGAL MEDICINE

c. Arms. d. Abdomen. e. Legs.

Decomposition — The whole body almost skeletonized

Influence of Bacteria in Decomposition: Decomposition is due to action of bacteria in various tissues of

the body. During the early period of decomposition, aerobic activities are prominent. Later, the facultative aerobes and anaerobes are present. In the advanced stage, the activities of the anearobes are the most prominent with the production of gasses. The softening of the tissues is the result of bacterial action, proteolytic and autolytic ferments.

The microorganism that plays an important and dominant role in decomposition is Clostridium welchii. This bacteria starts to grow in parenchymatous organs. It is responsible for the disintegration of cytoplasm, destruction of nuclei and generation of gases in the cells.

Other bacteria which participate in tissue destruction during the period of decomposition are: a. Bacillus coli. b. Bacillus proteus vulgaris. c. Bacillus mesentericus. d. Bacillus aerogenes capsulatus.


Other Destructive Agents During Decomposition: a. Flies:

(1) Maggots (Larvae): The presence of maggots is dependent upon the acces

sibility of the body to adult flies. The flies lay eggs which after a time is hatched to form maggots. The maggots have a strong desire to live in damaged skin surface. Maggots may also be observed in bodies buried in shallow graves and even in floating decomposed bodies in water pools.

(2) Adult Flies: The common house flies are carnivorous.* They devour

the juicy areas of exposed portions of the body. Destruction by adult flies is observed better when the body is found on surface ground.

b. Reptiles: Lizards and snakes are attracted to dead bodies and eat the

soft tissues. Small bones may be fractured in the process and may be mistaken for injuries during the life time of the deceased.

c. Rodents: Rats and mice will nibble the skin and other tissues and may

show unexplainable injuries. The bones may also be attacked and showed certain degree of erosions.

d. Other Mammals: The dogs may participate in the destruction of the soft

tissues especially in cases where the victim is lying on the ground. In most instances, the different parts of the body is scattered and separated from one another. A part may be missing or seen in some far distant places. In India, jackals also participate in the destruction of decomposed tissues.

e. Fishes and Crabs: If the body is in water, fish of almost all species and crus

tacean will be feeding on the soft tissues. Man-eating fishes like sharks may devour the whole body of a person.

f. Molds: As a general rule, molds do not destroy the dead bodies but

their growth cause disfigurement and minor superficial lesions on the skin.

After a period of time, all of the soft tissues of the body will disappear. Only the teeth, bones and hair will remain. These tissues will remain undestroyed for an indefinite time. The bones may show signs of disintegration by the diminution of

LEGAL MEDICINE

weight and erosion of the epiphysis. Flat bones disintegrate faster than round bones. The degree of ossification is also a factor in the bone destruction.

Death in the sea with post-mortem erosion of the face due to the activities of the fishes and other aquatic animals.

SPECIAL MODIFICATION OF PUTREFACTION: a. Mummification:

Mummification is the dehydration of the whole body which results in the shivering and preservation of the body. It usually occurs when a dead body is buried in a hot, and arid place with dry atmosphere and with free access of hot air. In most cases, the natural physical appearance is not modified, hair may be kept intact although there may be change in color of the skin. The internal organs may be shrunken, hard and with a dark-brown or black color. If the whole fluid contents of the body has evaporated, preservation is for an indefinite time but the whole body may become brittle, weight markedly reduced and may later be destroyed by pulverization.

Mummification is observed in warm countries where evaporation of body fluid takes place earlier and faster than decomposition. Death in deserts, like in Egypt, the body has more tendency to mummify. However, a mummified body may after a time be attacked by moths and verm ins causing destruction.


Kinds of Mummification: (1) Natural Mummification;

When a person is buried in hot, arid, sandy soil, there will be insufficient moisture for the growth and multiplication of putrefactive bacteria. The body will become dehydrated and mummified which is caused by the forces of nature.

(2) Artificial Mummification: The principles involved in artificial mummuification are: (a) Acceleration of the evaporation of the tissue fluid of

the body before the actual onset of decomposition.

(b) Addition of some body preservatives to inhibit decomposition and to allow evaporation of fluid. This is made by treatment of the body with arsenic, formalin, resinous or tarry materials.

b. Saponification or Adipocere Formation: This is a condition wherein the fatty tissues of the body are

transformed to soft brownish-white substance known as adipocere. The layer of subcutaneous tissue is the frequent site of its formation. It occurs naturally in the visceral organs and even in non-fatty tissues of the body like the muscles.

Adipocere is a waxy material, rancid or moldy in odor, floats in water, and dissolves in ether and alcohol. With diluted solution of copper sulfate, it gives a light greenish-blue color. It is inflammable and burns with a faint yellow flame. When distilled it produces a dense oily vapor.

Some Theories on the Formation of Adipocere: (1) The fats of the body split into glycerol and fatty acids.

The fatty acids combine with calcium, magnesium, potassium, sodium, and ammonium salts to form an insoluble soap. These ester of fatty acid somehow delay body decomposition and make the body surface greasy to touch.

(2) There is gradual hydrogenation of pre-existing fat in the body like olein to higher fatty acids. Hydrogenation causes remarkable swelling and stiffening of the fats. The new hydrogenated fat is quite stable but on exposure to air becomes yellow, hard and brittle.

Factors Influencing Adipocere Formation in Earth Burial: (1) State of Health Before Death:

Adipocere formation depends primarily on the presence of fat in the body of the deceased. It is difficult for adi-

LEGAL MEDICINE

pocere to develop in the state of extreme emaciation. Areas of the body where fat is abundant develop adipocere recognizable through the naked eye rapidly as compared with the other areas. The amount of water in the surroundings is not very essential to the phenomena. Water of the body may be drawn from the muscles and internal organs.

(2) Time Interval between Death and Burial: Generally, the longer the space of time interval between

death and burial, the greater is the degree of adipocere formation. This is further accelerated when the body is subjected to autopsy. Exposure of the internal organs to external elements promotes enzymatic and bacterial actions in the process of hydrolysis and glycerol formation.

(3) Effect of the Coffin: The coffin has air space and if crudely made, it may

allow water to come in contact with the body surface thereby enhancing hyrolysis of fat. If water has been freely admitted, colliquative putrefaction will develop for a longer time thus making adipocere formation scanty.

(4) Presence of Clothings and Other Coverings of the Body: Adipocere formation is found to be more advanced

under clothings or other body coverings, especially if the clothings are tight.

(5) Type of Soil: Dry soil is conducive to mummification. Sufficiently

moist soil accelerates adipocere formation. (6) Access of Air to the Body After Burial:

The disturbance of a body in the grave shortly after burial or before the formation of adipocere prolongs its formation.

(7) Mass Grave: There is more tendency for adipocere formation when

several bodies are located in a grave because of the abundance of moisture.

Maceration: This is the softening of the tissues when in a fluid medium

in the absence of putrefactive microorganism which is frequently observed in the death of the fetus en utero.

When the fetus dies en utero, provided that the death of the fetus is not due to attempted abortion or rupture of the membrane, the child is enclosed by the membrane in sterile con-


dition. Putrefaction does not take place and the fetus becomes soft. The softening of the body may be due to the action of the autolytic and proteolytic enzymes and ferments. /

The appearance of the fetus is typical. The hody is discolored either reddish or greenish with the skin peeling off and the arms flaccid and frail. As maceration advances, there is brownish-red discoloration of the skin. There may be blister formation and the odor is somewhat rancid. For a definite and appreciable degree of maceration to take place, it requires about twenty-four hours.

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 in

from 2 to 3 hours after the 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, decompo

sition 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. For the stage of decomposition and the approximate time after death, see tabulations (supra p. 143).

5. Entomology of the Cadaver: 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

DURATION OF DEATH

152 LEGAL MEDICINE

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

contents after a 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.

The extent of the gastric emptying and the progression of the meal in the gastro-intestinal tract can be useful in estimating the time of death. However, the position and condition of the decedent's last meal is influenced by the following factors: a. Size of the Last Meal — The stomach usually starts to empty

within ten minutes after the first mouthful has entered. A light meal leaves the stomach within 1-1/2 to 2 hours after being eaten. A medium-sized meal will require 3 to 4 hours. A heavy meal is entirely expelled into duodenum in 4 to 6 hours.

b. Kind of Meal — Liquid move more rapidly than semi-solid and the latter more rapidly than solids.

c. Personal Variation — Psychogenic pylorospasm can prevent departure of the meal from a stomach for several hours, contrariwise, a hypermotile stomach may enhance entry of food into the duodenum.

d. Other Factors: (1) Kinds of Food Eaten — Vegetables may require more time

for gastric digestion. The less fragmentation of the food will require more time to stay in the stomach. The absence or insufficiency of pepsin and other digestive ferments will delay the food in the stomach. Absence or insufficiency of the gastric hydrochloric acid content and lesser amount of liquid consumed with solid food will likewise delay gastric evacuation.

The head of the meal ordinarily reaches the distal ileum and cecum between 6 and 8 hours after eating.

The conclusion may be of value in the estimation of death if one is familiar with the decedent's eating habit and meal time, quantity of the last meal and the interval between the last two meals.


7. Presence of Live Fleas in the Clothings in Drowning Cases: A flea can survive for approximately 24 hours submerged in

water. It can no longer be revived if submerged more than that period. In temperate countries, people use to wear woolen clothes. If the body is found in water, the fleas may be found in the woolen clothings. The fleas recovered must be placed 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 caution.

9. State of the Clothings: A circumstantial proof of the time of death is the apparel

of the deceased. If the victim is wearing street clothes, there is more likehood that death 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 Cerebrospinal Fluid (15 Hours Following Death): a. Lactic acid increases from 15 mg. to 200 mg. per 100 cc. b. Non-protein nitrogen increases from 15 to 40 mg. ( c. 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 years time after burial. The disappearance of the soft tissues varies and are 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 elements and animals may accelerate its destruction.

13. Condition of the Bones: If all of the soft tissues have already disappeared from the

skeletal remains, the degree of erosion of the epiphyseal ends of

154 LEGAL MEDICINE

long bones, pulverization of flat bones and the diminution of weight due to the loss of animal matter may be the basis of the approximation. Post-mortem Conditions Simulating Disease, Poisoning or Injury: a. Post-mortem hypostasis simulating contusion or inflammation

or poisoning. b. Blister of the cuticle simulating scalds or burns. c. Swelling, detachment or splitting of the skin simulating

Rule 131, Sec. 5(x), Rules of Court: Disputable Presumption:

That a person not heard from for seven years, is dead. Presumption of Death: Art. 390, Civil Code and Sec. 5(x), Rule 131, Rules of Court:

After an absence of seven years, it being unknown whether or not the absentee still lives, he shall be presumed dead for all purposes, except for those of succession.

The absentee shall not be presumed dead for the purpose of opening his succession till after an absence of ten years. If he disappeared after the age of seventy-five years, an absence of five years shall be sufficient in order that his succession may be opened.^

Art. 391, Civil Code and Sec. 5(x), Rule 131, Rules of Court:

The following shall be presumed dead for all purposes, including the division of the estate among the heirs:

(1) A person on board a vessel lost during a sea voyage, or an aeroplane which is missing, who has not been heard of for four years since the loss of the vessel or aeroplane.

(2) A person in the armed forces who has taken part in war, and has been missing for four years:

(3) A person who has been in danger of death under other circumstances and his existence has not been known for four years.

Art. 392, Civil Code:

If the absentee appears, or without appearing his existence is proved, he shall recover his property in the condition in which it may be found, and the price of any property that may have been alienated or the property acquired therewith; but he cannot claim either fruits or rents

injury.

E. PRESUMPTION OF DEATH


F. PRESUMPTION OF SURVIVORSHIP

Sec. 5(jj), Rule 131, Rules of Court: When two persons perish in the same calamity, such as wreck,

battle, or conflagration, and it is not shown who died first, there are no particular circumstances from which it can be inferred, the survivorship is presumed from the probabilities resulting from the strength and age of the sexes, according to the following:

1. If both were under the age of fifteen years, the older is presumed to have survived;

2. If both were above the age of sixty, the younger is presumed to have survived;

3. If one is under fifteen and the other above sixty, the former is presumed to have survived;

4. If both be over fifteen and under sixty, and the sexes be different, the male is presumed to have survived; if the sexes be the same, then the older;

5. If one be under fifteen or over sixty, and the other between those ages, the latter is presumed to have survived.

Art. 43, Civil Code: If there is a doubt, as between two or more persons who are called

to succeed each other, as to which of them died first, whoever alleges the death of one prior to the other, shall prove the same; in the absence of proof, it is presumed that they died at the same time and there shall be no transmission of rights from one to the other.

Chapter V

MEDICO-LEGAL INVESTIGATION OF DEATH

An inquest officer is an official of the state charged with the duty of inquiring into certain matters. In a medico-legal investigation, an inquest officer is the one charged with the duty of investigating the manner and cause of death of a person. He is authorized to summon witnesses and direct any person to perform or assist in the investigation when necessary.

The following officials of the government are authorized to make death investigations:

1. The Provincial and City Fiscals: Sec. 983, Revised Aministrative Code:

The district health officer, upon the request of any provincial fiscal of a province within his district, or of any judge of a Court of the First Instance (now Regional Trial Court), or of any justice of the peace (now, Municipal Trial Court), shall conduct in person, when practicable, investigations in cases of death where there is suspicion that death was caused by the unlawful act or omission of any person, and shall make such other investigations as may be required in the proper administration of justice.

Sec. 38, Rep. Act 409 as amended by Rep. Act. 1934 (Revised Charter of the City of Manila):

The City Fiscal shall also cause to be investigated the cause of sudden deaths which have not been satisfactorily explained and when there is suspicion that the cause arose from the unlawful acts or omissions of other person, or from foul play, and, in general, victims of violence, sex crimes, accidents, self-inflicted injuries, intoxications, drug addiction, states of malingering and mental disorders, which occur within the jurisdiction of the City of Manila, and the examination of evidences and telltale marks of crimes. For that purpose, he may cause autopsies to be made and shall be entitled to demand and receive for purposes of the office of the medical examiner, or the criminal investigation laboratory of the Manila Police Department, or subject to the rules and conditions previously established by the Secretary of Justice, the aid of the medico-legal section of the National Bureau of Investigation. If in case the fiscal

156

MEDICO-LEGAL INVESTIGATION OF DEATH 157

of the city deems it necessary to have further expert assistance for the satisfactory performance of his duties in relation with medicolegal matters or knowledge, including the giving of medical testimony in the courts of justice, he shall request the same, in the same manner and subject to the same rules and conditions as above specified, from the office of the medical examiner, or from the criminal investigation laboratory of the Manila Police Department, or from the medico-legal officer of the said bureau, who shall thereupon furnish the assistance required in accordance with his powers and facilities. He shall at all times render such professional services as the Mayor or board may require and shall have such powers and perform such other duties as may be prescribed by law or ordinance.

2. Judges of the Courts of the First Instance (now Regional Trial Courts) Sec. 983, Revised Administrative Code (Supra).

3. Justice of the Peace (now Municipal Trial Courts) Sec. 983, Administrative Code (Supra).

4. The Director of the National Bureau of Investigation — Rep. Act. 157 (An act creating the National Bureau of Investigation).

Sec. 1. — There is hereby created a Bureau of Investigation under the Department of Justice which shall have the following functions: (a) To undertake investigations of crimes and other offenses

against the laws of the Philippines, upon its own initiative and as public interest may require;

(b) To render assistance, whenever properly requested in the investigation or detection of crimes and other offenses;

(c) To act as a national clearing house Of criminal and other information for the benefit of all prosecuting and law-enforcement entities of the Philippines, identification records of all persons without criminal convictions, records of identifying marks, characteristics, and ownership or possession of all firearms as well as the test bullets fired therefrom;

(d) To give technical aid to all prosecuting and law-enforcement officers and entities of the Government as well as courts that may request its services;

(e) To extend its services, whenever properly requested in the investigation of cases of administrative or civil nature in which the government is interested;

(f) To undertake the instruction and training of a representative number of city and municipal peace officers at the request of their respective superiors along effective methods of crime

158 LEGAL MEDICINE

investigation and detection in order to insure greater efficiency in the discharge of their duties;

(g) To establish and maintain an up-to-date scientific crime laboratory and to conduct researches in the furtherance of scientific knowledge in criminal investigation;

(h) To perform such other related functions as the Secretary (now Minister) of Justice may assign from time to time.

Sec. 5. — The members of the investigation staff of the Bureau of Investigation shall be peace officers, and as such have the following powers: (a) To make arrests, searches, and seizures in accordance with

existing laws and rules; (b) To issue subpoena or subpoena duces tecum for the appearance

at government expense of any person for investigation; (c) To take and require sworn truthful statements of any person

or person so summoned in relation to cases under investigation, subject to constitutional restrictions;

(d) To administer oaths upon cases under investigation; (e) To possess suitable and adequate firearms for their personal

protection in connection with their duties and for the proper protection of witnesses and persons in custody; Provided, that no previous special permit for such possession shall be required;

(f) To have access to all public records and, upon authority of the President of the Philippines in the exercise of his visitorial powers, to record of private parties and concerns.

5. The Chief of Police of the City of Manila: Sec. 34, Rep. Act 409 (Revised Charter of the City of Manila) as amended by Sec. 1, Rep. Act. 1934 — Chief of Police:

There shall be a chief of police. . . (who) shall cause medicolegal examination by the medical examiner of the Manila Police Department of victims of violence or foul play, sex crimes, accidents, sudden death when the cause thereof is not known, self-inflicted injuries, intoxication, drug addiction, states of malingering and mental disorders, which are being investigated by the Manila Police Department or, in exceptional cases, by other agencies requesting assistance of the Manila Police Department; and shall cause examination by the medical examiner of the Manila Police Department or by a criminal investigation laboratory established within said department, or evidences and telltale marks of crime. He shall have such powers and perform such further duties as may be prescribed by law or ordinances.


6. Solicitor General: Sec. 95 (b) P.D. 856 (Code of Sanitation of the Philippines)

Autopsies shall be performed in the following cases: 3 4. Whenever the Solicitor General, provincial or city fiscal

as authorized by existing laws, shall deem it necessary to disinter and take possession of remains for examination to determine the cause of death.

Stages of Medico-Legal Investigation: 1. Crime Scene Investigation (Investigation of the place of com

mission of the crime). 2. Autopsy (Investigation of the body of the victim).

1. CRIME SCENE INVESTIGATION: The crime scene is the place where the essential ingredients of

the criminal act took place. It 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.

Violent death in a vehicular accident scene.

160 LEGAL MEDICINE

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.

Importance of Crime Scene Investigation: A great amount of physical evidence may be lost or unrecovered

if the investigation merely starts at the autopsy table or in the medical examining room. Blood, semen and other stains, latent finger and foot prints, and articles of value that may lead to the identification of the offender and victim may be beyond the comprehension of the investigator if the crime scene is not investigated.

In violent death.cases, the manner and cause of death may be inferred from the condition of the crime scene. The condition of the crime scene may indicate struggle, handgun firmly grasped in the palm of the hand of the deceased may indicate suicide, the presence of a great quantity of shed blood may infer hemorrhage as the cause of death of the victim.

The investigator has the earliest possible opportunity to interview persons who have knowledge of the circumstances of actual events in the commission of the criminal act. The proximity of the narration to the actual occurrence makes it reliable than those given after a lapse of time. ^

Persons to Compose the Search Team: a. A physician who has had previous knowledge and training in

medico-legal investigation must direct the search and assume responsibility for an effective search.

b. A photographer who will take pictures of the scene and the pieces of evidence recovered. He may also act as sketcher and measurer.

c. An assistant who will act as the note taker, evidence collector and helper. He must have previous knowledge and training in evidence collection.

Equipment Needed in Crime Scene Investigation: a. Those needed in the search of physical evidence — Flashlight

and magnifying lens. b. Those needed in the collection of evidence — forceps, knife,

screw driver, scalpel, cutting instruments like plier, pair of scissors and fingerprint kit.


D. WHEEL METHOD E. ZONE METHOD

METHODS OF SEARCH AT THE CRIME SCENE.

162 LEGAL MEDICINE

c. Those needed in the preservation and transportation of evidence collected — Bottles, envelopes, test tubes, pins, thumb tacks, labelling tag and pencil.

d. Those necessary for the documentation of the scene — Photographic camera, sketching kit, measuring tape, compass, chalk or any writing instrument.

Methods of Conducting a Search: Before the actual performance of the search, it is advisable to

stand aside and make an estimate of the situation. A picture of the whole area must be taken and the area must be cordoned or bystanders must not be allowed to get in. Depending upon the size, terrain and condition of the crime scene, the following methods of search may be applied: a. Strip Method — The area is blocked out in the form of a rect

angle. The searcher proceeds slowly at the same pace along the path parallel to one side of the rectangle.

b. Double Strip or Grid Method — The searchers will traverse first parallel to the base and then parallel to the side.

c. Spiral Method — The searchers follow each other in the path in the spiral manner beginning from the center towards the outside or vice versa.

d. Wheel Method — The searchers gather at the center and proceed outwards along radii or spokes.

e. Zone Method — Whole area is divided into subdivisions or quadrants and search is made in the individual quadrants.

Disposal of the Collected Evidence: All evidences collected must be protected, identified and

preserved. Reasonable degree of care must be exercised to preserve shape, to minimize alterations due to contamination, chemical changes, addition of extreneous substances. In the process of transferring of the evidences, the number of persons who handle them must be kept at a minimum and each transfer should be receipted.

Examination of the Dead Body in the Crime Scene: After a complete search, the investigating physician must make

a thorough inspection of the dead body. Special consideration must be made on the following: a. Evidences which will tend to prove identity. b. Position of the victim. c. Condition of the apparel worn. d. Approximate time of death.-


e. Presence of wounding instrument and its approximate distance from the body.

f. Potential cause of death. In a death by gunshot, the clothing must be left Undisturbed

at the crime scene. A lot of information may be gathered from it: a. The bullet might have produced an exit on the skin but failed to

cause mark or tear on the clothings which through improper handling may not be recovered.

b. Examination "in situ" may be useful in the determination of the site of entrance and exit of the bullet and also the trajectory of the shot.

2. AUTOPSIES: An autopsy is a comprehensive study of a dead body, per

formed by a trained physician employing recognized dissection procedure and techniques. It includes removal of tissues for further examination.

Autopsies vs. Post-mortem Examination: Post-mortem examination — refers to an external examination

of a dead body without incision being made, although blood and other body fluids may be collected for examination.

Autopsy — indicates that, in addition to an external examination, the body is opened and an internal examination is conducted. (Modern Legal Medicine Psychiatry and Forensic Science by Curran, McGarry and Petty, p. 51 footnote).

Kinds of Autopsies: a. Hospital or Non-official Autopsy b. Medico-legal or Official Autopsy

a. 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 purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease process; and (5) educating students and physicians (Forensic Pathology, A Handbook for Pathologists, Fisher and Petty, July 1977, p. 1).

Inasmuch as previous consent of the next of kin is necessary before a non-official autopsy can be performed, the Civil

164 LEGAL MEDICINE

Code states who is the rightful person to give such consent. The order is provided in Articles 294 and 305.

The consent shall be obtained from: (1) The spouse; (2) the descendants of the nearest degree; (3) the ascendants, also of the nearest degree; (4) the brothers and sisters (Art. 294, Civil Code).

In case of descendants of the same degree, or of brothers and sisters, the oldest shall be preferred. In case of ascendants, the paternal shall have a better right (Art. 305, Civil Code).

b. Medico-Legal or Official Autopsy: This is an examination performed on a dead body for the

purposes of: (1) determining the cause, manner (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 (Forensic Pathology, A Handbook for Pathologists, Fisher and Petty, July 1977, p. 1).

In cases which require a medico-legal autopsy, the dead body belongs to the state for the protection of public interest until such time as a complete and thorough investigation into the circumstances surrounding the death and the cause thereof has been completed. The physician entasked to perform such autopsy is considered to be the authoritative agent and representative of the state who has the "property right" of the dead body.

All that need to be turned over to the next of kin responsible for burial of the deceased is that remaining portion or portions of the body not needed for any medicolegal purposes (Forensic Medicine by Tedeschi, Eckert & Tedeschi, Vol. II, p. 972). Sec. 983, Revised Administrative Code — Investigation into cause of death (supra p. 156). Sec. 1089, Revised Administrative Code — Proceedings in cases of suspected violence or crime:

If the person who issues a death certificate has any reason to suspect or if he shall observe any indication of violence or crime, he shall at once notify the justice of the peace (now Municipal Trial Judge), if he be available, or if neither the justice of the peace nor the auxiliary justice be available, he shall notify the municipal mayor, who shall take proper steps

MEDICO-LEGAL INVESTIGATION OF DEATH

to ascertain the circumstances and cause of death; and the corpse of such deceased person shall not be buried or interred until permission is obtained from the provincial fiscal, if he be available, and if he be not available, from the mayor of the municipality in which the death occurred.

When shall an Autopsy be Performed on a Dead Body: Sec. 95 (b), P.D. 856, Code of Sanitation: a. Whenever required by special laws; b. Upon order of a competent court, a mayor and a provincial or

city fiscal; c. Upon written request of police authorities; d. Whenever the Solicitor General, Provincial or city fiscal as

authorized by existing laws, shall deem it necessary to disinter and take possession of the remains for examination to determine the cause of death; and

e. Whenever the nearest kin shall request in writing the authorities concerned in order to ascertain the cause of death.

Persons who are Authorized to Perform Autopsies and Dissections: The following are authorized to perform autopsies and dissections: a. Health Officers; b. Medical officers of law enforcement agencies; and c. Members of the medical staff of accredited hospitals.

(Sec. 95 (a) P.D. 856).

a. Health officers: The health officers referred to by the Sanitation Code are

the district health officer (now provincial health officer) and local health officer (now the rural health officer). (1) District Health Officer (see Sec. 983, Revised Administrative

Code (supra, p. 156). (2) Local Health Officer:

Sec. 984, Revised Administrative Code —Person to make investigation — When it is not practicable for the district health officer to conduct such investigation in person, he may require any local health officer or member of a municipal board of health who is a registered physician to perform such duty; and where the services of a registered physician in the Government service cannot be thus obtained, he may require a "cirujano ministrante" who is a member of the board or a sanitary inspector to act in the matter.

b. Medical Officers of Law Enforcement Agencies:

166 LEGAL MEDICINE

(1) Medical examiner of the City of Manila (See Sec. 34 and 38 of Rep. Act 409 as amended by Rep. Act. 1934).

(2) Medical staff of the National Bureau of Investigation which is composed of those assigned in the central office in Manila under the Medico-Legal Section and those assigned in the regional offices of the Bureau in accordance with the administrative plantilla implementing Rep. Act. 157.

(3) Medico-Legal officers of the Philippine Constabulary assigned in the Philippine Constabulary Crime Laboratory (PCCL) and those assigned in different regional commands.

Insofar as medico-legal investigation of criminal cases occurring within the jurisdiction of the City of Manila is concerned, there are two officers qualified to make the investigation: (a) The medical examiners of the Manila Police Depart

ment; and (b) The Medico-Legal Officers of the National Bureau of

Investigation. The Medical examiner or medico-legal officer "may

investigate cases of sudden deaths, which have not been satisfactorily explained and when there is suspicion that the case arose from unlawful acts or omissions of other persons, or from foul play, and in general victims of violence, sex crimes, accidents, self-inflicted injuries, intoxication, drug addiction,. . ." (Sec. 38, Act. 409 as amended by Rep. Act. 1934).

c. Members of the medical staff of accredited hospitals.

Distinction between Pathological (Non-official) and Medicolegal (Official) Autopsies:

Pathological Autopsy Medico-legal Autopsy a. Requirement Must have the consent It is the law that gives

of the next of kin. the consent. Consent of relatives are not needed.

b. Purpose Confirmation of clini- Correlation of tissue cal findings of re- changes to the criminal search. act.

c. Emphasis Notation of all ab- Emphasis laid on effect normal findings. of wrongful act on the

body. Other findings


e. Conclusion

f. Minor or non-pathological

Summation of all abnormal findings irrespective of its correlation with clinical findings. Need not be mentioned in the report.

may only be noted in mitigation of the criminal responsibility. Must be specific for the purpose of determining whether it is in relation to the criminal act.

If the investigator thinks it will be useful in the administration of justice, it must be included.

Other Salient Features Peculiar to Medico-Legal Autopsies: a. Clinical history of the deceased in most instances absent,

sketchy or doubtful. b. The identity of the deceased is the responsibility of the foren

sic pathologist. c. The time of death and the timing of the tissue injuries must

be answered by the forensic pathologist. d. The forensic pathologist must alert himself of the possible

inconsistencies between the apparent cause of death and his actual findings in the crime scene.

e. A careful examination of the external surface for possible trauma including the clothings to determine the pattern of injuries in relation to the injurious agent.

f. The autopsy report is written in a style that will make it easier for laymen to read and more clearly organized insofar as the mechanism of death is concerned.

g. fhe professional and environmental climate of a forensic pathologist is with the courts, attorneys and police who make scrutiny of the findings and conclusion.

The following Manner of Death should be Autopsied:

a. Death by violence. b. Accidental death. c. Suicides. d. Sudden death of persons who are apparently in good health. e. Death unattended by physician. f. Death in hospitals or clinics (D.O.A.) wherein a physician was

not able to arrive at a clinical diagnosis as the cause of death. g. Death occurring in an unnatural manner.

168 LEGAL MEDICINE

PROCEDURE OF AUTOPSY

Guidelines in the Performance of Autopsies:

1. Be it an official (medico-legal) or non-official autopsy, the pathologist must be properly guided by the purposes for which autopsy is to be performed. In so doing the purpose of such dissection will be served.

2. The autopsy must be /comprehensive and must not leave some parts of the body unexamined. Even if the findings are already sufficient to account for the death, these should not be a sufficient reason for the premature termination of the autopsy. The existence of a certain disease or injury does not exclude the possibility of another much more fatal disease or injury. The findings of coronary disease does not exclude the probability of injury or poisoning.

3. Bodies which are severely mutilated, decomposing or damaged by fire are still suitable for autopsy. No matter how putrid or fragmentary the remains are, careful examination may be productive of information that bears the identity and other physical trauma received. Frequently a pathologist's reluctance to perform an autopsy on decomposed body is due to the odor or vermin rather than to his belief that the examination would not be productive.

4. All autopsies must be performed in a manner which show respect of the dead body. Unnecessary dissection must be avoided.

A wife consented to the performance of an autopsy but specifically stated that it must be performed in a "decent" manner. The autopsy was done in broad daylight in the cemetery in full view of all the neighborhood residents. Thetourt held that the condition was violated and she was awarded damage even though she has consented to the examination (Hill V. Travelers Ins. Co. 294 S.W. 1097, Tenn. 1927).

5. Proper identity of the deceased autopsied must be established in non-official autopsy. An autopsy on a wrong body may be a ground for damages.

Two patients occupying adjoining beds died within a five-minute interval. There was authorization to perform an autopsy on one of them but the nurse interchanged the tags. The deceased wherein there was no authorization given was autopsied. The next of kin brought an action against the hospital administrator, the pathologist and the coroner for unauthor-


ized autopsy. The liability was made on the nurse who unfortunately was not made as one of the defendants (Schwalb v. Connely, 179p. 2d 667, Colo.). The award for damages for wrongful autopsy is not on account

of the mutilation of the deceased body but for the injury to the feelings and mental suffering of the living because of the illegal act.

After the death of the husband and without the consent of the wife, an autopsy was performed on the body of the deceased. The widow filed a suit for unlawful autopsy and failure to replace the brain, heart and organs. The court held that there is no justification for the autopsy and dismemberment and have injured the feelings of the widow. The sum of $1,000 was awarded as reasonable damages (Gould v. State of New York, 181 Misc. 884, 46 N. Y.S. 2d 313).

6. A dead body must riot be embalmed before the autopsy. The embalming fluid may render the tissue and blood unfit for toxico-logical analyses. The embalming may alter the gross appearance of the tissues or may result to a wide variety of artifacts that tend to destroy or obscure evidence. An embalmer who applied embalming fluid on a dead body which in its very nature is a victim of violence is liable for his wrongful act.

7. The body must be autopsied in the same condition when found at the crime scene. A delay in its performance may fail or modify the possible findings thereby not serving the best interest of justice.

Precautions to be Observed in Making Medico-Legal Post-mortem Examination:

1. The physician must have all the necessary permit or authorization to perform such an examination. Such permit must be issued by the inquest officer. The absence of such authorization may hold the physician civilly and criminally liable.

2. The physician must have a detaUed'liistory of the previous symptoms and condition of deceased to be used as his guide in the post-mortem examination.

3. The true^fuentity of the deceased must be ascertained. If no one claims the body, a complete date to reveal his identity must be

4. Examination must be made in a Well-lighted place and it is advisable that no unauthorized person should be present.

taken.

170 LEGAL MEDICINE

5. All external findings must be properly described and if possible a sketch must be made or photograph must be taken to preserve the evidence.

6. All steps and findings in the examination must be recorded.

Rules in the Examination: 1. Look before you cut. 2. Never cut unless you know exactly what you are cutting. 3. Weigh and measure everything that can be weighed or measured.

Stages in the Post-mortem Examination of the Dead Body:

1. Preliminary Examination:

a. Examination of the Surroundings (Crime Scene): Attention must be focused on the furniture; bullet holes on

the ceiling, floor and walls; amount, color, shape and degree of spread of the blood stains, position of the wounding weapon; foot and fingerprints and hairs and clothes.

b. Examination of the Clothings: Look for marks to establish identity, kind and quality of the

garment, stains, grease, cut and "tear or other marks of resistance and violence.

c. Identity of the Body: Determine the height, weight, color of the hair and eyes,

complexion, condition and number of teeth, bodily deformity, scars and tattoo marks, clothings, dog tag and fingerprints.

2. External Examination: a. Examination of the Body Surfaces:

Inspect the natural orifice of the body. All wounds must be described in detail, blood stains and foreign bodies.

b. Determination of the Position and Approximate Time of Death: In this stage, the presence and degree of hypostasis, rigor

mortis and putrefaction and color of the blood stain must be noted. Examination of the hands for the presence of cadaveric spasm and wounding weapon may be necessary for the proper solution of the crime.

3. Internal Examination: Examine all body orifices for blood and foreign bodies. Blood

coming out of the nostrils may imply fracture on the base of the anterior cranial fossa. Hemorrhage of the ears may imply fracture of the middle cranial fossa.


Advantages of Starting Autopsy on the Head: 1. If the autopsy starts on the chest or abdomen, excision of the

organs will cause the blood content of the brain and the meninges to necessarily lose its original pattern;

2. There is the unavoidable contamination of the body associated with the autopsy, which prevents liable culturing of microorganisms from the cranial contents;

3. Manipulation of other blood vessels, specially at the neck may result in air bubbles' being artificially drawn into the cerebral vessels, impairing fair evaluation of air embolism that might have occurred during life (Forensic Medicine, Vol. 1, by Tedeschi, Eckert and Tedeschi, p. 35). A primary incision must be made from the suprasternal notch to

the pubic symphysis passing to the left of the umbilicus. Cut the rectus abdominis muscle at several points to expose the abdominal cavity and flap the skin at the region of the chest from the primary incision to the lateral aspect of the chest exposing the ribs. Disarticulate the sterno-clavicular joint and cut the ribs medial to the costo-chondral junction. Remove the breast and begin examining the following:

Abdominal and Chest Wall: Fat — Amount, color, moisture, fibrosis. Musculature — Development, color, thickness,

atrophic changes. Peritoneal Cavity:

Fluid

Omentum

Liver

Chest Cavity: Fluid

Adhesions

Pleura

Mediastinum

Thymus

— Amount, character, color, consistency, purulent or bloody material.

— Amount of fat, extent, adhesions, blood distribution.

— Level of the anterior border, adhesions, blood distribution, color, fatty or atrophic changes.

— Amount, color, character, consistency, purulent or bloody material.

— Kind, extent, concommitant disease, distribution.

— Luster, hemorrhage, disease. — Enlargement of the lymph nodes,

tumor. — Weight, lobulation, fatty degener

ation.

172 LEGAL MEDICINE

See a tabulation regarding the weight of the thymus gland with respect to age.

Open the pericardial sac and examine its contents, principally the heart. The normal pericardial fluid is from 5 cc. to 6 cc. and yellowish in color. Remove the heart by cutting the root of the blood vessels connected with it. Examine the heart on the following points:

Weight — Normal in men — 300 grams; women 250 grams.

External — Size, shape, consistency, contraction or relaxation of the ventricle.

Adhesions, amount of fat, luster, petechial hemorrhages, milky patches. Amount of blood, blood clots, emboli, dilatation. Normal: Tricuspid — 12 cm.; pulmonary — 8.0 cm.; mitral — 10.0 cm.; aortic — 7.0 om. Normal: left — 1.4 cm.; right — 0.4 cm. Ulceration, vegetation and sclerosis of the valves, mural endocardium, thrombi, cordae tendinae, trabecule , papillary muscles. Mottling (Tigroid heart). Color, consistency, resistance to section infraction, sclerosis, fibrosis edema. Special attention must be made to the anterior branch of the left coronary artery, sclerosis, atheroma, embolism.

Removed both lungs by cutting the region of the hilus. After examining the fluid or adhesions within the chest wall, the following points must be considered in the examination:

Weight — Normal: right — 400 grams; left — 350 grams.

External Examination — State of collapse, size, consistency, color, crepitation, consolidation, luster, exudate, anthracosis, pete-chiae, blood distribution.

Epicardium —

Cavities —

Measure of the Orifices —

Thickness of the Ventricle —

Endocardium —

Myocardium —

Coronary Vessels —


1. Size: Larger Smaller

2. Shape: Congenital changes

Acquired changes

3. Weight: Increased

Diminished

4. Color: Grayish-red

Slaty-black Bluish-red Light-brownish

— Emphysema, pneumonia, edema. — Compression, atelectasis.

— Abnormal furrows, increased number of lobes.

— Pleuritis deformans, retractions due to fibrosis in the lung itself, furrows corresponding to the first rib, partial enlargement due to localized emphysema, change due to adhesions.

— Edema, inflammation, congestion, induration.

— Emphysema.

— Variation due to age, occupation, content of air and blood.

— Anthracosis. — Atelectasis. — Hemosiderin brown induration.

5. Air content and consistency: Note the softness, crepitancy, and compressibility. Marked softness — Formation of cavity or post

mortem decomposition. Firm consistency — Consolidation. Compressibility — Emphysema.

Cut Surface — Color, condition of consolidation, amount of air and fluid exuding on pressure, bronchi, blood vessels.

Bronchial Lymph Nodes — Enlargement, anthracosis, tuberculosis.

Examine the mediastinum for enlargement of the lymph glands, hemorrhage, inflammatory conditions and other pathology.

Abdominal Cavity: Go to the abdominal cavity and remove the spleen by pulling it

and cutting the vessels at the region of the hilus. Examine the spleen on the following points:

Weight — Very variable, approximately 150 grams.

174 LEGAL MEDICINE

External Examination — Size, color, consistency, thickness of the capsule, smoothness or wrinkling of the capsule.

Cut Surface — Resistance to cutting, bulging of cut surface, color, prominence of the Malphigian corpuscles, and trabeculae, consistency of the pulp by scraping with sharp edge of knife.

Separate the intestine by cutting the mesentery near its attachment with the intestine from the jejenum downward. Open the duodenum and verify the potency of the common bile duct. Separate the stomach, duodenum, and pancreas by cutting at the cardiac end of the stomach.

Stomach

Small Intestine

Large Intestine

Rectum

— Distention, shape, contents, condition of the mucosa, post-mortem changes.

— Length, external appearance, contents, mucosa, lymphoid follicles and Peyer's patches, obstruction, Merkel's diverticulum, parasites.

— Length, external appearance, contents, mesocolic glands, epiploic appendages, thickness of the walls, condition of the mucosa, inflammation, ulcerations, condition of the appendix, parasites.

— New growth, hemorrhoid, dysenteric ulcers, fistulae.

The liver is removed by separating it from the diaphragm, but avoid cutting the suprarenal glands at the upper pole of the kidneys. The following points must be taken into consideration in the examination of the liver:

Weight

External Examination

Cut Surface

Male — 1,400 grams; Female: 1,200 grams (Filipino). Size, color, consistency, sharpness of the edges, rib markings, scars, thickness of the capsule, lobulation, granulation. Resistance to cutting, amount of blood vessels, condition of the bile duct.


Gall Bladder — Adhesions, distention, color and consistency >f the bile, condition and staining of the mucosa, thickness and adhesions of the walls, concretion, obstruction of the cystic, hepatic and the common bile duct.

The kidneys must be removed after the removal of the adrenals and examine them on the following points:

Weight

External Examination

Cut Surface

Pelvis

Ureter

Bladder

Genital Organs: Male

Female

Ovary Fallopian Tube

— 120 to 150 grams. The left is heavier than the right.

— Perirenal tissue, size, shape and consistency, color, thickness and adherence of the capsule, external surface of the cortex, granulation, cyst, fetal lobulation, condition of the veins.

— Condition of the cut edges (everted or not). Proportionate thickness of the cortex and the medulla (normal — 1.3), cortical striation, pyramidal striation.

— Pelvic fat, stones, inflammatory changes.

— Obstruction, dilatation, inflammatory changes.

— Distention and contents, condition of the mucosa and trigonum, opening of the ureter.

Remove the prostate and the seminal vesicle with the urinary bladder. The testicle and the epididymis is removed by pushing through the inguinal glands and opening the internal inguinal ring. Note the condition of the testicle, epididymis, seminal vesicle and prostate. Remove the uterus and its adnexa together with the upper portion of the vagina.

— Corpus luteum, hydatid cyst, tumor.

Uterus

— Distention, hydrosalpinx, pyosal-pinx, hematosalpinx adhesions.

— Resting, menstruating, gravid, involuting, atrophic, tumor.

176 LEGAL MEDICINE

Cardio-Vascular System: Aorta Sclerosis, atheroma, syphilis, aneu

rysm. Thrombosis, phlebitis. Veins

Neck Organs: Remove the larynx, pharynx and tongue including the tonsils.

The condition of the lymph glands, obstruction and edema of the glottis, foreign body and materials in the larynx and trachea, condition of the thyroid gland, and condition of the tongue and tonsils should be noted.

The scalp is incised from the mastoid process of one side passing the vertex to the mastoid process on the opposite side. The flaps are turned down to the back and to the front. Note the presence of hemorrhage, bruise, hematoma and fracture of the skull. Open the skull by sawing at the forehead above the eyebrow to the region of the upper portion of the ear and another vertically a little behind the vertex and meeting the horizontal cut at the region of the upper portion of the ear. Remove the flap of bone and note the condition of the meninges. Remove the brain after cutting it from its attachment and the tentorium cerebelli. Examine the brain for pathological condition, hemorrhage, laceration, softening, and the base and side of the cranial box for hemorrhage and fracture. Make several incisions on the brain and study the injury or disease.

Examination of the Extremities: There is no technical incision for the extremities. Just open what

is deemed necessary and appropriate for the occasion.

Weight and Measure of the Organs Removed: The specimen which are collected for further study must be placed

in clean jars and brought to the laboratory are: LjOrgans for toxicological examination. 2. Slices of organs for histopathologic^ study.

(For a more detailed examination of post-mortem examination, consult any textbook on pathology.)

Head:

AVERAGE MEASUREMENT OF INDIVIDUAL ORGANS

HEART: Weight of heart

Male 300 gms.

Both Female 250 gms.


Relative weight of heart to body 1 to 169 Length of heart 8.5 — 9 Circumference of

Mitral orifice 10.9 cms. Tricuspid orifice 12.7 cms. Aortic orifice 8.0 cms. Pulmonary orifice 9.2 cms. Pulmonary artery

Circumference base of ventricle

Thickness of the wall of Left ventricle Right ventricle

SPLEEN: Weight of spleen Measurement

PANCREAS: Weight of pancreas Measurement

LIVER: Weight Measurement

Length from right to left Width of right lobe Vertical diameter of right lobe Vertical diameter of left lobe

1 to 162 8 - 8 . 5

10.4 cms. 12.0 cms.

7.7 cms. 8.9 cms.

8.0 cms.

28.8 cms.

1.1 —1.4 cms. 0.5 — 0.7 cms.

150 —250 gms. 12.0 x 4.5 x 3.0 cms.

90 — 120 gms. 23.0 x 4.5 x 2.8 cms.

1500 to 1800 gms.

25 — 32 cms. 18 — 20 cms. 20 — 22 cms. 15 —16 cms.

KIDNEYS: Male Weight Measurement Thickness of:

Cortex Medulla

Relation to body weight Relation to weight of heart

OVARY: Weight

Both Female 150 gms.

11 x 5 x 4.5 cms.

4.6 cms. 1 — 3 cms.

1:200 1:1.1

7.0 gms.

BRAIN: Weight 1,358 gms. 1,234 gms.

178 LEGAL MEDICINE

ADRENALS: Weight Measurement

4.8 — 7.3 gms. 40 x 20 x 2 mms.

WEIGHT OF THYMUS: Both Newborn I - 5 j 6 - l O j I I - 1 5 3 16 - 20 j 21 - 25 3 26 - 35 3 36 - 45 3 46 - 55 3 56 - 65 3 6 6 - 7 5 3

5 years 10 years 15 years 20 years 25 years 35 years 45 years 55 years 65 years 75 years

13.26 gms. 22.08 gms. 26.18 gms. 37.52 gms. 25.52 gms. 24.73 gms. 19.8 gms. 16.27 gms. 12.85 gms.

6.08 gms. 6.00 gms.

Mistakes in Autopsies: 1. Error or omission in the collection of evidence for identification:

a. Failure to make frontal, oblique and profile photographs of the face;

b. Failure to have fingerprints made; c. Failure to have a complete dental examination performed.

2. Errors or omission in the collection of evidence required for establishing the time of death: a. Failure to report the rectal temperature of the body; b. Failure to observe changes that may occur in the intensity and

distribution of rigor mortis — before, during and after autopsy. c. Failure to observe the ingredients of the last meal and its

location in the alimentary tract. 3. Errors or omission in the collection of evidence required for other

medico-legal examination: a. Failure to collect specimens of blood and brain for deter

mination of the contents of alcohol and barbiturates; b. Failure to determine the blood group of the dead person if

death by violence was associated with external bleeding; c. Failure to collect nail scrapings and samples of hair if there is

reasonable chance that death resulted from assault. d. Failure to search for seminal fluid if there is a reasonable

chance that the fatal injuries occurred incident to a sexual crime;

e. Failure to examine clothings, skin and the superficial portion of the bullet tract for residue of powder, and the failure to


collect samples of any residue for the purpose of chemical identification;

f. Failure to use an X-ray for locating a bullet or fragments of bullet if there is any doubt with regard to their presence and location;

g. Failure to protect bullet from defacement, such as is likely to occur if they are handled with metal instruments.

h. Failure to collect separate specimens of blood from the right and left sides of the heart in instances in which the body was recovered from water.

i. Failure to strip the dura mater from the calvaria and base of the skull. Many fractures of the skull have been missed because the pathologist did not expose the surface of the fractured bone.

4. Errors or omission result in the production of undesirable artifacts or in the destruction of valid evidence:

a. Opening of the skull before blood is permitted to drain from the superior vena cava. If the head is opened before the blood drained from it, blood will almost invariably escape into the subdural and subarachnoidal space, and such an observation may then be interpreted as evidence of ante-mortem hemorrhage.

b. The use of a hammer and chisel for opening the skull. A hammer and chisel should never be used for the purpose in a medico-legal autopsy. Fracture produced by the chisel are frequently confused with ante-mortem.

c. Failure to open the thorax under water if one wishes to obtain evidence of pneumothorax.

d. Failure to tie the great vessels between sites of transection and the heart when air embolism is suspected.

e. Failure to open the right ventricle of the heart and the pulmonary artery in situ if pulmonary thrombo-embolism is suspected.

f. Failure to remove the uterus, vagina and vulva en masse if rape or abortion is suspected.

(From the American Journal of Forensic Medicine and Pathology, Vol. 2, No. 4 (Dec. 1981) p. 306).

Negative Autopsies — An autopsy is called a negative autopsy if after all efforts, including gross and microscopic studies and toxicological analyses, fail to reveal a cause of death. It is an autopsy which after a meticulous examination with the aid of other examinations does not yield any definite cause of death.

180 LEGAL MEDICINE

There are reports that approximately 2 to 10% of the total autopsy cases in medico-legal centers yield a negative result although theoretically there must be a cause of death.

Negligent Autopsy — An autopsy wherein no cause of death is found on account of imprudence, negligence, lack of skill or lack of foresight of the examiner. The act or omission which may be inadvertent or deliberate may be:

1. Failure to have an adequate history or facts and circumstances surrounding the death. Special circumstances surrounding death may require special autopsy techniques which the pathologist may fail to do during the autopsy. Air embolism, drug reaction, vagal inhibition may be left unnoticed because of absence of history.

2. Failure to make a thorough external examination — Animal bites, injection marks, electrical necrosis may be overlooked in a hasty external examination.

3. Inadequate or improper internal examinations — Condition of the organs, presence of air in pneumothorax or bubbles of air in the circulatory system may remain unnoticed by the pathologist.

4. Improper histological examination — Tissue blocks may not be taken in the proper areas, poor preparation of the microscopic slides and improper lighting during the process of examination may lead to an erroneous interpretation.

5. Lack of toxicological or other laboratory aids — A qualitative and quantitative determination of toxic materials or its metabolites must be shown. Sometimes difficulty is encountered by the forensic chemist because of the lapse of time and rapid elimination of the drug.

6. Pathologist incompetence — The examiner must have had vast experience in autopsy investigation and must have the capacity to distinguish pathological changes in the body tissues. (Handbook of Forensic Pathology by Abdullah Fatteh, pp. 254-255).

Religious Objections to Autopsies: There is no place in the Bible, in the Talmudic or Post-Talmud ic

writings, is there evidence that post-mortem examination is prohibited. According to traditional interpretation, which is not necessarily accepted by all Jewish groups, autopsies and transplantation of organs are permitted only in those cases where the decendants gave consent.

MEDICO-LEGAL INVESTIGATION CF DEATH 181

There is no definite statement by the Catholic Church which can be construed as prohibiting autopsies. Autopsies have been encouraged when it appeared that benefit would accrue from them. Similarly, there appears to be nothing in the writings of the Protestant clergy to point to the prohibition of autopsies.

Chapter VI

nation of the cause of death. It must further be shown that the death is the direct and proximate consequence of the criminal or negligent act of someone. If death developed independent of an unlawful act, then the person who committed the unlawful act cannot be held responsible for the death.

However, there are some post-mortem findings of a physician which may be useful in the proper adjudication of the case. The presence of defense wounds on the victim may qualify the crime to homicide. The presence of serration or series of cuts in the borders of a stab wound may infer multiple thrusts of the wounding instrument and show the manifest intent of the offender to kill.

The cause of death is the injury, disease or the combination of both injury and disease responsible for initiating the trend or physiological disturbance, brief or prolonged, which produce the fatal termination. It may be immediate or proximate.

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/The Proximate (Secondary) Cause of Death — The injury or disease was survived for a sufficiently prolonged interval which permitted the development of serious sequelae which actually caused the death. If a stab wound in the abdomen later caused generalized peritonitis, then peritonitis is the proximate cause of death.

The mechanism of death is the physiologic derangement or biochemical disturbance incompatible with life which is initiated by the cause of death. It may be hemorrhagic shock, metabolic disturbance, respiratory depression, toxemic condition, cardiac arrest, tamponade, etc.

Cardiorespiratory arrest is a terminal mechanism of most causes of death and can never stand independently as a reasonable explanation for the fatality. The cause of such arrest must be stated,

Cause of Death — This applies to cases

182

CAUSES OF DEATH 183

like hemorrhage, skull fracture, sepsis, trauma on the chest, etc. to make it valid as specific cause of death.

The manner of death is the explanation as to how the cause of death came into being or how the cause of death arose. The manner of death may be natural or violent.

V.Natural Death — It is natural when the fatality is caused solely by disease (lobar pneumonia, ruptured tubal pregnancy, cancerous growth, cerebral hemorrhage due to hypertension, etc.).

2/violent or Unnatural Death — Death due to injury of any sort (gunshot, stab, fracture, traumatic shock, etc.). A physician must not include in the consideration of the manner of death that such violent death is suicidal, accidental or homicidal.

Such conclusion cannot be determined in the post-mortem examination. It requires a thorough investigation of all possible clues in which medico-legal findings are only a part of. Medico-legal masquerade — Violent deaths may be accompanied by

minimal or no external evidence of injury or natural death where signs of violence may be present. In a case of homicide, the medical findings may tend to favor suicide or accidental death, and visa versa. Cases of such nature infer that the medical examination and police investigation is far from being complete. There is a need for further investigation and evaluation to unravel the truth.

Degree of Certainty to the Cause of Death: 1. When the structural abnormalities established beyond doubt the

identity of the cause of death (Ex.: Intracerebral spontaneous hemorrhage, stab wound with profuse hemorrhage, crushing head injury in vehicular accident, etc.).

2. When there is that degree of probability amounting to almost certainty the cause of death. (Ex.: Lobar pneumonia, electrical shock).

3. When the cause of death is established primarily by historical facts which are confirmed or supported by positive or negative anatomic or chemical findings (Ex.: Tetanus, hydrophobia, drug reaction).

4. When neither history, laboratory and anatomic findings, taken individually or in combination is sufficient to determine the cause of deathr.but merely speculate as to the cause of death (Ex.: Crib death among infants, Iatrogenic diseases).

Use of the Term "Probably": As much as possible the use of the term "probably" as a quali

fication to a cause of death must be discouraged inasmuch as it is

184 LEGAL MEDICINE

not definite. In the prosecution of a criminal case if the resulting cause of death is merely a probable consequence of a criminal act, such situation will fall short of "proof beyond reasonable doubt" and may lead to the acquital of the accused.

If sometime after painstaking effortB the examiner cannot ascribe a definite cause of death on the body lesions found, the use of the "probably" in the cause of death may be tolerated.

Steps in the Intellectual Process in the Determination of the Cause of Death: 1. Recognition of the structural organic changes or chemical abnor

malities responsible for cessation of vital functions. 2. Understanding and exposition of the mechanism by which the

anatomic and other deviations from normal actually caused the death, or how the deviation created or initiated the train of sufficiently potent functional disturbance which led ultimately either to cardiac standstill or to respiratory arrest. (The Pathology of Homicide by Lester Adelson (1974) p. 15).

Instantaneous Physiologic Death (Death from Inhibition, Death from Primary Shock, Syncope with Instantaneous Exitus):

This is sudden death which occurs within seconds or a minute or two (no more) after a minor trauma or peripheral stimulation of relatively simple and ordinarily innocuous nature. The peripheral irritation or stimulation initiates the cardio-vascular inhibitory reflex. The fulminant circulatory failure is caused by (vagocardiac) slowing or stoppage of the heart, reflex dilatation with profound fall in blood pressure or a combination of both mechanisms.

A blow to the larynx or solar plexus, a kick in the scrotum, pressure on the carotid sinus, etc. can cause such death.

Death by inhibition can be made only by exclusion and is completely dependent on the availability of accurate information. After serious natural disease has been eliminated by autopsy and toxi-cological analyses are noncontributory, then only the physiologic death may be entertained (Medico-legal Investigation of Death by Werner Spitz and Russel Fisherm, p. 93).

Among the diseases wherein there are no specific finding, pathognomic of a disease still determined are: 1. Sudden Infant Death Syndrome (Crib Death) — This is the unex

pected death of infants, usually under six months of age, while in apparently good health. The sudden death cannot be predicted and there is no way to prevent or foretell on the basis of present knowledge. Although autopsies in some of the cases revealed the

CAUSES OF DEATH 185

presence of congenital heart disease or abnormality, contagious disease, nutritional deficiency and other pathological conditions, no consensus has yet been arrived at as to the definite cause of death.

/2. Sudden Unexplained Nocturnal Death (SUND) — This is known as "pok-kuri" disease in Japan and "bangungut" in the Philippines. It is the sudden death of healthy men of young age seen in East Asian countries. Awareness of relatives and the prompt delivery of resuscitation are the only effective means of treatment. The term Dead on Arrival (DOA) must not be construed literally.

It may mean that the patient was actually dead on arrival or was dying on arrival. Death occurs on a precise time while dying is a continuing process. If a patient is dead then the procedure of management is resuscitative or to let him return to life again, while if the patient is dying, the procedure is to apply emergency measures to prevent death from ensuing.

DOA may be placed in the item "cause of death" in the death certificate even if the patient has stayed alive in the hospital or clinic for sometime provided the attending physician had not been given ample opportunity to arrive at a working diagnosis as to the cause of death. The working diagnosis need not be precise and exacting. It is sufficient that there are some bases to such conclusions.

If the attending physician cannot determine the cause of death, it will be much more appropriate to place under "Cause of Death" in the Death Certificate "undetermined" rather than DOA. It is more responsive to the purpose why such item is included in the certificate.

MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH: a. Natural Death. b. Violent Death:

(1) Accidental death. (2) Negligent death. (3) Infanticidal death. (4) Parricidal death. (5) Murder. (6) Homicidal death.

This is death caused by a 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

Natural Death:

186 LEGAL MEDICINE

intervention of the felonious acts of another person, no one can be held responsible for the death.

"Sudden death" is the termination of life which comes quickly under circumstances when its arrival is not expected. It may be due to natural or violent cause. Heart diseases and cerebral apoplexy are the most common causes of deaths due to natural causes, while poisoning, asphyxia and severe trauma are frequent causes of violent death.

The natural death may or may not be associated with violence. Although the history and external findings may show that death is due to natural cause, a complete autopsy must be made to determine exactly the cause of death and exclude the possibility of violent cause.

If signs of violence are associated with the natural cause of death, the physician must be able to answer the following questions:

Did the Person Die of a Natural Cause and were the Physical Injuries Inflicted Immediately After Death ?

If violence was applied on a dead person, the person inflicting the physical injuries cannot be guilty of murder, homicide or parricide. The act is considered to be an impossible crime and is penalized as such. In order that it may be considered an impossible crime, the person inflicting the physical injuries must have no knowledge that the victim is already dead at the time of infliction.

Criminal liability shall be incurred by any person who performs an act which would be an offense against persons and property, were it not for the inherent impossibility of its accomplishment. . . (Art. 4, No. 2, Revised Penal Code). The court having in mind the social danger and the degree of criminality shown by the offender shall impose upon him the penalty of arresto mayor or a fine ranging from 200 to 500 pesos. (Art. 59, Revised Penal Code).

"A" has a grudge and wanted to kill "B". One night "A" entered the bedroom of "B", and without knowing that "B" died of heart failure an hour ago, inflicted several stab wounds on "B" "A" cannot be held liable for murder because it is an impossible crime. "B" was already dead when the stab wounds were inflicted. However, the law still imposes penalty for such act depending upon the degree of criminality and social danger of the offender (Art. 59, Revised Penal Code).

CAUSES OF DEATH 187

Was the Victim Suffering from a Natural Disease and the Violence Only Accelerate the Death ?

If the violence inflicted on a person suffering from a natural disease only accelerated the death of the victim, the offender inflicting such violence is responsible for the death of the victim. It is immaterial as to whether the offender has no intention of killing the victim. The fact that the victim died, the offender must be held responsible to whatever be the consequence of his wrongful act.

Criminal liability shall be incurred by any person committing a felony although the wrongful act done be different from which he intended (Art. 4, No. 1, Revised Penal Code). Example:

"A" gave a blow in the abdomen of "R". Unfortunately "B" died of severe abdominal hemorrhage due to the traumatic rupture of the liver which was severely diseased. "A" is liable for the death of "B", even if "A" has no intention to kill "B". "A" must be held liable for consequences of his felonious act. However, he may avail himself of the mitigating circumstance that he had no intention to commit so grave a wrong as that committed (Art. 13, Revised Penal Code).

A blow with a fist or a kick, although it did not produce external injuries but inflammation of the spleen and peritonitis and although the victim was previously affected with the disease, the accused must be responsible for the death because he accelerated the time of death by his voluntary and unlawful act (U.S. v. Rodriguez, 23 Phil. 22).

The deceased was suffering from tuberculosis. The accused gave fist blows in the hypochondriac region which caused bruising of the liver, followed by internal hemorrhage and death. The accused is liable for homicide (People v. Ilustre, 54, Phil. 544).

Did the Victim Die of a Natural Cause Independent of the Violence Inflicted?

If a person died of a natural cause and the physical injuries inflicted is independent of the cause of death, the accused will not be responsible for the death but merely for the physical injuries he had inflicted. Example:

"A" and "B" are sweethearts. "A" at the fit of anger slapped "B" in the face. "B" is suffering from severe heart

LEGAL MEDICINE

disease. After the slapping, "B" died of heart failure. "A" cannot be held responsible for the death of "B". He can only be held for slight physical injury brought about by the slapping.

The defendant struck a boy with the back of his hand on the mouth. Although the mouth was bleeding, he was able to work. A few days later, he developed fever and died. The court believed that the fever which caused the death was not the direct consequence of the injury inflicted. It was not denied that malaria fever was prevalent in the locality, so it was quite probable that the death was due to a natural cause. The defendant was acquitted (U.S. v. Palaton, 49 Phil. 117).

To make the offender liable for the death of the victim, it must be proven that the death is the natural consequence of the physical injuries inflicted. If the physical injuries is not the proximate- cause of death of the victim, then the offender cannot be held liable for such death. Proximate cause is that cause, which in natural and continuous sequence, unbroken by an efficient intervening cause, produces injury or death, and without which the result would not have occurred.

So in natural death with concomitant physical injuries, it is necessary for the physician to determine whether the physical injuries would accelerate the death, or the injuries itself developed independently and produced the death or that the person died absolutely of a natural cause.

A physician must determine for the interest of justice with absolute care at autopsy and laboratory examination the real cause of death. Opinion evidence must be given with caution and must be made after a thorough deliberation of the facts and other findings.

The Following are Deaths Due to Natural Cause: (1) Affection of the central nervous system:

(a) Cerebral Apoplexy: The sudden loss of consciousness followed by paraly

sis or death due to hemorrhage from thrombosis or embolism in the cerebral vessels.

i. Cerebral Hemorrhage: This is brought about by the breaking or rupture

of the blood vessels inside the cranial cavity. ii. Cerebral Embolism:

This is the blocking of the cerebral blood vessels by bolus or matters in the circulation.

CAUSES OF DEATH 189

iii. Cerebral Thrombosis: This is the occlusion of the lumen of the cerebral

vessels by the gradual thickening of its wall thereby preventing the flow of blood peripheral to it.

(b) Abscess of the Brain: A circumscribed accumulation of infective materials

in certain areas of the brain. It may produce coma or death when it ruptures or when it produces acute edema of the brain.

(c) Meningitis of the Fulminant Type: There is inflammation of the covering membranes of

the brain due to infection or some other causes. (2) Affection of the Circulatory System:

(a) Occlusion of the Coronary Vessels: The occlusion may be due to embolism, thrombosis

or stenosis of the coronary openings. This is the most common cause of sudden death due to natural cause.

(b) Fatty or Myocardial Degeneration of the Heart: The heart muscles may gradually degenerate and

replaced by fatty or fibrous tissues such that extra strain put on the heart may produce sudden heart failure.

(c) Rupture of the Aneurysm of the Aorta. (d) Valvular Heart Diseases:

The valves of the heart may be diseased either to become insufficient or stenotic and may produce sudden death.

(e) Rupture of the Heart: This is found in severe cardiac dilatation with fibrosis

of the myocardium. (3) Affections of the Respiratory System:

(a) Acute edema of the larynx: This may develop from acute infection or from

swallowing irritant substance. (b) Tumor of the larynx. (c) Diphtheria. (d) Edema of the lungs. (e) Pulmonary embolism. (f) Lobar pneumonia. (g) Pulmonary hemorrhage:

Severe coughing or slight exertion may rupture a normal or diseased pulmonary vessel causing severe hemorrhage.

190 LEGAL MEDICINE

(4) Affection of the Gastro-Intestinal Tract: (a) Ruptured peptic ulcer. (b) Acute intestinal obstruction.

(5) Affections of the Genito-Urinary Tract: (a) Acute strangulated hernia. (b) Ruptured tubal pregnancy. (c) Ovarian cyst with twisted pedicle.

(6) Affection of the Glands: (a) Status thymico-lymphaticus:

This is a condition associated with the enlargement of the thymus and hyperplasia of the lymphoid tissues in general.

(b) Acute Hemorrhagic Pancreatitis: An acute inflammation of the pancreas accompanied

with hemorrhages and in some cases suppuration and gangrene.

(7) Sudden Death in Young Children: (a) Bronchitis. (b) Congestion of the lungs. (c) Acute broncho-pneumonia. (d) Acute gastro-enteritis. (e) Convulsion.

, (f) Spasm of the larynx.

Violent 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 the physical injuries were in

flicted was in normal health. (2) That the death may be expected from physical injuries

inflicted. (3) That death ensued within a reasonable time (People v.

Datu Baginda, C.A. 44 O.G. 2287).

Classification of Trauma or Injuries: (1) Physical injury — Trauma sustained thru the use of physical

force. (2) Thermal injury — Injury caused by heat or cold. (3) Electrical injury — Injury due to electrical energy.

CAUSES OF DEATH 191

(4) Atmospheric injury — Those due to the change of atmospheric pressure.

(5) Chemical injury — Those caused by chemicals. (6) Radiation injury — Those brought about by radiation. (7) Infection — Those caused by microbic invasion.

In violent death, the death of the victim is not due to the natural and direct consequence of the injuries inflicted. If there is an intervening cause other than the physical injuries, then the offender cannot be held liable for the death of the patient.

Refusal of the victim to submit to a surgical operation do not relieve the accused from the natural and ordinary result of the felonious act and does not relieve him of his criminal liability (U.S. v. Marasigan, 27 Phil. 504).

The presence of infection on the wounds inflicted if not deliberately induced by the victim makes the offender also responsible for it (People v. Red, C.A. 43 O.G. 5072).

The accused inflicted physical injuries to the victim. While the victim was undergoing medical treatment, he removed the drainage from his wound and as a result of which he died of peritonitis. The defense made by the offender is that the deceased could not have died had he not removed the drainage. HELD: Death was the natural consequence of the mortal wound. The victim in removing the drainage from his wound did not appear as acting voluntarily and with knowledge that he was performing an act prejudicial to his health (People v. Quiamon, 62 Phil. 162).

Penal Classification of Violent Deaths:

(Âccidental Death: Death due to misadventure or accident. An accident is

something that happens outside the sway of our will, and although it comes about through some act of will, lies beyond bounds of human forseeable consequences.

In a pure accidental death, the person who causes the death is exempted from criminal liability. Art. 12, No. 4, Revised Penal Code: Exempting Circumstances: The following are exempt from criminal liability:

4. Any person who, while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it.

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Elements of the Provision: (a) A person is performing a lawful act. (b) He performed it with due care. (c) He caused injury to another by mere accident. (d) He is without fault and with no intention of causing it. Example:

A patient died a few minutes after the administration of penicillin by injection. The physician took the history from the patient as to the presence of allergic diseases, made the necessary tests and took other necessary precautions to prevent any untoward reaction. The physician cannot be held liable for the death of the patient because it is purely accidental.

A driver who, while driving his automobile on the proper side of the road at a moderate speed and with due diligence, suddenly and unexpectedly sees a man in front of his vehicle coming from the sidewalk and crossing the street without any warning that he would do so, but because it is not physically possible to avoid hitting him, the said driver runs over the man. He is not criminally liable, it being a mere accident (U.S. v. Tayongtong, 21 Phil. 476, cited by L. Reyes).

The accused was a driver of a loaded truck. While driving at a curve the front tire exploded and as a consequence of which the truck fell in a ditch and pinned one of the passengers. The tire, engine, brake and wheel were in good condition before the incident. HELD: There being no proof of excessive speed, the accident under consideration caused by the blow-out of the tire cannot give rise to liability of the driver (People v. Hatton (C.A.) 49 O.G. 1866).

The accused while hunting saw wild chickens and fired a shot. He heard a human being cry and found that the victim was hit. There was no evidence of the intention of the accused to kill the deceased. HELD: If life is taken by misfortune while the actor is in the performance of a lawful act executed with due care and without intention of doing harm, there is no criminal liability (U.S. v. Tanedo, 15 Phtf 196).

(2yNegligent Death: Death due to reckless imprudence, negligence, lack of

skill or lack of foresight.'

CAUSES OF DEATH 193

The Revised Penal Code provides that felonies may be committed when the wrongful act results from imprudence, negligence, lack or foresight or lack of skill.

If death occurred due to the recklessness of someone, he may be charged for homicide through reckless imprudence. Example:

A surgeon while performing a laparotomy to arrest bleeding, left foreign bodies (forcep or gauze) inside the abdominal cavity and as a result of which the patient died. The surgeon is liable for homicide through reckless imprudence.

A physician is equally liable for the same offense if the untoward effects of the administration of drug administered is due to the want of the necessary precautionary measures in the administration of the drug.

If a person does an act and death of the victim is a plain foreseeable consequence, then it is not accidental but homicidal through simple negligence or reckless imprudence.

The defendant fired a shot on the ground to pacify a quarrel. The bullet ricochetted and hit a bystander who died thereafter. The defendant is guilty of homicide though reckless imprudence. It is apparent that he did not exercise precautionary measures, considering that the place is populated and there is likelihood to hit the bystander (People v. Nocum, 77 PhU. 1018).

(^Suicidal Death (Destruction of One's Self): The law does not punish the person committing suicide

because society has always considered a person who attempts to kill himself as an unfortunate being, a wretched person deserving more of pity than of penalty.

But, a person who gives assistance to the commission of suicide of another is punishable because he has no right to destroy or assist in the destruction of the life of another. Art. 253, Revised Penal Code: Giving assistance to suicide:

Any person who shall assist another to commit suicide shall suffer the penalty of prision mayor; if such person lends his assistance to another to the extent of doing the killing himself, he shall suffer the penalty of reclusion temporal. However, if the suicide is not consummated

LEGAL MEDICINE

the penalty of arresto mayor in its medium and maximum periods shall be imposed. Acts Punishable in Giving Assistance to Suicide: (a) The offender assisted in the commission of suicide of

another which was consummated. (b) The offender gave assistance in the commission of

suicide to the extent of d6ing the killing himself which is consummated.

(c) The offender assisted another in the commission of suicide which is not consummated.

(4fParricidal Death (Killing of One's Relative): Art. 246, Revised Penal Code: Parricide:

Any person who shall kill his father, mother, or child, whether legitimate or illegitimate, or any of his ascendants or descendants, or his spouse, shall be guilty of parricide and be punished by the penalty of reclusion perpetua to death.

Requisites of the Crime: (a) A person was killed by the offender. (b) The person killed was the father, mother, or child,

whether legitimate or illegitimate in relation with the offender, or other legitimate ascendants, or descendants or spouse of the offender. The father, mother or child killed must either be legi

timate or illegitimate to make it parricide, so that the killing of one's illegitimate father is parricide.

But, insofar as with the other ascendants or descendants or spouse, it must be legitimate to make it parricide. Thus, the killing of a common-law wife or one's illegitimate grandfather is not parricide.

A moro who has three wives and killed the last married to him cannot be guilty of parricide (People v. Subano, 73 Phil. 692).

A stranger who cooperated and took part in the commission of the crime of parricide is not guilty of parricide but only of homicide or murder as the case may be

J (People v. Patricio, 46 Phil. 875).

(Sr) Infanticidal Death (Killing of a child less than three days old): Art. 265, Revised Penal Code:

CAUSES OF DEATH 195

Infanticide: The penalty provided for parricide in article 246 and for

murder in article 248 shall be imposed upon any person who shall kill any child less than three days of age.

If the crime penalized in this article be committed by the mother of the child for the purpose of concealing for dishonor, she shall suffer the penalty of prision correccional in its medium and maximum periods, and if said crime be committed for the same purpose by the maternal grandparents or either of them, the penalty shall be prision mayor. Requisites of the Crime: (a) A person was killed. (b) The person killed was a child less than three days old.

The penalty to be imposed depends upon the killer of the child. If the killer is the father, mother or any of the legitimate ascendants, the penalty corresponding to parricide shall be imposed. If the killing is made by any other persons, the penalty for murder shall be imposed.

There is no medical explanation why three days is made to distinguish infanticide from murder and parricide.

Concealment of the dishonor is not an element of the crime but only mitigates penalty. So that if the mother or the maternal grandparents killed the child to conceal the dishonor the penalty for parricide is not imposed but only that jone provided in the second paragraph of Art. 255.

(6TMurder: Art. 248, Revised Penal Code: Murder:

Any person who, not falling within the provisions of article 246 shall kill another, shall be guilty of murder and shall be punished by reclusion temporal in its maximum period of death, if committed with any of the following circumstances:

1. With treachery, taking advantage of superior strength, with the aid of armed men, or employing means to weaken the defense or of means or persons to insure or afford impunity.

2. In consideration of a price, reward or promise. 3. By means of inundation, fire, poison, explosion,

shipwreck, stranding of a vessel, derailment or assault

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upon a street car or locomotive, fall of an airship, by means of motor vehicles, or with the use of any other means involving great waste and ruin;

4. On occasion of any of calamities enumerated in the preceding paragraph, or of an earthquake, eruption of a volcano, destructive cyclone, epidemic, or any other public calamity;

5. With evident premeditation; 6. With cruelty, by deliberately inhumanly augmenting

the suffering of the victim, or outraging or scoffing at his person or corpse.

Requisites for the Crime of Murder: (a) The offender killed the victim; (b) The killing is attended by any of the qualifying circum

stances mentioned; (c) There was the intent of the offender to kill the victim; (d) The killing is not parricide or infanticide.

Whenever the killing is attended by more than one of the qualifying circumstances mentioned, only one of them will make the killing, murder and the rest will be considered as generic aggravating circumstances.

The presence of several wounds inflicted by the offender prove murder because there is cruelty if the victim is alive, or scoffing or outraging at the corpse if inflicted after death.

The presence of gunshot wound of entrance at the back as a general rule qualifies act to murder because there was treachery, i There is treachery when the offender commits any of the crimes against person, employing means, or method, or form in its execution thereof which tend directly or specially to insure its execution, without risk to himself arising from the defense which the offended party may make (Art. 14, Par. 16, Revised Penal Code).

(7-Hlomicidal Death: Art. 249, Revised Penal Code: Homicide:

Any person who, not falling within the provisions of article 246 shall kill another without the attendance of any of the circumstances enumerated in the next preceding article, shall be deemed guilty of homicide and be punished by reclusion temporal.

CAUSES OF DEATH 197

Requisites of the Crime of Homicide: (a) The victim of a criminal assault was killed; (b) The offender killed the victim without any justification; (c) There is the intention on the part of the offender to kill

the victim and such presumption can be inferred from the death of the victim;

(d) That the killing does not fall under the definition of the crime of murder, parricide or infanticide. If a pharmccist wrongly compound a prescription cor

rectly prescribed by the physician and lethal dose of poisonous drugs were included and as a result of which the patient almost died, the crime committed is physicial injuries through reckless imprudence. It cannot be frustrated homicide through reckless imprudence because of the absence of intent to kill by the pharmacist (People v. Castillo, 76 Phil. 72).

Frustrated homicide is distinguished from physical injuries in that in the commission of the latter there is no intent to kill.

Death under Special Circumstances: (1) Death Caused in a Tumultuous Affray:

Art. 251, Revised Penal Code: When while several persons, not composing groups

organized for the common purpose of assaulting and attacking each other reciprocally, quarrel and assault each other in a confused and tumultuous manner, and in the course of affray someone is killed, and it cannot be ascertained who actually killed the deceased, but the person or persons who inflicted serious physical injuries can be identified, such person or persons shall be punished by prision mayor.

If it cannot be determined who inflicted the serious physical injuries on the deceased, the penalty of prision correccional in its medium and maximum periods shall be imposed upon all those who shall have used violence upon the person of the victim. Requisites of the Crime: (a) The person was killed in a confused or tumultuous

affray; (b) That the actual killer is not known; and (c) That the person or persons who inflicted the serious

physical injuries or violence are known.

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(2) Death or Physical Injuries Inflicted under Exceptional Circumstances: Art. 247, Revised Penal Code:

Any legally married person who, having surprised his spouse in the act of committing sexual intercourse with another person, shall kill any of them or both of them in the act or immediately thereafter, or shall inflict upon them any serious physical injury, shall suffer the penalty of de8tierro.

If he shall inflict upon them physical injuries of any other kind, he shall be exempt from punishment.

These rules shall be applicable, under the same circumstances, to parents with respect to their daughters under eighteen years of age, and their seducers, while the daughters are living with their parents.

Any person who shall promote or facilitate the prostitution of his wife or daughter, or shall otherwise have consented to the infidelity of the other spouse shall not be entitled to the benefits of this article. Requisites of the Crime: (a) Surprise of the spouse:

i. There must be valid marriage. ii. That the guilty spouse was caught by surprise in

the act of committing sexual intercourse with another person.

iii. That the killing or the injury was inflicted to either or both at the very act or immediately thereafter.

(b) Surprise of a daughter: i. The daughter is below 18 years of age.

ii. The daughter is living with the parents. iii. The parents caught her by surprise committing

sexual intercourse with the seducer. iv. The killing was done at the very act of sexual

intercourse or immediately thereafter.

2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH:

An analysis of all deaths from natural causes will ultimately lead to the failure of the heart, lungs, and the brain, so that death due to pathological lesions may be classified into:

a. Death from Syncope b. Death from Asphyxia c. Death from Coma.

CAUSES OF DEATH 199

All of the above mentioned conditions invariably produce the so-called sudden death. Sudden death is the termination of life which comes quickly when it is not expected.

a. Death from Syncope: This is death due to sudden and fatal cessation of the action

of the heart with circulation included. ,

Causes of Death from Syncope: (1) Coronary disease, as embolism or thrombosis. (2) Rupture of the heart through softened infarct. ( 3 ) Myocardial degeneration. (4) Valvular diseases. (5) Rupture of the aortic and other aneurysm. (6) Systemic embolism occurring in bacterial endocarditis. ( 7 ) Congenital heart diseases of the newborn. (8) Reflex inhibition of the heart or of the cardiac center,

as in shock, emotion or blow over the area of some of the sensory nerve.

( 9 ) Arterial hypertension with sclerosis. (10) Deficiency cf blood as in profused hemorrhage, especially

if sudden. (11) Exhaustive diseases. (12) Extensive injury to the body from mechanical cause.

Symptoms of Syncope: (1) Person falls and remains motionless. (2) Face is pale. ( 3 ) Pulse at the wrist disappears or is filiform. ( 4 ) Respiration ceases.

In non-fatal cases, consciousness returns in a few second, but in fatal ones, the following other symptoms appear:

(5) Person breaks out into cold sweat. (6) Dimness of vision. ( 7 ) Pulse rapid and filiform. ( 8 ) There may be vomiting and involuntary movement of the

limbs. ( 9 ) The person may be passing into the state of delirium.

(10) Death may be preceded by convulsion.

b. Death from Asphyxia: Asphyxia is a condition in which the supply of oxygen to

the blood or to the tissues or to both has been reduced below normal working level.

200 LEGAL MEDICINE

Gauges of Death from Asphyxia: (1) Diseases of the respiratory system, as pneumonia, acute

bronchitis, bronchitis in infancy, rupture of the blood vessels in pulmonary tuberculosis with cavitation.

(2) Impaction of foreign bodies in the larynx. (3) Compression of the larynx. (4) Pressure on the respiratory tract due to tumor, or intra

cranial hemorrhage. (5) Strangulation, suffocation, hanging, drowning, inhalation

or irritant gases. (6) Refraction of the atmosphere. (7) Causes operating in the nervous system:

(a) Paralysis of the respiratory muscles or respiratory center from injury or disease or action of poison.

(b) Fixation of the respiratory muscles from over stimulation of the spinal cord as in strychnine poisoning.

(8) Causes operating from the lung or pulmonary circulation:

(a) Pleurisy with effusion. (b) Emphysema. (c) Pulmonary embolism.

(d) Pulmonary thrombosis.

Symptoms of Asphyxia: (1) Stage of Increasing Dyspnea :

This stage usually lasts from 1/2 to 1 minute: (a) Increased rate and depth of respiration, leading to

difficulty of breathing (dyspnea). (b) Exaggerated movement of inspiratory muscles soon

replaced by exaggerated expiration. (c) Rise of blood pressure, consequently the heart beat

becomes quicker and more forcible. (d) Person becomes bluish and consciousness is lost. (e) Pupils are contracted.

(2) Stage of Expiratory Convulsion:

(a) This stage lasts for about a minute:

i. Marked expiratory effort.

ii. Convulsive movement of the limbs accompanied by expiratory effort.

iii. Blood pressure gradually lowers owing to the failure of the heart due to lack of oxygen.

CAUSES OF DEATH 201

(3) Stage of Exhaustion: This stage lasts for about three minutes. The person lies

still except for occasional deep inspiration. Blood pressure falls and pupils are dilated.

Post-mortem Findings in Death from Asphyxia: (1) External Findings:

(a) Lividity of the hps, fingers and toenails. (b) Livid markings on the skin. (c) Marked post-mortem lividity.

(2) Internal Findings: (a) Lungs:

i. Lungs engorged with dark blood. ii. On section, there is dark color frothy exudation. iii. Punctiform hemorrhages of the pleura (Tardieu

Spots). iv. Reddish discoloration of the trachea and bronchial

mucous membrane. (b) Heart:

i. Subpericardial petechial hemorrhages. ii. Right ventricle of the heart dilated and engorged.

iii. Left side of the heart and arterial system empty. (c) Abdominal viscera congested. (d) Brain congested and may show punctiform hemorrhages. (e) Blood dark in color. (f) Rigor mortis has slow onset.

c. 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. Causes of Coma: (1) Gross lesions of the brain:

(a) Depressed fracture. (b) Apoplexy. (c) Embolus. (d) Abscess. (e) Tumor.

(2) Poisons: (a) Uremia. (b) Cholemia. (c) Acetonemia. (d) Ingested morphine.

LEGAL MEDICINE

(e) Ingested alcohol. Symptoms of Coma: (1) Person unconscious. (2) Breathing is stertorous. (3) Pulse is full but intermittent. (4) Cold, clammy perspiration. (5) Imperfect perception of sensory impression. (6) Delirium. (7) Relaxation of all sphincter muscles. (8) Accumulation of mucous in the respiratory passages. Post-mortem Findings:

The findings in coma are the same as in asphyxia, and addition, there is congestion of the brain and the spinal cord.

Chapter VII

^SÊCIAL DEATHS

1. JUDICIAL DEATH:

Modern methods in the execution of death sentences have abandoned inhuman, cruel and barbarous means. Executions by garroting, decapitation by means of the guillotine and by drowning which were common during the medieval days are no longer practiced. The statutes of all countries state the legal procedure for the execution of death penalties. The constitution, like that of the Philippines, imposes certain limitations to the law-making body as to the method to be established.

Art. Ill , Sec. 1, Par. 19, of the Philippine Constitution provides that "cruel and unusual punishment shall not be inflicted." The wait for the provision of the new constitution punishment prohibited must not only be cruel but also unusual or vice versa. Banishment may be unusual but not cruel and therefore valid. Death penalty is not cruel and unusual whether it be by hanging, shooting, or electrocution (Legarda v. Valdez, 1 Phil 146).

Punishments are cruel when they involved torture or a lingering death, but the punishment of death is not cruel because it is not barbarous and inhuman.

The purpose of the guaranty by the constitution is to eliminate many inhuman and uncivilized punishments formerly known, the infliction of which tend to barbarize present civilization (McElvaine v. Brush, 142 U.S. 155).

Death Penalty:

1. Arguments in Favor of the Death Penalty:

(1) It is the only method of eliminating the hopeless enemy of society — Escape from prison, commutation of sentence and pardon are ways that criminals, helped by their friends, escaped life imprisonment.

(2) It deters potential criminals as no other form of punishment does.

(3) Its brutalizing effect is an unproven assumption. — It is contended that if capital punishment is properly carried out, instead of brutalizing society, it satisfies the sense of justice and provides social satisfaction and a sense of protection.

203

204 LEGAL MEDICINE

(4) It is the only means whereby society is relieved of the support for those who continually war upon it. Society will be relieved of- expenses of maintaining the irreformable criminals who prey upon it.

(5) It is a positive selective agency to wipe out the stock of irreformable criminals — Killing the hopeless criminals will eliminate some of the degenerated stock of society.

2. Arguments Against Death Penalty:

(1) It is an irreversible penalty. — Mistaken judgments as to guilt can no longer be remedied.

(2) It is not reformative. — Capital punishment indicates impossibility of reformation of offenders. No one is incorrigible sociologically.

(3) Capital punishment is not a deterrent in effect. — There is no country where death penalty is imposed and criminality, diminished.

(4) Capital punishment diminished the certainty of punishment. — It is a common experience that the court will not convict a person when the penalty to be imposed is death. If capital punishment is done away entirely, the court is more likely to convict and thus society is protected in greater measure.

(5) Capital punishment violates humanitarian sentiments. — Men can take a life in self-defense or in the heat of passion, and have a relieving sense of justification, but to take in cold blood the life of a prisoner causes all the humanitarian sentiments developed in thousands of years to revolt.

(6) Capital punishment is retributive — Revengeful acts of society is already an out of fashion philosophy. The test is to have a corrective approach.

(7) It is a cold-blooded and deliberate kind of murder. — The executioner has no passion to justify the performance of his act. It is, however, a question whether a man who pulls the trap may not feel he is doing a public service that is even greater than a policeman who shoots a fleeing murderer or robber.

Methods of Judicial Death:

1. Death by Electrocution:

A person is made to sit on a chair made of electrical conducting materials with straps of electrodes on both wrists, ankles, and head. An alternating current voltage of more than 1,500 volts is put on until the convict dies.

SPECIAL DEATHS 205

If the convict does not die after a few minutes that the current was put on, it is necessary to apply another current until he is pronounced dead by the physician. The law states that the penalty is death by electrocution so that the convict must be put to death. It is the duty of the administrator of the penitentiary to mitigate as much as possible the sufferings of the convict in the execution of death sentence.

Art. 81, Revised Penal Code — When and how the death penalty is to be executed. — The death sentence shall be executed with preference to any other and shall consist in putting the person under sentence to death by electrocution. The death sentence shall be executed under the authority of the Director of Prisons, endeavoring so far as possible to mitigate the sufferings of the person under sentence during electrocution as well as during the proceedings prior to the execution.

If the person under sentence so desire, he shall be anesthe-sized at the moment of the electrocution.

Art. 82, Revised Penal Code — Notification and execution of the sentence and assistance to the culprit. — The court shall designate a working day for the execution, but not the hour thereof, and such designation shall not be communicated to the offender before sunrise of said day, and the execution shall not take place until after the expiration of at least eight hours following the notification, but before sunset. During the interval between notification and the execution, the culprit shall, in so far as possible, be furnished with assistance as he may request in order to be attended in his last moments by priests or ministers of the religion he professes and to consult lawyers, as well as in order to make a will and confer with members of his family or persons in charge of the management of his business, of the administration of his property, or of the care of his descendants.

Art. 83, Revised Penal Code — Suspension of the execution of the death sentence. — The death sentence shall not be inflicted upon a woman within the three years next following the date of the sentence or while she is pregnant not upon any person over seventy years of age. In this last case, the death sentence shall be commuted to reclusion perpetua with the accessory penalties provided in article 40.

Art. 84, Revised Penal Code — Place of execution and persons who may witness the same. The execution shall take place in the penitentiary of Bilibid in a space closed to public view and shall be witnessed only by the priests assisting the offender

206 LEGAL MEDICINE

and by his lawyers and by his relatives, not exceeding six, if he so request, by the physician and the necessary personnel of the penal establishment, and by such persons as the Director of Prisons may authorize.

Death by electrocution is the only method recognized by our civil law. There is a growing sentiment to remove capital punishment although it is a means to discourage future wrongdoers.

Death may be due to shock; respiratory failure due to bulbar paralysis or asphyxia;and due to prolong and violent convulsion.

2. Death by Hanging:

The convict is made to stand in an elevated collapsible flat-form with a black hood on the head, a noose made of rope around the neck and the other end of which is fixed in an elevated structure above the head. Without the knowledge of the convict, the flatform suddenly collapses which causes the sudden suspension of the body and tightening of the noose around the neck. Death may be due to asphyxia or injury of the cervical portion of the spinal cord.

In the Philippines, this method of death execution is only allowed on death penalties imposed by military tribunals or court marshals. It is considered to be the most gruesome means of death and is imposed primarily to those who have been found guilty of very grave offenses.

In the Philippines, death penalty that are imposed by the civil court must only be by electrocution. Hanging is not recognized as a means of executing death sentence, although the decision of the military tribunals may impose death by hanging. The following are the causes of death in judicial hanging:

a. Dislocation or fracture of the upper cervical vertebrae. b. Partial or complete severance of the spinal cord. c. Rupture of the cervical muscles. d. Asphyxia due to the pressure on the vagus nerve. e. Syncope due to the pressure on the vagus nerve. f. Cerebral anemia which results to an inhibition of the vital

centers of the brain.

3. Death by Musketry:

The convict is made to face a firing squad and is put to death by a volley of fire. The convict may be facing or with his back towards the firing squad.

SPECIAL DEATHS 207

This method of execution of death penalty is applied to military personnel and decided by the court marshals. Death by musketry is considered less heinous than death by hanging.

4. Death by Gas Chamber:

The convict is enclosed in a compartment and an abnoxious or asphyxiating gas is introduced. The most common gas used is carbon monoxide. The convict will not be removed from the gas chamber unless he is pronounced dead by the penitentiary physician.

This method is not recognized by the Philippine civil or military law. In some states of the United States, it is a legal means of judicial death execution.

Other Methods of Capital Punishment:

1. Beheading — The most common way of beheading is with the use of the guillotine. The device is something like a file-driver with a heavy axe to severe the head. The descent of the blade strikes the neck from behind and the head falls into a basket.

2. Crucifixion — Nailing the person on a cross and death develops by traumatic asphyxia.

3. Beating — A hard object is forcibly applied to the head to crush the skull.

4. Cutting asunder — Mutilating the body usually with sharp heavy instrument until death ensues.

5. Precipitation from a height.

6. Destruction by wild beast.

7. Flaying — skinning alive.

8. Impaling.

9. Stoning.

10. Strangling.

11. Smothering.

12T Drowning.

Euthanasia or "mercy killing" is the deliberate and painless acceleration of death of a person usually suffering from an incurable and distressing disease.

It is universally condemned but some advocate its legalization based on humanitarian sentiments.

In the Philippines there is no law dealing specifically with the matter but the general sentiment is that it is contrary to the principle that "no person has the right to end his own life, much

208 LEGAL MEDICINE

less can he delegate such right to another." Medical ethics states that the duty of a physician is to save life, not to end it.

Philosophically — It is the proper function of society to safeguard man's right to die when he chooses to, provided it will not prejudice the rights of others.

Churches — All churches are against euthanasia because an individual does not have the full dominion over his life to the extent of determining whether or not he will continue to live. Only God who created mankind has the sole right to extinguish it.

Medicine — There is no sense in performing euthanasia inasmuch as there is no physical pain so severe that modern medication available today cannot substantially provide relief. The physician may be mistaken in the diagnosis of impending death. Recovery, of the kind bordering closely on a miracle, may occur. There is belief in the saying, "While there is life, there is hope."

Sociologically — The practice of euthanasia is an endorsement or toleration of society to suicide and a general approval of crime committed for a benevolent motive.

Types of Euthanasia:

1. Active Euthanasia — Intentional or deliberate application of the means to shorten the life of a person. It may be done with or without the consent or knowledge of the person. Active euthanasia on demand is the putting to death of a person in compliance with the wishes of the person (patient) to shorten his sufferings.

2. Passive Euthanasia — There is absence of the application of the means to accelerate death but the natural course of the disease is allowed to have its way to extinguish the life of a person. Consequently the concept of orthothanasia and dysthanasia was adopted.

a. Orthothanasia — When an incurably ill person is allowed to die a natural death without the application of any operation or treatment procedure.

b. Dysthanasia — When there is an attempt to extend the life span of a person by the use of extraordinary treatments without which the patient would have died earlier. Note: Dysthanasia does not comply with the definition of euthanasia. (Report on the 4th World Congress on Medical Law, Manila, March 16-17, 1976, p. 57).

SPECIAL DEATHS 209

Ways of the Performing Euthanasia:

1. Administration of a lethal dose of poison. 2. Overdosage of sedatives, hypnotics or other pain relieving drugs. 3. Injection of air into the blood stream. 4. Application of strong electric currents. 5. Failure to institute the necessary management procedure which

is essential to preserve the life of the patient.

a. Failure to perform tracheostomy when there is marked distress in breathing due to laryngeal obstruction.

b. Failure to give transfusion in severe hemorrhage. c. Depriving the child of nutrition. d. Removal of patient from a respirator when voluntary breath

ing is not possible.

Who May Perforin Euthanasia:

1. The patient himself:

Any person who deliberately puts an end to his life commits suicide. Suicide is not a crime in our jurisdiction because a person committing suicide is a moral wreck and he must be given an eye of pity or sympathy rather than an eye of penalty by law. This is also based on a philosophy that a person has a complete dominion over his own body.

2. The physician, with or without the knowledge and consent of the patient:

Even if a physician has humanitarian or merciful motive in putting to death a patient, his act his punishable in spite of the patient's consent.

Art. 253, Revised Penal Code — Giving assistance to suicide — Any person who shall assist another to commit suicide shall suffer the penalty of prision mayor; if such person lends his assistance to another to the extent of doing the killing himself, he shall suffer the penalty of reclusion temporal. However, if the suicide is not consummated, the penalty of arresto mayor in its medium and maximum periods shall be imposed. The above provision contemplates the following situations:

a. If a physician assists a person in the commission of suicide (by giving him a lethal dose of poison, for example) without actually administering it, the law imposes upon him the penalty of prision mayor (6 yrs. and 1 day to 12 yrs. imprisonment).

b. If the physician lends his assistance to another to the extent of doing the killing himself, he shall be punished by reclusion temporal (12 yrs. and 1 day to 20 yrs.);

210 LEGAL MEDICINE

c. If the suicide with the assistance of the physician is not consummated, the penalty of arresto mayor (1 month and 1 day to 6 months) in its medium and maximum period shall be imposed; and

3. If poison was administered by the physician to the patient without the knowledge and consent of the patient, then it is murder. Treachery is inherent to the act of poisoning and treachery qualifies the killing to murder.

In other jurisdictions, the modern attitude is to allow physicians to perform euthanasia in some special cases.

In the case of Dr. Adams who was charged for murder by administering a pain-killing drug to a patient suffering from a painful and- incurable disease, which he was then acquitted, the court held that "If the first purpose of medicine (the restoration of health) could no longer be achieved, there was much for the doctor to do, and he was entitled to do all that was proper and necessary to relieve pain and suffering even if the means he took might incidentally shorten life by hours or perhaps even prolong it. The doctor who decides whether or not to administer the drug would not do his job if he were thinking in terms of hours or even in months. The defense in the present case was that the treatment given by Dr. Adams was designed to promote comfort, and if it was the right ana proper treatment the fact that it shortened life did not convict him of murder" (R. v. Adams, Crim., L.R. 365, 1957).

In a recently decided case (In the matter of Karen Quin-lan, N.J. Sup. Ct. Mar. 31,1976), Karen Quinlan had been in coma for almost a year and has been kept alive by a respirator. The father petitioned the court to authorize discontinuation of the respirator because there is no "reasonable possibility" that she would recover and to allow her to die "with grace and dignity". The court allowed such removal provided it is with the consent of the attending physician and a panel of hospital staff. The court based it on the right of privacy of the patient or the right of the patient to make life— sustaining medical decision and that since the patient was incompetent to make such decision, it belonged to her father acting as a guardian. The court does not question the "state's undoubted power to punish the taking of human life, but that power does not encompass individuals terminating treatment pursuant to their right of privacy".

SPECIAL DEATHS 211

3. SUICIDE:

Suicide or self-destruction is usually the unfortunate consequence of mental illness and social disorganization. Societal reaction to suicide varies in different jurisdiction. Some consider suicide a crime (Maryland, New Jersey, North Carolina, Oklahoma, South Dakota); others impose no penalty for suicide but suicide attempts are considered felonies or misdemeanors and could result to jail sentences.

In criminal statistics there is under-reporting of suicide cases because of the following reasons:

1. Even if the facts are clear to support suicide, the strong opposition of the family, the physician, attorney and friends may cause a certification that it is accidental, because they are not only bereaved but also stigmatized. The legal and moral implications of suicidal death prevent certification of such manner of death. If insured may deprive the beneficiary from receiving the full value of the policy, the usual religious rites may not be accorded the deceased, and other benefits provided by law which the heirs are entitled may not be received.

2. There is a lack of generally accepted standards for determining death by suicide. To make death suicidal, it must be the direct, conscious, intentional act of self-destruction. Subconscious or sub intended acts which directly or indirectly cause or hasten death is not considered to be suicide. No single finding in the investigation of death is an absolute criterion of suicide.

Suicide rarely occurs during the pre-addescent age. The incidence increase with the age but more in the elderly. There is more incidence in male than in female. Most victims have experienced depression of long duration prior to dying.

Suicide occurs in almost every conceivable location but a vast majority of cases occur at home. It may occur in other places like hotel, automobile, jails, hospitals and mental institutions. The bodies of victims may be found in rivers, lakes, open fields. The scene of death is orderly.

Psychological Classification of Suicide: 1. First degree — deliberate, planned, premeditated, self-murder.

2. Second degree — impulsive, unplanned, under great provocation or mitigating circumstances.

3. Third degree — sometimes called "accidental" suicide. This occurs when a person puts his or her life into jeopardy by

212 LEGAL MEDICINE

voluntary self-injury, but where we infer that the intention to die was relatively low because the method of self-injury was relatively harmless, or because provisions for rescue were made. The person was "unlucky" actually to die.

4. Suicide under circumstances which suggest a lack of capacity for intention, as when the person was psychotic or highly intoxicated from the effects of drugs, including alcohol.

5. Self-destruction due to self-negligence — for example, such self-destructive behaviors as chronic alcoholism, reckless driving, ignoring medical instructions, cigarette smoking, and similar dangerous activities. In general, such deaths are not at present classified as "suicide."

6. Justifiable suicide — for example, the self-destructive action of a person with a terminal illness. This last category is of considerable current interest to philosophers, theologians and social psychologists.

(From: Psychological Aspects of Suicide by Robert Litman, Modern Legal Medicine Psychiatry and Forensic Science, Curran, McGarry & Petty, ed. 19, 980, F. A. Davis Co., p. 843).

Common Methods of Commiting Suicide:

1. Drugs and poisons — Barbiturates, non-barbiturate sedatives, acids and other irritants, carbon monoxide, pesticides and herbicides, other organic and inorganic poisons.

2. Hanging. 3. Firearm. 4. Jumping from a height. 5. Drowning. 6. Cutting and stabbing. 7. Suffocation by plastic bag. 8. Electrocution.

Suicide and Drug: "Automatism" due to drug may be considered as accidental

rather than suicidal. A patient develops a state of toxic delirium after ingesting one or several doses of tlffe drugs, alcohol or a combination thereof and while in the delirious or automatism stage, takes much more of the drug unintentionally.

Evidences That Will Infer Death is Suicidal:

1. History of depression, unresolved personal problem, or mental disease;

2. Previous attempt of self-destruction; 3. If committed by infliction of physical injuries, the wounds are

SPECIAL DEATHS 213

located in areas accessible to the hand, vital parts of the body and usually solitary.

4. The effects of the act of self-destruction may be found in the body of the victim:

a. Hand may be blood-stained if suicide was done by inflicting wound;

b. Wounding hand may be positive to paraffin test in gunshot. The wound of entrance may show manifestation of a contact or near shot.

c. Empty bottle or container of poison may be present at the suicide scene;

d. Absence of signs of struggle; or e. Cadaveric spasm present in the wounding hand holding the

weapon.

5. Presence of suicide note; 6. Suicide scene in a place not susceptible to public view, and 7. Evidences that will rule out homicide, murder, parricide, and

other manner of violent death.

D E A T H F R O M S T A R V A T I O N

Starvation or inanition is the deprivation of a regular and constant supply of food and water which is necessary to normal health of a person.

Death by itarvation

214 LEGAL MEDICINE

Types of Starvation:

1. Acute starvation — is when the necessary food has been suddenly and completely withheld from a person.

2. Chronic starvation — is when there is a gradual or deficient supply of food.

Causes of Starvation:

1. Suicidal:

a. People deprived of liberty or prisoners may go in a "hunger strike" to create sympathy.

b. Mistaken belief that people can live without food for a prolonged period.

c. Excessive desire to lose weight.

d. Lunatics during depressive state.

e. As an expression of political dissent.

2. Homicidal:

a. Deliberate deprival of food for helpless illegitimate children, feeble-minded and old persons.

b. Punishment or act of revenge by deliberate incarceration in an enclosed place without food m water.

3. Accidental:

a. Scarcity of food or water during famines or draught.

b. Shipwreck, entombment of miners caused by landslides, marooned sailors, or fall in a pit.

Length of Survival:

The human body without food loses l/24th of its weight daily, and a loss of 40% of the weight results to death.

The length of survival depends upon the presence or absence of water. Without food and water, a person cannot survive more than 10 days, but with water a person may survive without food for 50 to 60 days.

Factors that Influence the Length of Survival:

a. Age — Children suffer earlier from the effects of starvation than old aged people. A child demand more food for growth and development. Assimilation and utilization of food elements is slowed and weakened in old age.

b. Condition of the body — During starvation, fat stored up in the body is the one utilized to maintain life. It is but natural that a healthy person with more fat deposit can resist more deprival of food.

SPECIAL DEATHS 21S

c. Sex — Women can withstand starvation longer because they have relatively more adipose tissues than men.

d. Environment — Exposure to higher temperature will accelerate death. Suitable clothings will delay death. Active physical exertion will hasten death. Severe cold will also hasten death.

The Length of Survival Depends Upon the Following:

a. Presence or absence of water. b. Partial or complete withdrawal of food. c. Surroundings. d. Females survive better than males, but children and older

persons die quickly. e. Condition of the body.

Symptoms:

1. Acute feeling of hunger for the first 30 to 48 hours and this is succeeded by localization of the pain at the epigastrium which can be relieved by pressure.

2. A feeling of extreme thirst.

3. The face is pale and cadaverous.

4. Four or five days later, there is a general emaciation and absorption of the subcutaneous fat.

5. The eyes are sunkened, glistening dilated pupils and with anxious expression.

6. The lips and tongue are dry and with cracks, while the breath is foul and offensive.

7. The voice becomes weak, faint and inaudible.

8. The skin is dry, rough, wrinkled and emitting a peculiar disagreeable odor.

9. The pulse is weak and the temperature is subnormal.

10. The abdomen is sunkened and the extremities are thin, flaccid with marked loss of muscular power.

11. The intellect may remain for sometime, later becomes delirious and convulsion or coma appears before death.

12. Symptoms of secondary infection may later appear on account of the weakened resistance of the body.

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

216 LEGAL MEDICINE

Post-mortem Findings:

1. External Findings:

a. Body greatly emaciated and emitting a peculiar offensive odor.

b. The eyes are dry, red and open with the eyeballs sunkened.

c. The skin is dry, shrivelled and sometimes with secondary skin infection.

d. Bed sores may be present.

2. Internal Findings:

a. The muscles are pale, soft, wasted with the subcutaneous fat almost completely disappeared.

b. There is a general reduction in the size and weight of all organs, except the brain.

c. The brain is pale and soft, while meningeal vessels are congested and frequently, there is a serous effusion in the ventricle.

d. The heart is small, with flabby and pale muscles and generally empty chambers (brown atrophy).

e. The lungs are edematous with hypostatic congestion.

f. The stomach is small, contracted and empty with the mucous membrane less stained with bile.

g. The intestine is thin, empty, with its thin and translucent wall and with the disappearance of the mucosal folds.

h. There may be superficial or extensive ulceration of the colon as in ulcerative colitis.

i. The liver, spleen, kidneys and pancreas are small and shrunken. Microscopically, the liver shows necrosis of the central zone. The liver damage was due to protein deficiency.

j. The gall bladder is distended with bile while the urinary bladder is empty.

k. There is demineralization of bones and in pregnant women, it may produce osteomalacia.

1. Findings are refenable to concomitant disease which may develop on account of the diminished resistance.

Effects of Chronic Starvation:

Incomplete withdrawal of food to the body may cause a different effect. The person will manifest symptoms referrable to the food deficiency.

1. Deprivation of protein in the diet reduces the amount of protein in the serum and edema, anemia, leucopenia and weakened cardiac function develop.

SPECIAL DEATHS 217

2. Absence of various vitamins in the food for a long period of time may cause nutritional disturbance:

a. Deficiency in Vitamin A will cause hyperkeratosis of the skin atrophy of the mucous membrane, drying up of the salivary and lacrimal glands and night blindness.

b. Deficiency of Vitamin B will cause neuritis, sore tongue, hypertrophy of the heart, and other manifestations of beri-berL

c. Deficiency of Vitamin C will cause hemorrhage in various parts of the body, kidneys, periosteum. Massive hemorrhage in the gums is observed in adults.

d. Deficiency of Vitamin D and calcium may be followed by respiratory catarrh, anemia, osteomalacia and skeletal deformities.

3. Deficiency of sugar, fat and minerals produce various disturbance in the body.

Medico-Legal Questions in Death Due to Starvation:

1. Determination whether death was caused by starvation:

It is necessary to examine carefully the internal organs and to search for the existence of any disease which may possibly be the cause of death. Some diseases may also lead to pathological emaciation, like malignant disease, tuberculosis, diabetes mellitus, anemia and chronic diarrhea. Absence of any disease which may cause severe emaciation and the presence of a cause for the deprivation of food are the basis for the diagnosis of death by starvation.

2. Determination of the cause of the starvation:

Starvation may be suicidal, homicidal or accidental. The condition of the surroundings, history and previous life of the victim and his mental condition before he starved must be taken into consideration in the determination of the cause.

Chapter VIII

DISPOSAL OF THE DEAD BODY

Sec. 1103, Revised Administrative Code: Persons Charged with Duty of Burial:

The immediate duty of burying the body of a deceased person, regardless of the ultimate liability for the expense thereof, shall devolve upon the persons hereinbelow specified:

(a) If the deceased was a married man or woman, the duty of burial shall devolve upon the surviving spouse if he or she possesses sufficient means to pay the necessary expenses.

(b ) If the deceased was an unmarried man or woman, or a child, and left any kin, the duty of burial shall devolve upon the nearest kin of the deceased, if they be adults and within the Philippines and in possession of sufficient means to defray the necessary expenses.

(c) If the deceased left no spouse or kindred possessed of sufficient means to defray the necessary expenses, as provided in the two foregoing subsection, the duty of burial shall devolve upon the municipal authorities.

Any person upon whom the duty of burying a dead body is imposed by law shall perform such duty within forty-eight hours after death, having ability to do so.

Sec. 1104, Revised Administrative Code: Right of Custody to body:

Any person charged by law with the duty of burying the body of a deceased person is entitled to the custody of such body for the purpose of burying it, except when an inquest is required by law for the purpose of determining the cause of death; and, in case of death due to or accompanied by a dangerous communicable disease, such body shall until buried remain in the custody of the local board of health or local health officer, or if there be no such, then in the custody of the municipal council.

CONCEPT OF POSSESSION:

The right of custody over a dead body means possession. Possession means the holding of a thing or enjoyment of a right. The possession of a thing means two things: either in the concept of

218

DISPOSAL OF THE DEAD BODY 219

ownership or the holder of a thing keeping it while the ownership belongs to another.

Literally speaking, the right of custody does not -mean ownership of a dead body. The possessor cannot exercise the full rights of ownership.

Kenny (Canada), in his Outlines of Criminal Law (15 ed. p. 219) cited a case of a group of individuals known as "resurrection men" who used to disinter dead bodies from cemeteries and sell them to the anatomy departments of medical colleges. Since the law provides that the crime of theft or robbery cannot be committed on things which have no owner, these people were not successfully prosecuted for theft.

In the case of Philips v. Montreal General Hospital (33 S.C. 483; 14 R.L. 159) decided in Quebec, Canada, it has been held that there is a right of property in human remains, at least in a limited sense. The right of possession of a corpse is equivalent to ownership and any unlawful interference with that right is an actionable wrong.

The surviving spouse has the preferential right and duty to make arrangements, for the funeral of the deceased spouse and to decide how the remains should be disposed of. This is also the rule in the United States, where the superior and preferred right of the surviving spouse to the burial and any other legal disposition of the remains of the husband is undisputed (Ameida Vda. de Carillo v. Carillo, 67 Phil. 92).

Executor's Right of Custody Superior to the Right of Spouse Dead Body:

If ever the deceased left a will stating among other things the manner his body will be disposed, such provision of the will if validly executed and allowed, will prevail over the provisions of the Administrative Code.

An executor is the person mentioned in a will who will carry on the provision of the will. He is duty-bound to execute whatever is stated in the will after the death of the decedent. But, in the absence of a testamentary disposition, the right of the surviving spouse is paramount.

In the case of Hunter v. Hunter, decided in Ontario, Canada (65 O.L.R. 586), the deceased had been a staunch and devout Protestant and an Orangeman. His wife is an equally devout Catholic. At the time of his last illness he expressed a wish to be buried in the place where his wife would be buried, which was taken to mean, in a Roman Catholic cemetery. He was then received into the Roman Catholic Church and died about three weeks later. One of the deceased's son-the plaintiff in the case-has been named

220 LEGAL MEDICINE

executor of the will, and claimed the body for burial, which he intended should be in a Protestant cemetery. This was resisted by the widow who contended that her husband should be buried in a cemetery of the church he had joined recently. The court maintained the son's claim holding that, as executor, he had a right to have the body for the purpose of burial. The wife was prevented from interfering with that right (Cited by Meridith).

METHODS O F DISPOSAL O F THE D E A D B O D Y :

1. Embalming:

Embalming is the artificial way of preserving the body after death by injecting 6 to 8 quarts of antiseptic solutions of formalin, perchloride of mercury or arsenic, which is carried into the common carotid and the femoral arteries. Usually, alcohol is added to minimize the strong odor of the chemical and glycerine to lessen the evaporation of water from the tissues of the body. If the preservation of the body is for a longer time, the abdominal and thoractic viscera are removed, washed and soaked in strong antiseptic solution before they are returned. The skin is painted with vaseline or covered with plaster of Paris to prevent too much evaporation.

2. Burial or Inhumation:

a. The body must be buried within forty-eight hours after death:

Sec. 1092, Revised Administrative Code:

Time within which body shall be buried:

Except when required for the purposes of legal investigation or when specifically authorized by the local health authorities, no unembalmed body shall remain unhurried longer than forty-eight hours after death; and after the lapse of such period the permit for burial, interment, or cremation of any such body shall be void and a new permit must be obtained.

When it has been certified or is known that any person died of, or with a dangerous communicable disease, the body of such person shall be buried within twelve hours after death, unless otherwise directed by the local board of health or other health authority.

The dead body must be buried within forty-eight hours after death except:

(1) When it is still a subject matter of legal investigation; (2) When it is specifically authorized by the local health author

ities that the body may be buried more than 48 hours after death;


(3) Impliedly when the body is embalmed.

If the person died of communicable disease, the body must be buried within 12 hours unless the local health officer permits otherwise.

If the body is not buried within 48 hours after death, the permit previously issued is deemed cancelled and there is a need of a new permit.

Considering the climatic conditions in the Philippines, the time limit provided for by law regarding burial time should be reduced to 24 hours instead of 48 hours. Decomposition of the body in tropical countries, like the Philippines, is relatively rapid.

b. Death Certificate Necessary before Burial:


Requirement of Certificate of Death — By whom to be issued: Except in cases of emergency, no dead body shall be buried

without a certificate of death. If there has been a physician in attendance upon the deceased, it shall be the duty of the said physician to furnish required certificate. If there has been no physician in attendance, it shall be the duty of the local health officer or of any physician to furnish such certificate. Should no physician or medical officer be available, it shall be the duty of the mayor, the secretary, or of a councilor of the municipality to furnish the required certificate.

Sec, 91, P.D. 856 Code of Sanitation — Burial Requirement: The burial of remains is subject to the following requirements:

(a) No remains shall be buried without a death certificate. This certificate shall be issued by the attending physician. If there has been no physician in attendance, it shall be issued by the mayor, the secretary of the municipal board, or a councilor of the municipality where the death occurred. The death certificate shall be forwarded to the local civil registrar within 48 hours after death.

The death certificate shall be forwarded by the person issuing it to the municipal secretary within forty-eight hours after death.

The law requires the necessity of a death certificate before burial, except in emergency cases. The following may sign the death certificate: (1) The attending physician, if there is any; (2) The local health (municipal health officer) if there is no

physician in attendance;

222 LEGAL MEDICINE

(3) The municipal mayor, if there is no local health officer and no physician in attendance;

(4) The municipal secretary, in the absence of the mayor; (5) Any councilor.

The order in the enumeration is exclusive and successive. The presence of the preceding person will exclude the succeeding person in the enumeration.

Inasmuch as almost all municipalities of the Philippines have municipal health officers; the municipal mayor, secretary and any of the councilors are practically inhibited to sign the death certificate.

It appears unusual and contrary to the intent and purpose of the death certificate when persons not qualified to know the cause of death, are authorized by law to sign it.

This provision of the Administrative Code was promulgated during the time when physicians were quite scarce.

c. Permission from the Provincial Fiscal or from the Municipal Mayor is Necessary if Death is Due to Violence or Crime:

Sec. 1089, RevisedAdministrative Code:

Proceedings in case of suspected violence or crime:

If the person who issues a death certificate has any reason to suspect or if he shall observe any indication of violence or crime, he shall at once notify the justice of the peace, if he be available, or if neither the justice of the peace nor the auxiliary justice be available, he shall notify the municipal mayor, who shall take proper steps to ascertain the circumstances and cause of death; and the corpse of such deceased person shall not be buried or interred until permission is obtained from the provincial fiscal, if he be available, and if he be not available, fjom the mayor of the municipality in which the death occurred.

Sec. 91 ( f ) , P.D. 856 Code of Sanitation: If the person who issues a death certificate has reasons to

believe or suspect that the cause of death was due to violence or crime, he shall notify immediately the local authorities concerned. In this case the deceased shall not be buried until a permission is obtained from the provincial or city fiscal. If these officials are not available, permission shall be obtained from any government official authorized by the law.


In cases of death wherein violence or crime is suspected, it is necessary to notify the following in order to determine the circumstances and nature of death:

(1) Justice of the peace. (2) Auxiliary justice of the peace, if the former is not available.

But the permission for burial may only be granted by:

(1) Provincial fiscal.

(2) Municipal mayor if the fiscal is not available.


Burial and transfer permits: Municipal secretaries, in the capacity of secretaries of munici

pal boards of health in places where such boards have been organized, or, in places where there are no municipal boards of health, in the capacity of clerks to municipal councils, shall, upon the presentation of death certificates, issue permits for the burial or transfer of the dead and shall record on said certificates the place of interment and when practicable the number of the grave from which the body or remains have been transferred, and the disposition that is to be made of such body or remains. No permit shall be granted by any municipal secretary, or by any other person, to inter or disinter, bury or remove for burial, any human body or remains until a certificate of death, as hereinbefore required, shall have been filed; when it is impossible to secure a death certificate in the form and manner hereinbefore provided, municipal secretaries may issue the same upon such data as may be obtainable.

In case of the transfer of bodies or remains from one municipality to another municipality, a copy of the death certificate shall accompany the transfer permit.

Sec. 1094, Revised Administrative Code: Disposition of body and belonging of person dying of dangerous communicable disease:

The body of a person dead of any dangerous communicable disease shall not be carried from place to place, except for the purpose of burial or cremation. It shall be the duty of the local health authorities to cause such body to be thoroughly disinfected before being prepared for burial and the house, furniture, wearing apparel, and everything capable of conveying or spreading infection shall also be disinfected or destroyed £y fire. The local health authority, if there be any, subject to the approval of the Director of Health, shall,consistently with the provisions hereof, prescribe the conditions under which the

224 LEGAL MEDICINE

bodies of persons dying of a dangerous communicable disease shall be buried or cremated.

Sec. 91 (h) , P.D. 856 Code of Sanitation: When the cause of death is a dangerous communicable

disease, the remains shall be buried within 12 hours after death. They shall not be taken to any place of public assembly. Only the adult members of the family pf the deceased may be permitted to attend the funeral.

Sec. 1091, Revised Administrative Code: Burial permit (Death Certificate) must be presented before burial:

No sexton, superintendent, or other person having charge of a burial ground or cemetery shall assist in, assent to or allow any interment, disinterment or cremation to be made until a permit from the municipal secretary, authorizing the same, has been presented.

Placing of body in overground tomb:


Exhibition of permit to sexton:

The placing of the body of any deceased person in an unsealed overground tomb is prohibited, unless the coffin, or casket containing the remains shall be permanently sealed.

The provision shall not apply to tombs and vaults which are strictly receiving vaults for bodies or remains awaiting final disposition, nor to embalmed bodies awaiting final disposition.

The depth of the grave must be at least 1-1/2 meters:


Depth of grave:

A grave shall be dug, when practicable, to a depth of one and one-half meters and after the implacement of the body shall be well and firmly filled.

Sec. 91 (c) , P.D. 856 Code of Sanitation: Graves where remains are buried shall be at least one and one-

half (1-1/2) meters deep and filled well and firmly.

The Law Penalizes Desecration of Burial Premises:


Desecration of burial premises:

Any person who wantonly or maliciously defaces, breaks, or destroys any tomb, ornament, or gravestone erected to any deceased person, or any momento or memorial, or any plant, tree or shrub pertaining to places of burial of a dead body, or


who shall wantonly or maliciously remove any fence, post, or wall or any burial ground or cemetery, shall be punished by a fine of not more than two hundred pesos or by imprisonment for not more than six months, or both.

Although it did not totally repeal the provision of the Administrative Code, The Code of Sanitation provides:

Burial Grounds Requirements: (Sec. 90, Code of Sanitation, P.D. 856)

The following requirements shall be applied and enforced:

a. It shall be unlawful for any person to bury remains in places other than those legally authorized in conformity with the provisions of the Chapter.

b. A burial ground shall at least be 25 meters distant from any dwelling house and no house shall be constructed within the same distance from any burial ground.

c. No burial ground shall be located within 50 meters from any source of water supply.

Other Burial Requirements: The burial of remains is subject to the following requirements:

(1) Shipment of remains abroad shall be governed by the rules and regulations of the Bureau of Quarantine.

(2) The burial or remains in city or municipal grounds shall not be prohibited on account of race, nationality, religious or political persuasion.

(3) Except when required by legal investigation or when permitted by the local health authority, no unembalmed remains shall remain unburied longer than 48 hours after death.

F U N E R A L S : Art. 305, Civil Code:

The duty and the right to make arrangements for the funeral of a relative shall be in accordance with the order established for support, under article 294. In case of descendants are of the same degree, or of brothers and sisters, the eldest shall be preferred. In case of ascendants, the paternal shall have a better right. The order mentioned in the article 294 is as follows:

a. The spouse; b. The descendants of the nearest degree; c. The ascendant, also of the nearest degree; d. The brothers and sisters.

226 LEGAL MEDICINE

Att. 306, Civil Code: Every funeral shall be in keeping with the social position of the

deceased.

Art. 307, Civil Code: The funeral shall be in accordance with the expressed wishes of

of the deceased. In the absence of such expression, his religious belief or affiliation shall determine the funeral rites. In case of doubt, the form of funeral shall be decided upon by the person obliged to make arrangement for the same, after consulting the other members of the family.

Art. 309, Civil Code: Any person who shows disrespect to the dead, or wrongfully

interferes with a funeral shall be liable to the family of the deceased for damages, material or moral.

This provision is further implemented by the Revised Penal Code by considering it a criminal act. The funeral rite is a religious ceremony or manifestations of any religion.

Art. 132, Revised Penal Code:

Interruption of religious worship:

The penalty of prision correccional in its minimum period shall be imposed upon any public officer or employee who shall prevent or disturb the ceremonies or manifestations of any religion.

If the crime shall have been committed with violence, or threat, the penalty shall be prision correccional in its medium and maximum periods.


Offending the religious feeling:

The penalty of arresto mayor in its maximum period to prision correccional in its minimum period shall be imposed upon anyone who, in a place devoted to religious worship or during the celebration of any religious ceremony shall perform acts notoriously offensive to the feeling of the faithful.

Art. 2219, Civil Code provides that moral damages may be recovered for acts mentioned in Art. 309, Civil Coda)

Limitations to the Funeral Rites:

a. Will of Deceased:

The deceased during his lifetime may have made a will or expressly stated to his next of kin that his body after his death must be disposed in the manner he desires.

b. Burial of the person sentenced to death must not be held with pomp:



Provision relative to the corpse of person executed and its burial:

Unless claimed by his family, the corpse of the culprit shall, upon the completion of the legal proceedings subsequent to the execution, be turned over to the institute of learning or scientific research first applying for it, for the purpose of study and investigation, provided that such institute shall take charge of the decent burial of the remains. Otherwise, the Director of Prisons shall order the burial of the body of the culprit at government expense, granting permission to be present thereat to the members of the family of the culprit and the friends of the latter. In no case, shall the burial of the body of the person sentenced to death be held with pomp.

c. Restriction as to funeral ceremonies in cases of deaths due to communicable disease: Sec. 1105, Revised Administrative Code: Restrictions as to funeral ceremonies in certain cases:

In case of death due to dangerous communicable disease or due to any epidemic recognized by the Director of Health, the body of the deceased shall not be taken to any place of public assembly, nor shall any person be permitted to attend the funeral of such deceased person, except the adult members of the immediate family of the deceased, his nearest friends, not exceeding four, and other persons whose attendance is absolutely necessary. After the deceased shall have been buried for a period of one hour, a public funeral may be held at the grave or in a place of public assembly or elsewhere.

In case of death due to other causes the right to hold public funerals in an orderly manner and to take the remains of the deceased into churches or other places for this purpose shall not be interferred with.

Sec. 91 (h), P.D. 856 Code of Sanitation: When the cause of death is a dangerous communicable

disease, the remains shall be buried within 12 hours after death. They shall not ba taken to any place of public assembly. Only adult members of the family of the deceased may be permitted to attend the funeral.

3. Disposing of the Dead Body in the Sea: Some dead bodies are not buried, embalmed or cremated but

thrown over board in an open sea provided that the deceased is

228 LEGAL MEDICINE

not suffering from dangerous communicable disease. Such manner of disposal may be the will of the deceased or a part of religious practice.

Sec. 1093, Revised Administrative Code: Permit for conveyance of body to sea for burial:

Where death is not due to a dangerous communicable disease a special permit may, upon written request, be issued, by the officer authorized to issue burial permits, for the conveyance of a dead body to sea for burial. In such cases, the body must be transported in the manner prescribed by the municipal board of health, if such there be, and the marine laws governing burial at sea must be complied with.

4. Cremation:

Cremation is the pulverization of the body into ashes by the application of heat.

The body must first be identified before cremation, and no cremation must be made unless there is a permit to do so. Cremation must be made in a crematory made for the purpose.

The time required to transform the human body to ashes is dependent upon the degree or intensity of heat applied, duration of the application of heat, physical condition of the body and the presence of clothings and other protective materials in the body. In a gas incinerator, it usually requires about four hours to transform the whole body into ashes.

Instances When Permission for Cremation Must Not Be Granted:

a. If the deceased left a written direction that he or she must not be cremated.

b. If the exact identity of the deceased has not yet been definitely ascertained.

c. When the exact cause of death cannot be definitely ascertained and further inquiry or examination may be needed (Forensic Medicine by Kerr, 4th ed., p. 22).

5. Use of tiie Body for Scientific Purposes:

Sec. 97, P.D. 856, Code of Sanitation:

Use of remains for medical studies and scientific research:

Unclaimed remains may be used by medical schools and scientific institutions for studies and research subject to the rules and regulations prescribed by the Department. Sec. 1107, Revised Administrative Code: Use of dead body for scientific purposes:


The body of any deceased person which is to be buried at public expense and which is unclaimed by relatives or friends for a period of twenty-four hours after death shall be subject to the disposition of the Bureau of Health, and, by order of the Director of Health, may be devoted to the purposes of medical science and to the advancement and promotion of medical knowledge and information, subject to such regulations as said Director of Health, with the approval of the Department Head, may prescribe. The regulations of the Director of Health shall provide for the decent burial of the remains of such bodies and for defraying the necessary expenses incident thereto. Except as herein provided, it shall be unlawful for any person to make use of any dead body for any scientific investigation other than that of performing an autopsy.

Corpse of prisoners after judicial execution may be turned over to institution of learning or scientific research: Art. 85, Revised Penal Code:

Provisions relative to the corpse of the person executed and its burial:

Unless claimed by the family, the corpse of the culprit shall upon completion of the legal proceedings subsequent to the execution, be turned over to the institute of learning or scientific research first applying for it, for the purpose of study and investigation, provided that such institution shall take charge of the decent burial of the remains. Otherwise, the Director of Prisons shall order the burial of the body of the culprit at government expense, granting permission to be present thereat to the members of the family of the culprit and the friends of the latter. In no case shall the burial of the body of a person sentenced to death be held with pomp.

Sec. 98, P.D. 856, Code of Sanitation: Special precautions for safe handling of cadavers containing radioactive isotopes:

a. Cadavers containing only traces (very small dose) of radioactive isotope do not require any special handling precautions.

b. Cadavers containing large amounts of radioactive isotopes should be labelled properly identifying the type and amount of radioactive isotopes present and the date of its administration.

c. Before autopsy is performed, the Radiation Health Officer or his duly authorized representative should be notified for proper advice. The pathologist and/or embalmer should be warned accordingly of the radioactivity of the cadaver so that radiation precautions can be properly enforced.

230 LEGAL MEDICINE

d. Normal burial procedures, rules and regulations may be carried out on the above-mentioned cadaver provided that their amount of radioactivity has decayed to a safe level which will be determined by the Radiation Health Officer or his authorized representative.

e. Cremation — If cremation is performed without autopsy, there is no handling problem; otherwise, autopsy precautions should be strictly enforced. Precautions should be taken to prevent any possible concentration of radioactivity at the base cf the stack of the crematorium.

DONATION OF PART(S) OF HUMAN BODY

PERMISSIONS TO USE H U M A N O R G A N S OR PORTIONS OF THE H U M A N B O D Y FOR M E D I C A L , S U R G I C A L , OR SCIENTIFIC PURPOSES, U N D E R C E R T A I N CONDITIONS

Republic Act No . 349 as amended by Republic Act 1056

A N ACT T O L E G A L I Z E PERMISSIONS T O USE H U M A N ORG A N S O R A N Y P O R T I O N O R PORTIONS O F THE H U M A N B O D Y FOR M E D I C A L , S U R G I C A L , OR SCIENTIFIC PURPOSES, U N D E R C E R T A I N C O N D I T I O N S

Sec. 1. Any person may validly grant to a licensed physician, surgeon, known scientist, or any medical or scientific institution, including eye banks and other similar institutions, authority to detach at any time after the grantor's death any organ, part or parts of his body and to utilize the same for medical, surgical or scientific purposes.

Similar authority may also be granted for the utilization for medical, surgical, or scientific purposes, of any organ, part or parts of the body which, for a legitimate reason, would be detached from the body of the grantor.

Sec. 2. The authorization referred to in section one of this Act must: be in writing; specify the person or institution granted the authorization; the organ, part or parts to be detached, the specific use or uses to which the organ, part or parts are to be employed; and, signed by the grantor and two disinterested witnesses.

If the grantor is a minor or an incompetent person, the authorization may be executed by his guardian with the approval of the court; in default thereof, by the legitimate father or mother, in the order named. Married women may grant the authorization re-


ferred to in section one of this Act, without the consent of the husband.

After the death of the person, authority to use human organs or any portion or portions of the human body for medical, surgical or scientific purposes may also be granted by his nearest relative or guardian at the time of his death or in the absence thereof, by the person or head of the hospital, or institution having custody of the deceased. Provided, however, that the said person or head of the hospital or institution has exerted reasonable efforts to locate the aforesaid guardian cr relative.

A copy of every such authorization must be furnished the Secretary of Health.

Sec. 2-A. The provisions of sections one and two of this Act notwithstanding, it shall be illegal for any person or any institution to detach any organ or portion of the body of a person dying of a dangerous communicable disease even if said organ or portions of the human body shall be used for medical or scientific purposes. Any person who shall violate the provisions of this section shall be punished with an imprisonment of not less than six months nor more than one year. If the violation is committed by an institution, corporation or association, the director, manager, president, and/or other officials and employees who, knowingly or through neglect, perform the act or acts resulting in said violation shall be held criminally responsible therefore.

Sec. 3. An authorization granted in accordance with the provisions of this Act shall bind the executors, administrators and successors of the deceased and all members of his family.

Sec. 4. Any law or regulation inconsistent with the Act are hereby repealed.

Sec. 5. This Act shall take effect upon its approval.

A P P R O V E D , May 17, 1949, Amendment Approved June 12, 1954.

Sec. 96, Code of Sanitation (P.D. 856).

Donation of Human Organs for Medical, Surgical and Scientific Purposes According to the Sanitation Code (P.D. 856):

Any person may donate an organ or any part of his body to a person, a physician, a scientist, a hospital or a scientific institution upon his death for transplant, medical, or research purposes Bubject to the following requirements:

a. The donation shall be authorized in writing by the donor specifying the recipient, the organ or part of his body to be donated and the specific purpose for which it will be utilized.

232 LEGAL MEDICINE

b. A married person may make such donation without the consent of his spouse.

c. After the death of a person the next of kin may authorize the donation of an organ or any part of the body of the deceased for similar purposes in accordance with the prescribed procedure.

d. If the deceased has no next of kin and his remains are in the custody of an accredited hospital, the Director of the hospital may donate an organ or any part of the body of the deceased in accordance with the requirements prescribed in this Section.

e. A simple written authorization signed by the donor in the presence of two witnesses shall be deemed sufficient for the donation of organs or parts of the human body required in this Section, notwithstanding the provisions of the Civil Code of the Philippines on matters of donation. A copy of written authorization shall be forwarded to the Secretary.

f. Any authorization granted in accordance with the requirements of this Section is binding to the executors, administrators, and members of the family of the deceased.

Persons who can grant permission to detach, after death, human organs or part or parts of the human body for medical, surgical and other scientific purpose:

a. Before Death:

(1) By the deceased during his lifetime.

(2) If the deceased is a minor or incompetent, permission may be executed by the guardian with the approval of the court or by the legitimate father or mother. A married woman may give consent without the consent of the husband.

b. After Death:

(1) The nearest relative.

(2) In the absence of the nearest relative, permission may be given by the head of the hospital or institution having custody of the deceased.

Persons permitted to detach human organs, or parts of the human

body for medical, surgical and other scientific use:

a. Licensed physicians and surgeons. b. Known scientists. c. Medical or scientific institutions including eye-banks.

Requirements for a Valid Authorization:

a. It must be in writing. b. It must specify the person or institution granted the author

ization.


c. It must specify the organ or part of the body to be detached. d. It must be signed by the grantor and two disinterested persons. e. A copy of the authorization must be furnished to the Secretary

of Health.

Limitation to the Authorization:

It will be illegal to removed organs or portions of the human body if the deceased died of a dangerous communicable disease.

Penal Provision:

Imprisonment of not less than six months nor more than one year. If committed by an institution, the director, manager, president or other officials or employees who knowingly or through neglect performed an act or acts resulting in said violation shall be criminally responsible.

E X H U M A T I O N :

The deceased buried may be raised or disinterred upon the lawful order of the proper authorities. The order may come from the provincial or city fiscals, from the court, and from any entity vested with authority to investigate.

If the body is exhumed for the purpose of performing postmortem examination, no deodorant must be applied to the body for it might interfere in the detection of, chemicals. After the body has been disinterred, it must be identified by relatives, friends, or by marks on the body. The physician must describe the coffin, clothings, degree of decomposition before stating the actual disease or violence in his report.

Sec. 1082, Revised Administrative Code: Cemetery permits — It shall be unlawful to establish, maintain, enlarge, reopen, or remove any burial ground or cemetery, or to disinter a human body or human remains, until a permit therefor, approved by the Director of Health, shall have been obtained.

Questions: Is the National Bureau of Investigation required to obtain a permit from the Director of Health for exhumation of a dead body in the course of a legal investigation conducted by it? The query was made on the presumption that the one to perform the exhumation is a physician who is in a capacity to protect public health.

Answer: In the opinion rendered by the Secretary of Justice the answer is yes. Sec. 1082 and 1095 of the Revised Administrative Code requiring a permit in disinterring a human or human remains from the Director of Health also extends to cases where exhu-

234 LEGAL MEDICINE

mation has to be done for an autopsy by any person authorized to do so in the course of a legal investigation. The language of those two sections are clear and absolute in terms and admits of no exception. Nor any exception to the said requirement be found in any of the provisions dealing with legal investigations. This is so because the purpose of the requirement of said permit is the protection of health which may not be sacrificed where a legal investigation is being conducted (Opinion of the Secretary of Justice, No. 26, series of 1954).

Sec. 1095, Revised Administrative Code: Permit to disinter after three years — Treatment of remains:

Permission to disinter the bodies or remains of persons who have died of other dangerous communicable disease, may be granted after such bodies had been buried for a period of three years; and, in special cases, the Director of Health may grant permission to disinter after a shorter period when in his opinion the public health will not be endangered thereby.

The body or remains of any such deceased person, upon exhumation, shall be immediately disinfected and inclosed in a coffin, case, or box, securely fastened, and this coffin, case, or box shall be placed in sn outside box which shall also be securely fastened.


Special permit to disinter embalmed body or to remove from receiving vault for transfer:

Special permits may be issued at any time for the disinterment or exhumation of remains of persons, dying of other than dangerous communicable disease, that have been properly embalmed by an undertaker or embalmer, or for the transfer or removal of bodies that have been placed in a receiving vault awaiting transportation from the Philippines. Boxes containing the bodies or remains shall be plainly marked so as to show the name of the deceased, place of death, cause of death and the point to which such bodies or remains are to be shipped. Sec. 1097, Administrative Code:

Exhumation in case of death from dangerous communicable disease:

Bodies or remains of persons who have died of any dangerous communicable disease may be exhumed only after the lapse of five years from burial, though in special cases the Director of Health may grant a permit to disinter after a shorter period when in his opinion the public health will not be endangered thereby.


In every such case, the body or remains, after being disinfected must be placed in a suitable and hermetically sealed container! Sec. 92, Code of Sanitation — Disinterment Requirements: Disinterment of remains is subject to the following requirements;

a. Permission to disinter remains of persons who died of non-dangerous communicable diseases may be granted after a burial period of three (3) years.

b. Permission to disinter remains of persons who died of dangerous communicable diseases may be granted after a burial period of five (5) years.

c. Disinterment of remains covered in paragraphs "a" and " b " of this Section may be permitted within a shorter time than that prescribed in special cases, subject to the approval of the Regional Director concerned or his duly authorized representative.

d. In all cases of disinterment, the remains shall be disinfected and placed in a durable and sealed container prior to their final disposal.

Art. 308, Civil Code: No human remains shall be retained, interred, disposed of or

exhumed without the consent of the persons mentioned in articles 294 and 305.

The persons mentioned in articles 294 are: (1) Spouse; (2) Descendants of the nearest degree; (3) Ascendants of the nearest degree; and (4) Brothers and sisters.

How Long Can Exhumation Be Done After Interment: a. If the person died of dangerous communicable disease, the dead

body may be exhumed only after a lapse of five years from the date of burial. However, permit to disinter may be given after a shorter period when in the opinion of the Director of Health it will not endanger public health.

Sec. 1097, Administrative Code — Exhumation in case of death from dangerous communicable disease — Bodies or remains of persons who have died of any dangerous communicable disease may be exhumed only after the lapse of five years from burial, though in special cases the Director of Health may grant a permit to disinter after a shorter period when in his opinion the public health will not be endangered thereby.

236 LEGAL MEDICINE

Sec. 92 (b & c), (P.D. 856) Code of Sanitation — Disinterment requirements:

a

b. Permission to disinter remains of persons who died of dangerous communicable diseases may be granted after burial period of five (5) years.

c. Disinterment of remains covered in paragraphs "a" and " b " of this Section may be permitted within a shorter time than that prescribed in special cases, subject to the approval of the Regional Director concerned or his duly authorized representative.

b. If a person died of a cause other than dangerous communicable disease, permission for exhumation may be granted after such body had been buried for a period of three (3) years. However, in special cases the Director of Health may grant permission after a shorter period when in his opinion the public health will not be endangered thereby.

Sec. 1095, Revised Administrative Code — Permit to disinter after three years — Treatment of Remains — Permission to disinter the bodies or remains of persons who have died of other than dangerous communicable disease, may be granted after such bodies had been buried for a period of three years; and, in special cases, the Director of Health may grant permission to disinter after a shorter period when in his opinion the public health will not be endangered thereby.

Sec. 92 (a) , (P .D. 856) Code of Sanitation — Disinterment requirement — Permission to disinter remains of person who died of non-dangerous communicable diseases may be granted after a burial period of three (3) years.

c. Sec. 1098, Revised Administrative Code — Shipment of remains by sea — No body or remains shall be shipped to the United States except under such conditions and regulations as may be prescribed by the United States Public Health Service. The outside box containing the body or remains of a deceased person intended for shipment by sea shall be plainly marked so as to show the name, age, nationality of the deceased person, the cause of death, and the destination of the remains.

d. If the dead body is a subject matter of criminal investigation it may be exhumed anytime.

Sec. 95 ( b ) , (P .D. 856) Code of Sanitation — Autopsy shall be performed in the following cases — (4) Whenever the Solicitor General, Provincial or city fiscal as authorized by existing laws,


shall deem it necessary to disinter and take possession of the remains for examination to determine the cause of death.

Requirements to be Satisfied in Exhumation:

a. Duration of interment as required (supra).

b. Exhumation permit:

Sec. 1082, Revised Administrative Code — Cemetery permits — It shall be unlawful to establish, maintain, enlarge, reopen, or remove any burial ground or cemetery, or to disinter a human body or human remains, until a permit therefor, approved by the Director of Health, shall have been obtained.

c. Compliance of the sanitary requirements:

Sec. 1095,2nd. par., Revised Administrative Code —Permit to disinter after three years — The body or remains of any such deceased person, upon exhumation, shall be immediately disinfected and inclosed in a coffin, case, or box, as securely fastened, and this coffin, case, or box shall be placed in an outside box which shall also be securely fastened.

Sec. 92 (d ) , (P.D. 856) Code of Sanitation — In all cases of disinterment, the remains shall be disinfected and placed in a durable and sealed container prior to their final disposal.

Procedures Followed in Medico-Legal Exhumations:

a. There must be a formal request from any of the law enforcement agency or any entity or person authorized by law to make investigation addressed to any establishment or person authorized to perform medico-legal investigation. The request must mention the name of the deceased, place of interment, date of interment, suspicion as to the cause of death, etc. The reason for the request may be:

(1) To determine the cause of death; (2) To determine the identity of the deceased; (3) To recover organs or tissues for further examination:

(a) For toxicological analysis, ( b ) For histopathological examination, (c) Smears from vaginal canal and blood for alcohol deter

mination; or (4) To recover foreign bodies:

(a) Metallic fragment or whole slug for ballistic examination. ( b ) Operative sponge, medical instrument to prove neg

ligence of surgeon. b. If the physician found out that there is justification to the

exhumation and a strong probability for the purpose to be realized, he may then set the date and time of the exhumation.

238 LEGAL MEDICINE

c. A written request for exhumation of the body of the deceased must be sent to the Ministry of Health or the Regional Director concerned, mentioning among other things: (1) Name of the deceased. (2) Place of exhumation. (3) Date and time of exhumation. (4) Duration of interment. (5) Purpose of exhumation.

The Ministry of Health aside from issuing the necessary permit together with the conditions to be complied with, will inform the local health officer concerned to assist the physician to perform the exhumation to see to it that public health will not be prejudiced.

d. During actual exhumation, the grave must be properly identified by the person who was present when the body was interred.

e. During the process of disinterment care and diligence must be observed to avoid destruction, deformity, contamination or such other effects that will prevent the realization of its objectives.

f. After opening the coffin, the body must be viewed by any or more persons who can identify the deceased. The names of the person who identified the grave, who viewed and identified the deceased must be included in the report. The exhuming physician must describe the coffin, wearing apparel and condition of the body.

g. Actual autopsy and adoption of the procedure is needed to accomplish the purpose of the exhumation.

h. Disinfection of the body and all the areas involved must be carried out with the assistance of the local health officer and return of the body to the burial place.

What must be Included in the Exhumation Report:

a. The name of the deceased and the personal circumstances (age, sex, civil status, address, occupation, etc.).

b. The purpose(s) of exhumation; c. The name, address and designation of the requesting party; d. The date, time and place of exhumation; e. The description of the burial place; f. The name and address of person(s) who identified the burial

place; g. The condition of the body and coffin (if there is) after dis

interment.


h. The name and address of the person(s) who identified the body of the deceased;

i. The post-mortem examination and accomplishment of the pnrpose(s) of the exhumation;

j. The conclusion(s) based on the findings and result of the examination;

k. Remarks (if any); and

1. The signature and designation of the physician.

Some Problems in Exhumation: a. Identity of the deceased:

The exhumed buried deceased might not be subject-matter of exhumation especially when the burial ground is a cemetery. Mass burial of "salvaging" victims or disaster victims may cause serious problem to the physician. There must be a meticulous and time consuming attempt of the exhuming physician to establish identity in order that his report may be of some value in the investigative or judicial proceedings.

b. Refusal of the next-of-kin to give consent or to cooperate in the exhumation-autopsy:

This situation is frequently observed when the next-of-kin has a strong possibility to be involved in the investigation.

The proper remedy to this situation is to petition the court to issue an order to exhume the body stating the specific reasons why exhumation-autopsy will serve the best interest of justice.

Chapter IX

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 edged 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.

^Causes of Physicial Injuries:

A^Thysical Violence J Br Heat or Cold

J Or Electrical Energy A ECChemical Energy

\ E. Radiation by Radio-Active Substances V F Change of Atmospheric Pressure (Barotrauma)

G. Infection

A. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

The effect of theâpphcation of physical violence on a person is the production ofTwojund: ) f\

A wound is the solution of the natural continuity of any tissue of the living body. It is the disruption of the anatomic integrity of a tissue of the body. In several occasions, the word physical injury is used interchangeably with wound. However, the effect of the physical violence may not always result to the production of wound, but the wound is always the effect of physical violence.

Physics of Wound Production:

Wound = Kinetic energy X time X area X "other factors"

M V 2 M=Mass V=Velocity Kinetic Energy =

240


Kinetic energy:

Inasmuch as kinetic energy is based on the mass and velocity factors and that the velocity is squared, the velocity component is the important factor. This explains why an M-16 bullet which has a speed or 3,200 ft/sec. will do more damage than a 0.38 caliber bullet which is heavier but has a much slower velocity.

Time:

The shorter the period of time needed for the transfer of energy, the greater the likelihood of producing damage. If a person is hit on the body and the body moves towards the direction of the force applied, the injury is less as when the body is stationary. The longer the time of contact between the object or instrument causing the injury, the greater will be the dissipation of energy. Area of Transfer:

The larger the area of contact between the force applied on the body, the lesser is the damage to the body. By applying an equal force, the damage caused by stabbing is greater compared to a blunt instrument.

"Other Factors":

The less elastic and plastic the tissue, the greater the likelihood that a laceration will result. Elasticity and plasticity refer to the ability of a tissue to return to its "normal" size and shape after being deformed by a pressure.

The movement of the parts of the body as a result of the force being applied to them and the local stretching of tissue during acceleration and deceleration cause most of the internal injuries seen in traumatized individuals.

A force transmitted through a tissue containing fluid will force the fluid away from the area of contact in all directions equally, frequently causing the tissue to lacerate (Legal Medicine Annual 1980, Cyril Wecht ea\, p. 36).

Vital Reaction: It is the sum total of all reactions 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:

a. "Rubor" — Redness or congestion of the area due to an increase of blood supply as a part of the reparative mechanism.

b. "Calor" — Sensation of heat or increase in temperature. c. "Dolor" — Pain on account of the involvement of the sensory

nerve.

242 LEGAL MEDICINE

d. Loss of function — On account of the trauma, the tissue may not be able to function normally.

The presence of the vital reaction differentiates an ante-mortem from a post-mortem injury.

In the following instances vital reactions or changes may not be observed even if injury was inflicted during life:

a. If physical injuries are inflicted during the agonal state of a living person. The body cells or tissue during the period may no longer have the potential capacity to react to the trauma; and

b. If death is so sudden as not to give the tissues of the body, the chance to react properly. This is commonly observed in deaths due to sudden coronary occlusion.

t / cLASSIFICATION OF WOUNDS:

cV^fs to Severity:

&S&ortal 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:

(a) Heart and big blood vessels. (2) Brain and upper portion of the spinal cord. (3) Lungs. (4) Stomach, liver, spleen and intestine.

J f Non-mortal wound — Wound which is not capable of producing death immediately after infliction or shortly thereafter.

3^. As to the Kind of Instrument Used:

a. Wound brought about by blunt instrument (contusion, hematoma, lacerated wound). ~~

b. 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).

c. Wound brought about by tearing force (lacerated wound).

d. Wound brought about by change of atmospheric pressure (barotrauma).

e. Wound brought about by heat or cold (frostbite, burns or scald).

f. Wound brought about by chemical explosion (gunshot or shrapnel wound).

g. Wound brought about by infection,

ifc As to the Manner of Infliction:

a. Hit — by means of bolo, blunt instrument, axe.

MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 243

b. Thrust or stab — bayonet dagger. c. Gunpowder explosion — projectile or shrapnel wound. d. SlidingTor rubbing or abrasion.

^4^s regards to the Depth of the Wound:

a. /Superficial — When the wound involves only the layers of the skin.

iyDeep — When the wound involves the inner structure beyond the layers of the skin.

{Impenetrating — 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 — Wound where the dimension of depth and direction is an important factor in its description. It involves the skin or mucous surface and the deeper underlying tissues or organs caused directly by the wounding instrument. Punctured, stab and gunshot wounds

/ usually belong to this type of wound."

(£) 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. fî^

>. As regards to the Relation of the Site of the Application of Force and the Location of Injury:

a. Coup Injury — Physical injury which is located at the site of the application of force, -y. k***'

s b. Contre-Coup Injury — Physical injury found opposite the site

of the application force.

c. Coup Contre-Coup Injury — Physical injury located at u\e site and also opposite the site of application of force.

d. "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.

e. Extensive Injury — Physical injury involving a 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 a vehicular

244 LEGAL MEDICINE

accident may suffer from multiple fractures, laceration of organs, and all types of skin injuries.

When a stationary head is hit by a moving object, there is the tendency for the development of contusion of 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-contra-coup location of brain injury may be found when a fixed head is hit with a moving object and then falls on another hard object.

(^4s to the Regions or Organs of the Body Involved:

The wounds of the different organs and regions of the body will be discussed separately under "Injuries in Various Parts of the Body.'

7. Special Types of Wounds:

a. 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 Qblnni instrument on the head may raise his flexed forearms over

his head, causing injuries on the forearms.

Incised (defense) w o u n d


If someone is going to stab another with Psharp instrument the tendency of the potential victim is to taê~Hbld of the instrument thus causing the production of an incised or a stab wound on the palm of the hand. v n - U A j „ L

\yPatterned 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 the face.

A person run over by a wheel of a car, tire marks are shown on the body.

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.

jtf 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. Motive of Producing Self-inflicted Wounds:

(1) To create or deliberately magnify an existing injury or disease for pension or workman's compensation;

(2) To escape certain'obligations or punishment. During war time soldiers may cut their fingers to avoid frontline assignments and prisoners may inflict physical injuries on their body to avoid hard labor and just be confined in a hospital to receive food and rest.

(3) To create a new identity or destroy the existing one. Fingerprints may be destroyed by acid, by cutting or burning. A person may even Request for the services of a plastic surgeon to create a new identity or destroy existing ones.

(4) To gain attention or sympathy.

(5) Psychotic behavior.

Some Ways of Self-Mutilation:

(1) Head banging or bumping — This is commonly observed in overactive children and causes hematoma.

(2) Exposure of parts of the body to heat radiation from open fires, radiators, or protective grills over radiator (thermo-philia).

(3) Penetrating nail or spike to the chest wall, or insertion into the urinary bladder in a female.

(4) Castration by amputation of the penis.

246 LEGAL MEDICINE

(5) Trauma inflicted on the female genitalia to induce abortion or promotes hemorrhage and creates an anemia.

(6) Subcutaneous injection of fecal matters to promote abscess formation.

(7) Pricking of acne eruption to lead to a severe facial disfigurement.

(8) Subcutaneous injection of air to create a condition of emphysema.

(9) Nail-biting (onychophagia) which may lead to maceration of the skin and an infection.

(10) Grinding of the teeth (bruxism) is frequently seen in the mentally retarded and can lead to abnormal tooth wear, a bilateral hypertrophy of the masseter and a pain on chewing.

(11) Pressure on the subcutaneous tissue by a tightly applied cord or belt around the body: (a) Tribal customs of metal band around the heck or a

leg by some African tribes may cause a permanent disfigurement.

(b ) Use of shoes made of metal by Chinese women. (12) Pulling of the body hair (Trichotillomania). (Forensic Medicine A Study in Trauma & Environmental Hazards by Tedeschi, Eckert & Tedeschi, Vol. 1, p. 496).

LEGAL CLASSIFICATION OF PHYSICAL INJURIES:

utilation: Art. 262, Revised Penal Code:

The penalty of reclusion temporal to reclusion perpetua shall be imposed upon any person who shall intentionally mutilate another by depriving him, either totally or partially, of some essential organ for reproduction.

Any other intentional mutilation shall be punished by prision mayor in its medium and maximum periods.

Kinds of Mutilation Punishable Under the Code:

1. Intentionally depriving a person, totally or partially of some of the essential organs for reproduction, and

2. Intentionally depriving a person of any part or parts of the human body other than the organs for reproduction.

Mutilation is the act of looping or cutting off any part or parts of the living body. In order to be punishable under the Code, it must be intentional, otherwise it will be considered as a physical injury.


The loss of an eye due to stabbing is not mutilation. It is evident that the putting out of an eye does not fall under the definition (U.S. v. Bogel, 7Phil 285).

"Mayhem " is the unlawful and violent deprival of another of the use of a part of the body so as to render him less able in fighting, either to defend himself or to annoy his adversary. Mutilation of other parts of the body other than the organ of reproduction may be classified as mayhem. However, if it is not deliberate then it may fall on paragraph 2, Art. 263, Revised Penal Code (Serious Physical Injuries).

Is vasectomy and tubal ligation within the purview of mutilation as defined and penalized by Art. 262 of the Revised Penal Code?

On September 1973 upon the request of the Executive Director of the Population Commission, the Secretary of Justice rendered an opinion that vasectomy and tubal ligation are not mutilation and a legitimate method of contraception despite the fact that it is done intentionally and deprives a person of his power of reproduction because:

"1. In the case of U.S. v. Bogel et. aL 5 Phil. 285 (1907) the Supreme Court, in holding that the putting out of an eye is not mutilation under Article 415 of the Spanish Penal Code which penalized intentional mutilation, stated "Viada in his commentary on Article 415 which penalized intentional mutilations, points out that by mutilation (mutilacion) is understood, according to the "Diccionario de la Lengua Espahola", the looping or clipping off (ceranamiento) of one part of the body. As this provision of the Spanish Penal Code was the source of the above quoted provision of the Revised Penal Code, it is the same expounded by Viada that the prohibition in the latter provision should be understood.

You stated that tubal ligation and vasectomy "do not involve looping or clipping off of the organs of reproduction of both sexes". I understood that these two methods of surgical sterilization are affected by the closing of a pair of tubes in either man or the woman so that the sperm and ovum cannot meet; it does not involve the removal of reproductive glands or organs as in the case of castration, with which it is sometimes confused. {Encyclopedia Americana, Sterilization, Human Vol. 25, p. 269; an article written by the Executive Director of the Human Betterment Association of American, I.C.) Such being the case, I do not think that these method of contraception could be regarded as mutilation within the contemplation of Article 262, Supra."

248 LEGAL MEDICINE

/ Serious Physical Injuries: Art. 263, Revised Penal Code:

Any person who shall wound, beat, or assault another, shall be guilty of the crime of serious physical injuries and shall suffer:

1. The penalty of prision mayor, if in consequence of the physical injuries inflicted, the injured person shall become insane, imbecile, impotent, or blind;

2. The penalty of prision correccional in its medium and maximum periods, if in consequence of the physical injuries inflicted, the person injured shall have lost the use of speech or the power to hear or to smell, or shall have lost an eye, a hand, a foot, an arm, or a leg or shall have lost the use of any such member, or shall have become incapacitated for the work in which he was thereto-for habitually engaged;

3. The penalty of prision correccional in its minimum and medium periods, if in consequence of the physical injuries inflicted, the person injured shall have become deformed, or shall have lost any other part of his body, or shall have lost the use thereof, or shall have been ill or incapacitated for the performance of the work in which he was habitually engaged for a period of more than ninety days;

4. The penalty of arresto mayor in its maximum period to prision correccional in its minimum period, if the physical injuries inflicted shall have caused the illness or incapacity for labor of the injured person for more than thirty days.

If the offense shall have been committed against any of the persons enumerated in article 246, or with attendance of any of the circumstances mentioned in article 248, the case covered by subdivision number 1 of this article shall be punished by reclusion temporal in its medium and maximum periods; the case covered by subdivision number 2 by prision correccional in its maximum period to prision mayor in its minimum period; the case covered by subdivision number 3 by prision correccional in its medium and maximum periods; and the case covered by subdivision number 4 by prision correccional in its minimum and medium periods.

The provisions of the preceding paragraph shall not be applicable to a parent who shall inflict physical injuries upon his child by excessive chastisement.

The crime of serious physical injuries may be due to: (1) Wounding; (2) Beating;


(3) Assaulting (Art. 263); or (4) Administering injurious substances (Art. 264) without the in

tent to kill.

It may be committed through a simple negligence or imprudence.

The main purpose of dividing the provision into four paragraphs is to graduate the penalties depending upon the nature and character of the wound inflicted and their consequences on the person of the victim.

In paragraph one, the injured person became insane, imbecile, impotent, or blind.

Insanity has not been defined or qualified by the article.

Imbecility infers that the injured person must be of the pre-adolescent age and that on account of the physical injuries inflicted there is an arrest of mental development.

Impotency is the inability to grant to the partner sexual gratification.

Blindness must be total or involvement of both eyes. If only one eye became blind, then the physical injury will fall in paragraph 2 of Article 263.

In paragraph two, the following nature and character of the wound or consequences of the injuries inflicted must be present:

a. Loss of the use of speech or the power to hear or to smell, or loss of an eye, a hand, a foot, an arm, or a leg;

b. Loss of the use of any such member; or

c. Becomes incapacitated for the work in which he was therefore habitually engaged.

There must be a total loss of hearing capacity. If the loss of power to hear is only in one ear, it is a serious physical injury under paragraph 3, article 263 (People v. Hernandez, 94 Phil. 49).

Insofar as loss of a hand is concerned, the prosecution must prove by clear and conclusive evidence that the offended party actually cannot make use of his hand and that such impairment is permanent (People v. Reli. C.A. 53 O.G. 5695). In paragraph three, the following physical injuries or their consequences are included:

a. Deformity; b. Loss of any other member of his body; c. Loss the use thereof; or d. Becomes ill or incapacitated for the performance of the work

in which he was habitually engaged for more than 90 days, as a consequence of the physical injuries inflicted.

250 LEGAL MEDICINE

Deformity is a condition of physical ugliness. It must be permanent and conspicuous. The loss of the front teeth, the development of a pigmented scar on the face, or loss of the pinna of the ear are considered deformities. However, the development of a scar in covered plots of the body may not be considered deformity because it is not conspicuous and visible.

"The loss of any other part of his body" means loss of the parts of the body not mentioned in paragraph 2, Art. -263.

Incapacity means the inability of the injured person to perform, or engage on a work or vocation before he sustained injury.

In paragraph four, the injured person becomes ill or incapacitated for labor for more than thirty days and impliedly less than 90 days.

It is noteworthy to mention that in paragraphs 3 and 4 of article 263 there is no mention of periods of medical attendance but merely incapacity.

Administering Injurious Substances or Beverages: Art. 264, Revised Penal Code:

The penalties established by the next preceding article shall be applicable in the respective cases to any person who, without intent to kill, shall inflict upon another any serious physical injury, by knowingly administering to him any injurious substances or beverages or by taking advantages of his weakness of mind or credulity.

Elements of the crime:

a. The offender inflicted upon another person any serious physical

b. The infliction of physical injury was done knowing that the substance or beverage administered is injurious or took advantage of the victim's weakness or credulity; and

c. There was no intent to kill on the part of the offender.

If the offender does not know that the substance administered is injurious, he cannot be held liable under the above provision.

The throwing of acid on the face of someone does not fall within the provision because what the provision contemplates is administering or taking in the injurious substance or beverages (U.S. Chiong Songco, 18 Phil. 459).

The provision does not contemplate of slight or less serious physical injuries which is the consequence of injurious substances or beverages, but results only in serious physical injuries.

If the administration of injurious substances or beverages is intentional, the crime committed is frustrated murder. Treachery is.

injury.


inherent when injurious substances or beverages are introduced into the body.

/ L e s s Serious Physical Injuries: Art. 265, Revised Penal Code:

Any person who shall inflict upon another physical injuries not described in the preceding articles, but which shall incapacitate the offended party for labor ten_days„or more, or shall require medical attendance for the same period, shall be guilty of less serious physical injuries and shall suffer the penalty of arresto mayor.

Whenever less serious physical injuries shall have been afflicted with the manifest intent to insult or offend the injured person, or under circumstances adding ignominy to the offense, in addition to the penalty of arresto mayor, a fine not exceeding 500 pesos shall be imposed.

Any less serious physical injury inflicted upon the offender's parents, ascendants, guardians, curators, teachers, or persons of rank or persons in authority, shall be punished by prision correccional in its minimum and medium periods, provided that, in the case of persons in authority, the deed does not constitute the crime of assault upon such person.

The basis to determine whether the physical injury is less serious or not is by either the period of medical attendance or period of incapacity; both of which is ten days or more but not more than thjrty days.

The fact that the injury only requires medical attendance for two days but incapacitated the victim from attending to his ordinary work for a period of 29 days makes the crime less serious physical injuries (U.S. v. Trinidad, 4 Phil. 152).

There must be proof as to the period of medical attendance. In the absence of such proof of medical attendance or incapacity, although the wound actually healed in more than 30 days, the crime committed is only slight physical injuries (People v. Penesa, 81 Phil. 398).

The crime *of less serious physical injuries may be qualified and a fine or a higher penalty is imposed when:

a. There is a manifest intent to insult or offend the injured person;

b. There are circumstances adding ignominy to the offense; c. The victim is the offender's parents, ascendants, guardian,

curators or teachers; or d. The victim is a person of rank or person in authority, provided

that the crime is not direct assault.

LEGAL MEDICINE

Obligation Imposed on Physicians Who have Treated Persons Suffering From Serious and Less Serious Physical Injuries:

PRESIDENTIAL DECREE NO. 169

WHEREAS, Pursuant to Proclamation No. 1081, dated September 21, 1972 and No. 1104, dated January 17, 1973, martial law has been declared throughout the Philippines to, among other goals, restore and maintain peace and order;

WHEREAS, for the attainment of the aforesaid goal, and to enable the law-enforcement agencies to keep track of all violent crimes, conduct timely investigation thereon and effect the immediate arrest of the perpetrators thereof, it is necessary that all persons treating physical injuries resulting from any form of violence be required to report such fact to said agencies;

WHEREAS, while some of the victims of violent crimes, or those who may have sustained physical injuries in the act of committing or as a result of the commission of a crime submit themselves for medical treatment in hospitals, medical clinics, sanitariums, or other medical establishments or to medical practitioners, they do not report their injuries to the law-enforcement agencies for one reason or another;

NOW, T H E R E F O R E , I, F E R D I N A N D E. MARCOS, pursuant to Proclamation No. 1081, dated September 21, 1972 and No. 1104, dated January 17, 1973 and in my capacity as Commander-in-Chief of all the Armed Forces of the Philippines, do hereby order and decree that:

1. The attending physician of any hospital, medical clinic, sanitarium or other medical establishments, or any medical practitioner, who has treated any person for serious or less serious physical injuries as those injuries are defined in Articles 262, 263, 264 and 265 of the Revised Penal Code shall report the fact of such treatment personally or by the fastest means of communication to the nearest Philippine Constabulary unit without delay: provided, that no fee shall be charged for the transmission of such report thru government communication facilities; and

2. The report called for in this Decree shall indicate when practicable the name, age, address and nearest of kin of the patient; the nature and probable cause of the injury; the approximate time and date when, and the place where the injury was sustained; time, date and nature of treatment; and the physical diagnosis and/or disposition of the patient.


I do further order and decree that any violation of this Decree and/or the rules and regulations which shall be promulgated by competent authorities in accordance herewith, with malicious intent or gross negligence, shall suffer the penalty of imprisonment for not less than one year nor more than (3) years and/or a fine of not less than 1,000 nor more than 3,000 pesos, as a military tribunal may direct. In addition, the government license or permit of the attending physician to practice his profession shall be cancelled by the Civil Service Commission after the sentence imposed by the military tribunal become final and executory.

The Secretary of Health and the Secretary of National Defense shall promulgate the necessary rules and regulations to carry out the purpose of this Decree.

Done in the City of Manila, this 4th day of April, in the Year of Our Lord, nineteen hundred and seventy-three.

Slight Physical Injuries and Maltreatment: Art. 266, Revised Penal Code:

The crime of slight physical injuries shall be punished:

1. By arresto menor when the offender has inflicted physical injuries which shall incapacitate the offended party for labor from one to nine days, or shall require medical attendance during the same period;

2. By arresto menor or a fine not exceeding 200 pesos and censure when the offender has caused physical injuries which do not prevent the offended party from engaging in his habitual work nor require medical attendance;

3. By arresto menor in its minimum period or a fine not exceeding 50 pesos when the offender shall illtreat another by deed without causing any injury.

Kinds of Slight Physical Injuries Punishable by the Code: 1. Physical injuries which incapacitate the victim for labor from one

to nine days, or require medical attendance for the same period.

This kind of slight physical injuries will require medical certification as to the duration of medical attendance, or period of incapacity. In case of divergency in the duration of medical attendance and incapacity, the physician must always consider the best interest of the victim in the determination of the period.

(SGD) F E R D I N A N D E. M A R C O S President

Republic of the Philippines

254 LEGAL MEDICINE

2. Physical injuries which did not prevent the offended party from engaging in his habitual work or which did not require medical attendance.

If the victim merely suffered from small contusion or superficial abrasion which does not require medical attendance or incapacity, this falls in the paragraph of slight physical injury.

3. Ill-treatment of another by deed without causing any injury.

A slight slap on the face or holding tightly the arm of the victim which did not even develop redness of the skin may be a form of ill-treatment.

If there is no evidence to show actual injury, or incapacity for labor, or period of medical attendance, the accused can only be guilty of slight physical injuries (People v. Penesa, 81 Phil. 398; People v. Amarao et al., C.A. 36 O.G. 3462).

A tender slap on the face, holding the arm tightly, application of pressure in some parts of the body, or mild blow which show no sign of physical violence may still be considered slight physical injuries or maltreatment (3rd paragraph).

Physical Injuries Inflicted in a Tumultuous Affray: Art. 252, Revised Penal Code:

When in a tumultuous affray as referred to in the preceding article, only serious physical injuries are inflicted upon the participants thereof and the person responsible therefor cannot be identified, all those who appear to have used violence upon the person of the offended party shall suffer the penalty next lower in degree than that provided for the physical injuries so inflicted.

When the physical injuries inflicted are of a less serious nature than the person responsible therefor cannot be identified, all those who appear to have used any violence upon the person of the offended party shall be punished by arresto from five to fifteen days.

Elements of the Crime:

a. There is a tumultuous affray; b. Participant(s) suffered from serious physical injuries; c. The person(s) who inflicted such serious physical injuries

cannot be identified; and d. All those who appear to have used violence upon the person

of the offended party shall be penalized by arresto from five to fifteen days.

/ T Y P E OF WOUNDS (Medical Classification): \/Closed Wound — There is nojareach of continuity of the skin or

mucous membrane.


a. Superficial — When the wound is just underneath the layers of the skin or mucous membrane. (1) Petechiae. r***-*"** (2) Contusion. \ - * * - « \ . (3) Hematoma. £ i M

b. Deep.

(1) Musculoskeletal Injuries. (a) Sprain. ( b ) Dislocation. (c) Fracture. (d) Strain. ( f ) Subluxation.

(2) Internal Hemorrhage.

(3) Cerebral Concussion.

2^. Open Wound — There is a breach of continuity of the skin or mucous membrane. ~~ "

a. Abrasion, q*!*-1

b. Incised Wound, h-'iva c. Stab Wound. d. Punctured. e. Lacerated.

CLOSED WOUNDS:

Petecbjaej_^___

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

Petechiae is not always a product of trauma. Petechial hemorrhage may be a post-mortem finding in asphyxial death, coronary occlusion and blood diseases. It may also develop post-mortem in death by hanging. There is gravitation of blood into the most dependent part of the body which eventually leads to the rupture of over-distended capillaries specially seen at the region of the leg.

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.

256 LEGAL MEDICINE

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 of force. It may develop after a lapse of minutes or even hours after the application of 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 inspite of heavy punishment.

Contusion of the right eyelids

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 force. For instance, a blow on 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.

Age of Contusion:

The age of contusion can be appreciated from its color changes. The size tends to become smaller from the periphery to the center and passes through a series of color changes as a result of the disintegration of the red blood corpuscles and liberation of hemoglobin.

The contusion is red sometimes purple soon after its complete development.

In 4 to 5 days, the color changes to green.

In 7 to 10 days, it becomes yellow and gradually disappears on the 14th or 15th day.

The ultimate disappearance of color varies from one to four weeks depending upon the severity and constitution of the body.

The color changes start from the periphery inwards.

Distinction Between Contusion and Post-mortem Hypostasis (Supra p. 133).

Factors Influencing the Degree and Extent of Contusion:

(a) General condition of the victim — Some healthy persons are easily bruised.

(b) Part of the body affected — Bloody parts of the body produce larger contusion, specially where subcutaneous tissue is loose. In areas of the body with excessive fat, contusion easily develops, while parts of the body with abundant fibrous tissue and good muscle tone, bruising is less.

(c) Amount of force applied — Other factors being equal, the greater the force applied the more effusion of blood will develop.

(d) Disease — Contusion may develop with or without the application of force. Examples: Purpura, Hemophilia, Aplastic anemia, Whooping cough, even vicarious menstruation.

(e) Age — Children and old age persons tend to bruise more easily. Children have loose and tender skin. Old people have less flesh and the blood vessels are more fragile.

(f) Sex — Women, specially if obese, easily develop contusion. Athletes, like boxers do not develop contusion easily.

(g) Application of heat and cold — If immediately after injury cold compress is applied the production of contusion will be

258 LEGAL MEDICINE

minimized. After it has already developed, application of warm compress will hasten its disappearance.

The distinction between ante-mortem and post-mortem contusions in an undecomposed body is that in ante-mortem bruising, there is swelling, damage to epithelium, extravasation, coagulation and infiltration of the tissues with blood, while in post-mortem bruising there are no such findings.

/Hematoma (Blood Cyst, Blood Tumor, "Bukolg):

/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 tissue is superficially located, like the head, chest and anterior aspect of the legs. The force applied causes the subcutaneous tissue to rupture on account of the presence of a hard structure underneath. The destruction of the subcutaneous tissue will lead to the accumulation of blood causing it to elevate.

Distinction Between Contusion and Hematoma:

(a) In contusion the effused blood are accumulated in the interstices of the tissue underneath the skin, while in hematoma blood accumulates in a newly formed cavity underneath the skin.

(b ) In contusion, the skin shows no elevation and if ever elevated, the elevation is slight and is on account of inflammatory changes, while in hematoma the skin is always elevated.

(c) In contusion, puncture or aspiration with syringe of the lesion no blood can be obtained, while in hematoma, aspiration will show presence of blood and subsequent depression of the elevated lesion.

Abscess, gangrene, hypertrophy, fibroid thickening and even malignancy are potential complications of hematoma.

/Musculo-Skeletal Injuries:

(1) 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.

(2) Dislocation — Displacement of the articular surface of bones entering into the formation of a joint.

(3) Fracture — Solution of continuity of bone resulting from violence or some existing pathology.

(a) Close or Simple Fracture — Fracture wherein there is no break in continuity of the overlying skin or where the external air has no point of access to the site of injury.


( b ) Open or Compound Fracture — The fracture is complicated by an open wound caused by the broken bone which protruded with other tissues of the broken skin.

(c) Comminuted Fracture — the fractured bone is fragmented into several pieces.

(d) Greenstick Fracture — A fracture wherein only one side of the bone is broken while the other side is merely bent.

(e) Linear Fracture — When the fracture forms a crack commonly observed in flat bones.

( f ) Spina/ Fracture — The break in the bone forms a spiral manner as observed in long bones.

(g) Pathologic Fracture — Fracture caused by weakness of the bone due to disease rather than violence.

• ( 4 ) 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.

/ ( 5 ) Subluxation — Incomplete dislocation.

/Internal Hemorrhage:

Rupture of blood vessel which may cause hemorrhage may be due to the following:

(a> Traumatic intracranial hemorrhage. (b)- Rupture of parenchymatous organs. (c)-Laceration of other parts of the body.

Cerebral Concussion (Commotio 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 hard object as compared when the head is fixed and struck by a hard moving object.

s^Signs and Symptoms:

(a) Unconsciousness which is more or less complete. (b ) Muscles are relaxed and flaccid. (c) Eyelids are closed and the conjunctivae are insensitive. (d) Surface of the body is pale, cold and clammy. (e) Respiration is slow, shallow and sighing. (f) Pulse is rapid, weak, faltering and scarcely perceptible to the

fingers. (g) Temperature is subnormal.

260 LEGAL MEDICINE

(h) Sphincters are relaxed perhaps with unconscious evacuation of the bowel and bladder.

( i ) Reflexes are present but sluggish and in severe cases may be absent.

Loss of memory for events just before the injury (retrograde amnesia) is a constant effect of cerebral concussion and is of medicolegal importance.

/ O P E N WOUNDS: Âbrasion (Scratch, Graze, Impression Mark, Friction Mark):

[ i t 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.

Abrasions

Characteristics of Abrasion:

a. ft develops at the precise point of impact of the force causing it.

b. Grossly or with the aid of a hand lens the injury consists of parallel linear injuries which are in line with the direction of the rub or friction causing it.

c. It may exhibit the pattern of the wounding material.


d. It is usually ignored by the attending physician for it does not require medical treatment but it has far-reaching importance in the medico-legal viewpoint.

(1) Abrasions caused by fingernails may indicate struggle or assault and are usually located in the face, neck, forearms, and hands.

(2) Abrasions resulting from friction on rough surfaces, either intentional or accidental are located on bony parts of the body and usually associated with contusion or laceration.

(3) Nature of the abrasion may infer degree of pressure, nature of the rubbing object and the direction of movement.

e. Unless there is a supervening infection, abrasion heals in a short time and leaves no scar. If the whole thickness of the skin is involved, healing may be delayed and occasionally with scar formation.

Torms of A brasion:

a. Linear: \MOA

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.

b. Multi-Linear:

An abrasion which develops when the skin is rubbed on a hard rough object thereby producing several linear marks parallel to one another. This is frequently seen among victims of vehicular accidents.

c. Confluent:

An abrasion where the linear marks on the skin are almost indistinguishable on account of the severity of friction and roughness o the object.

d. Multiple: Several abrasions of varying sizes and shapes may be found in

different parts of the body.

Types of Abrasions: a. Scratch:

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

262 LEGAL MEDICINE

b. Graze:

These are usually caused by forcible contact with rough, hard objects resulting to irregular removal of the skin surface. The nature of the 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.

c. 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.

(1) Marks of the grid of the radiator may be imprinted on the skin.

(2) Tire thread marks may be seen on the skin in vehicular accidents.

(3) Muzzle imprint in contact fire gunshot wound of entrance. (4) Teeth impression mark in skin bites.

d. Pressure or Friction Abrasion:

Abrasion caused by pressure accompanied by movement usually observed in hanging or 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.

. ~ , ,, ^ — . . .

Abrasion in the form of tire marks in a victim of vehicular accident


Differential Diagnosis:

a. Dermal Erosion — A gradual breakdown or very shallow ulceration of the skin which involves only the epidermis and heals withour scarring. It may appear in spots and with no previous history of friction or sliding.

b. Marks of Insects and Fishes Bites — The skin injury is irregular with no vital reaction and usually found on angles of the mouth, margins of nose, eyelids and forehead.

c. Excoriation of the Skin by Excreta — This condition is only found among infants and the skin lesion heals when the cause is removed. There is no apparent history of rubbing trauma on the affected area.

d. Pressure Sore — Usually found at the back at the region of bony prominence. History of long standing illness, bed ridden condition although pressure sore may start as a previous area of abrasion.

^Distinction Between Ante-mortem from Post-mortem Abrasions:

Point of Ante-mortem Distinction Abrasion

Color Reddish-bronze. in appearance due to slight exudation of blood.

Location Any area.

Vital With intravital reaction reaction and may show remains of

damaged epithelium.

2. Incised Wound (Cut, Slash, Slice): 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, saber, the wound produced is called Chopped or

Post-mortem Abrasion

Yellowish and translucent in appearance.

Generally occurs over bony prominence, such as elbow, and attributed to rough handling of the cadaver.

Shows no vital reaction and is characterized by a separation of the epidermis from complete loss of the former.

264 LEGAL MEDICINE

Hacked 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 Incised Wound:

a. Edges are clean- both extremities are sharp, except in areas where the skin is loose or folded at the time of infliction.

b. 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.

c. Usually the wound is shallow near the extremities and deeper at the middle portion. However, this finding may be modified by the shape of the wounding instrument and part of the body involved.

d. Because the blood vessels involved are clean-cut, profuse hemorrhage is invariably a feature.

e. Gaping is usually present due to the 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).

f. If the incised wound is located in parts of the body covered with clothes, the clothing itself will show clean-cut of its texture.

g. In the absence of complication and/or when there is deeper involvement present, healing is relatively fast and the scar may not or may develop conspicuously.

h. 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. Examination with the aid of a magnifying lens is necessary to determine the presence and removal of particles of flakes of glasses in the wound.

Changes that occur in an Incised Wound: After 12 hours — Edges are swollen; adherent with blood and

with leucocyte infiltration. After 24 hours — Proliferation of the vascular endothelium

and connective-tissue cells. After 36-48 hours — Capillary network complete; fibrolasts run

ning at right angles to the vessels. After 3-5 days — Vessels show thickening and obliteration.

(From: Gradwohl's Legal Medicine by F.E. Camps ed., 3rd ed., p. 272).


Multiple Incised w o u n d s (Homic ida l ) .

Deep incised wound may cause clean-cut fracture of the bone, severance of blood vessels and nerves or amputation. Paralysis may develop on account of the severed nerve and profuse hemorrhage may result to death. Embolism or supervening infection may later develop.

^ Why a Person Suffers from Incised Wound:

a. As a therapeutic procedure — Pyogenic abscess and cystic conditions may be treated by incision.

b. As a consequence of_self-defense — The sharp-edged instrument may be held by the victim in his attempt to avoid the offender to inflict more serious injuries on him.

c. Masochist may self-inflict incised wound as a means of sexual gratification.

dÂddicts and mental patients may suffer from incised wound irrationally.

Incised Wounds may be Suicidal, Homicidal or Accidental:

Suicidal — Located in peculiar parts of the body, like the jjeck, flexor surfaces of the extremities (elbow, groin, knee), wrist, and accessible to the hand in inflicting the injury. The most common instrument used is the Jaarber's razor blade with an improvised handle. There is usually superficial tentative cut (hesitation cuts) and the direction varies with the location and the hand (left or right) used in inflicting the injuries. The most

266 LEGAL MEDICINE

common site of suicidal incised wounds are on the wrist with involvement of the radial artery and the neck.

^Homicidal — The incised wounds are deep, multiple and involve both accessible and non-accessible parts of the body to the hands of. the viGtim. "defense and other forms of wounds may be present. Clothings are always involved.

ytil Accidental — Multiple incised wound isjoommonly 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 glassesTsharp edges of metal sheets are common causes of incised wound on the sole of the foot. 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.

Distinction Between Suicidal and Homicidal Cut-throat

Suicidal

Direction Oblique, from* Below left ear, downwards, .across front ^ e c k just .above Adam's apple.

Severity Usually _noi_so deep and may only involve trachea carotid and sometimes the esophagus is involved.

Superficial Usually present before Cut the commencement of

deeper wound.

Position May be__sjtting facing a of the mirror or standing, b o d y

Wounding Firmly grasped (Cadaveric w e a p o n spasm) or found lying

beside victim. Blood Blood found in front part distri- of the body. Hand gen-bution erally smeared with

blood.

Motive History of mental depression, domestic, financial social problems, alcoholism etc. may prove suicide.

Homicidal Usually horizontal below tho "Adam's'apple.

Usually deep and may cause involvement of the cartilage and bones.

Practically jibsent but may rarely be present when the victim struggled when attacked. Usually victim _lying on bed or in other place.

Weapon is jjbsent.

Blood found at the back of the neck. JIands clean.

Absence of such history.


Previous May be present. Always absent, history of self-destruction

Stab Wound:

Stab wound is produced by the penetration of a sharp-pointed and sharp edged instrument, like a^knjfe, saber, dagger, scissors. It may involve the skin or mucous surface. IftRe sharp edgTportion 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 come in contact, then the wound is a stab wound. As a general rule, like an incised wound, the edges are cleanzcut, 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 defect is in line with direction of the slashing movement.

Incised and stab wounds of the face and neck.

268 LEGAL MEDICINE

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).

The depth may be influenced 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 a stab wound. This is due to the severance of blood vessels or involvement of bloody organs.

Multiple stab w o u n d s

In the Description of a Stab Wound, the following must be included:


a. Length of the skin defect — The edges must be coaptated before the length is measured. If the abrasion tailing is present in one of the extremities, it must not be included in the measurement. The length of the tailing must be mentioned separately. The tailing infers the direction of withdrawal of the wounding weapon.

b. Condition of the extremities — A sharp extremity may infer the sharpness of the edge of the instrument used. If both extremities are sharp, it may be inferred that a double-bladed weapon was used.

c. Condition of the edges — If the injury is due to one stabbing act, the edges are regular and clean-cut. However if the wound is caused by several stabbing acts (series of thrusts and withdrawal), the edges may be serrated or zigzag in appearance.

d. Linear direction of the surface wound — It may be running vertically, horizontally, or upward medially or laterally.

e. Location of the stab wound — Aside from mentioning the region of body where it is located, its exact measurement to some anatomical landmarks must be stated.

f. Direction of penetration — This must be tri-dimensional (backwards or forwards, upwards or downwards, and medially or laterally).

g. Depth of the penetration.

h. Tissue and organs involved.

^Stab Wound(s) may be Suicidal, Homicidal or Accidental:

a. Suicidal — Evidences showing that the stab wound is suicidal:

( l ) - r t is located over the .vital parts of the body.

(2) It is usually solitary. If multiple, they are located on one part of the body.

(3) If located on covered parts of the body, the clothings are not involved.

(AyThe stab wound is accessible to the hand of the victim.

(5)-The hand of the victim is smeared with blood. (6)/The wounding weapon is firmly grasped by the hand of the

victim (cadaveric spasm).

(7) If stabbing is accompanied with slashing movement, the wound tailing abrasion is seen towards the hand inflicting

the injury,

(a HA suicide note may be present.

(9)/There is the presence of a motive for self-destruction.

270 LEGAL MEDICINE

(10)-No disturbance in the death scene, wounding instrument is found near the victim.

b. Homicidal — Stabbing with homicidal intent is the most common.

Characteristics:

(1) Injuries other than stab wound may be present. (2) Stab wound may be located injmy part of the body. (3) Usually there are ©ore than one stab wound. (4) There is a motive for the stabbing. If without motive, the

offender must be insane or under the influence of drugs. (5) There is disturbance in the crime scene.

Stab w o u n d with intestinal herniation.

^Medical evidences showing intent of the offender to kill the victim:

a. There are more than one stab wounds.

b. The stab wounds are located in different parts of the body or on parts of the body where vital organs are located.

c. Stab wounds are_deep.

d. Stab wound with serrated or zigzag borders infers alternative thrust and withdrawal of the wounding weapon to increase internal damages.

e. Irregular or stellate shape skin defects may be due to changing direction of the weapon with the portion of the instrument at the level of the skin as the lever. In this way a greater area of involvement internally will be realized.


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 object like broken pieces of glass or flattened and_pointed iron bars.

x^Tpunctured Wound: ^ > '#^J£ . •

Punctured wound is the result of a thrust 6f'a jharp 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,jJointed stick, thom, fang of animal ancfhook.

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 well be 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 consequence 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: a. The opening on the skin is very small and may become un-

noticeable because of clotted blood and elasticity of the skin. The wound is much deeper than it is wide.

b. External hemorrhage is limited although internally it may be severe.

272 LEGAL MEDICINE

c. Sealing of the external opening will be favorable for the growth and multiplication of anaerobic microorganism like bacillus

Medical evidences that tend to show it is Homicidal:Mpppp

a. It is multiple and usually located in different parts of the body. It may however be found in certain areas of the body.

b. The wounds are deep. c. There are defense wounds on the victim.

d. There is disturbance in the crime scene (sign of struggle).

Proof to show it is Suicidal:

a. Located in areas of the body where the vital organs are located.

b. Usually singular but may be multiple but located in one area of the body.

c. Parts of the body involved is accessible to the hand of the victim.

d. Clothings usually is not involved.

e. Wounding is made by the weapon while the victim is in sitting or standing position. There is bleeding towards the lower part of body or clothing.

f. No disturbance of the crime scene.

g. Presence of suicide note.

h. Wounding instrument found near the body of the victim.

Punctured wound with puncturing instrument "loaded" with

poison:

a. Poison dart — cyanide or nicotine. b. Fish spines. c. Dog bites with hydrophobia virus. d.Jnjection of air and poison as a way of euthanasia.

Lacerated Wound (Tear, Rupture, Stretch "Pulok."): $

Lacerated wound is a tear of the skin and the underlying tissues due to forcible contact with a 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 without sharp objects.

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

tetani.

MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 27 3

a. The shape and size of the injury do not correspond to the wounding instrument.

b. The tear on the skin is rugged with extremities irregular and ill-defined.

c. The injury developed is at the site where the blunt force is applied.

d. The borders of the wound are contused and swollen.

e. 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.

f. Examination with the aid of the hand lens shows bridging tissue joining the edges and hair bulbs intact.

g. Bleeding is not extensive because the blood vessels are not severed evenly.

h. Healing process is delayed and has more tendency to develop scar.

Classification of Lacerated Wounds

a. 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.

b. Overstretching of the skin. When pressure is applied on one side of the bone, the skin over the area will be stretched up to a breaking point to cause laceration and exposure of the fractured bone. In avulsion, the edges of the remaining tissue is that of laceration.

c. Grinding compression — The weight and the grinding movement may cause separation of the skin with the underlying tissues.

d. Tearing — This may be produced by a semi-sharp-edged instrument which causes irregular edges on the wound, like hatchet and choppers.

Lacerated 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.

continuity may only extend deeper to the stronger layer like that of the galea aponeuritica in case of scalp injury. Characteristics:

274 LEGAL MEDICINE

pistinctions Between an Incised Wound and a Lacerated Wound:

Incised Wound Lacerated Wound

CJ*Edges are clean-cut, regular AUtfges are roughly cut, irregular and well-defined. and ill-defined.

M& There is no swelling or con- S There is swelling and contusion tusion around the incised around the lacerated wound. wound.

cj* Extremities of the wound are ^.Extremities of the wound are sharp or may be round or ill-defined and irregular, contused.

Examination by means of a Examination with a magnifying magnifying lens shows that lens shows that the hair bulbs are

the hair bulbs are cut. preserved,

f Healing is faster. n Healing is delayed.

Vt Scar is linear or spindle-shaped. X Scar is irregular.

St, It is caused by a sharp-edged 0 It is caused by a blunt instru-instrument. ment.

G A P I N G O F W O U N D :

The separation of the edges especially in deep wound may be due to the following:

Avulsion of the skin at the forehead with exposure of the fractured skull and part of the brain.


1. Mechanical stretching or dilatation — The presence of a mechanical device on the edges to prevent coaptation will cause separation. The presence of a canula in tracheostomy, drain (rubber or gauze) in an incised abscess, or a retractor during a 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:

a. Destruction by pressure, infection, cell lysis, burning or chemical reaction.

b. Avulsion or physical or mechanical stretching resulting to separation of a portion of the tissue.

c. Trimming of the edges. Debridment of the skin which came in contact with the bullet at the gunshot wound of entrance and the removal of 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 or less present in all persons. This pattern of fiber arrangement is called cleavage direction or lines or 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 direction 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.

Practical Ways of Determining How Much of the Skin Surface is Involved in an Injury or Disease:

The skin serves as a mechanical protection to the body. It is punctuated with sensory nerve endings for pain, temperature and touch. It also acts as a thermo-regulator, storage of water, excre-tor of sweat and also an organ for absorption.

The determination of how much skin involvement is important in the mode of treatment and prognosis. Such determination may

276 LEGAL MEDICINE

Line of cleavage

Langer's line


Body surface

278 LEGAL MEDICINE

be significant in cases of burns, contusion and dermal manifestation of certain diseases.

In cases of burns in children and old age persons, involvement of more than 70% of the body surface are almost invariably fatal.

In the estimation as to how much (by percentage) of the body surface is involved, the rule of nine is used.

Body surface expressed as percentage using the rule of nine:

Whole of head and neck 9% 9% Whole of one upper extremity 9% 18% Whole of front chest and abdomen 18% 18% Whole of posterior chest and abdomen 18% 18% Whole of one lower extremity (front) 9% 18% Whole of one lower extremity (back) 9% 18% Pudental area 1% 1%

T o t a l 100%

Factors Responsible for the Severity of Wounds:

1. Hemorrhage:

a. Hemorrhage may influence the severity of wound by:

(1) Loss of blood incompatible with life:

Blood constitutes about 1/20 of the body weight of an adult. By volume, an average size adult has 5 to 6 quarts of blood (one quart is 946 c c ) . A loss of one tenth of its volume may not cause any significant clinical change. A loss of one quart may cause fainting even if the subject is lying down. But a loss of 1/3 to 2/5 of the circulating blood may result to irreversible hypovolemic shock and may be fatal.

The volume of blood lost may be related to the rate or space of time a certain volume of blood has been shed. The blood loss may be massive but if it occurred for a long period of time, the hemopoietic organs may be able to replace it thereby preventing the development of any untoward effects.

Males can stand more lost of blood than females. Hypertension may cause excessive and rapid bleeding from an arterial wound. Persons suffering from hemophilia and other clotting disorders and those being treated by anticoagulants can cause prolonged bleeding.

(2) Hemorrhage may result in ah increase in pressure in or on the vital organs to affect the normal function:

Intracranial hemorrhage may cause compression of the vital centers of the brain. Hemopericardium (pericardial


tamponade) may cause embarrassment of the contraction of the heart. Hemorrhage into the chest cavity may cause diminution of the respiratory output with subsequent anoxia.

(3) Hemorrhage may cause mechanical barriers to the function of organs:

Hemorrhage into the tracheo-bronchial lumina can cause asphyxia. Interstitial hemorrhage into the muscles may cause disturbance in the contractility.

b. Causes of Hemorrhage:

(1) Trauma — Destruction of the blood vessel wall or increase permeability of its wall due to external force.

(2) Natural Causes:

(a) Common causes of hemorrhage due to natural causes:

i. Intra-cerebral hemorrhage (apoplexy):

The most common blood vessel involved is the lenticulostraite branch of the middle cerebral artery with subsequent bleeding into the basal ganglia and adjacent structure.

ii. Spontaneous subarachnoid hemorrhage:

Usually due to rupture or perforation of a saccular berry aneurysm, commonly located at the bifurcation of one of the constituent vessels of the circle of Willis or one of its major branches. This is usually a congenital focal defect of the muscular layer with subsequent over stretching and degeneration of the internal elastic layer of the blood vessel wall.

iii. Rupture of the arteriosclerotic aneurysm of the aorta:

The weakening and thinning of the aortic wall may lead to fusiform or saccular aneurysm usually located at the abdominal portion.

iv. Rupture of esophageal varices in cases of cirrhosis of the liver and bleeding of peptic ulcer of the stomach and duodenum.

v. Pulmonary hemorrhage may be due to tuberculosis, lung abscess, or bronchiectasis. The hemorrhage may be profused to cause severe anemia or may be small to cause asphyxia.

vi. Ruptured ectopic pregnancy.

280 LEGAL MEDICINE

vii. Spontaneous rupture of cavernous hemangioma or hepatoma.

viii. Rupture of the enlarged spleen (malaria, infectious mononucleosis, typhoid fever).

(Medico-legal Investigation of Death by Fischer, p. 102).

2. Size of Injury:

Burns affecting one-third of the body surface of the third degree type is usually fatal. Bigger wounds are more exposed to infection and other physical conditions of the surroundings.

3. Organs Involved:

Trauma on the vital organs of the body are always serious. Crushing wounds of the heart, brain or lungs are almost fatal.

4. Shock:

Shock may occur with or without violence. A slight blow on the genitalia, slight bums in children or old persons, or slight violence on the head or neck may cause severe shock. However, violent traumas to healthy, strong persons may not produce shock.

5. Foreign Body or Substance Introduced into the Body:

Incision with an unsterilized scalpel may not be serious as the bite of a venomous snake. A foreign substance or body may be toxic by itself or may act as a physical irritant.

The Foreign Body or Substance may be:

a. Bacterial: Tetanus b~1f Pathogenic microorganism

b. Viral: HydrophobiaW-H|f Hepatitis

c. Foreign body: Bullet F- *>ZS (, Glass fragments Shrapnel Gauze or rubber drain

d. Chemical: Cyanide o- ^ Nicotine

e. Toxin-: j-fr

(1) Snake Venom — Snake bite is characterized as two punctured wounds at the center of the reddened affected area. The venom is injected through its fangs which is connected to the poison gland.


Snake Venom Toxicity will Depend on:

(a) Potency of venom injected.

( b ) The amount of venom injected by the fang depends on the season of the year and the length of time the snake has eaten. If a snake has just killed his prey, the toxic content of its bite is smaller.

(c) Size of the patient.

(d) The immediate treatment instituted.

Snake Venoms are of Two Principal Classes:

(a) Neurotoxic — It primarily paralyzes the respiratory and cardiac center of the brain. Absorption of the venom may cause nausea, vomiting, ascending paralysis, coma, convulsion, and cardiac and respiratory arrest.

( b ) Hematoxic — Which affects particularly the blood. The manifestations are pain and swelling of the affected area, intravascular hemolysis, abdominal pain, nausea, vomiting, petechial: hemorrhage on the gum, pulmonary and cardiac edema.

Emergency Treatment may be:

(a) Incision of the wound to promote more external hemorrhage to drain the venom.

(b ) Tourniquette above the site of the wound. (c) Placing ice on the bite site. (d) Sucking the wound to drain venom with the mouth. (e) Administration of anti-snake venom serum.

(2) Scorpion Venom — The venom of the scorpion has neurotoxic, hemolytic and hemorrhagic effect. A scorpion sting produces only one punctured wound on the center of a reddened area. The main symptoms are pain, edema and reddening.

(3) Coelenterate Sting (Jellyfish) — The tentacles penetrate into the skin and cause explosion of the nematocyst and liberation of the venom. The symptoms are extreme pain of the affected area, urticarial rash, abdominal pain, dilated pupils, paleness and labored breathing.

Absence of Medical or Surgical Intervention: A wound may not be fatal but on account of the neglect or ig

norance in its management, it may become serious and fatal.

282 LEGAL MEDICINE

FATAL EFFECT OF WOUNDS: p M r V 1. Wound may be Directly Fatal by Reason of:

a. Hemorrhage: 7p~£*SS

An incised wound at the lateral aspect of the neck involving the carotid artery without surgical intervention is fatal due to hemorrhage. While wounds in some areas of the body where big blood vessels are not present and the retraction of tissues are strong, death will not be a direct consequence due to hemorrhage in the absence of complication that may set in.

b. Mechanical Injuries on the Vital Organs:

A blow on the head may not necessarily produce external lesions but may produce severe meningeal hemorrhage producing compression of the brain. A punctured wound of the heart, even though how small, may produce death on account of the tamponade of the heart.

c. Shock:

This is the disturbance of the balance of fluid in the body capable of producing delayed or immediate death.

2. Wound may be Indirectly Fatal by Reason of:

a. Secondary Hemorrhage Following Sepsis:

A wound because of its nature and location is not capable of producing severe hemorrhage, but on account of infection that sets in, deeper tissues are involved including big blood vessels thereby producing severe hemorrhage.

b. Specific Infection:

Pathogenic microorganisms may develop and multiply in the wound causing septicemia, bacteremia, or toxemia. Tetanus, gas gangrene infection are common in open wounds.

c. Scarring Effect:

Chronic gonorrheal infection may cause stricture of the urethra. Stricture of the esophagus may follow ingestion of irritant poison. Keloid formation in burns may not only cause deformity but disturbance of the normal respiration of locomotion.

d. Secondary Shock:

Nature of Death Due to Secondary Causes:

A person may have recovered from the immediate effects of the trauma or violence, but may later die of its secondary effects or changes.

These changes may be classified as follows:

1. Changes whose natural sequence are direct and obvious.


Example: Septicemia, tetanus or complications arising from the wounds.

2. Changes producing separate pathological lesions which in turn proves to be fatal.

Example: Operation performed on a patient to ligate bleeding vessel inside the abdominal cavity with reasonable skill and with due diligence but as a result of which peritonitis developed and caused death of the patient.

3. Changes where a definite pathological condition was present before the injury.

Example: A person suffering from tumor or cyst and was stabbed by someone. The stab is not capable of producing death ordinarily. The person may die of the pathological condition and the accused is liable for his death.

4. Changes where a definite pathological condition of totally different nature arises after the wounding and the consequential sequence is doubtful.

Example: Tuberculosis meningitis that develops following a blow on the head.

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, hemoconcentration 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.

a. Injury to the receptive nervous system.

b. Anoxemia — Reduction of effective volume of oxygen carrying capacity of the blood.

c. Endothelial damage, thus increasing capillary permeability.

Kinds of Shock:

a. 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.

284 LEGAL MEDICINE

b. 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, cold clammy perspiration, muscular incoordination, rapid and shallow respiration. The shock may be severe to produce death or the patient may recover completely from its effects.

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:

a. Primary Hemorrhage:

It is the bleeding which occurs immediately after the traumatic injury of the blood vessel.

b. Secondary Hemorrhage:

This occurs not immediately after the infliction of the injury but sometime thereafter on or near the injured area.

3. Infection:

Infection is the appearance, growth and development of microorganisms at the site of injury:

How Injury or Trauma Acquires Infections:

a. From the instrument or substance which produces the injury.

b. From the organs involved in the trauma applied. A bullet wound may involve the intestine and causes its contents to spill out in the peritoneal cavity causing peritonitis.

c. As an indirect effect of the injury which creates a local area of diminished resistance causing the invasion and multiplication of microorganisms.

d. Injury may depress the general vitality, especially among the aged and the young children and makes the patient succumb to terminal disease.

e. 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.


The Most Common Emboli in the Blood Stream are:

a. Fat Embolus:

(1) Causes of Fat Embolus:

(a) By injection of oily substance into the circulation. ( b ) By injury of the adipose tissue which forces fat into the

circulation.

b. Air Embolism:

(1) Causes of Air Embolism:

(a) Gaping incised wound of the jugular vein.

(b ) Injection of soapsuds or air into pregnant uterus for the purpose of tubal insuflation or criminal abortion.

(c) Injection of air into the urinary bladder for radiological study.

(d) Insuflation of the other non-potent tubes or hollow organs.

(e) Injection of air under pressure into the nasal sinus after a therapeutic lavage.

HEALING OF WOUNDS:

1. Power of the Human Tissue to Regenerate:

Regeneration is the replacement of destroyed tissue by newly formed similar tissue. The more highly specialized the tissue, the less is the capacity for regeneration. Capacity for regeneration decreases as age increases. The state of nutrition of the individual aifects the capacity of regeneration.

The Following Regenerates Rapidly:

a. Connective tissues. b. Blood forming tissues. c. Surface epithelium of the skin. Those Having No Power or Limited Capacity to Regenerate:

a. Highly specialized glandular epithelium. b. Smooth muscles. c. Neurons of the central nervous system.

Small clean-cut wound is covered with lymph in 36 hours.

The edges adhere in two days and the wound heals on the 7th day leaving a linear scar.

Larger incised wound shows swelling of the edges 8 to 12 hours. Blood-stained serum is present in 2 days which afterwards become seropurulent on the 3rd day, lasting in state from 4 to 5 days. Small red granulation forms in 12 to 15 days and the epithelium grows from the edges. Scar develops later.

286 LEGAL MEDICINE

In cases wherein a definite infection is present, the time of healing is very indefinite, however, at the advent of antibiotic and sulfa drugs, healing is somewhat accelerated. The Time of Healing of Wounds is Dependent on the following:

a. Vascularity b. Age of the Person c. Degree of Rest or Immobilization d. Nature of the Injury

2. Kinds of Healing of Wounds:

a. Healing by Primary (First) Intention:

This type of healing takes place when there is minimal tissue loss, more approximation of the edges and without significant bacterial contamination.

Histologically, within 24 hours following injury, there is an acute neutrophilic response, the epidermal layer thickened on account of the mitotic activities of the basal cells. Scab will be formed on the surface on account of the dehydration of the surface clot.

After three days, the neutrophils will be replaced by the macrophages and fibroblasts will appear in the epithelial layer. Collagen fibers will bridge the raw area and epithelial proliferation will then cover the raw area. Newly formed capillaries sprout on all sides to form the vascular network and collagen fibrils become abundant and differentiated surface cells begin to proliferate to cover the exposed area.

Complete return of the area to its normal state may appear after a lapse of one month with or without the formation of a scar.

b. Healing by Secondary Intention:

This takes place when the injury causes a more extensive loss of cells and tissues. Inevitably, there is more necrotic debris and exudate that has to be removed. Inflammatory reaction is more intense as compared with healing by primary intention. Granulation tissue growth bears all the responsibility for its closure. Healing process may result to the production of a large scar and greater loss of skin appendages such as hair, sweat and sebaceous glands, and slower reparative process.

c. Aberrated Healing Process:

In some instances healing process deviates from the normal way on a normal individual. Healing may result to: (1) Formation of Exuberant Granulation or "Proud Flesh" —

Excessive amount of granulation tissue may protrude and


prevent closing of the wound. This can be remedied by excision or cautery.

Keloid formation after a severe acid bums .

(2) Keloid Formation — There is abnormal amount of collagen formed in the connective tissue thus producing a large bulging tumorous scar, commonly known as keloid. It has been claimed to be hereditary.

(3) Stricture — This is due to the contraction of the fibrous tissue of the scar formed.

(4) Fistula or Sinus Formation — A fistula is a communication between an inner cavity and the outside. Sinus is a tract of infection traversing the inner part of the body. Unless the causal factor, usually infection or foreign body is removed, the condition may remain for a long time.

Chapter X

MEDICO-LEGAL INVESTIGATION OF WOUNDS:

The following rules must always be observed by the physician in the examination of wounds:

1. All injuries must be described, however small for it may be important later.

2. The description of the wounds must be comprehensive, and if possible a sketch or photograph must be taken.

3. The examination must not be influenced by any other information obtained from others in making a report or a conclusion.

Outline of the Medico-legal Investigation of Physical Injuries:

1. General Investigation of the Surroundings:

a. Examination of the place where the crime was committed.

b. Examination of the clothings, stains, cuts, hair and other foreign bodies that can be found in the scene of the crime.

c. Investigation of those persons who may be the witnesses to the incident or those who could give light to the case.

d. Examination of the wounding instrument.

e. Photography, sketching, or accurate description of the scene of the crime for purposes of preservation.

2. Examinations of the Wounded Body:

a. Examinations that are applicable to the living and dead victim:

(1) Age of the wound from the degree of healing.

(2) Determination of the weapon used in the commission of the offense.

(3) Reasons for the multiplicity of wounds in cases where there are more than one wound.

(4) Determination whether the injury is accidental, suicidal or homicidal.

b. Examinations that are applicable only to the living:

(1) Determination whether the injury is dangerous to life.

(2) Determination whether the injury will produce permanent deformity.

(3) Determination whether the wound(s) produced shock.

288

MEDICO-LEGAL INVESTIGATION OF WOUNDS

(4) Determination whether the injury will produce complication as a consequence,

c. Examinations that are applicable to the dead victim:

(1) Determination whether the wound is ante-mortem or postmortem.

(2) Determination whether the wound is mortal or not.

(3) Determination whether death is accelerated by a disease or some abnormal developments which are present at the time of the infliction of the wound.

(4) Determination whether the wound was caused by accident, suicide or homicide.

3. Examinations of the Wound:

The following must be included in the examinations of the wound. The report made in connection with such examination must also include in detail the following items:

a. Character of the Wound:

The description must first state the type of wound, e.g. abrasion, contusion, hematoma, incised, lacerated, stab wound etc. It must include the size, shape, nature of the edges, extremities and other characteristic marks. The presence of contusion collar in case of gunshot wound of entrance, scab formation in abrasion and other open wounds, infection, surgical intervention, etc., must also be stated.

b. Location of the Wound:

The region of the body where the wound is situated must be stated. It is advisable to measure the distance of the wound from some fixed point of the body prominence to facilitate reconstruction. This is important in determining the trajectory or course of the wounding weapon inside the body.

c. Depth of the Wound: The determination of the exact depth of the wound must

not be attempted in a living subject if in so doing it will prejudice the health or life. Depth is measurable if the outer wound and the inner end is fixed. No attempt must be made in measuring the stabbed wound of the abdomen because of the movability of the abdominal wall.

c. Condition of the Surroundings: The area surrounding the wound must be examined. In

gunshot wound near or contact fire will produce burning or tattooing of the surrounding skin. In suicidal incised wound,

290 LEGAL MEDICINE

there may be superficial tentative cuts (hesitation cuts). Lacerated wound may show contusion of the neighboring skin.

e. Extent of the Wound: Extensive injury may show marked degree of force applied in

the production of the wound. In homicidal cut-throat cases, it is generally deeper than in cases of suicide. Homicidal wounds are extensive and numerous.

f. Direction of the Wound:

The direction of the wound is material in the determination of the relative position of the victim and the offender when such wound has been inflicted. The direction of the incised wound of the anterior aspect of the neck may differentiate whether it is homicidal or suicidal.

g. Number of Wounds:

Several wounds found in different parts of the body are generally indicative of murder or homicide.

h. Conditions of the Locality:

(1) Degree of hemorrhage. (2) Evidence of struggle. (3) Information as to the position of the body (4) Presence of letter or suicide note. (5) Condition of the weapon.

Determination Whether the Wounds were Inflicted During Life or After Death:

In the determination whether the wounds were inflicted during life or after death, the following factors must be taken into consideration:

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, the absence of heart action and the 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. Signs of Inflammation:

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 the resistance of

MEDICO-LEGAL INVESTIGATION OF WOUNDS 291

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 reaction.

3. Signs of Repair:

Fibrin formation, growth or epithelium, scab or scar formation conclusively show 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 edges 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.

sanctions between Ante-mortem and Post-mortem Wounds:

Ante-mortem Wound U- ok*

1. Hemorrhage more or less copious and generally arterial.

(AC 2. Marks of spouting of blood

from arteries. 3. Clotted blood

4. Deep staining of the edges and cellular tissues, which is not removed by washing.

EfcrThe edges gape owing to the reaction of the skin and muscle fibers.

3 * 6. Inflammation and reparative 6

processes. (From: Medical Jurisprudence and ed.yp. 237).

Post-mortem Wound

. Hemorrhage slight or none at all and always venous.

. No spouting of blood.

auc . Blood is not clotted; if at all,

it is a soft clot.

. The edges and cellular tissues are not deeply stained. The staining can be removed by washing.

. The edges do not gape, but are closely approximated to each other, unless the wound is caused within one or two hours after death.

. Nd^mflammation or reparative processes.

Toxicology by N.J. Modi, 12th

292 LEGAL MEDICINE

Determinations whether the wounds are homicidal, suicidal or accidental: 1. As to the Nature of the Wound Inflicted:

a. Abrasions:

Extensive abiasions on the body are always suggestive of accidental death, especially in death due to traffic accident. In suicidal death, abrasions are rarely observed. In case of murder, abrasions are not common except when the body is dragged on the ground. In homicide, abrasions may commonly be observed especially when the victim offered some degree of resistance to the attacker.

b. Contusion:

Contusion is rarely observed in suicidal death, except when the suicidal act was done by jumping from a height. A person contemplating to commit suicide will not choose a blunt instrument.

Contusion in accidental death may also be found in any portion of the body. It is often due to a fall and due to a forcible contact with some hard objects.

c. Incised Wounds:.

Incised wounds are commonly observed in suicide and homicide. The depth, location and other surrounding circumstances will differentiate one from the other. Accidental cuts are frequent everyday occurrences, but rarely as a cause of death.

Points to be Considered in the Determination as to whether the Wound is Homicidal, Suicidal or Accidental:

1. External signs and circumstances related to the position and attitude of the body when found.

2. Location of the weapon or the manner in which it was held.

3. The motive underlying the commission of the crime and the like.

4. The personal character of the deceased.

5. The possibility for the offender to have purposely changed the truth of the condition.

6. Other information:

a. Signs of Struggle:

Absence of signs of struggle is more in suicide, accident or murder.

Contusion or abrasion may indicate trauma due to fist, finger or feet of the assailant.


Presence of hair or portion of the skin (epidermis) on the nails of the assailant or deceased may be a clue in the determination whether death is suicidal, homicidal or accidental.

b. Number and Direction of Wounds:

Multiple wounds in concealed portions of the body are generally indicative of homicide.

Single wound located in a position that the deceased could have been conveniently inflicted is usually suicidal.

c. Direction of the Wound:

This is important in the case of cut-throat. It is generally transverse in case of homicide while it is oblique in case of suicide.

d. Nature and Extent of the Wound:

Homicidal wounds may be brought about by any wounding instrument. Suicidal wounds are frequent due to sharp instruments. Accidental physical injuries may be of any kind.

e. Stare of the Clothings:

There is usually no change in the condition of the clothings in suicide case. In homicidal death, on account of the struggle which took place before death, the clothings of the victim are in a disorderly fashion.

Length of Time of Survival of the Victim After Infliction of the Wound:

In the approximation of the length of survival of the victim after receipt of the physical injury, the following factors must be taken into consideration:

1. Degree of Healing:

The injured portion of the body undergoes certain chemical and physical changes as a normal course of repair. The capillaries are dilated and edema develops at once. This is followed by the migration of the white cells from the capillaries to the damaged area. Fibroblasts begin to proliferate later with the formation of the granulation tissues.

Signs of repair of the wound appear in less than a day after the infliction of injury. By the degree of granulation tissue formation and other reparative changes, the age of the wound may be estimated.

2. Changes in the Body in Relation to the Time of Death: The length of time in the survival of the victim may be approxi

mated from the systematic changes in the body. The degree of

294 LEGAL MEDICINE

wasting, anemia, condition of the face, and bed sore formation may be a basis as to how long a person survived.

3. Age of the Blood Stain:

The age of the blood stain may be determined from the physical color changes of the skin, although it is not reliable. Although there are some basis for such method, it must not be relied upon because the physical changes of the blood is modified by several external factors.

4. Testimony of the Witness When the Wound was Inflicted:

The actual witness may testify in court as to the exact time the wound was inflicted by the offender. In this case, medical evidence as to the duration of survival is merely corroborative.

Possible Instruments Used by the Assailant in Inflicting the Injuries:

The determination of the wounding instrument may be made from the nature of the wound found in the body of the victim:

1. Contusion — produced by blunt instrument. 2. Incised wound — produced by sharp-edged instrument inflicted

by hitting. 3. Lacerated wound — produced by blunt instrument. 4. Punctured wound — produced by sharp-pointed instrument. 5. Abrasion — body surface is rubbed on a rough hard surface. 6. Gunshot wound — the diameter of the wound of entrance may

approximate the caliber of the wounding firearm.

Could the injury have been inflicted by a special weapon?

A physician cannot determine definitely that a certain specific weapon was used in inflicting a wound. He can only state that it is possible that a certain injury is possibly caused by a certain instrument presented. He must be cautious in making a categoric statement.

Which of the injuries sustained by the victim caused death?

If there are several offenders who conspired with one another in the commission of the offense, it is not necessary to determine who among them gave the fatal blow. In the crime of conspiracy, the act of one is the act of all. But if there is no conspiracy in the commission of the offense it is necessary to determine who among the offenders gave the fatal injury to the victim, because they are only responsible for their individual acts.

In a case wherein the victim is a recipient of multiple injuries, the determination as to which of the injuries caused death is dependent on the testimony of the physician. This can be ascertained by


examining individually the wounds and note which of them are involved in the injury to some vital organs or large vessels, or led to secondary results causing death. When two or more wounds involved the vital organs, it is difficult to ascertain which ^mong them caused the death. It is important to determine the degree of the damage of each of the wound caused on the vital organ.

Which of the wounds was inflicted first?

When there are several wounds present on the body of the victim, it is important to determine which of them was inflicted first because it may be necessary for the qualification of the offense committed. If the first wound was inflicted in a treacherous way that the victim after receipt is incapable of defense, then murder is committed, but if the fatal wound was inflicted last, it is possible that the crime committed is only homicide.

In the determination as to which of the wounds present was inflicted first, the following factors must be taken into consideration:

1. Relative position of the assailant and the victim when the first injury was inflicted on the latter.

2. Trajectory or course of the wound inside the body of the victim.

3. Organs involved and degree of injury sustained by the victim.

4. Testimony of the witness.

5. Presence of defense wounds on the victim. If the victim tried to make a defensive act during the initial attack, then the defense wounds must have been inflicted first.

Effect of Medical and Surgical Intervention on the Death:

If the death of the victim followed a surgical or medical intervention, the offender will still be held responsible for the death of the victim if it can be proven that death was inevitable and that even without the operation, death is a normal and a direct consequence of the injuries sustained. It must be shown that the physician treating the victim must be competent and that in spite his exercise of care and diligence, still death was the final outcome. A person committing a felony shall be responsible for whatever will be the outcome of his felonious act. The wound inflicted by him must be the direct and proximate cause of the death of the victim.

On the other hand, if the victim merely received minor wounds but death resulted on account of the gross incompetence or negligence of the physician, then the offender cannot be held responsible for the death. The offender can only be made responsible for the physical injuries inflicted on the victim and the physician must be made to answer for the death.

296 LEGAL MEDICINE

Effect of Negligence of the Injured Person on the Death: If death occurred from complications arising from a simple in

jury owing to the negligence of the injured person in its proper care and treatment, the offender is still held responsible for the death. A person is not bound to submit himself to medical treatment for the injuries received during the assault.

The fact that the victim would have lived had he received appropriate medical attention, is immaterial. Hence, the refusal of the deceased to be operated does not relieve the offender of the criminal liability for his death (People v. Sto. Domingo, C.A. — G.R. No. 3783, May 1939).

But, if it could be proven that the negligence of the victim is deliberate and that this intention is really the cause of death on himself, then the offender cannot be held responsible for the death but only for the physical injuries he had inflicted.

Power of Volitional Acts of the Victim after Receiving a Fatal Injury:

Sometimes it is necessary to determine whether a victim of a fatal wound is still capable of speaking, walking or performing any other volitional acts. A dying declaration may be presented by the prosecutor mentioning the accused as the assailant; the offender may allege that the physical injuries inflicted by him while the victim was inside his house and that he walked for some distance where he fell, or that the victim after the fatal injury made an attempt to inflict injuries to the accused which justified the latter to give another fatal blow. The determination of the victim's capacity to perform volitional acts rests upon the medical witness.

As a general rule, severe injury of the brain and the cranial box usually produces unconsciousness, but after a while.the victim may be capable of performing volitional acts. The power to perform volitional acts is dependent upon the areas of the brain involved. Wounds of the big blood vessels, like the carotid, jugular or even the aorta, do not prevent a person from exercising voluntary acts or even from running a certain distance. Penetrating wound of the heart is often considered to be instantaneously fatal but experience shows that the victim may still be capable of locomotion. Rupture of the organs is not always followed by death. The victim has for sometime still retains the rapacity to move and speak.

Extreme caution must be exercised by the physician in expressing his opinion as to the limitation of powers possessed by the injured person to perform acts of volition, locomotion, or speech subsequent to receipt of extensive or fatal injury or wound.


Relative Position of the Victim and Assailant When Injury Was Inflicted:

In the determination of the relative position of the victim and the assailant when the wound was inflicted, the following points must be considered by the physician:

1. Location of the wound in the body of the victim. 2. Direction of the wound. 3. Nature of the instrument used in inflicting the injury. 4. Testimony of witnesses.

Extrinsic Evidences in Wounds:

1. Evidences from the Wounding Weapon:

a. Position of the Weapon:

The location and position- of the weapon at the scene of the crime may afford strong evidence in the court. As a rule, in cases of accidental or suicidal death, the wounding weapon is found near the body of the victim, but it is not uncommon to find the victim at some distance from the weapon when the victim is capable of walking. If the wounding instrument is firmly grasped by the victim, it is a strong presumption that it is a suicidal case.

b. Blood on Weapon:

The weapon responsible for the production of wound may be stained with blood. In some instances, the wounding weapon does not show blood stains because of the rapidity of the blow and compression of the blood vessels. Even if the weapon is stained with blood, it may be wiped out by the clothings in the process of withdrawal.

The weapon must be subjected to a complete examination to determine whether it is the one used in the commission of the offense.

c. Hair and Other Substance on Weapon:

Hair or fibers of cotton, silk, linen and other fabrics may be found adhering on the weapon. It must be preserved and submitted for comparison with the clothings or hair found at the site of the injury on the victim's body.

2. Evidences in the Clothings of the Victim:

Injuries inflicted on the covered portions of the body may also show injury on the covered apparel. In gurrhot wound, the hole in the clothings may be a factor in the determination of the site of the wound of entrance. Occasionally, two or more tears or holes

298 LEGAL MEDICINE

are produced on the dress by a single wound. This can be explained by the presence of folds on the clothings.

In gunshot wound, determination of the presence of gunpowder at the hole of entrance may show distance. The presence of clean-cut tear in the clothings shows that a sharp-edged instrument was used. The presence of severe tearing of the clothing shows struggle. The degree of soaking of the clothings with blood may depict the degree of hemorrhage.

3. Evidences Derived from the Examination of the Assailant:

The clothings of the assailant may be stained with blood from the victim. Tear may be present on account of the struggle which existed at the time of the commission of the offense. The fingernails may show foreign substances coming from the body of the victim.

The offender may also show to a certain degree marks of violence. Paraffin test of the assailant's hands may be useful to determine whether he fired the gun in case of shooting.

Determination of the degree of intoxication, mental condition, physical power, etc. of the offender may be necessary in the solution of the crime.

4. Evidences Derived from the Scene of the Crime:

The condition of the surrounding objects, the amount of hemorrhage, the presence of identifying articles belonging to the victim or assailant, the wounding instrument, all these must be observed or collected by the investigator.

Chapter XI

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY:

1. HEAD AND NECK INJURIES:

Injuries of the head must not be underestimated. They must be treated with extreme care. The absence of an external wound on the head does not itself permit a conclusion that there is no internal damage. Contusion and hematoma of the scalp may only be appreciated during the post-mortem examination. The presence of hair further augments the difficulty of appreciating head injuries.

The presence of bleeding from the ear, nostrils and mouth may be associated with basal fracture. Fracture of the vault and other portions of the cranial box may cause unconsciousness and this may be mistaken for simple intoxication. It is preferable to have the patient under careful, intelligent and continuous observation for at least twelve to twenty-four hours to avoid risk to the life of the patient. X-ray examinations may be useful in order to determine the presence of fracture. However, it is not uncommon that no fracture is observed, and yet the intracranial injury is quite severe.

Factors Influencing the Degree and Extent of Head Injuries:

a. Nature of the Wounding Agent:

Weapons with a small striking face usually produce a localized depressed fracture with laceration of the scalp. The degree of injury depends upon the degree of violence applied, the thickness of the scalp struck and the weight of the weapon.

Violent contact with the wheel of a motor vehicle causes fissure or comminuted fracture of the cranial box. There is always an associated injury of the brain substance and laceration of the meninges.

Penetrating injuries of the skull like those caused by a dagger, a nail or a bullet, may leave a clean-cut opening with the shape and size of the wounding weapon. A glancing hit of a bullet may cause a gutter-like depressed fracture of the vault of the skull.

299

300 LEGAL MEDICINE

b. Intensity of the Force:

As a general rule, the intensity of force is proportional to the degree of damage it will produce. However, in cases where the striking face is small, the amount of force which produces the same injury is smaller. This is, however, qualified by the part of the skull involved. For example, less force is required to produce injury when applied at the temple than when it is applied elsewhere in the exposed surface of the skull.

Heavy agents may require less force to produce extensive damage to the skull although the point of impact is wide.

c. Point of Impact:

There are areas in the cranium wherein if force is applied to them, the injuries are extensive. Fractures of the vaults, either on the side or at the back, usually causes a stellate comminution at the point of impact with linear extensions to some other areas. Basal fractures are often caused by transmitted force from some points of impact.

d. Mobility of the Skull at the Time of the Application of Force:

If the head is mobile, unsupported and free, the principal effects on the brain is due to the shearing movement imparted to the brain. It may produce contusion, laceration or hemorrhage without any fracture on the skull.

If the head is fixed and supported, as when the head is caught by the wheel of a vehicle, jarring movement of the brain is absent but the fracture is extensive. Usually the fracture forms a line from the point of contact with the wheel up to the point of support of the head. There may be complete separation of the naso-facial mass from the rest of the skull.

Head Injuries are Classified as to the Site of the Application of Force:

a. Direct or Coup Injuries:

These are injuries which occur at the site of the application of force and will develop as a natural consequence of the force applied.

Direct Injuries may Result to:

(1) In compression of the head by the wheel of a vehicle. (2) When the head strikes an object in motion, as bullets. (3) When the head is in motion and strikes an object, as in

vehicular accidents.

b. Indirect Injuries:

These are injuries in the head which are not found at the site of the application of force. The injury may be at the opposite, or

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY 301

in some areas offering the least resistance, or in areas which have no relation with the site of the impact.

(1) Contre Coup Injuries:

These are injuries which develop opposite the site of the application of force. A blow on the occiput may produce laceration or contusion of the frontal lobe of the brain. This is observed when the head is free and mobile.

(2) Remote Injuries:

Remote injuries are produced in cases where the force is applied in some areas of the body which have no relation to the head. A fall on the feet or buttocks may cause basal fracture of the skull.

(3) "Locus Minoris Resistencia":

The injury sustained in the head may not be at or opposite the application of force but may be found in some areas of the skull offering the least resistance. A blow on the head may cause a linear fracture of the roof of the orbit on account of the papyraceous nature of the bone.

c. Coup-contre-coup Injuries (Direct and Indirect Injuries):

The injuries may be at the site of impact and at the same time found in some other pafts of the head which may be opposite the site of application of force, or elsewhere. A hammer blow in the frontal portion of the head may cause depressed fracture of the frontal bone and at the same time fracture of the roof of the orbit and laceration of the posterior lobe of the cerebrum.

Wounds of the Scalp: A wound of the scalp although small and negligible is always

potentially serious because:

a. It is difficult to prevent the spread of infection.

b. There is proximity of the scalp to the brain.

c. There is a free vascular connection between the structures inside and outside the cranium.

d. It is frequently difficult to determine the extent of damage of the skull.

Abrasion of the scalp is commonly unnoticed because of the protective covering of the hair. Contusion may not be visible because of the thick resistant scalp and may only be noticed on autopsy.

Hematoma easily develops in the scalp because the cranium is located superficially and the subaponeurotic tissue is loose.

302 LEGAL MEDICINE

The most common lesion of the scalp is a lacerated wound. There may or may not be involvement of the skull. Difficulty is sometimes experienced in differentiating a lacerated from an incised wound of the scalp. With the aid of a hand lens, the laceration shows irregular borders and hair bulbs are preserved. Laceration of the scalp may be due to the impact of a blunt force or to the sharp edges of the fractured skull.

Incised wounds of the scalp in general involve the cranium. The force necessary may not be so strong as to produce a clean-cut fracture of the cranium.

Fractures of the Skull:

Fractures of the skull may or may not be associated with injury on the scalp, but usually there is an accompanying injury inside the cranial box. Meningeal vessels are so situated in the furrows of the cranium that fracture of the cranium will always lead to laceration of the blood vessels.

a. Fissure Fractures:

Fissure or linear fracture involves the inner and outer table. It is usually caused by the impact of a blunt object and may appear as a radiating crack from the site of the application of force and may involve the base of the cranial fossae.

b. Localized Depressed Fracture:

Localized depressed fracture is sometimes called "Fracture a La Signature". It invariably shows the nature of the instrument that causes the fracture. The round face of the hammer may show a round depressed fracture in the cranium.

c. Penetrating Injuries of the Skull:

Sharp-edged instrument produces clean-cut fracture of the skull. The size and shape of the fracture may correspond to the shape of the wounding instrument. A gunshot produces an oval or round hole with bevelling of the inner table at the wound of entrance. The blade of the wounding weapon may be left inside without causing trouble but complications like infection may later develop and may cause a fatal consequence.

d. Comminuted Fractures:

Comminution of the skull may develop as a result of a fissure or a depressed fracture. The presence of comminuted fracture is an indication of the severity of force applied or the use of a heavy weapon.

Majority of comminuted fractures are caused by motor vehicle accidents. In a near shot with a firearm, there is usually


a radiating fissure fracture from the point of impact which forms a "spider web" comminution of the cranium.

e. Pond or Indented Fracture:

In the skull of infants wherein there is undue elasticity, the production of a pond or indented fracture is common. It may be a result of a simple compression of the skull, as in a pingpong ball. Fissure fracture is likely to develop around the periphery of the dent.

f. Gutter Fractures:

A tangential or glancing approach of a bullet may cause the production of a furrow in the cranium. It may involve both the outer and inner tables. The furrow may cause injury on the blood vessels causing intracranial hemorrhage or laceration of the brain.

g. Bursting Fractures:

It is an extensive fracture running parallel to the two points of contact, if mechanical force is applied on one side of the head, while it is pressed on the other side against a hard substance, such as a wall, while the individual is standing, or against the hard ground or floor, when he is in a lying posture. In such cases the fracture may extend transversely to the base of the skull. The passage of the wheel of a heavy vehicle over the head often causes a complete division of the skull into two parts. The direction of the burst correspond to that in which the wheel passed over the head. (From: A Handbook of Medical Jurisprudence & Toxicology with State Medicine & Post-Mortem Techniques by C.C. Mallik, p. 206).

Intracranial Hemorrhages: Intracranial hemorrhages may occur even in the absence of a

fracture. Hemorrhage may be present without trauma. The blood vessels of the brain may be diseased and may rupture spontaneously, a. Extradural or Epidural Hemorrhage (almost exclusively due to

trauma):

Extradural hemorrhage is caused by a fracture of the skull. The fracture will cause laceration of the blood vessels which are grooved at the inner table of the skull. The branches of the meningeal vessels are usually involved, the most frequent of which are the branches of the middle meningeal vessels. The laceration is commonly unilateral except when the fracture extends to the opposite side.

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Severe extra-dural hemorrhage with compression of the brain

Hemorrhage at the region of the vault produces a discus-shaped clot with compression of the brain substance and this may cause neurologic disturbance. If the patient lives for sometime, there will be an organization of the clot and a fibrous thickening of the dura.

A person suffering from extradural hemorrhage may complain of headache, vomiting and drowsiness. The pupils may be dilated on the side of the hemorrhage. Examination of the cerebro-spinal fluid shows absence of blood, unless it is complicated with hemorrhage in other regions in the cranial cavity.

b. Subdural Hemorrhage:

Unlike extradural hemorrhage, subdural bleeding is essentially venous or capillary. It is the most common cause of cerebral compression. It may be a consequence of fracture of the skull, laceration of the brain, spontaneous rupture of the blood vessels on the surface of the brain or laceration of the dura and meningeal vessels. It usually comes from the small blood vessels which cross the subdural space to the subarachnoidal area.

Majority of subdural hemorrhages are traumatic in origin although a few may be due to a natural disease of the blood vessels of the brain. There are difficulties in ascertaining the cause and source of such hemorrhage.


Extensive subdural hemorrhage

Ageing Subdural Hematoma Munro-Merritt Method:

In the determination as to how long subdural hematoma existed, the study of the structure of its membrane is made as a basis (Munro-Merritt Method).

1st 24 hours — Deposit of fibrin at the margin of the clot with red blood cells and leucocytes well preserved.

24 — 36 hours — Fibroblast found at the junction of the dura mater and the blood clot.

4 days — Definite histological evidence of 2 to 3 layers of cell thickness neomembrane. The red blood cells have begun to lose their sharp contour.

4 to 5 days — Increasingly prominent membrane with extension of the fibroblasts into the underlying clot.

8th day — The membrane has become 12 — 14 cells in thickness. Pigment-laden phagocytes are found.

11th day — Clot broken up into islands by the invasion of strands of fibroblasts.

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Membrane has formed on the undersurface of the clot and strands of fibroblasts. Red blood cells have broken up. The outer layer of the neomembrane is 1/3 to 1/2 the thickness of the overlaying dura.

Neomembrane is about the thickness of the overlying dura. Blood has liquified. Red blood cells not clearly apparent.

Progressive decrease in the number of nuclei of the fibroblasts and progressive hyalinization of the membrane. Large blood spaces ("sinusoidal vessels") filled with red blood cells have become increasingly prominent in the new-formed connective tissue. Neomembrane has become thick and fibrous, blood has disappeared leaving only a few scattered pigment-laden phagocytes. The new-formed membrane is distinguishable from the overlying dura only by the parallel arrangements of the connective tissue fibers which have become more or less completely hyalinized.

(GradwohVs Legal Medicine by F.E. Camps ed., 3rd ed., p. 316).

c. Subarachnoidal Hemorrhage:

Subarachnoidal hemorrhage may be due to trauma or to spontaneous rupture of blood vessels. Its causes may be summarized as follows:

(1) It may be produced by severe head injury especially in contre coup kind.

(2) It may be due to ruptured cerebral aneurysm and is commonly seen at the base of the brain.

(3) It may be an extension of the spontaneous hemorrhage of the brain which extends to the subarachnoid space.

(4) In asphyxia there may be subarachnoidal hemorrhage in the form of petechial hemorrhage.

d. Cerebral Hemorrhage:

Cerebral hemorrhage may be traumatic or spontaneous in origin. If a person develops rupture of a blood vessel and suddenly collapses and falls on the ground producing a certain degree of head injury, it is quite difficult to ascertain the exact origin of the hemorrhage. A careful dissection of the brain

15th day -

26th day —

1 to 3 months —

6 to 12 months —

1 to 2 years —


tissue involved is necessary to determine the presence of pathology of the blood vessel.

Traumatic cerebral hemorrhage is usually due to laceration or contusion of the brain in contre-coup injuries. Severe crushing of the skull in vehicular accident cases may cause the sharp fractured edges of the bone to lacerate the brain and produces severe cerebral hemorrhage. It may involve the gray matter only but in severe cases the hemorrhage extends up to the white matter.

Distinction between Cerebral Apoplexy and Post-traumatic Intracerebral Hemorrhage:

a. In traumatic intracerebral hemorrhage the interval between the injury and onset of "stroke" (symptoms) is usually a week or less.

b. In traumatic intracerebral hemorrhage, the injury to the head must be sustained when the head is in motion and the hemorrhage is the result of the coup-contre-coup mechanism.

c. The location of traumatic intracerebral hemorrhage is in the central white matter of the frontal or temporo-occipital region. Cerebral apoplexy is usually at the basal ganglia, a very uncommon site of traumatic intracerebral hemorrhage.

d. History of hypertension prior to the "stroke" and evidence of degenerative disease are present in cerebral apoplexy. There is a history of head trauma in traumatic intracerebral hemorrhage.

(Gradwohl's Legal Medicine, 2nd ed. by F.E. Camps, p. 312).

Brain:

a. Laceration of the Brain:

Lacerations of the brain may be:

(1) Direct or Coup Laceration: This is produced by the fracture of the skull. The edges

of the fractured bone lacerate the arachnoid and the underlying brain tissue. It may occur any where in the brain but it usually follows the line of fracture. The most frequent sites are the parietal and the frontal lobes.

(2) Contre-coup Laceration: Contre-coup laceration occurs usually directly across the

point of impact and fracture. Contre-coup injuries occur only when the head is free to move at the time of the impact. If the head is held immovable the mechanism of contre-coup will not operate. A frontal impact may pro-

308 LEGAL MEDICINE

duce laceration of the cerebellum while an impact in the occipital region may cause contre-coup laceration of the fronta-. and temporal lobes of the brain.

Brain laceration may lead to granulation tissue formation and ultimately to fibrosis in the absence of infection.

Histo-pathological changes following contusion and laceration of the cerebral cortex:

Within 3 hours — Minimal alteration of the cellular elements at the margin of the wound. Microglia may show slight swelling of the cytoplasm of the dendrites. There is fracturing of the myelin sheath. Cortical nerve cells may show pyknotic changes.

6 to 12 hours — Pyknotic cells become more apparent and blood pigment is found between cortical neurons. Glial cells look swollen especially oligo-dendroglia in the white matter and perineuronal satellite cells in the gray matter, as cerebral edema begins to develop.

12 — 24 hours — Cortical nerve fibers show fairly numerous end-bulbs and early degeneration of the interrupted fibers. Microglia continue to show early swelling of their processes. Pyknotic change and pigmentary infiltration of the nerve cells are still present at the margin of the contusion. Loss of Nissl substance may be detected in larger nerve cells.

1—2 weeks — Increase in the number of granular corpuscles in activity of phagocytic action. Astrocytes are plump and the nuclei are very prominent. Cerebral edema is well shown by the spongy appearance of the white matter. Nerve cells in the border zone may show fatty degeneration or cytoplasmic vacuolation.

1 month — Scarring process becomes fairly static. The gliotic astrocytic scar shrinks and appears gray or brownish in color. Blood vessels are thickened, hyalinized coats owing to increased density of astrocytic end-process attached to them.

(GradwohVs Legal Medicine by F.E. Camps ed., 2nd ed., pp. 317-319).


b. Edemas of the Brain:

Edema of the brain which is usually the effect of trauma may be localized or generalized.

(1) Localized Edema:

Localized edema is observed in deep brain lacerations. The edematous area is soft, swollen, gelatinous and yellowish-red in appearance. It is observed in abscess and neoplasm.

(2) Generalized Edema:

This is usually associated with severe trauma of the head. The brain has a swollen appearance, with flattening and broadening of the convolutions and diminution of the sizes of the ventricle. Microscopically, there is an intracellular, pericellular and perivascular accumulation of fluid.

Edema of the brain of the generalized type may also be observed in a prolonged convulsive seizure, a sudden death due to tetanus antitoxin, an encephalitis, and in an excesssive hydration.

c. Concussion of the Brain:

Concussion of the brain is a transitory period of unconsciousness resulting from a blow on the head, unrelated to any injury to the brain which is apparent to the unaided eye. The cause of cerebral concussion is still undetermined. Some authorities consider it to be a rotational injury as it will occur only when the head is free to move but not when it is fixed.

The symptoms of concussion vary upon the degree of injury. In a severe injury the patient may fall down and becomes unconscious. There is flaccidity of the muscles and sphincters are relaxed. The face is pale, pupils are dilated and insensible, skin is cold and clammy, the pulse is rapid, the respiration is slow, irregular and sighing and the temperature is subnormal.

In cases of recovery, there is usually a retrograde amnesia of the accident and even events before and after it. The patient may also develop automatism and may perform criminal acts which may be mistaken to be volitional or voluntary.

d. Compression of the Brain: On account of the severe intracranial hemorrhage, depressed

fracture of the skull, or edema of the brain, compression of some vital areas of the brain may lead to paralysis or loss of consciousness. Natural diseases, like newgrowth, abscess and hydrocephalus may also cause compression of the brain.

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In traumatic compression, the symptoms do not appear immediately after the injury. The symptoms depend upon the area of the brain involved but signs of increased intracranial pressure are always present. Vomiting, headache, irregular breathing, incontinence of urination and defecation, and paralysis are usually present. Recovery develops when the cause is completely removed but usually the patient has loss of memory, epilepsy, paralysis, or insanity as a sequelae.

Medico-Legal Questions in Intracranial Injuries:

a. Is the origin of the intracranial hemorrhage due to trauma or disease?

Extradural or epidural hemorrhage is always caused by trauma. The blood vessels causing the hemorrhage which are grooved at the inner table of the skull are usually lacerated by the fractured skull.

Subdural hemorrhage is, as a rule, traumatic in origin but it may also be caused by some diseased condition of the blood vessels or by a local inflammatory process.

Subarachnoidal hemorrhages are usually spontaneous and are usually caused by ruptured aneurysm or sclerotic vessels at the circle of the Willis.

Hemorrhage in the brain substance is usually spontaneous and usually involves the deep tissues of the brain, pons and cerebellum. Age, blood pressure, chronic alcoholism, kidney disease must be taken into account to determine whether it is traumatic or spontaneous in origin.

b. In cases of cerebral concussion, can the victim remember the incidents before, during or after the accidents?

In mild form of cerebral concussion or after a psychological treatment, 'the victim may be able to recall the incident. A person may suffer from severe concussion and still retain a good memory of the past. In severe form of concussion, the victim may totally lose the recollection'of past events.

c. Can the victim of head injuries still retain voluntary movement and speech?

In severe head injuries with comminuted fracture of the skull there is immediate loss of consciousness such that voluntary movement and speech are no longer possible. Depressed fracture of the skull may cause also immediate loss of consciousness that may develop sometime after the impact.


The capacity of the victim to retain voluntary movements and speech depends upon the loss of consciousness and the area of the brain involved.

d. Post-traumatic Automatism:

A person while under the state of post-traumatic automatism may commit a crime while in an unconscious state. He is considered to be exempted from criminal liability because he did not act with intelligence. There can be criminal intent if a person acted with voluntariness or with intelligence. A person under the state of post-traumatic automatism acted involuntarily.

e. In gunshot wounds of the head, how can the point of entrance be determined?

In some instances the gunshot wound on the head may not clearly show characteristic findings of a wound of entrance. The examiner must resort to the examination of the fracture of the skull. At fhe point of entrance, the injury at the outer table is oval or round while there is bevelling fracture at the inner table. The opposite is true at the point of exit.

f. Post-traumatic Irritability:

The victim of a head injury may suffer post-traumatic irritability and may lead to do acts of impulsive violence. If irritability develops after a head injury, it is doubtful if it will be a valid defense following the doctrine of acting under an irresistible impulse. But, if genuine traumatic psychosis develops later, the responsibility is evaluated in accordance with the general principle of appraisal of responsibility of insanity (Medical Trial Technic, Mar. 59, p. 32).

Face: Generally, wounds on the face heal relatively faster as compared

with wounds of the other parts of the body on account of its great vascularity. Most often, injuries on the face are serious because they produce ugly scars or other forms of deformity. Because of their proximity to and the presence of free communication with the brain, facial injuries are always a threat to life. As a whole, wounds on the face may be due to a blow, vehicular accident, kick, sharp instrument, gunshot, or a blunt weapon. Fractures of the facial bones, especially of the nasal bone and mandible, are quite frequent, a. Eye:

Contusion of the soft tissue about the eyes is sub-conjunc-tival. Hemorrhage is frequently observed in a fist blow. Fracture

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of the base of the anterior cranial fossa may also produce contusion of the eyelids, and this may be distinguished from contusion due to a blow by the absence of swelling and skin injuries in the former.

The eye may be lacerated by a blunt weapon or by a piece of stone. Acute inflammatory changes usually occur with injury of the cornea, iris and lens and may require total enucleation of the eyeball. Penetrating wounds due to sharp instruments or bullets may cause meningitis or total blindness.

b. Nose:

Fracture of the nasal bone is a common sequelae of fist blows, and may cause severe epistaxis and facial deformity. The nose may be bitten in a quarrel, cut with a sharp-edge instrument, and contused, abraded or lacerated by a blow. In suicide, the muzzle of the death gun might be placed in the nostril and may cause no visible wound of entrance.

Injuries of the nose are usually dangerous to life on account of the extension of infection to the brain.

c. Ear:

A blow on the ear may produce a rupture of the tympanic membrane leading to permanent or temporary deafness. Hemorrhage coming from the ear may suggest fracture of the base of the middle cranial fossa. In a quarrel, the pinna of the ear may be cut off or markedly lacerated or contused by a strong blow.

The trauma in the ear may cause septic infection and may extend to the brain and causes death.

d. Mouth:

Contusion, laceration and swelling of the lips are usually observed in a fist blow, kick or bite. It may or may not be associated with fracture of the teeth or injury of the gum.

Fracture of the lower jaw is usually due to direct violence and the most common site is at the region of the insertion of the canine and at the region of the condyle. Fracture of the jaw is always associated with laceration of the gums which may extend to the floor of the buccal cavity.

Occasionally a gunshot wound in suicidal case is found inside the mouth and investigators are usually at a loss in the examination and location of the wound of entrance.

Infections following injury of the mouth may extend to the upper respiratory system and cause edema or gangrene of the glottis.


Neck:

Abrasions of the neck may be present in cases of manual strangulation. Ligature marks are present in death by hanging or strangulation by ligature. Incised wounds may be homicidal or suicidal. Suicidal cut-throat wounds are usually diagonal while homicidal wounds are usually horizontal. Incised and stab wounds of the neck may involve the trachea and the big blood vessels and nerves and in most cases, end fatally. Asphyxia, pneumonia, hemorrhage and shock are the common causes of death from neck injuries.

Wounds of the esophagus are not common. They are usually accompanied by wounds of the trachea and large blood vessels of the neck. Severance of the recurrent laryngeal nerve causes aphonia.

Contusion or rupture of the muscles, severance of the nerves are sometimes observed in severe trauma applied to the neck. Forcible blow in the anterior portion of the neck may cause unconsciousness or even death due to reflexed inhibitory action on the vagus nerve.

Vertebral Column and Spinal Cord:

a. Fracture of the Vertebrae:

Fracture of the vertebrae is dangerous to life because of the involvement of the spinal cord. Injury of the cord due to fracture of the upper four cervical vertebrae causes paralysis of the phrenic nerve, while those due to fractures of the fifth cervical vertebra to the first dorsal vertebrae may cause paralysis of all the extremities. Injury of the cord at other levels may not cause immediate death but complications like hypostatic pneumonia, bed sores and other secondary infections may set in and cause death.

The causes of the fracture of the spine may be:

(1) Direct Violence: The fracture of the spine may be due to a blow by a

heavy instrument coming from the back, fall from a height, collision with motor vehicles and hit of a projecting instrument.

(2) Indirect Violence: Indirect violence may be due to a fall on the feet or

buttocks, forcible bending of the body as in wrestling, a blow on the chin or forehead, forcible bending of the head towards the sternum, and slight twist of the body if the person is suffering from Pott's disease.

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Recovery from spinal fracture may cause deformity or paralysis of certain areas of the body. Injury of the spine is usually associated with considerable, pain.

b. Concussion of the Spine:

Concussion or jarring of the spinal cord may occur even without any visible signs of external injuries. A physician usually has much difficulty making diagnosis of concussion of the spine.

The usual complaints are headache, restlessness, pain and tenderness over the spine, loss of sexual power, irritability of the bladder, inability to walk, weakness of the limbs, and derangement of the special senses.

Concussion of the spine may be sustained in a motor vehicle collision and in a railway accident.

2. INJURIES IN THE CHEST:

Injuries in the chest are important because vital organs are inside the chest cavity, namely: the heart, lungs and the principal blood vessels.

Injuries to the Chest Wall:

The chest wall is easily contused by the application of moderate force on account of the superficial location of the ribs. Lacerated wounds are rarely observed as a direct effect of violence, but are observed when the fractured ends of the ribs pierce the skin in severe crush injuries due to motor vehicle accidents.

Stab wounds on the chest are quite common on account of its accessibility when both the assailant and the victim are in a standing position. The intercostal vessels may be involved, causing considerable hemorrhage. Stab wounds of the chest, as a general rule, involve the lungs, heart and the big blood vessels in the chest cavity.

Bullet wounds of the chest may be superficial or may involve the pleural viscera. Hemorrhage, collapse of the lungs due to the removal of the negative intrathoractic pressure and pneumonia may develop if the victim does not die immediately.

Fracture of the ribs causes severe pain during each phase of respiration and if complete, it may be associated with laceration of the parietal pleura or of the skin. The lungs and the heart may also be lacerated when there is an inward displacement of the fractured ends.

Fracture of the Ribs may be Caused by:

a. Direct Violence:


The fracture of the ribs is at the site of the application of force as in cases of blow, stab, or bullet wounds,

b. Indirect Violence:

The fracture of the ribs is not at the point of the application of force, as in crush injuries in vehicular accidents, a pressure on the chest by heavy objects, a fall of earth or pressure with the knee. Fracture of the ribs is usually along the mid-axillary line or may run obliquely in the chest depending upon the manner the force was applied.

Fracture of the ribs lacerates the parietal pleura and the sharp ends of the ribs cause injury to the lungs, heart and big blood vessels. The laceration of the skin may cause collapse of the lungs and the victim dies of asphyxia.

The usual site of fracture of the sternum is the junction of the manubrium and the gladiolus. The fracture is usually transverse and most often associated with fracture of the ribs. It results from a sudden impact of heavy, blunt object or compression of the chest due to a fall or a vehicular accident. Fracture of the sternum may be associated with laceration of the pericardium and injury to the heart.

Injuries to the Lungs:

Hemorrhage in the pleural cavity coming either from the intercostal vessels or from the lung tissue itself may cause compression and collapse of the lungs and the patient may die of respiratory embarrassment or anemia.

Contusion of the lungs may be caused by a blunt instrument with or without fracture of the ribs, or by compression of the chest. The lungs may be injured by a sharp-pointed instrument or by a bullet. Injury of the lungs may cause bloody froth coming out of the mouth.

Severe traction exerted at the region of the hilus may tear the lungs at the point of attachment. Death is usually due to a severe shock or a rapid hemorrhage.

Application of a severe crushing or grinding force in the chest wall causes extensive fracture of the ribs and may results to contusion and crushing injury to the lungs. The laceration may not be so severe but later the victim succumbs to lobar pneumonia.

Complications of Lung Injuries: a. Hemorrhage — Injury to the lung may cause severe hemorrhage

and about 1,500 cc. of blood may be recovered free in the pleural cavity.

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b. Compression of the lungs — The hemorrhage or the compression of the chest wall may cause limitation of the excursion of the lungs during respiration and ultimately the victim dies of asphyxia.

c. Severe Pneumothorax — Laceration of the bronchi leads to the escape of air into the pleural cavity and embarrasses the respiration.

d. Cerebral air embolism — Laceration of the lungs may also cause laceration of the pulmonary veinB and causes cerebral air embolism.

e. Hemoptysis — The blood from the injured lungs may find its way to the bronchial tubes to the trachea and be spilled out through the mouth. If hemorrhage is severe, the blood may clot inside the bronchial tubes and causes acute asphyxia.

f. Subcutaneous emphysema — Laceration of the parietal pleura and the lung tissue may cause the escape of air which finds its way into the subcutaneous tissue causing crepitation of the skin.

Injuries to the Heart:

The heart may fail and causes death due to an existing natural disease independent of trauma. Coronary insufficiency, myocardial fibrosis, valvular lesion or tamponade due to the rupture of the ventricle are common lesions.

Wounds of the heart are produced by sharp instruments, bullets or the sharp ends of the fractured ribs. Contusion of the heart is easily produced on slight trauma on account of its vascularity. Wounds of the ventricle if small and oblique are less dangerous than those of the auricle because of the thickness of its wall. The right ventricle is the most common site of the wounds due to external violence, because it is the most exposed part of the heart.

Foreign bodies like bullets, shrapnels, fragments of a shell may be embedded in the myocardium without any cardiac embarrassment. The person may live for a long time and may die of some other causes.

Tearing of the heart from its attachments may be due to violent compression of the chest with the pressure forcing the organ downward and away from the neck v The severe traction may cause the laceration of the aorta.

Rupture of the heart is usually produced by a blunt instrument or by a crushing injury due to vehicular accidents. The heart is commonly ruptured at the right side towards the base. Death is due to severe hemorrhage, cardiac tamponade or shock.


Crushing injuries of the heart are due to compression of the chest with the fractured fragments injuring the heart as in vehicular accidents, violent dynamite blast, or crushing of the chest between hard object.

Wounds of the aorta and pulmonary vessels are rapidly fatal. Rupture of the aorta may be traumatic or spontaneous. Spontaneous rupture may be due to aneurysm. The cause of death is either the profuse hemorrhage or cardiac tamponade.

Injuries of the Diaphragm:

Wounds of the diaphragm due to a sharp instrument and bullets are caused by injuries either of the chest or abdomen. Their fatal effect is not on the injury to the diaphragm but on the accompanying injuries to the other organs. Any penetrating wound in the diaphragm may cause a potent rent for diaphragmatic herniation.

Rupture of the diaphragm is due to a sudden increase of intraabdominal pressure crushing injuries caused by vehicular accidents or traumatic compression of the chest.

Death in diaphragmatic injuries may be due to shock, hemorrhage, intestinal obstruction caused by herniation, or the accompanying injuries.

3. ABDOMINAL INJURIES:

Abdominal Wall:

The skin may remain unmarked inspite of extensive internal injuries with bleeding and disruption of the internal organs. The areas most vulnerable are the point of attachment of internal organs, especially at the source of its blood supply and at the point where blood vessels change direction.

The area in the middle superior half of the abdomen, forming a triangle bounded by the ribs on the two sides and a line drawn horizontally through the umbilicus forming its base, is vulnerable to trauma applied from any direction. In this triangle are found several blood vessels changing direction, particularly the celiac trunk, its branches (the hepatic, splenic and gastric arteries) as well as the accompanying veins. The loop of the duodenum, the ligament of Treitz and the pancreas are in the retroperitoneal space, and the stomach and transverse colon are in the triangle, located in the peritoneal cavity. Compression or blow on the area may cause detachment, laceration, stretch-stress, contusion of the organs (Legal Medicine 1980, Cyril H. Wecht ed., p. 41).

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Stomach:

Spontaneous rupture of the stomach may be observed in cases of gastric ulcer or new growth. A blunt force applied at the upper portion of the abdomen may cause bruising or even rupture. The pyloric end and the greater curvature are the most frequent sites of a rupture.

Penetrating stab wounds of the stomach are dangerous to life on account of a hemorrhage, infection and injury to the adjacent organs like the liver. Tearing of the stomach is common when the person is run over by a motor vehicle at the region of the abdomen.

Intestine:

Ulcer at the duodenum may rupture spontaneously. The same is true in cases of tuberculous, amoebic, cancerous or typhoid ulcerations. Peritonitis and hemorrhage are the common causes of death.

Traumatic rupture may be due to a blow, kick, fall or vehicular accident. When force is applied to the front portion of the abdominal wall, the intestine may be pressed between the vertebral column and the force applied, producing either partial or complete severance or laceration. Its septic contents will scatter in the abdominal cavity and cause generalized peritonitis.

Injuries caused by sharp instruments or by gunshots usually cause multiple lesions in the intestine and may also involve other visceral organs. The intestine may be involved in vehicular accidents and on account of the grinding force of the wheel, severe hemorrhage, laceration and herniation in the abdominal wall are usually observed.

The mesentery may be contused, lacerated or crushed but in most cases its involvement is secondary to lesion in the intestine.

Liver:

The liver is one of the most vulnerable organs in the abdominal cavity because of its size, weight, location, friability, and fixed position. Injuries are frequently met in cases of blow, kick, crush, fall or sometimes in sudden contraction of the abdominal wall. The right lobe is more frequently involved than the left owing to its size and exposed location. Rupture is usually transversely or anteroposteriorly. On account of its extreme vascularity, the victim usually dies of severe hemorrhage, shock and very rarely of supervening infection. Sometimes recovery occurs after slight laceration but occasionally, abscess develops.


Stab and gunshot wounds of the abdomen may involve the liver. Severe hemorrhage or shock usually causes the death. It may be lacerated by the fractured ends of the lower ribs in crush injuries.

The gall bladder may be ruptured as a result of a kick, blow or crush injury. It may be inju*ed-by penetrating weapons. Death is due to hemorrhage and the effusion of bile into the peritoneal cavity.

Spleen:

The spleen usually suffers traumatic rupture resulting from the impact of a fall or blow and from the crushing and grinding effects of wheels of motor vehicles. Although the organ is protected at its upper portion by the ribs and also by the air-containing visceral organs, yet on account of its superficiality and fragility, it is usually affected by trauma. Congestion and diseased condition of the spleen, as in malaria, typhoid, kala-zar, make it more easily susceptible to slight trauma.

Laceration of the spleen is more common at the region of the hilus and the lesion may be longitudinal or transverse. Lesion on the convex surface is also common especially when the force is applied to the left flank. On account of the vascular nature of the organ and its proximity to the plexuses of nerves, the victim usually dies of severe shock or hemorrhage.

Penetrating stab wounds of the spleen are common but most often other visceral organs are also involved. Death is due to hemorrhage.

Kidney: Traumatic injury of the kidney may be due to a blow at the

lumbar region somewhere at the region of the 12th rib. It may be ruptured at the slightest violence when it is diseased as in cases of hydronephrosis, pyelonephritis, tuberculosis, abscess or tumor. The kidney may also be ruptured when the individual is run over by a vehicle or severely crushed from a fall

Injury of the kidney is accompanied by peri-renal hematoma which consists of blood and urine. Death is due to a severe hemorrhage, loss of kidney functions and shock. Abdominal hemorrhage is present only if there is injury to the peritoneum concomitant to the lesions in the kidney.

The adrenals may be contused, crushed or lacerated by severe violence. The right is more prone to injury of its vulnerable location.

"Crush syndrome" — These are secondary kidney changes in crush injuries. Edema and anuria follow a crush. If death super-

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venes, the kidneys are found to be swollen, pale with marked degeneration of the cells lining the tubules (Taylor's Principles & Practice of Medical Jurisprudence by Simpson, 12th ed.. Vol II, p. 332).

Pancreas:

The pancreas may be injured by a violent blow at the epigastric region. Death may be due to hemorrhage, shock, or insulin insufficiency. If death does not occur immediately, fat necrosis is observed in the abdominal cavity on account of the leakage of the lipolytic enzyme.

Spontaneous hemorrhage of the pancreas is frequently observed in the tropics. Its exact cause is still a matter of medical research.

4. PELVIC INJURIES:

Fracture of the pelvic bones, especially of the pubis, is common in vehicular accidents and crush injuries. Separation of the symphysis may be observed without any external sign of injury. The patient may show difficulty of locomotion, and to a certain degree, damage to the urinary bladder.

Urinary Bladder:

The bladder may be involved in a blow, crush, or kick at the hypogastrium especially when distended with urine. Among parturient women, the bladder may rupture in the course of delivery. It may also be involved in fractures of the pubic bones. Spontaneous rupture is rare when it is over-distended due to urethal stricture, enlargement of the prostate, or tumor. Symptoms of rupture of the bladder are pain, tenderness at the lower portion of the abdomen, bloody urine, difficulty in urination and rigidity of the abdominal muscles. Death may be due to shock or super-imposed infection.

Uterus:

A non-gravid uterus is rarely involved in pelvic injuries, but a gravid uterus is likely to be ruptured in a blow, kick, or crush injuries. Spontaneous rupture of the uterus is commonly observed among pregnant women due to the injudicious use of drugs or abnormal presentation. Partial separation of the placenta may be spontaneous or due to trauma. Death is due to shock, hemorrhage, peritonitis or septicemia.

Vagina:

Laceration of the vagina may be due to a sexual act or a faulty instrumentation to induce a criminal abortion. The vaginal wall


may be lacerated during parturition.

5. EXTREMITIES:

Physical injuries on both upper and lower extremities are usually due to direct violence, crushing or some indirect force.

a. Direct violence will result in a contusion and when the force applied is severe it may cause interstitial muscular hemorrhage and fractures of the underlying bone. Direct violence may be due to a fall, a vehicular accident, or a direct application of force.

b. Indirect violence, such as twisting or pathological fracture of the bone underneath, causes laceration of the muscles around with marked hemorrhage. A patient may suffer deformity, shortening of the extremity and shock.

c. Crushing injuries of the limb can result in severe soft tissue trauma and are most commonly caused by vehicular accidents or fall of heavy materials. These are usually accompanied by marked swelling, comminution of the bone and extravasation of the blood.

Contusions and abrasions are frequent lesions of the extremities. Lacerated wounds are commonly observed in portion where the bones are superficially located as in the anterior aspect of the leg. Incised and punctured wounds of the hand are quite common on account of its utility and movability.

Crushing injury of the extremities may cause laceration of the blood vessels and nerves. Injury of the intima of the blood vessels causes thrombus formation and in severe cases aneurysm may develop. Extravasation of the blood into the muscles causes swelling and pain.

Fracture of the bones may be due to a direct violence, an indirect violence or a muscular action.

Injury of the extremities may cause shock, hemorrhage and infection. The shock is principally due to the injury on the nerve, hemorrhage and fracture of the bones. Infection may be severe and may require amputation of the extremities.

Chapter XII

DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION

Explosion is the sudden release of potential energy producing a localized increase in pressure.

Investigation of death or physical injuries that is produced by explosion must be concerned in determining the following:

1. What exploded?

2. What caused it to explode?

3. How it produced the injury?

4. How was it initiated?

Classification of Explosion as to the Source of Energy:

1. Mechanical (Hydraulic) Explosion — This occurs when the pressure inside a container exceeds its structural strength. Explosions of air pressure tanks for cleaning or paint spray, water pressure tanks to establish water pressure, and the air pumped kerosene burner are examples of mechanical explosions. These explode when the pressures applied are in excess of the strength of the containers. As the container disintegrates, there is a rapid localized increase in pressure resulting in the characteristic explosive sound.

2. Electrical Explosion — When electricity arcs through the air, a phenomenon that occurs when two objects of different electrical potential are brought close to one another, a large amount of heat develops. This heat rapidly expands the air in and around the arc which produces the popping sound of an arc. Lightning though it occurs in a much complex form with extremely high temperature, may be an example of an electrical explosion.

3. Nuclear Explosion — The release of a significant amount of energy by fusion or fission and consequently with a significant increase of destructiveness.

Atomic Explosion — Atomic nuclei can be regarded as stored condensed energy. The uncontrolled release of this energy constitutes atomic explosion.

4. Chemical Explosion — Chemical explosion occurs when a chemical reaction'produces heat and gas at a rate faster than the surroundings can dissipate. At the start of the reaction the initial heat or gas

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DEATH OR PHYSICAL INJURIES CAUSED BY EXPLOSION 323

pressure increases the rate of reaction, which progresses at a faster rate until the explosion results.

Types of Chemical Explosion:

a. Diffused Reactant Explosion — This is caused by the mixture of gas and air. If the gas and air are mixed in correct proportion, product of heat and subsequent pressure is produced. Explosion of diffused reactants must be initiated by flame, spark or sometimes heat. Mixture of gases with other materials may cause production of flame. The most common example of dispersed gas explosion is in the internal combustion engine.

b. Condensed Reactant Explosion — This chemical explosion occurs when large quantity of heat and gas is produced as a result of rapid chemical reaction in a solid or liquid material. It has a point of origin so that the most severe damage is closest to the source and the effects diminish as the distance from the center increases. There is no need of atmospheric oxygen and if oxygen is required in the reaction it is incorporated into the explosive. Condensed reactant explosives may be classified as:

(1) Low Order Explosive (Deflagrating Explosive) — Those which rely on burning and confinement to produce explosions. When the reaction is confined, the built-up of heat and pressure causes the reaction rate to increase rapidly to an explosion. Gunpowder is the best known low order explosive. When sufficiently heated the nitrate content is decomposed to nitrate and oxygen. The oxygen reacts with sulfur and carbon producing sulfur oxide, sulfur dioxide, carbon monoxide and carbon dioxide in various combinations.

(2) High Order Explosive — This is the kind that detonates. Detonation is a chemical process which results in the extremely rapid decomposition of nitrogenous compounds. Releasing heat and gas is its reaction by-product. It is the shock wave spreading out of the explosion that causes the destructive effect of high explosive. Dynamite is an example of a high order explosive.

(a) Stable High Order Explosive — This compound will not detonate unless they are subjected to detonation. This includes dynamite (nitroglycerin made stable by clay absorption).

(b) Unstable High Order Explosive — Easily detonates from heat, flame, spark or percussion. This includes trinitro-benzene (Picric acid), fulminate of mercury, lead, antimony or bismuth and nitroglycerine (Clinics in

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Laboratory Medicine by V. Di Maio, Vol. 3, No. 2, June 1983, pp. 309-314).

Death or physical injuries due to detonation of high explosives may be due to the following causes:

The destructive effects varies with the kind and amount of explosive used and the location of the victim at the time of the explosion. The explosion is accompanied by blast, flame and fragment primarily. The nature and extent of the injuries suffered by the victim may be:

(a) If the victim is in contact with the explosive, as when he is manipulating, carrying or sitting on it at the time of the explosion, there is complete disruption or fragmentation of the body. Pieces of the body may be found several meters away from the site of explosion. Some parts of the body may be found hanging on the electric power line, bones completely shattered, skin and other soft tissues may be found scattered at a certain distance from the site of the explosion.

Burns and other injuries brought about by dynamite explosion.

The explosion causes sudden increase of atmospheric pressure which is immediately followed by a sudden fall. This compression-decompression effect causes displacement, distortion and bursting effects on body parts, especially in the brain and abdominal visceral organs. Aside from these injuries, there is rapid development of scattered foci or small


hemorrhages mostly in organs which easily change in shape and which are rich in blood supply.

( b ) If the victim is not so close to the site of explosion, the body though badly injured may remain in one piece. Some parts may be dismembered but may be recovered within a few meters. Certain areas of the body may show severe injury, but the triad of punctate bruises, abrasions and lacerations may be found distributed all over the body. (All of these injuries have still the effect of the blast wave with a diminishing intensity.)

(c) The peppering kind of injuries may be observed as the distance from the site of explosion increases. The density and severity becomes less until it disappears. However, one or more metallic fragments travelling with moderate velocity may strike the vital parts of the body and may cause death.

(d) Other effects of the blast wave:

i. The impact of the high pressured wave can knock down the person.

ii. In the respiratory organ, the bronchus may be lacerated or the mucosa of the trachea may develop petechial hemorrhages. This effect is not due to the entry of the high pressured wave along the trachea and bronchi but by its passing directly on the body wall.

iii. The ear is the organ most vulnerable to the blast. Most person at the vicinity of the explosion may suffer from slight reddening of the tympanic membrane which signifies that the cochlea has been damaged

(e) Burns from the flame or heated gas — The instantaneous or momentary flame of high intensity during explosion may cause singeing of the eyebrow, scalp hair and eyelashes. Clothings may also be burned. Body surface in contact with the flame or exposed to the heated air may develop burns, the degree of which depends upon the intensity and duration of exposure.

(f) Asphyxia due to lack of oxygen — Explosion causes consumption of oxygen in the surrounding atmosphere, thereby limiting the amount available for human consumption.

(g) Poisoning by inhalation of carbon monoxide, nitrous or nitric gases, hydrogen sulfide, sulfur dioxide, or hydrocyanic gas — The by-products of combustion may be protoplasmic poison or may cause death by interfering with the

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normal transportation and utilization of air by the tissues of the body.

(h) Direct injury by the flying missiles — The injury due to flying missiles is influenced by the proximity of the individual to the site of explosion, velocity of the missiles, manner or approach of the missiles on the body surface involved and the subsequent complications arising from such injuries.

The shrapnel wound may go much deeper or the foreign body may lodged inside the body. The edges of the missiles may be irregular or smooth so that the lesion on the skin may appear like an incised wound. If lacerated, the surrounding tissues may be contused.

The following explosives may cause shrapnel wound: Grenade — Rifle or hand.

Bomb — Demolition or incendiary. Mine.s — Underground or submarine. Exploding missiles — Anti-aircraft

( i ) Injuries from the falling debris — If the explosion took place in a building the victim may be injured and buried under the rubbles. The victim may suffer from multiple injuries of whatever description or die of traumatic or crash asphyxia.

Identification of the Site of Explosion and Collection of Evidences:

The site of explosion may be identified by the presence of a crater. The original location of other objects located near the blast may be useful clues in the determination of the site of explosion. Soil and other debris may be collected for laboratory examination.

The entire area must be systematically searched for traces of the detonation mechanism. All blown out materials must be tested for explosive residues.

If the investigator arrived at the site immediately after the explosion, he may be able to smell the odor of the gas. One of the simplest way of collecting gas samples for analysis is to take a bottle full of water in the area where odor is the strongest and pour the water out of the container. The surrounding air will immediately replace the water removed from the bottle. Then the bottle must be tightly sealed and sent to the laboratory for examination.

Scrapings from the debris and other materials at or near the site of the explosion may be subjected to extensive stereoscopic and microscopic examination. Particles of unconsumed explosive may be recovered.


Fragments of the explosive materials and debris recovered may be rinsed with hot water so that water-soluble inorganic substances (nitrates and chlorates) may be extracted. The materials may be rinsed with acetone inasmuch as most explosives are highly soluble to acetone. The extract is concentrated and analyzed.

Color Spot Tests for Common Chemical Explosives:

Substances Griess Diphenylamine Alcoholic KC

Chlorate No color Blue No color Nitrate Pink to red Blue No color Nitrocellulose Pink Blue-black No color Nitroglycerin Pink to red Blue No color PETN Pink to red Blue No color R D X Pink to red Blue No color TNT No color No color Red Tetryl Pink to red Blue Red-violet

Griess Reagent:

Solution 1 — Dissolve 1 mg. sulfanilic acid in 100 ml. of 30% acetic acid.

Solution 2 — Dissolve 1 g. alpha-naphthylamine in 230 ml. of boiling distilled water, cool.

Decant the colorless supernatant liquid and mix with 110 ml. of glacial acetic acid. Add solutions 1 and 2 and a few milligrams of zinc dust to the suspect extract. Diphenylamine Reagent:

Solution 1 — Dissolve 1 g. diphenylamine in 100 ml. concentrated sulfuric acid.

Alcoholic KOH Reagent:

Solution 1 — Dissolve 10 g. of potassium hydroxide in 100 ml. of absolute alcohol.

(Criminalistics by Richard Saferstein, p. 242).

Other Tests on Extract:

1. Infra-red spectrophotometry.

2. X-ray diffraction.

3. Gas chromatographic analysis.

ATOMIC BOMB EXPLOSION: Atomic nuclei can be regarded as storage of highly condensed

energy and that the uncontrolled release of this energy constitute an atomic explosion. The explosion is caused by the fission of about 100 pounds of uranium and liberates energy equal to that of a

328 LEGAL MEDICINE

million tons of TNT. It produces millions of pounds per square inch of gas pressure, with heat comparable to the sun and light of more than 30 times as bright as the sun at noontime. After explosion, it produces a luminous ball of fire containing radioactive fission products, which increases upward in size and creates shock waves moving sidewards in all directions. The fireball may have the diameter of 7,200 feet in ten seconds and in one minute time it may reach a height of 4-1/2 miles.

Place of Atomic Explosion:

1. Aerial Explosion — The bomb is made to explode on the air.

2. Ground Explosion — Explosion is made when the bomb reaches the ground.

3. Submarine Explosion — Explosion takes place underneath the surface of a body of water.

Rays Emitted by Radioactive Substances During Explosion:

1. Alpha Rays — Composed of positively charged helium, having a high linear energy transfer and with a poor penetrating power that can be stopped by a sheet of paper.

2. Beta Rays — Composed of positively or negatively charged electrons with a higher penetrating power than the alpha rays but the ionizing power is much less. The electrons are travelling at a very high velocity and in some cases approaching the speed of light.

3. Gamma Rays — Composed of short rays with high energy and greater penetrating power and like neutrons it extends a significant distance and causes much damage to the human body.

4. Neutron Rays — Uncharged and composed of highly penetrating particles and basic element in nuclei of atoms.

Characteristics of Nuclear Bomb Explosion that Distinguishes it from Conventional High Explosive Bomb Explosion:

1. It is many thousand times as powerful as a highly conventional bomb explosion and the effects of the blast are very prominent.

2. A large proportion of its energy is emitted as thermal radiation, causing skin burns and it is capable of starting a fire at a considerable distance.

3. The explosion emits a highly penetrating and harmful radiation, and the substance which remains after the explosion continues to emit radiation over a long period of time.

(Forensic Medicine by Tedeschi, Eckert & Tedeschi, Vol. 1, p. 633).

Effects of Atomic Explosion to the Human Body:

The effects of atomic explosion of the human body are inversely proportional to the distance. One megaton of atomic bomb exploded


in air can cause fire of up to a 10 miles radius. The pressure front of the blast can be felt one mile away in 2 seconds time. The blast wave is of sufficiently long duration which is accompanied by transient blast winds causing damages to the people and the surrounding structures.

Other effects of atomic explosion are the same as that of ordinary chemical bomb explosion but of a much more severe intensity.

Aside from the immediate traumatic effects, the radiation emitted by the radio-active substances can also have an effect which may be local or general. 1. General Effects:

Massive dose causes generalized erythema, disorientation followed by coma and death.

Lesser dose may-cause nausea, vomiting followed by prostration and rapidly developing and persistent leukemia.

Later symptoms may develop in the form of rise of temperature, ulceration of lymphoid, easy fatigability, oro-pharyngeal ulceration and severe leukopenia.

2. Local Effects:

a. Individual Cells — It causes retardation of cell division, structural changes in the chromosomes and cytoplasm, vacuolization, and with evidence of maturation. There is loss of the supporting mesenchymal cells.

b. Skin — Epilation of the hair with the follicles remaining intact, sweat glands lose their function, erector pili muscles not much affected. The skin become edematous and later disquamated and ulcerated. Radiation dermatitis is persistent, usually painful with patchy keratitis and foci of ulceration. Hyperpigmen-tation or depigmentation may later develop.

c. Blood Vessels — There is endothelial necrosis and localized thrombosis. The blood vessels thicken because of the hyalin-ization of the collagen. Some blood vessels are occluded with the loss of the muscular layer.

d. Eye — Cataract develops. e. Genital Organ — In female it causes sterility, abortion or still

birth. In men, it also causes sterility without loss of sexual potency. •

Factors Responsible for the EffectB of Radiation: 1. Age — Children and old persons are more susceptible to radiation.

2. Dosage — Bigger dose of radiation will cause more damaging effects on the body tissues.

330 LEGAL MEDICINE

3. Kind of Radiation — The biological damage is not always proportional to the energy absorbed, but it depends on the kind of energy emitted. Gamma and neutron radiations are most destructive.

4. Fractional Doses — A single dose may be lethal when administered fractionally over a long interval of time.

5. Sensitivity — Muscles and connective tissue are radioresistant while actively dividing tissues like blood forming organs, intestinal epithelium are quite radiosensitive.

Other Sources of Radiation:

1. Natural Source:

a. Cosmic Origin — Radiation from the sun or from outer space.

b. Terrestial Origin — Chiefly from radiothorium series of granite rocks.

2. Man-made Source:

a. Diagnostic X-ray Equipment:

The filament inside a vacuum tube is heated by a strong electric current so that it will emit electrons. The electron is driven on an anode target (Rhenium and molybdenum) which causes the development of electromagnetic energy, the wave length and the ability to penetrate depends on the kilovoltage applied. The higher the voltage, the shorter is the wave length and the more penetrating are the X-rays.

As the X-ray passes the tissues of the body, the degree of absorption depends on the density. The bones absorb more X-ray than the air containing tissues. Naturally the film behind receives a differential amount of X-ray. The denser substance like the bone, will be represented by a lighter image while the less denser organs will have a darker image.

In a fluoroscope, the X-ray after passing the body goes to a screen and the differential absorption of X-ray by the body is reflected in the fluoroscopic screen (Legal Medicine by Tadeschi p. €86).

b. Clinical nuclear pharmaceutical agents.

c. Therapeutic radiation apparatus.

d. Radiation sources used in industry, like nuclear power plant

The problem of the use of nuclear power in generating plants is the disposal of the radioactive waste which may be in the form of:

(1) Gases chiefly emitted from the vapor.

Chapter XIII

/GUNSHOT WOUNDS

D E A T H O R PHYSICAL INJURIES B R O U G H T A B O U T B Y POWDERED P R O P E L L E D SUBSTANCES

Death or physical injuries brought about by the powder propelled substances may be due to the following:

1. Firearm Shot — The injury is caused by the missile propelled by the explosion of the gunpowder located in the cartridge shell and at the rear of the missile. The direction of the movement of the missile is influenced by the desire of the person firing the firearm. The missile may be single as in the case of a pistol or revolver or may be of multiple shots or pellets as in the case of a shotgun. The cartridge shell is physically preserved after the fire.

2. Detonation of high explosives, as in grenades, bombs and mine explosion. Explosion of the gunpowder inside the metallic container will cause fragmentation of the container. Each fragment or shrapnel is moving with certain velocity without any predetermined direction.

I . F I R E A R M W O U N D

Definition of Firearm:

1. Technical Definition:

A firearm is an instrument used for thejpropulsion of a projectile_7 by theêxpansive force of gases^coming from the burning of gunpowder.

2. Legal Definition: Section 877, Revised Administrative Code — "Firearm" defined:

"Firearm" or "arm", as herein used, includes.jrifles,^muskets, shotguns,wrevolvers,^pistols, and jill other deadly weapons from

"which a bullet, >al l , shot, shell, or pfher missile may be discharged by means of gunpowder or other explosives. The term also includes air rifles except such as being of small caliber and limited range are used as toys. The barrel of any firearm shall be considered as a complete firearm for all purposes thereof.

Penal Provisions of Laws Relative to Firearm: Section 2692, Revised Administrative Code:

332

GUNSHOT WOUNDS 333

Unlawful manufacture, dealing in acquisition, disposition, or possession of firearms, or ammunitions therefor, or instrument used or intended to be used in the manufacture of firearms or ammunition: yj<KL

Any person who manufactures, deals in, acquires, disposes, or .possesses any firearm, parts of firearms, or ammunition therefor, or instrument or implement used or intended to be used in the manufacture of ammunition in violation of any provision of sections eight ^To-ltfv hundred seventy-seven to nine hundred and six, inclusive, of the code, as amended, .shall, upon conviction, be punished by imprisonment for a period of not less than pjie year and one day nor more*^' \^<ku\ than five years, or both such imprisonment and a fine of not less^^*R

than one thousand pesos nor more than five thousand pesos, in the discretion of the court. If the article illegally possessed is a rifle, carbine, grease gun, bazooka, machine gun, submachine gun, hand grenade, bomb, artillery of any kind or ammunition exclusively intended for such weapons, such period of imprisonment shall be not less than five years nor more than ten years. A conviction under this section shall carry with it the forfeiture of the prohibited article or articles by the Philippine Government.

Section 2690, Revised Administrative Code: ^

Selling of firearms to unlicensed purchaser:

It shall be unlawful for any dealer in firearms or ammunition to sell or_deliver any firearms or ammunition or any part of a firearm to a purchaser or other person until such purchaser or other person shall have obtained the necessary license therefor. Any person violating the provisions of this section, upon conviction in a court of competent jurisdiction, shall be punished by a fine not exceeding two thousand pesos, or by imprisonment not exceeding two years, or both. U 11**

Section 2691, Revised Administrative Code: /

Failure of personal representative of deceased licersee to surrender firearm:

When a holder of any firearm license shall .dfc ° r become subject to legal disability and any of his relatives, or his legal represenative, or any other person shall knowingly come into_j>ossession of any firearm or ammunition covered by such license, such person, upon failure to deliver the same to the Chief of .Constabulary in Manila or to the senior officers of Constabulary in the province, shall be punished by a fine not exceeding five hundred pesos or by imprisonment not exceeding six months, or both. If £r**

334 LEGAL MEDICINE


Alarms and Scandals:

The penalty of arresto menor or fine not exceeding 200 pesos shall be imposed upon:

1. Any person who within any town or public place, shall discharge any firearm, rocket, firecracker, or other explosive calculated to cause alarm or danger;

2


Discharge of firearms:

Any person who shall shoot at another with any firearm shall suffer the penalty of prision correccional in its minimum and medium periods, unless the facts of the case are such that the act can be held to constitute frustrated or attempted parricide, murder, homicide or any other crime for which a higher penalty is prescribed by any of the articles of the code:

Classification of Small Firearms: y

Small firearms are those whichQpropel projectile] of less than one inch in diameter.

1. As to Wounding Power:

a. Low Velocity Firearm — These are firearms with muzzle velocity of not more than 1,400 feet per second.

Example: Revolver,

b. High Power Firearm — These are firearms with muzzle velocity of more than 1,400 feet per second. The usual muzzle velocity is 2,200 to 2,500 feet per second or more.

Example: Military Rifle.

2. As to the Nature of the Bore:^*-

a. Smooth Bore Weapon — This firearm has the inside portion of the barrel that is perfectly smooth from the firing chamber to the muzzle.

Example: Shotgun,

b. Rifled Bore Firearm — This is a firearm with the bore of the barrel with a number of spiral lands and grooves which run parallel with one another, but twisted spirally from breech to muzzle.

Example: Military Rifle.

3. As to the Manner of Firing:

a. Pistol — Firearm which may be fired only by a single hand.

Example: Revolver.

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b. Rifle — Firearm which may be fired from the shoulder.

Example: Shotgun.

4. As to the Nature of the Magazine:

a. Cylindrical Revolving Magazine Firearm — The .cartridge is located in a cylindrical magazine which ^tates at the rear portion of the barrel.

Example: Revolver.

b. Vertical or Horizontal Magazine — The cartridge is held one after another vertically or horizontally and also held in place by a spring side to side or end to end.

Example: Automatic Pistol.

Types of Small Firearms which are of Medico-legal Interests

1. Revolver — A revolver is a firearm which has a cylindrical magazine situated at the rear of the barrel, capable or revolving motion and which can accommodate five or six cartridges; each of which is housed in a separate chamber. After a shot, the circular magazine rotates by the cocking of the hammer in a way that the next cartridge is brought in the proper position for firing. The usual muzzle velocity of a revolver is 600 feet per second.

Kinds of Revolver as to Construction or Mechanism:

a. Revolver with the barrelffirmly fixed to the frame and the revolving cylinder may swing oufjto the side for the purpose of loading or extraction of the spent shell.

b. Revolver with the barrel Vhinged to the frame and the revolver cylinder may be brokerfjto load by releasing the barrel latch.

c. Revolver with barrel£firmly fixed to the frame and the revolving cylinder may be removed} by taking out the cylinder pin on which it rotates.

2. Automatic Pistol — This is a firing weapon in which the empty shell is ejected when the cartridge is fired and a new cartridge is slipped into the breech automatically as a result of the recoil. The cartridge is contained in a vertical magazine which holds six to seven cartridges. It is not automatic in action in the sense that a continuous pressure on the trigger will not make the firearm fire continuously. It is more correct to call it a "self-loading firearm." It has a usual muzzle velocity of 1,200 feet or more per second.

3. Rifle — A rifle is a firearm with a long barrel and butt. It may be a military rifle or a miniature rifle. A military rifle has a magazine and volt action of various types. The miniature rifle is a single self-loading weapon. A military rifle usually has a muzzle velocity

336 LEGAL MEDICINE

of 2,500 feet per second and a range of 3,000 feet. Unlike a revolver or automatic pistol which can be fired by a single hand, a rifle is fired from a shoulder.

4. Shotgun — A shotgun is a firearm whose projectile is a collection of lead pellets which varies in sizes with the type of the cartridge applied.

A Weapon, In Order to Cause Injury must have Two Principal Component Parts, Namely:

1. The Cartridge or Ammunition — a complete unfired unit consisting of bullet, primer, cartridge case and powder charge.

2. The Firearm — the instrument for the propulsion of a projectile by the expansive force of gases from a burning gunpowder.

CARTRIDGES OR AMMUNITION

The Principal Parts of a Cartridge or Ammunition are:

1. The cartridge case or shell.

2. Primer.

3. Powder or propellant.

4. Bullet or projectile.

1. Cartridge Case or Shell:

The cartridge case or shell is a cylindrical structure with a base which houses the powder, the primer at the base and with the bullet attached at the tip. In ordinary hand guns the cylindrical structure is made of brass while in shotguns it is usually made of cardboard. The base is always made of metal. Inscription at the base may show the manufacturer, the caliber and even the date it was manufactured.

Depending upon the relationship of the diameter of the base with that of the cylindrical portion, a cartridge may be classified as:

a. Cartridge With a Rim — The base of the cartridge has a diameter more than the cylindrical portion. The rim is used to prevent the cartridge from going through the barrel. This is common among revolvers.

b. Rimless Cartridge — The base or head of the cartridge has the same diameter as that of the cylindrical body. There is a groove cut between the base and the cylindrical body for the extractor to hook into. This is usually found in self-loading firearms.

c. Semi-rimless Cartridge — This looks like a rimless at first glance but actually the rim does project very slightly above the line of the cylindrical part.

GUNSHOT WOUNDS 337

d. Belted Cartridge — The cartridges are attached in a series in a canvass belt for successive fires.

2. Primer:

The primer compound is located and sealed at the cartridge base covered by a small disc of soft metal, which is usually a lead-tin alloy known as percussion cap or primer cap. The main function of the primer is the transformation of mechanical energy by the hit of the firing pin on the percussion cap to chemical energy by its rapid combustion. As the firing pin hits the primer cap (percussion cap), the primer compound hits the anvil which causes the generation of a flash which in turn ignites the powder. The time of the primer activation is approximately 0.00001 second.

Although, there are variations in the chemical constituents of the primer in the past, it is composed of a mixture of mercury fulminate, stibnite (antimony sulfide), potassium chlorate and powdered glass. Later, mercury fulminate is partially or completely replaced by lead azide and lead stypnate together with potassium chlorate which are replaced by barium nitrate to reduce the development of rust. Lead stypnate is utilized as base, tetracene is sometimes added to control sensitivity and barium nitrate acts as moderator and oxidizer. The most common constituents of primer are lead, antimony and barium.

As to the location of the percussion cap at the base, cartridge may be:

a. Cartridge with Center Fire — The percussion cap is located at the center of the base of the cartridge. This is the most common.

b. Cartridge with Rim Fire — The primer is placed inside the rim of the shell. This is common in 0.22 caliber firearms.

c. Firearm with Pin — The firing pin strikes a needle which is placed at the rim of the shell. The needle will then press on the percussion cap which is inside the cartridge. This type is obsolete and now rarely found.

3. Gunpowder or Propellant: ^ The propellant is the primary propulsive force in a cartridge

which when exploded will cause the bullet to be driven forward towards the gun muzzle.

There are Different Types of Powder Propellant Used:-a. Black Powder — A mixture of potassium nitrate (75%), sulfur

(15%) and charcoal (10%).

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Explosion of one grain of black powder (one grain = 0.065 gm.) will produce 200 to 300 cc. of gas composed of carbon dioxide (50%), carbon monoxide (10%), nitrogen (35%), hydrogen sulfide (3%) and traces of methane and oxygen. The solid residues following its combustion are potassium sulfate, potassium sulfide, potassium carbonate together with its original components.

b. Smokeless Powder — It may be:

(1) Single Base — When it contains either cellulose nitrate or nitroglycerine.

(2) Double Base — When the powder is composed of both cellulose nitrate and nitroglycerine.

Explosion of one grain (one grain = 0.065 gm.) of smokeless powder will cause the development of 800 to 900 cc. of gas consisting of carbon dioxide, nitrogen, hydrogen with some unburnt powder in the form of nitrate and cellulose nitrate which can be detected chemically.

c. Semi-smokeless Powder — This is a mixture of 80% of black and 20% of the smokeless powder.

Smokeless powder causes development of less flame and less powder residue as compared with black powder.

There is more complete burning of gunpowder in smokeless as compared with the black powder.

Inasmuch as the gas produced by combustion of smokeless powder is three times more than the black powder, the muzzle velocity of bullets with smokeless powder is also approximately three times greater than the bullets using black-powder.

Smokeless powder granules are usually coated with graphite and consequently form different shapes. They may appear as a ball, square, cylinder, disc or flakes. Consequently when discharged from the firearm after explosion they will cause individual shapes of tattooing. The flake or disc shape powder may cause varying shapes of the tattoos depending upon how the grain struck the skin. Ball powder may cause small, hemorrhagic punctate marks. The cylindrical shape powder grains may cause heavy tattooing with deposition of soot at 6 inches range.

4. Bullet (Slug, Missile, Projectile):

It is the metallic object attached to the free end of the cylindrical tip of the cartridge case, propelled by the expansive force of the propellant, and responsible in the production of damages in the target. In some instances bullets are not metallic but made

Bullets lodged and extracted from a victim

of rubber, plastic, or even paraffin, but their uses are primarily confined to target practice.

Classification:

a. Shape of the free end:

(1) Conical — The free end of the bullet is tapering and pointed. The purpose is to minimize the resistance offered by the atmosphere, to increasing its penetrating power and to minimize deflection upon hitting the target.

(2) Hemispherical — The free end is dome-like and commonly observed in short firearms.

(3) Wad-cutter (Square Nose) — The free end is flattened commonly used in target practices.

(4) Hollow-point — There is a depression at the tip to expand or "mushroom" at impact on hard object, to slow its speed in the body so that more kinetic energy will be released thereby increasing its shocking effect.

b. As to presence or absence of jacket:

(1) Naked Lead Bullet — Bullet without outer coating.

(2) Jacketed Bullet — Bullet with external coating usually copper, nickel, steel or zinc. The purpose of the coating are to:

(a) To prevent fouling of the barrel;

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( b ) To withstand deformity in automatic loading process; and

(c) To prevent deformity when carried and exposed to rough handling.

A jacketed bullet may be:

i. Full Jacketed Bullet — the whole bullet up to the base is enveloped with a metallic jacket.

ii. Semi-jacketed Bullet — The nose or free end is partly or fully exposed while there is relatively thin but tough coating of the base and the cylindrical portion. This is made to permit expansion of the bullet when it hits hard objects. Semi-jacketed bullets may be hollow-point.

The general rule is that soft-metal, round nose bullets are fired from a revolver; full-jacketed bullets are fired from a rifle and self-loading firearm; semi-jacketed bullets are fired from an automatic (self-loading) firearm or rifle.

Special Bullets:

a. Armour Piercing Bullet — made of steel with copper coating (jacket).

b. Phosphorus Flare or Tracer Bullet — This consists of an aluminum tip and is packed with incendiary (phosphorus) which burns during flight. It is used to determine the direction of the fire. The speed of sound in air is 1,087 feet per second or 331.3 meters per second.

c. Plastic Bullet — used for target practice. d. Bullet with Plastic Sabot — The bullet together with the sabot

travel up to the bore. The bullet never comes in contact with the barrel and therefore there will be no rifling marks imparted in the bullet but on the sabot. The front half of the sabot has six slits. As the sabot leaves the barrel it offers resistance and the slit part of the sabot will fold backward, causing resistance and falls away.

At three feet, the sabot and bullet are still in line. At 6 to 7 feet, they strike the target separately. The sabot itself travels approximately 50 feet.

e. Bullet with Secondary Explosion — The bullet may leave the barrel and upon reaching a certain distance it produces secondary explosion and shrapnel splinters.

f. Soft Point Bullet — A bullet which is easily flattened upon hitting the target to increase the wounding effect.

GUNSHOT WOUNDS 343

FIREARM

For purposes of Medico-legal Investigation, the following Parts of a Firearm are important:

1. The trigger with the firing pin.

2. The barrel.

Other Parts of a Firearm:

1. Handle or Butt — The portion of the firearm used for handling it. It may house the magazine.

2. Firing Chamber — The place where the cartridge is held in position before the fire mechanism starts.

3. Breechblock — The steel block which closes the rear of the bore against the force of the charge. The face of this block which comes in contact with the base of the cartridge is known as the breech-face.

4. Trigger Guard.

5. Front and Rear Sight.

6. Safety Device like safety lock.

7. Sling.

In a Self-loading Firearm, the following are the Additional Parts:

1. Extractor — The mechanism by which the spent shell or ammunition is withdrawn from the firing chamber.

2. Ejector — The mechanism by which the empty shell or ammunition is thrown from the firearm.

1. Trigger: This is a part of the firearm which causes firing mechanism.

Except in a single action firearm, pressure on the trigger is the commencement of the whole firearm mechanism. To avoid accidental firing, the trigger is surrounded by a trigger guard. Classification of Firearm Based on Trigger Mechanism:

a. Relation of Cocking and Trigger Pressure:

(1) Single Action Firearm — The firearm is first manually cocked then followed by pressure on the trigger to release the hammer.

Example: Home-made "Paltik". (2) Double Action Firearm — A pressure applied on the trigger

will both cock and fire the firearm by release of the hammer. Example: Standard Revolver.

b. Number of Shots on Pressure on the Trigger:

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a. Shotgun 4 lbs. b. Self-loading pistol 3 to 4 lbs. c. Revolver 3 to 5 lbs. d. Service rifle 6 to 7 lbs.

2. Barrel:

a. Riflings:

The inner surface of a shotgun and that of a home-made gun is smooth while single shot standard firearms are with riflings.

The inner surface of the barrel has a series of parallel spiral grooves on the whole length called riflings. The space between the two grooves is the land. The riflings are made to have a strong barrel grip on the bullet, to stabilize its movement and to impart a rotational movement on the bullet. Incidentally, the rifling reflected on the bullet becomes an important factor in the identification of firearms.

Gun manufacturers vary the way the riflings are imprinted in the inner surface of the barrel on the following aspects: (1) Number — The number of lands and grooves varies from 2

to 12.

Most high velocity firearms have 4 to 6 grooves. Some firearms have multiple shallow grooves and this is known as microgroove6 rifling.

(1) Single Shot Firearm — A pull or pressure on the trigger will cause only one shot. Example: Revolver.

(2) Automatic Firearm — A continuous pressure on the trigger will cause a series of shots until the trigger pressure is released. Example: Machine gun.

Trigger pressure is the amount of force (pressure) on the trigger necessary to fire a gun. Its determination is necessary in the assessment of whether the firing can possibly be accidental.

"Hair trigger" is a vague term used when the firearm trigger pressure is 1.0 lb. (pound) or less. It is intrinsically unsafe and should only be used under rigorously controlled situations because of the possibility of unintended or accidental fire.

In general, the single action firearm varies from 3-1/2 to 10 pounds and in double action, it varies from 6 pounds to as much as 18 pounds. The following are the approximate trigger pressures of certain types of firearms.

GUNSHOT WOUNDS 345

(2) Twist or Rate — This is the expression for one complete turn of the rifling on a certain length of the barrel. We say the twist rate is 1:12 when there is one complete spiral groove in 12 inch of the barrel. Spiral groove twist or rate may be:

(a) Fast Twist — When the number of inches of the barrel required for a complete turn is small, like 1:8.

(b ) Slow Twist — When a greater number of inches in the barrel is necessary to have one complete turn, like 1:14.

(3) Direction — The direction of rifling may either be righ£ (clockwise) or left (counterclockwise).

(4) Width of the Groove and Land — The width of the groove varies with the manufacturer and caliber. Some have the width of the groove different with that of the land while others are the same or equidistant.

Example:

Colt 0.32 has 6 lands and grooves, twist to the left, the width of the land and groove are 0.048 and 0.108 respectively.

Smith and Wesson 0.32 has 5 lands and grooves, twist to the right and are equidistant at 0.095 inch.

Table of Number of Grooves and the Direction of Riflings

No. of Direction of Grooves Riflings

1. Revolvers: - Webley, 455, .38, .32 7 right — Colt, all calibers 6 left

— Smith and Wesson, .45, .32 5 right

- J.T. & S. & W. model 4 right

2. Automatic Pistols: - Webley, .455, .32, .25 6 right

— Browning 6 right

— Mauser, .25 6 right - Colt, .45, .38, .25 6 left

— Delta 6 left

— Victoria (Spanish make) 6 left

— Luger P-08, 9 mm. (German) 6 right — Fibrique National, 9 mm. (Belgian) 6 right

Aside from those marks previously mentioned, the bullet or the shell shows individual or accidental characteristics which are deter-

346 LEGAL MEDICINE

mutable only after the manufacture. They have characteristics whose existence is beyond the control of men and which have a random distribution. Their existence in a firearm are brought about through the failure of a tool in its normal operation, through wear, abuse, mutilation, corrosion, erosion, or other fortuitous causes. Those marks may be imprinted in the bullet or shell and may be used for identification purpose.

When the bullet or the shell or both has been recovered and a suspected firearm has been found in the possession of a person, the procedure is to fire the suspected firearm at a recovery box and compare the shell and bullet in the comparison microscope with the one in question.

How to Determine the Caliber of Firearm:

The caliber is the diameter of the barrel between two lands. Table showing the relation between American, English and Con

tinental Caliber:

American Caliber English Caliber Continental Caliber in Mm.

.22 Inch .220 Inch 5.6

.25 " .250 M 6.5(6.35)

.28 M .280 M 7.0

.30 M (.32 Rev.) .300 " (.303) 7.65

.32 .320 " 8.0

.35 •• (.351) .350 9.0

.38 » .360 " 9.3

.38 .370 » 9.5

.38-.40-.41 Inch 410 •• 10.0

.405 Inch 10.5

.44 " .440 " 11.0

.45 M .450 " (.455) 11.25 (From: Modern Criminal Investigation by Harry Soderman and John O'Connell, 4th ed., p. 201).

To convert millimeter calibration to inches, multiply the caliber

in millimeters by 0.03937 or divide by 25.4. To convert inches calibration to millimeters, multiply by 25.4 or

divide by 0.03937.

MECHANISM OF FIREARM ACTION:

Generally, the principles involved in all firearm actions are the same. When the firearm is cocked and ready to fire, a pull on the trigger will cause the firing pin of the hammer to hit the percussion cap of the cartridge in the firing chamber which is aligned with rear

GUNSHOT WOUNDS 347

portion of the barrel. The hit by the firing pin on the percussion cap will cause generation of a sufficient heat capable of igniting the primer. The primer will in turn ignite the gunpowder or propellant which will cause evolution of gases under pressure and temperature. The marked expansion of the gases will force the projectile forward with certain velocity. Owing to the presence of the rifling at the inner wall of the bore, the barrel offers some degree of resistance to the projectile. Inasmuch as the rifling marks are arranged in a spiral manner, the projectile will produce a spinning movement as it comes out of the muzzle.

Together with the bullet passing out of the barrel are the high-pressured heated gases, unbumt powder grains with flame and smoke.

During explosion, there is a backward kick of the firearm which in an automatic firearm causes the cocking and the empty shell thrown out by the ejector. The backward movement is called recoil of the firearm.

Things Coming Out of the Gun Muzzle After the Fire: ^

1. Bullet. 2. Flame. 3. Heated, compressed and expanded*gas. 4. Residues coming from:

a. Bullet: (1) Fragment (jacket, lead). (2) Lubricant.

b. Powder particles: (1) Powder grains (unbumed, burning). (2) Soot. (3) Graphite.

c. Primer: (1) Lead, barium, antimony, etc..

d. Barrel: (1) Lubricant. (2) Rust, dust, etc.. (3) Scraping from bullet by previous fire.

e. Cartridge case: (1) Copper, zinc.

Bullet's Kinetic Energy: Kinetic energy is energy associated with motion. In the English

system it is express in foot pound or the work of a force resulting when a weight of one pound is brought to a height of one foot.

348 LEGAL MEDICINE

In ballistics, the wounding power of a bullet is due to the mass (weight) and its velocity, with the velocity playing a very important

Tissue damage of a bullet of a very high velocity is very much greater than those with much less velocity.

The damage cause by a bullet with impact velocity similar to muzzle velocity is greater than when the impact occurred at a reduced speed after the bullet has travelled a distance.

Bullet Efficiency:

The cartridge powder charge can be burned in approximately 0.00001 second. The conversion rate by combustion of the gunpowder to bullet energy is about 30 to 32 percent. The loss of some energies from the gunpowder explosion may be due to:

a. Loss of energy to force the bullet out of the cartridge case, rifling and friction in the barrel.

b. Heating of the barrel and chamber.

c. Escape of some of the compressed gasses at the breech and barrel.

d. Not all gunpowder are ignited.

Obturation:

This is the sealing or prevention of gunpowder gas after explosion from escaping so as to maintain high pressure in the firing chamber thereby increasing the propulsive power on the bullet. This is maintained:

a. By insuring that the bullet tightly fits the bore throughout its entire length;

b. By sealing the cartridge case to the chamber wall; and

c. By preventing leakage between the primer cap and its retaining wall in the cartridge.

Ballistics Coefficient:

This describes the ability of a bullet to maintain its velocity against air resistance. It may be expressed in the following formula:

role.

Kinetic Energy = M V 2

2 G

M = Mass (Weight) V = Velocity G = Gravity

C — ballistic coefficient m — mass i — form factor d — diameter

GUNSHOT WOUNDS 349

The larger the coefficient, the more efficient is the bullet or projectile. The better the ballistic coefficient of a bullet, the less velocity loss it will suffer over a given resistance.

Movements of the Bullet as it Moves Out of the Muzzle:

1. Forward Movement — The velocity depends upon the propulsion created by the ignition of the propellant.

2. Spinning Movement — This is due to the passage of the bullet at the spiral landings and groovings of the barrel. The ratio depends on the twist and length of the barrel.

3. Tumbling Movement (End-over-end flotation/-The bullet may be rotating on the long axis of its flight while the nose and the base are alternating ahead in its flight. This accounts why in some instances, the bullet hits the skin with its base.

4. Wabbling Movement (Tailwag) — The rear end of the bullet aside from spinning may also vibrate vertically or sidewise in its flight. Like tumbling movement, it may cause hitting the target sidewise.

5. Pull of Gravity — As the bullet is moving forward, it gradually goes downward on account of the pull of the force of gravity. As the bullet looses its kinetic energy, the pull of the force of gravity becomes dominant until it falls on the ground.

Flame:

Ignition of the propellant will cause the production of flame. It is conical in shape with the vertex located at the gun muzzle. The flame does not usually go beyond a distance of 6 inches and in pistols or revolvers the flame is often less than 3 inches.

The flame causes scorching or burning of the skin and searing of the hair at the target in a very near shot. In contact fire, the edges of the wound of entry may be burned.

Heated, Compressed and Expanded Gas: Ignition of the gunpowder will cause production of heat and gas.

Considering the limited space of the firing chamber and barrel, the compressed gas propels the bullet to move forward. The volume of the gas generated is dependent on the nature and quantity of the propellant. Thus a 50 grain gunpowder in a cartridge with black powder (one grain producing 200 to 300 cc. of gas) will cause the production of 10 to 15 liters of gas while the same amount of cartridge with smokeless powder (one grain producing 800 to 900 cc. of gas) will cause production of 40 to 45 liters of gas confined in a very limited space. This is on the presumption that all of the gunpowder were ignited.

350 LEGAL MEDICINE

The sudden release of the expanded gas from the muzzle following the bullet is known as a muzzle blast.

Smoke (Soot, Smudging, Fouling, Smoke Blackening):

This is one of the byproducts of complete combustion of the gunpowder and other elements with the propellant. It is light, almost black, and lack sufficient force to penetrate the skin. It is merely deposited on the target and readily wiped off. It may be seen with a distance of up to 12 inches.

The presence of smudging at the wound of entrance infers a near shot. The shape may also be useful in determining the trajectory. A circular shape deposition may be typical of a perpendicular approach of the bullet while in case of an acute angle the deposition may appear to be elliptical.

Powder Grains:

This consists of the unburned, burning and partially bumed powder, together with graphite which come out of the muzzle. Inasmuch as it is relatively heavier than smoke, it leaves the barrel with appreciable velocity and in near shot, it is responsible to the production of tattooing (stippling, peppering) around the gunshot wound of entrance.

In close range, the powder grains penetrate the dermal and epidermal layers of the skin and may cause hemorrhage in deeper tissue which cannot be removed by ordinary wiping. Microcontusion may be observed around the punctured area and the shape of the puncture may denote the shape of the penetrating grain. As the distance of the gun muzzle to the target increases, the area of destruction increases, but the density of tattooing decreases.

In case of black powder, the residue is composed of nitrates, thiocyanates, thiosulphates, potassium carbonates, potassium sulphate and potassium sulphide, while in smokeless powder, the residue is composed of granules with nitrites and cellulose nitrates with graphite.

The presence of tattooing or stippling may be seen around the wound of entrance up to a distance of 24 inches, although there may be considerable variation from gun to gun.

Powder Burns:

Powder burns is a term commonly used by physicians whenever there is blackening of the margin of the gunshot wound of entrance. The blackening is due to smoke smudging, gunpowder tattooing and to a certain extent burning of the wound margin. It is the combined effects of these elements that are considered to be powder bums. Actually, such blackening is primarily due to smoke smudging and

GUNSHOT WOUNDS 351

gunpowder tattooing so that the term sotting of the target rather than powder bums is more appropriate to describe the condition.

Factors Responsible for the Injurious Effects of Missile:

1. Factors Inherent on the Missile:

a. Speed of the Bullet — The greater the muzzle velocity, the greater is the destruction inasmuch as more kinetic energy can be liberated.

b. Size and Shape of the Bullet — The bigger the diameter or the more deformed the bullet is, the greater are the injuries in the body tissues.

c. Character of the Missile's Movement in Flight — Spinning movement will increase the wounding power; "Yawing" and stumbling movement may cause sidewise penetration and entry and cause more destruction; and ricochette may alter tissue involvement in its course.

2. Nature of the Target:

a. Density of Target — The greater the density of the tissue struck, the greater will be the damage. More energy will be spent by the bullet in its course in penetrating skin, bones and clothes. Heavy thick clothes may prevent penetration of missile; fragile bone may fragment when hit and each fragment may act as a secondary splinter to cause further injuries.

b. Length of Tissue Involvement in its Course — The longer the distance of travel of the missile in the body, the more kinetic energy it liberates, and the more destruction it will produce.

c. Nature of the Media Traversed — Bullet passing air spaces is less destructive inasmuch as air is relatively compressible however, bullet traveling in a liquid or solid media may accelerate transmission of force to the surrounding tissue thus, causing more destruction.

d. Vitality of the Part Involved — There is more likelihood for a fatal consequence when vital organs are involved than those in other parts of the body.

Abrasion Collar (Contuso-abradded Collar, Marginal Abrasion):

The pressure of the bullet on the skin will cause the skin to be depressed and as the bullet lacerates the skin, the depressed portion will be rubbed with the rough surface of the bullet. A perpendicular approach will produce an even width of the collar. An acute angle of approach will cause an abrasion collar wider at the acute angle of approach.

352 LEGAL MEDICINE

Destructive Mechanism of Gunshot:

The following physical phenomena are responsible for the causation of injury in the body of the victim:

1. Laceration and Permanent Cavity in the Bullet Trajectory:

The pressure of the speeding bullet produces severe pressure on the tissues and organs causing laceration and mechanically creates a permanent cavity. High velocity bullets can cause bigger damage and wider cavity formation.

2. Temporary Cavity:

This is the instantaneous radial displacement of the soft tissues during the passage of the bullet due to the liberation of kinetic energy. The size of the cavity is dependent on the velocity of the bullet and elasticity of the tissues. The greater the velocity, the larger the temporary cavity formed. The diameter and volume of the temporary cavity are many times greater than the diameter and volume of the projectile that produces it. Although the development is transient during the passage of the missile, it causes loss of function to the part involved and further act as a secondary missile to involve other areas.

3. Hydrostatic Force:

When the bullet traverses organs filled with fluid, like a full stomach, cerebral ventricle, heart chambers, the liquid contents within the lumen of these organs are displaced radially away from the bullet path producing extensive laceration. The displaced fluid carries with it the kinetic energy which in turn acts as a secondary projectile causing destruction of tissues not on the path of the bullet.

4. Shock Wave:

This is the dissipation of kinetic energy in a radial direction perpendicular to the path of the bullet when the bullet velocity is more than the speed of sound (the speed of sound is 1,087 feet per second). The severe intensity of the wave causes severe shocking effect on the adjacent tissues and may cause actual destruction or lessening of function.

5. Fragmentation or Disintegration of the Bullet:

When the bullet hits a hard object (bone), it fragments to several pieces. When the bullet velocity is more than 2,000 ft/sec. it disintegrates and each fragment has sufficient kinetic energy to cause injuries similar to the mother bullet. It may cause laceration, fracture and shocking effect, thus increasing the destructive effect of gunshot. This causes more "shocking power" or "knockdown power" of the bullet.

GUNSHOT WOUNDS 353

6. Fragmentation of Hard Brittle Object in the Trajectory:

Bone involvement along the trajectory may cause comminuted fracture and each bone fragment may cause additional damage on the surrounding tissues and even in the wound of exit.

Passage of the bullet causes a clean-cut hole at the point of initial contact and beveling at the point of exit. The beveling is due to the absence of a hard support as the bullet leaves the bone.

In the skull a through and through wound will produce a round or oval hole at the outer table with leveling of the inner table and at the point when a bullet makes the exit, the clean cut hole will be at the inner table and beveling will be at the outer table.

7. Muzzle Blast in Contact Fire:

When the gun muzzle is pressed on the skin when fired, all of the products of combustion primarily the muzzle blast will penetrate the tissues causing severe mechanical destruction on account of pressure. The explosive effect will cause extensive laceration of soft tissues and fracture of bones.

8. Other Consequential Effects on the Body of the Victim:

Aside from direct involvement of vital structures of the body, pressure to other organs and tissues, the gunshot wound may be the source of hemorrhage, infection, paralysis, shock, loss of functioning etc. which may cause disability or death on the victim.

/ Gunshot Wound of Entrance (Entrance Defect, Inshoot):

The appearance of the gunshot wound of entrance depends upon the following: 1. Caliber of the Wounding Weapon:

Excluding other factors which may influence the size of the wound of entrance^ the higher the caliber of the wounding bullet the greater will be the size of the wound of entrance'/ It must not be overlooked that the manner of approach of the bullet to the skin, the distance of the muzzle of the firearm to the skin surface, the deformity or splitting of the bullet and the portion of the skin surface involves modification of the size and shape of the entrance.

2. Characteristics Inherent to the Wound of Entrance:. The wound of entrance, as a general rule, is»'oval or circular

with inverted edges,' except in near shot or in grazing or slap wounaT'ÂTUieTDuiret approaches the skin, there is an indentation of the skin surface but later, on account of the extreme pressure; the skin tissues give way. The rough surface of the bullet comes in contact with the skin thereby producing a contusion or abrasion

354 LEGAL MEDICINE

collar. In most cases,' the size of the wound of entrance is smaller than the caliber of the wounding bullet'on account of the retraction of the connective tissues.

The0 wound of exit is usually larger than the wound of entrance*—' It may be stellate, slit-like, cruciform, or markedly lacerated. The deformity of the bullet in its course inside the body, the lack of support beyond the skin, and the velocity of the missile are responsible for the increase in size of the exit wound.

3. Direction of the Fire:

A* right angl£ approach of the bullet will make the wound of entrance circular in shape, except when the missile is deformed or the fire is in contact or near. In cases of an acute angle of approach of the bullet, the wound of entrance is oval in shape with the contusion or abrasion collar widest on the side of the acute angle of approach. There is more likelihood for deflection of the bullet course wherever it hits the bony tissue.

4. Shape and Composition of the Missile:

Deformity of the bullet modifies the shape of the wound of entrance. Some missiles are purposely made to enhance deformity upon hitting hard objects like hollow-point, dum-dum and soft point bullets. Hard or armor-piercing bullets are not usually deformed on account of their hard metallic constituents.

5. Range:

In close range fire, the injury is not only due to the missile but also due to the pressure of the expanded gases, flame and other solid products of combustion. Distant fire usually produces the characteristic effect of the bullet alone.

6. Kind of Weapon:

High power weapon has more destructive effect as compared with low power one. The shape of the bullet also plays an important role. Conical shape free end bullets have more piercing power without marked tissue destruction while missiles with hemispherical free ends are more destructive.

Contact F i r e : ^

The nature and extent of the injury is caused not only by the force of the bullet but also by the gas of the muzzle blast and part of the body involved. The following factors must be taken into consideration:

1. The Effectiveness of the Sealing Between the Gun Muzzle and the Skin:

If all the gaseous product of combustion is prevented from

GUNSHOT WOUNDS 355

being spilled out, there will be more destructive effects on the tissues.

2. The Amount of Gas Liberated by the Combustion of the Propellant:

The volume of gas liberated after explosion of the propellant is dependent on the amount and nature of the powder, and the extent of powder combustion. The greater is the amount of gas in a confined area, the greater will be the tissue destruction.

3. Nature of Bullet:

Bigger caliber bullet is obviously more destructive than smaller ones. Soft or hollow point bullet has the tendency to flatten and causes more damage to tissues.

4. Part of the Body Involved:

The nature, character and extent of injury in contact fire is different (1) when the bone is superficially located under the skin, and (2) when the bone is deeply located in loose or soft parts of the body.

Pressed and Firm Contact Fire: S

1. On Parts of the Body Where Bone is Superficial:

This is commonly observed on the head where the skull is just underneath the scalp. The following are the characteristics of the injuries:

a. The wound of entrance is* large," frequently star-shaped due to tear radiating from the entrance wound caused by the blast effect which follows the sudden release of gases into a confined area between the skin and the underlying bone.

b. Edges of the wound may be" everted.' The creeping of the gases between the skull and the scalp causes the skin to move towards the muzzle.

c. Areas in the entrance wound is blackened by burns, tattooing and smudging1.1 Singeing of the hair is confined only at the site of wound of entrance.

d. Muzzle imprint, Barrel impression (Profile of the muzzle) on the skin — The outward movement of the skin caused by the imprisoned gas will add more pressure to the gun muzzle coupled with the heat of the explosion and will cause iron-like effect on the pressed skin.

Causes of Muzzle Imprint: (1) The gun muzzle is pressed on the body at the time of the

fire and the heated muzzle during the blast produced an ironing effect on the skin.

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(2) The gun muzzle is pressed on the body, pushed momentarily away and then hit the body again because of the continuous inward pressure.

(3) When the gun is fired on areas of the body where bony tissue is superficial, like the scalp, the muzzle blast has the tendency to creep in the loose connective tissue between the skull and the skin thereby pushing the skin outward to press on the gun muzzle.

e. The bullet may cause radiating fracture and the pressure of the gases may cause fragmentation of the skull and a severe laceration of the brain and its meninges.

f. Blood and tissue become pink due to carbon monoxide.

g. Fragments of lead and bullet jacket may be found.

Metal Fouling — When the bullet travels the whole length of the tight fitting barrel, it is rotated by the lands and grooves. Its surface is scraped by the lands and the scraping is ejected from the barrel and strikes the target. It may lodge on the clothings or may cause small abrasions or superficial lacerations on the skin around the main wound.

h. Singeing of hair.

Gunshot wound of entrance with contusion collar, powder burns and tattooing.

2. Parts of the Body Where the Bone is Deeply Located:

a. Wound of entrance is usually large, circular and without radiating

GUNSHOT WOUNDS 357

laceration. The gas from the muzzle can easily penetrate deeper structures.

b. Edges are everted due to outward slapping of the skin. In some instances, soft tissues (blood, fibrous and muscular tissues) may be found inside the gun barrel. This is due to the negative pressure created in the barrel after the blast.

c. Singeing of the hair, blackening of the wound due to fouling, burn, and tattooing.

d. Muzzle imprint due to outward slapping of the skin and heat.

e. Pinkish color of the deeper structures due to carbon monoxide.

Loose Contact or Near F i r e : ^

1. Entrance wound may be^large circular or oval depending upon the angle of approach of the bullet.

2Âbrasion collar**or ring is distinct.

3^Smudging, burning and tattooing are prominent with singeing of the hair.

4. Muzzle imprint may be seen depending upon the degree of slapping of the skin of the gun muzzle.

5. There is^blackening of the bullet tract to a certain depth.

6.TJarboxyhemoglobin is present in the wound" and surrounding areas.

Short Range Fire (1 to 15 cm. distance): ^

1. Edges of the entrance wound is inverted.

2. If within the flame reach (about 6 inches in rifle and high powered firearms and less than 3 inches from an ordinary handgun), there is an area of burning.

S.^mudging is present'due to smoke.

4. "Powder tattooing* is present (dense and limited dimension of spread).

S.'vAbrasion ring'br collar is present (contact ring).

Medium Range Fire (more than 15 cm. but less than 60 c m . ) : ^

1. Gunshot wound with* inverted edges'and with abrasion collar is present.

T

2. Burning effects (skin bum and hair singeing) is absent.

3. Smudging may be present if less than 30 cm. distance.

4. cGunpowder tattooing" is present but of lesser density and has a wider area of distribution.

o. Contact ring is present.

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Fired More Than 60 cm. Distance: / 1. Gunshot wound is'circular or ovaf depending on the angle of

approach with abrasion collar.

2. Wound of entrance has°no* burning, smudging or tattooing.

3. Contact ring is present.

Microscopic Examination of Gunshot Wound of Entrance:

1. In Contact or Near Contact Fire:

a. Epithelial damage and powder residue deposit are present. b. Massive heat may carbonize the epithelial cells. c. The hot bullet may produce coagulation necrosis. d. Basilar cells are swollen and vacuolated. e. The corium may show thermal changes manifested by nuclear

shrinkage, pyknosis and vacuolization.

2. In far Distant Fire:

a. There may be a spotty deposit of powder on skin and subcutaneous tissue.

b. There is cellular destruction along the course of bullet.

înstances When the Size of the Wound of Entrance Do Not Approxi-'mate the Caliber of the Firearm:

In distant fire, the rule is that the diameter of the gunshot wound of entrance is almost the same as the caliber of the wounding firearm, but in the following instances, the rule is not followed: 1. Factors which make the wound of entrance bigger than the caliber:

a. In contact or near fire — The size of the entrance wound in contact and near fire is caused by the force of the expanded gases of explosion and by the bullet.

b. Deformity of the bullet which entered — The bullet might have hit a hard object before it pierces the skin thereby making the wound of entrance bigger than the caliber of the missile.

c. Bullet might have entered the skin sidewise — Ordinarily, it is the ogival portion which pierces the skin first, but occasionally it may hit the skin sidewise on account of the inequality of resistance of the surrounding media in its flight. The spinning movement and the tail wag (wobble) may cause the bullet to enter in its vertical axis.

d. Acute angular approach of the bullet — Due to the sliding trajectory of the bullet, the wound becomes oval in shape with prominence of the contusion collar at the side of the acute angle of approach.

GUNSHOT WOUNDS 359

2. Factors which make the wound of entrance smaller than the caliber:

a. Fragmentation of the bullet before penetrating the skin — If in the flight of the bullet it hits a hard target which causes its fragmentation and only the fragments pierce the skin, the wound produced will be smaller than the caliber of the firearm which causes the fire.

b. Contraction of the elastic tissues of the skin — The form of the bullet may be preserved but the entrance wound may be smaller than the caliber on account of the contraction of the elastic tissues of the skin.

In shotgun fire, the size of the wound of entrance is dependent upon the distance of the fire. Near fire causes concentration of entry of the pellets, and as distance increases the pellets disperse with individual pellets causing individual wounds of entry. Only in this instance may the wound of entrance of the same size as the gauge of the shotgun pellets.

Other Evidences or Findings Used to Determine Entrance of Gunshot: When the course of the bullet is through and through and there is

difficulty in the determination as to which is the entrance because it does not show characteristic findings, or it has been modified by healing, infection or surgical intervention, the medical examiner must resort to the following:

1. Examination of the clothings, if involved in the course of the bullet:

a. The fabric of the clothings may show punch in destruction at the site of the wound of entrance.

b. Examination for particles of gunpowder on the clothings at the site near the wound in question. If the clothings give a positive test for gunpowder, then it must be the wound of entrance. This is only true if the fire is near.

2. Examination of the internal injuries caused by the bullet:

a. In case where the missile hits a bone, the bone fragments are driven away from the wound of entrance.

b. Destruction of the bone at the surface facing the wound of entrance is oval and with sharp edges, while the surface facing the wound of exit is bigger, irregular and bevelled.

c. Direction of the cartilage and other soft tissues will be driven away from the gunshot wound of entrance.

360 LEGAL MEDICINE

3. Testimony of witnesses:

The testimony of the witness as to the position of the victim and the assailant when the firearm was fired may determine which of the wounds is the entrance wound.

Determination of the Trajectory of the Bullet Inside the Body of the Victim:

The following must be taken into consideration to determine the course of the bullet inside the body of the victim:

1. External Examination:

a. Shape of the Wound of Entrance — When the bullet is fired at right angle with the skin the wound of entrance is circular except in cases of near fire. If fired at another angle, the wound of entrance is usually oval in shape. When the bullet is deformed, no such characteristic findings will be observed.

b. Shape and Distribution of the Contusion or Abrasion Collar — As a general rule, the contusion (abrasion) collar is widest at the side of the acute angle of approach of the bullet. If the bullet hits the skin perpendicularly, then the collar will have a uniform width around the gunshot wound, except when the bullet is deformed or in near fire.

c. Difference in Level Between the Entrance and Exit Wounds — The difference in height between the gunshot wound of entrance and exit may be determined by measuring those wounds from the fixed references in the body, e.g. sole of the foot, or by drawing a horizontal line across the body and using it as a reference point.

d. By Probing the Wound of Entrance — The probe must be applied without too much force so as not to create a new course in the soft tissues. Care must be observed in cases of deflection of the course due to some hard objects that might have been involved.

2. Internal Examination:

a. Actual Dissection and Tracing the Course of the Wound at Autopsy:

The tissues involved are hemorrhagic and bone spicules and lead particles may be seen or felt.

b. Fracture of Bones and Course in Visceral Organs:

Occasionally, the nature of the bone fracture may show the direction, especially when the bullet is not deformed before causing the fracture. Injuries in solid visceral organs may clearly manifest the course because of the absence of contractility.

GUNSHOT WOUNDS 361

c. Location of Bone Fragments and Lead Particles:

The bone spicules and lead fragments go with the flight of the bullet and may be utilized in the determination of the trajectory.

d. X-ray Examination:

Bone spicules and lead fragments may be observed and their exact location determined in relation with the wound of entrance.

3. Other Evidences to Show Trajectory:

a. Relative difference in the vertical location of the entrance from the exit in the clothings.

b. Relative position and distance of the assailant from the victim in the reconstruction or reenactment of the crime.

xi. Testimony of witnesses.

Exit (Outshoot) Wound: ^

An exit wound does not show characteristic shape unlike the wound of entrance. It may be slit-like, stellate, irregular or even similar to the wound of entrance. This is due to the absence of external support beyond the skin so the bullet tends to tear or shatter the skin while sufficient amount of kinetic energy is still in the bullet during the process of piercing the skin. ^•The edges of the wound are everted and occasionally portions of the inner tissues are protruding. Aside from the bone, the skin is one of the most resistant to penetrate in the course of the bullet so that most often the bullet is lodged just underneath the skin. It may only be noticed by the presence of contusion over the area wherein it is lodged or its presence may be noticed by palpitation. The bullet may have lost its^monierjûm after piercing_the_skin and just fall without perforation of the clothing.

Bones may be involved in the trajectory and its spicules may create additional injury to the wound of exit.

Variation on the shape of the wound of exit may be attributable to the deformity of the bullet in its passage in the body and to the wabbling and stumbling movement of the bullet during its course and fragmentation of the missiles.

Shored Gunshot Wound of Exit — If the place where the gunshot wound of exit is pressed on a hard pbject as when the victim is lying on his back on a hard object or in small caliber shots (like 0.22) the wound of exit tends to be circular or nearly circular with abrasion at its border. It is also observed that tight-fitting clothings, waist band, belt collar, brassiere may also support the skin to enhance formation

362 LEGAL MEDICINE

of a circular wound of exit. This is known as a shored gunshot wound of exit.

Shored gunshot wound of exit is produced when the outstretched skin is impaled, sandwiched and crushed between the outgoing bullet and the unyielding object is over the exit site, thus making the wound to be circular with abrasion collar at its margin. Proper coaptation of the wound margin is impossible because of the loss of skin just like those observed in entrance wound. In contrast with the entrance wound, the supported exit wound shows a scalloped or punched-out abrasion collar and sharply contoured skin in between the radiating skin lacerations marginating the abrasion (Journal of Forensic Medicine and Pathology, Vol. 4, Sept. 1983, p. 99).

Gunshot w o u n d of exit of the skull with punch out edges

stinction Between Gunshot Wound of Entrance and Wound of Exit:

Entrance Wound

1. Appears to be smaller than the missile owing to the elasticity of the tissue.

2. Edges are inverted.

3. Usually oval or round depending upon the angle of approach of the bullet.

4. "Contusion collar" or "Con-

Exit Wound

1. Always bigger than the missile.

2. Edges are everted.

3. It does not manifest any definite shape.

4. "Contusion collar" is absent.

GUNSHOT WOUNDS 363

tact ring" is present, due to invagination of the skin and api

4. Tat

Inning of the missile.

Tattooing or smudging may be .5v Always absent. present when firing is near.

6. Underlying tissues are not 6. Underlying tissues may be seen

8. Paxaffin test may be positive. 8. Paraffin test always negative.

The "Odd and Even Rule" in Gunshot Wounds: ^

If the number of gunshot wounds of entrance and exit found in the body of the victim is even, the presumption is that no bullet is lodged in the body, but if the number of the gunshot wounds of entrance and exit is odd, the presumption is that one or more bullets might have been lodged in the body.

The rule is merely presumptive and actual inspection and autopsy will verify the truth of the presumption. It may be possible that all of those wounds or a majority of them are entrance wounds with some bullets lodged, yet the number may still be even.

Sometimes it is difficult to locate the lodged bullet but with the help of a portable X-ray, its location and extraction can be facilitated.

How to Determine the Number of Fires Made by the Offenderrr

1. Determination of the Number of Spent Shells:

Search must be made at the scene of the crime or at the place where the offender made the fire, for spent shells, if the weapon used is an automatic pistol or rifle. In case of revolver fire, the empty shells may be found still inside the cylindrical magazine. In machine gun fire, the spent shells may still be attached to the cartridge belt.

2. Determination of Entrance Wounds in the Body of the Victim:

Although most often erroneous, the investigator may be given an idea as to the minimum number of shots made. The number of wounds of entrance may not show the exact number of fire because:

a. Not all the fire made may hit the body of the victim. b. The bullet may in the course of its flight hit a hard object

thereby splitting it and each fragment may produce separate wounds of entrance.

c. The bullet may have perforated a part of the body and then

protruding.

7. Always present after fire. protruding from the wound.

7. May be absent, if missile is lodged in the body.

364 LEGAL MEDICINE

made another wound of entrance in some other parts of the body; thus a single shot may produce two wounds of entrance.

3. Number of Shots Heard by Witnesses:

The witnesses might be able to count the number of shots heard especially if the shots were made at sufficient intervals of succession. However in cases of machine gun fire, there is difficulty in ascertaining the number heard and the testimony of witness as to the number of shots heard must be admitted with caution.

Mutilating gunshot wound of exit

^Distances when the Number of Gunshot Wounds of Entrance is Less than the Number of Gunshot Wounds of Exit in the Body of the Victim:

1. A bullet might have entered the body but split into several fragments, each of which made a separate exit.

2. One of the bullets might have entered a natural orifice of the body, e.g. mouth, nostrils, thereby making it not visible and then producing a wound of exit.

3. There might be two or more bullets which entered the body through a common entrance and later making individual exit wounds.

4. In near shot with a shotgun, the pellets might have entered in a common wound and later dispersed while inside the body and making separate wounds of exit.

GUNSHOT WOUNDS 365

yInstances when the Number of Gunshot Wounds of Entrance is More than the Number of Gunshot Wounds of Exit in the Body of the Victim:

1. When one or more bullets are not through and through and the bullet is lodged in the body.

2. When all of the bullets produce through and through wounds but one or more made an exit in the natural orifices of the body, e.g. eyes, mouth, nostrils.

3. When different shots produced different wounds of entrance but two or more shots produced a common exit wound.

/'Instances when there is No Gunshot Wound of Exit but the Bullet is Not Found in the Body of the Victim:

1. When the bullet is lodged in the gastro-intestinal tract and expelled through the bowel", or lodged in the pharynx and expelled through the mouth by coughing.

2. Near fire with a blank cartridge produced a wound of entrance but no slug may be recovered.

3. The bullet may enter the wound of entrance and upon hitting the bone the course is deflected to have the wound of entrance as the wound of exit (cited by Modi, A Textbook of Medical Jurisprudence & Toxicology, 10th ed.).

Trajectory of a gunshot w o u n d In the head.

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Determining Whether the Wound is Ante-mortem or Post-mortem: If the wound indicates that there has been profuse hemorrhage, or

there are signs of vital reactions in the tissue, then the gunshot wound is ante-mortem. The presence and degree of vital reactions depends upon the period of survival of the victim. It may be manifested in the form of swelling, effusion of lymph or other evidences of repair. Microscopically, there is congestion and leucocytic infiltration.

Wounds inflicted after death show no evidence of profuse hemorrhage, no retraction of the edges, and there are no vital reactions.

Problems Confronting Forensic Physician in the Identification of Gunshot Wounds:

1. Alteration of the Lesion Due to Natural Process:

The drying of the margins of the wound opening may modify measurements. The size and shape is considerably altered by decomposition. Healing process and infection may modify its appearance and it may be mistaken for some other types of injuries.

2. Medical and Surgical Intervention:

The wound may be scrubbed, medication applied, or surgically debridded, extended, excised or sutured. This problem is properly solved by having access to the clinical record of the patient.

3. Embalming:

Embalming trocar may be introduced on the gunshot wound itself or the trocar mark itself may be mistaken for a gunshot wound.

The gunshot wound may be extended to reach the principal artery for the embalming fluid to enter. The passage of the embalming fluid may wash out the product of the gunpowder combustion, The trajectory of the bullet may be modified by the trocar thrust. The suturing of the gunshot wound and the application of "makeup" may modify the actual appearance of the wound.

4. Problem Inherent to the Injury Itself:

The gunshot wound may be covered with clotted blood or with scab to make it not visible. Grazing injury caused by glancing of the bullet on the skin may appear like abrasions or lacerations. Wound brought about by screw drivers, icepicks or other sharp pointed instruments might be considered to be gunshot wounds. Bullet might have entered or made its exit in the natural openings, like mouth, nostril, ear, etc. making its identification difficult. The wound may be located in thick haired scalp, skin fold and make visibility difficult.

GUNSHOT WOUNDS 367

5. X-ray Examination:

The use of an X-ray is almost indispensable in the examination of gunshot injuries. The use of the apparatus will facilitate recovery of the lodged bullet together with the location of its fragments.

The body might have been X-rayed with unspent and spent ammunition clinging on the clothings and may be mistaken to be inside the body; teeth fillings or crown may resemble bullet on X-ray examination of the skull. "Migratory" bullets may be found in some parts of the body away from the bullet tract. Victim may have "bullet souvenir" on account of a previous gunshot injury and may confuse the examiner as to be an effect of recent shot.

Clothings:

The effects of the garments on the movement of the bullet depend upon:

1. The number of layers of fabric between the muzzle and subjacent skin;

2. Nature of the fabric which may be closely woven or loose mesh, light or heavy, cotton or synthetic fibers.

3. Muzzle-clothings distance.

Examination of the External Wearing Apparel of the Victim of Gunshot maybe Significant in Investigation because:

1. It may establish the possible range of the fire:

a. Contact Fire:

(1) There is a tear of the clothings covering the skin at the site of the gunshot wound with fusion of its fibers in case of artificial fabric. Fibers are turned outward away from the body.

(2) Soot deposit and gunpowder tattooing around the torn fabric. Burning of the fibers are visible.

(3) Muzzle imprint (profile of the muzzle) especially in artificial fabric may be present.

(4) Dirt and greasy deposit is carried by the bullet and may be wiped out and be visible on the torn clothing.

b. Not Contact but Near Shot: The same findings as in contact shot except when it is be

yond the flame range and absence of muzzle imprint.

c. Far Fire: There is a hole tear with inward direction of the thread.

368 LEGAL MEDICINE

2. It may be useful in the determination as to which is the point of entry and of exit of the bullet:

The direction of the fibers will be inward or inverted at the point of entry, while it is outward or everted at the point of exit. Care must be exercised in making the inference inasmuch as improper handling may change the direction of the fibers.

3. It may be useful in locating the bullet:

The clothings, like skin and bone are not easily perforated. It is frequently observed that the bullet is recovered just underneath the clothings of a dead victim at the crime scene.

Special Consideration on Bullets:

1. Souvenir Bullet:

Bullet has been lodged and has remained in the body. Its long presence causes the development of a dense fibrous tissue capsule around the bullet causing no untoward effect. It may be located just underneath the skin to be easily palpated and may cause inconvenience and irritation. Deep seated location may not cause any problem to warrant its immediate removal.

2. Bullet Migration:

Bullet that is not lodged in a place where it was previously located. A bullet which strikes the neck may enter the air passage, and it may be coughed out or swallowed and recovered in the stomach or intestine.

Bullets Embolism — a special form of bullet migration when the bullet loses its momentum while inside the chamber of the heart or inside the big blood vessels and carried by the circulating blood to some parts of the body where it may be lodged. It may cause sudden loss of function of the area supplied or death if vital organs are involved.

3. Tandem Bullet:

Two or more bullets leaving the barrel one after another. In cases of misfire or a defect in the cartridge, the bullet may be lodged in the barrel and a succeeding shot may cause the initial and the succeeding bullet to travel in tandem. There is a strong possibility for them to enter the target in a common hole. This might create doubt to the statement made by the firer that he made only a single shot, but ballistic examination can show as to whether the bullet travelled in tandem.

GUNSHOT WOUNDS 369

)<GUNSHOT WOUNDS MAY BE SUICIDAL, . HOMICIDAL OR ACCIDENTAL

Evidences that tend to show that the Gunshot(s) Wound is Suicidal. 1. The shot was fired in a closed or locked room, usually in the

office or bedroom. If in the bedroom, the shot was fired while the victim was lying in bed and the weapon covered with pillow or bedding to muffle the sound. It may be committed in an open isolated or uninhabited place.

2. The death weapon is almost always found near the place where the victim was found. When a light, low caliber hand firearm was used and the shot was made in parts of the body where death may develop almost instantaneously, the victim may be seen with the grip of the firearm firmly held in the palm of the wounding hand (cadaveric spasm).

3. The shot was fired with the muzzle of the gun in contact with the part of the body involved or at close range. The wound of entrance may show signs of muzzle impression, burning, smudging and tattooing.

4. The location of the gunshot wound of entrance is in an accessible part of the body to the wounding hand. It may be at the temple, roof of the mouth, precordial or epigastric region. A person committing suicide will do the act in his most convenient way, unless he has the intention of deceiving the investigator.

5. The shot is usually solitary. If the shot is made on the head involving the brain, the shocking effect of the injury will not make him capable of firing another shot. However, shots in some parts of the body which may not produce immediate death or sudden loss of consciousness, the possibility of additional shots is not remote. The victim may be determined to die and had fired additional shots to insure realization of his intention.

6. The direction of the fire is compatible with the usual trajectory of the bullet considering the hand used and the part of the body involved. A shot on the temple is usually directed towards the opposite temple and upwards, while a shot in the precordium and epigastrium is usually backwards and downwards.

7. Personal history may reveal social, economic, business or marital problem which the victim cannot solve. He may have history of mental disease, depression, severe frustration or previous attempt of self-destruction.

8. Examination of the hand of the victim may show presence of gunpowder.

9. Entrance wound do not usually involve clothings.

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10. Fingerprints of victim on the butt.

11. Search of the place where the shot took place may reveal a suicide note which usually mentions among other things the reason why the victim committed suicide.

12. No disturbance in the place of death.

''Russian Roulette:

A group of persons may agree to load a revolver with a single live cartridge and each member of the group will cock and pull the trigger with the muzzle pressed or directed to the temple or towards other vital parts of the body. The person who will pull the trigger with the live cartridge in the firing chamber will suffer the fatal consequence. Although it may be considered suicidal because any person who participates to such an agreement may have the desire to commit it, the unfortunate victim has no predetermined desire of self-destruction.

idences to show that the Gunshot Wound is Homicidal:

1. The site or sites of wound of entrance has no point of election.

2. The fire is made when the victim is usually at some distance from assailant.

3. Signs of struggle (defense wounds) may be present in the victim.

4. There may be a disturbance of the surroundings on account of previous struggle.

5. Wounding firearm usually is not found at the scene of the crime.

6. Testimony of witnesses.

-Evidences to show that the Gunshot Wound is Accidental:

1. Usually there is but one shot.

2. There is no special area of the body involved.

3. Consideration of the testimony of the assailant and determination as to whether it is possible to be accidental by knowing the relative position of the victim and the assailant.

4. Testimony of witnesses.

Points to be Considered and Included in the Report by the Physician:

1. Complete description of the wound of entrance and exit.

2. Location of the wound: a. Part of the body involved. b. Distance of the wound from the mid-line. c. Distance of the wound from the heel or buttock.

3. Direction and length of the bullet tract.

4. Organs or tissues involved in its course.

GUNSHOT WOUNDS 371

5. Location of the missile, if lodged in the body. (

6. Diagram, photograph, sketch, or drawing showing the location and number of wounds.

Questions that a Physician is Expected to Answer in Court:

1. Could the wound or wounds be inflicted by the weapon presented to him?

2. At what range was it fired?

3. What was the direction of the fire?

4. May it be possible that those gunshot wounds are self-inflicted?

5. Are there signs of struggle in the victim?

6. May it be possible for the victim to fire or resist the attack after the injury was sustained by him?

7. Did the victim die instantaneously?

8. Where was the relative position of the assailant and the victim when the shot was fired?

Can the Caliber of the Wounding Firearm be Determined from the Size of the Gunshot Wound of Entrance?

Although the size of the gunshot wound of entrance is influenced by several factors, the caliber may be inferred from the diameter of the gunshot wound. In most cases, especially when the wound is circular, the caliber is almost the same as the diameter of the wound of entrance.

Determination of the Length of Survival of the Victim:

The length of survival of the victim may be inferred from the

following:

1. Nature of the gunshot wound.

2. Organs involved.

3. Presence or absence of infection or other complications.

4. Amount of blood loss.

5. Physical condition of the victim.

Capacity of the Victim to Perform Volitional Acts:

The power of the victim to perform voluntary acts depends upon the area of the body involved, involvement of vital organs, and the resistance of the victim. Injuries which will cause incapacity to do voluntary acts as those involving the brain and the spinal cord definitely inhibits volitional acts.

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Determination as to the Length of Time a Firearm had been Fired s

Physical and chemical examinations of the residue inside the barrel does not give a conclusive evidence as to how long the firearm has been discharged. Most often the examiner does not know whether the barrel was cleaned immediately after the discharge. Smokeless powder which is now commonly used does not leave much residue for such determination. However, inferences may be drawn from the following:

1. Odor of the Gas Inside the Barrel:

Explosion of the gunpowder produces considerable evolution of gases consisting of nitrogen, hydrogen sulfide, carbon dioxide, carbon monoxide and methane. This mixture of gases has a peculiar characteristic odor which may be noticed several hours after the discharge. Later, it will disappear as gases usually evaporate or chemically transformed to other odorless compounds.

2. Chemical Changes Inside the Barrel:

Black powder is a mixture of charcoal, sulfur and nitrates of sodium or potassium. One of the products of combustion is hydrogen sulfide. Hydrogen sulfide is rapidly converted to thio-sulfate, thiocyanate and finally to sulfates of potassium or sodium. The absence of the peculiar characteristic odor and the presence of thiosulfate and thiocyanate which is increasing in amount shows that the discharge occurred in a matter of few days. Later the thiosulfate and thiocyanate of sodium or potassium will be chemically transformed to sulfates and its presence shows that firing occurred for sometime.

The iron salts in the ferrous state are found during the early stage and may be transformed to ferric salt after a lapse of a certain period.

The residue produced by smokeless powder explosion as nitrates are not liable to undergo changes even after a lapse of time, hence approximation of the time of the discharge is much more difficult.

The main difficulty in the determination is that the length of such physical and chemical transformation of the residue of combustion from one compound to another, cannot be definitely ascertained. It is dependent upon several factors.

3. Evidences that may be Deduced from the Wound: Approximation of the age of the wound also infers the time of

discharge. The degree of healing in the absence of subsequent infection must be considered. If an infection is present, then the degree of infection may be utilized in the approximation.

GUNSHOT WOUNDS 373

Determining Whether the Wounding Weapon is an Automatic Pistol or a Revolver:

The following must be taken into consideration to determine whether the wounding weapon is an automatic pistol or a revolver:

1. Location of the Empty Shells:

In a revolver, the empty shells are found in the cylindrical magazine chamber after the fire, but in cases of automatic pistol the empty shells are driven out of the weapon after the shot, to give way to live cartridge to be in the firing chamber. Thus, in cases of automatic pistol, the empty shells are found a few yards away from the place of the firing.

2. Nature of the Spent Bullet:

As a general rule, in automatic firearm, the bullet is copper jacketed or cupro-nickel jacketed, while in cases of revolver, no such coating is observed. This is not true in all cases.

3. Nature of the Base of the Cartridge or Spent Shell:

The base of a revolver has a wider diameter than that of the cylindrical body to keep the cartridge stay in the magazine chamber. There is no such difference in the diameter in case of shells of automatic pistol.

Can the Direction of the Shot be Determined from the Direction from which the Sound Came From?

Not possible, unless the flash or the person firing the shot is «een at the time the shot was fired. The ear is usually at a loss as to where the shot was fired.

Can the Firearm be Identified by the Sound of the Discharge?

It is impossible to distinguish and memorize the report from two firearms of the same caliber. It may be possible for a person who is accustomed to the sounds of firearms of different calibers to identify the firearm by the sound produced.

Example: The sound of a shotgun may be distinguished from the sound of a caliber 0.22 pistol.

Gunshot Wound may Not be a Near Fire or may Not Appear to be a Near Fire: 1. When a device is set up to hold the firearm and to enable it to be

discharged at a long range by the victim. 2. When the gunshot wound of entrance does not show characteristics

of a near shot because the clothings are interposed between the victim and the firearm.

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3. When the examining physician failed to distinguish between a near or far shot wound.

4. When the product of a near shot has been washed out of the wound.

X-ray:

The use of the x-ray must not be overlooked in a gunshot wound investigation. Several exposures at different angles must be made to determine the precise location of the bullet, trajectory, position of the slug, and other injuries.

X-ray Examinations may:

a. Facilitate location and extraction of the bullet lodged. b. It will reveal fragmentation and their location. c. It will show bone involvement like fracture. d. It will reveal trajectory of the bullet. e. It will show the effects of the bullet wound, like hemorrhage,

escape of air, laceration and other injuries.

SHOTGUN WOUNDS

A shotgun is a shoulder-fired firearm having a barrel that is smooth-bored and is intended for the firing of a charged compound of one or more round balls or pellets-

Classes of Shot in a Shotgun Shell:

1. Birdshot — The shot are small ranging in sizes from 0.05 inch to 0.15 diameter and loaded from 200 to 400 shots in the shell. Birdshots are small and are commonly used for hunting fowls and other small animals.

2. Buckshot — The shot ranges from 0.24 to 0.33 inch in diameter and obviously fewer in number in a shot. A standard 12-gauge shotgun contains only nine shots.

3. Single Projectile (Rifled Slug) — There is only a single shot or slug in a shell.

Systems Employed in the Determination of the Diameter of the Barrel of a Shotgun:

1. Gauge System — Determination of the number of lead balls, each fitting of the bore totals to one pound in weight. The smaller the gauge designation, the larger is the bore. If twelve balls can be made from one pound of lead, each fitting the inside of the barrel of a shotgun, the gun is called 12-gauge or 12-bore shotgun. 12-gauge shotgun is the most commonly used.

GUNSHOT WOUNDS 375

2. Expression of the Bore Diameter in Inches — The 0.410 bore shotgun is the only shotgun at present to be so designated.

3. Metric System — The bore is expressed in millimeters.

Length of the Barrel:

There is no standard length of the barrel but modem barrels measure 26, 28, and 30 inches in length.

Grade of Choke:

A shotgun is choked when the muzzle end of the barrel is a diameter smaller than the rest of the barrel. The main purpose of the constriction is to minimize the dispersal of the pellet or buckshots after the shot. It is based on the presence or absence of choke and the degree of choking, that shotguns are classified as:

1. Unchoke — The diameter of the barrel from the rear end up to the muzzle is the same.

2. Choke — The diameter of the barrel at the muzzle end is smaller than the rest of the barrel.

a. "Improved Cylinder" — The narrowing of the barrel by 3 to 5 thousands of an inch.

b. Half Choke — narrowing by 15 to 20 thousands of an inch.

c. Full Choke — narrowing from"35 to 40 thousands of an inch.

The lethal range is normally in an area of 30 inches in diameter at 30 to 40 yards according to the degree of choking.

Types of Shotgun:

1. As to the Number of Barrel:

a. Single Barrel Shotgun: There is only one barrel and basically the original type.

b. Double Barrel Shotgun: (1) Side-to-side barrel. (2) Over-and-under barrel.

2. As to the Manner of Firing and Reloading:

a. Bolt Action: The action of the bolt ejects the fired shell and loads the

next one.

b. Lever Action: When the lever is swing down it ejects the fired shell and

loads the next shot. c. Pump Action:

There is a cylindrical magazine which can accommodate up to six shells, end to end, beneath the barrel.

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d. Autoloading: A pull of the trigger not only fires and ejects the shell but

also reloads the next shot and locks it for firing.

Shotgun Cartridge: A shotgun cartridge is usually 2-3/4 or 3 inches long and the

diameter depends on the gauge of the firearm. The base and the lower portion of the cylindrical portion is made of brass with the primer cap at the center of the base. Attached to the free end of its cylindrical portion is the cylindrical laminated paper tube to complete the shell casmg.

When the trigger is pulled, the firing pin activates the primer which in turn ignites the powder charge. Explosion of the gunpowder will cause propulsion of the wad and pellets (shot) in front.

The muzzle velocity of the pellet is relatively smaller as compared from those discharged from rifled firearms.

Except for the presence and nature of the slug, the component of the shotgun blast is almost the same as that of a rifled firearm. It also consists of gunpowder, flame, smoke, pellets and wad.

Shotgun Wound of Entrance:

1. Contact or Near Contact Shot (not more than 6 inches):

On account of the greater quantity of gunpowder in the shotgun cartridge, there is relatively more damage due to muzzle olast, flame and gunpowder at the site of the wound of entrance as compared with rifled fire.

a. If the shot is made perpendicular to the skin surface, the wound of entrance is round but if the shot is made with an acute angle with the skin the wound is oval. In both instances, the wound border may be smooth or slightly rugged.

b. The entrance wound is burned, the width of which increases as the muzzle-skin distance increases but does not exceed 6 inches.

c. There is blackening due to smoke.

d. Gunpowder tattooing is densely located in a limited area. The area of spread is directly proportional to the muzzle skin distance.

e. There is contusion of the tissue that has been blackened by gunpowder.

f. There is singeing of the hair (less than 6 inches).

g. Subcutaneous and deeper tissues are severely disrupted.

h. Blood and other tissues along the bullet tract shows presence of carbon monoxide.

GUNSHOT WOUNDS 377

i . .Wad or its fragments together with shot (pellets) may be recovered from the bullet tract.

2. Long Range Shot (more than 6 inches skin-muzzle distance):

a. At 2 to 3 feet muzzle-skin distance, there is still a single wound of entry although there may be isolated shots causing independent entry.

b. At 3 to 4 feet distance the wound of entry is usually serrated or scalloped circumference and often referred to as a "rat hole".

c. At about 5 to 6 feet distance, the wad tends to produce an independent injury usually an abrasion at the vicinity of entry of the shots. The wounding capacity of the wad is very much less as compared with the shot on account of its lightness and size.

d. At 6 feet, the shots begins to separate from the conglomerate shot and at 10 feet each shot already produces independent wounds of entry.

As the shot begin to separate from one another, there is the tendency for one shot to strike another causing changes of the shot course. This phenomena is called "billiard ball ricochette effect".

e. Smudging due to smoke may be observed up to 15 inches.

f. Gunpowder tattooing may be detected up to 24 inches.

g. In an unchoked shotgun, to estimate the muzzle-target distance, the following rule must be applied.

Measure the distance between the two farthest shot (pellets) in inches and subtract one, the number thus obtained will give the muzzle-target distance in yards.

The character of the wound and the degree of dispersal is influenced by the muzzle-target distance, gauge of the shotgun, degree of choke and the type of ammunition. However, it is highly recommended to have an experimental shot with the firearm using similar cartridge and under the same environmental conditions.

A close shot produces more serious injuries because the shots are concentrated on a specific target and because of greater kinetic energy of the pellets.

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I / D E T E R M I N A T I O N O F T H E PRESENCE O F G U N P O W D E R A N D PRIMER COMPONENTS

The Importance of Determining the Gunpowder on the Skin of the Victim:

1. Determination of the distance of the gun muzzle from the victim's body when fired:

As discussed previously, the explosion of the powder in the cartridge expels particles which may be embedded in the skin or just clinging on the surface at a distance of not more than 24 inches. The distribution of the gunpowder is more at the upper portion of the wound of entrance, due to the upward position of the muzzle of the gun when fired. The presence of gunpowder at or near the wound of entrance shows that the gun muzzle when fired is not more than 24 inches but its absence will not preclude near fire because other factors might have intervened. Less powder particles at the wound of entrance is observed in smokeless powder as compared with black powder.

2. Determining whether a person has fired a firearm:

The dorsum of the hands are the ones examined to determine the presence of gunpowder. When a person fires a gun, the powder particles which escape may cling on the dorsum of the hand. The presence of gunpowder at the dorsum of the hand may infer that a person has fired a gun.

Basis of the Tests:

When a gun is discharged two types of residues are liberated namely, the metallic residues from the primer which is not only blown forward towards the target from the muzzle but also backward in the direction of the shooter, and also the particles of burned, burning and unburn ed gunpowder (propellant) moving also in the same directioni as the metallic residue of the primer. All of these residues are deposited on the back of the firing hand of the shooter.

Detection of metallic residue of the primer on the palm of the hand may also indicate that the individual was making a defensive movement, such as trying to ward off or grab the weapon at the time of the discharge. In suicide, residue may be deposited on the palm of the hand used to steady the barrel at the time of the discharge.

Procedures in Determining the Presence of Gunpowder:

1. Gross Examination or Examination with the Use of Hand Lens:

Fine black powder particles of varying sizes may be seen at the

GUNSHOT WOUNDS 379

region of the gunshot wound of entrance, on the dorsum of the hands or at the outer surface of the wearing apparel of the victim. This examination is not conclusive because other foreign particles may be mistaken for gunpowder or primer components.

2. Microscopic Examination:

Fine particles may be magnified but there are no characteristic shape, color or consistency of gunpowder.

3. Chemical Tests:

a. Laboratory Test to Determine Firearm Residues:

There is inference of contact or near distance of the gun muzzle to the skin when there is burning, tattooing and smudging visible through the naked eye. The burning and then the tattooing will gradually disappears as the muzzle distance increases. The powder tattooing will gradually spread out to a greater area until it is no longer detectible. Minute particles of burning and unburned residues and the primer constituents can be detected in the laboratory.

The same tests may also be applied on the dorsum of the hand of the persons suspected to have fired the gun. Although the test is not conclusive, it may be a corroborative evidence in the determination as to whether a person has fired a gun.

The tests may involve the determination of the presence of gunpowder residues of primer components.

Tests for the Presence of Powder Residues: l.On the Skin (Dorsum of the Hand or Site of the Wound of

Entrance): Dermal nitrate test (Paraffin test, Diphenylamine test, Lung's

test or Gonzales* tests) — The back of the fingers and of the hand up to the region of the wrist is coated with melted paraffin, heated at a temperature of 150 degrees fahrenheit. To avoid heat injury to the skin, a low melting point paraffin is used. The melted paraffin penetrates the minute crevices of the skin and when hardened and cooled off, some of the powder particles will be extracted and embedded in the paraffin cast. After the cast is built with layers of cotton and paraffin to a thickness of about 1/8 inch and solidified, it is then removed from the hand or from the site of the wound of entrance and the inner aspect of the cast is treated by means of a dropper with Lung's reagent.

The presence of small particles containing either nitrate or nitrite will be indicated by a blue reaction of the particles upon contact with Lung's reagent.

380 LEGAL MEDICINE

The test is not conclusive as to the presence of gunpowder because fertilizers, cosmetics, cigarettes, urine and other nitrogenous compounds with nitrites and .nitrates will give a positive reaction. A negative result is not also conclusive that the person did not fire a gun for a well constructed hand gun will not discharge any residue on the hand or the hand might have been subjected to extensive washing.

The test usually gives a positive result even, after a large lapse of three days or even though the hand has been subjected to ordinary washing.

Subjection of a suspect to the test is not self-incriminatory as the act is purely mechanical and does not require the use of mental faculties.

2. On Clothings (Especially Colored Ones):

Walker's test (C-acid test, H-acid test) — A glossy photographic paper is fixed thoroughly in hyposolution for 20 minutes to remove all the silver salts and then washed for 45 minutes and dried.

The dried photographic paper may be treated with any of the following:

a. Warm 5% solution of " C " acid (2 naphthalamine 4-8 disulfonic

acid) for 10 minutes and dry.

b. Warm 5% solution of " H " acid (l-amino-8-naphthol-3,6 disulfonic acid) for 10 minutes and dry.

c. Warm 0.5% solution of sulfanilic acid for TO minutes,,dry and then swab with a 0.5% solution of alpha naphthalamine in methyl alcohol and dry.

The sheet of the prepared paper of sufficient size is placed face up on a towel or pad of cotton and the material to be tested is placed on top, face down on the paper.

The preparation is then covered with a thin dry cloth or towel slightly moistened with 20% solution Of acetic acid, and another layer of dry cloth.

The entire pack is pressed with a hot iron for two minutes.

The paper is removed, washed with hot water and methyl alcohol to remove excess reagent and dried.

If unburned powder grains are present, it will result to the production of dark red or orange-brown spots on the prepared paper.

GUNSHOT WOUNDS 381

Tests for the Presence of Primer Components:

When an individual fires a weapon, the metallic primer residue (barium, antimony and lead) may be deposited on the back of the hand with the residue most likely deposited on the skin web, the hand between the thumb and index finger. The test for the presence of the metallic constituent of the primer may be done through any of the following:

1. Harrison and Gilroy Test:

A cotton swab moistened with 0.1 molar hydrochloric acid is used to gather antimony, barium and lead.

The cloth is then treated with various reagents to detect the presence of a primer component. The reagent sodium rhodi-sonate yields a red color in the presence of lead and barium. Addition of 1.5 hydrochloric acid to the red area that yields a blue-violet color in the presence of lead while a bright pink color is developed in the presence of barium.

The test is simply applied but does not enjoy substantial utilization in forensic laboratory because:

a. It lacks specificity of the color reaction for the trace of the element.

b. It is inadequately sensitive.

c. There is interference of the color reaction among the three elements themselves.

d. There is instability of the color that developed.

2. Neutron Activation Analysis (NAA):

A sample is obtained from the hands by the use of paraffin or by washing the hand with dilute acid. It is then exposed to radiation from a nuclear reactor emitting neutrons. Secondary radioactivity is induced in the materials removed from the hand. By making an appropriate counts at different energy levels, the elemental composition of the residues can be determined with precision and accuracy.

The technique is extremely sensitive and a very small quantity can be detected, but only few laboratories can afford to undertake the procedure because it is very expensive and the test is unable to detect the presence of lead. The test requires access to a nuclear reactor. Principle: Barium and antimony are converted into isotopes by

means of neutron bombardment, afterwards their quantity is measured.

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3. Flameless Atomic Absorption Spectroscopy (FAAS):

The sample of handwashing is subjected to a high temperature to vaporize the metallic elements of the primer residue. This in turn is detected and quantitated by absorption spectrophotometry.

This method is quick, sensitive and employs equipment within the economic means of a modern-size crime laboratory. It can detect the presence of barium, antimony and lead.

4. Use of Scanning Electron Microscope with a Linked X-ray Analyzer:

Adhesive material is used to remove any residue particles from the hand. The material is then examined under the scanning electron microscope with a linked X-ray analyzer. Particles of the primer residue have the characteristic size and shape which can easily be distinguished from other materials. Analysis of the particles with X-ray analyzer will confirm their identification.

While this method appears to be more specific than the-previously mentioned methods, it is seldom used because the initial equipment is expensive and it requires a longer period of time to analyze a case.

FIREARM IDENTIFICATION

The following factors must be utilized in the identification of the firearm used in the commission of crime:

1. Caliber of the Weapon:

A firearm may be identified by its caliber and it may be determined from the firearm itself, from the shell, bullet, cartridge or from the character of the wound of entrance.

2. Fingerprints:

Fingerprint marks may be found in the butt of the firearm or at the trigger and its guard. Care must be observed by the investigator in handling the firearm at the scene of the crime. The fingerprints found at the butt may distinguish homicidal or suicidal nature of death.

3. Fouling of the Barrel:

The firearm which is recently fired may have a characteristic odor of the smoke inside the barrel. Chemical analysis of the washing from the interior of the barrel will show whether the weapon was recently fired.

4. Serial Number:

All firearms bear serial numbers for purposes of identification. The offender may erase the number or may try to change it.

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Procedure of Restoring Serial Number if Tampered:

The procedure of restoring the obliterated numbers involve three steps, namely:

a. Cleaning — The site of the number should be carefully cleaned; all oil, dirt, grease, and paint should be removed with gasoline, xylol and acetone.

b. Polishing — This operation is by far the most important. The whole surface should be smoothly polished, using a fine file followed by a medium to fine grade carborondum cloth. When the area is large or the scratches are deep, a mechanical polisher may be used to save time. The time of polishing depends on the hardness and granularity of the metal. However, the area should always have the mirror-like surface.

c. Etching — For all iron or steel materials, the following etching solution may be used:

Hydrochloric acid 80 cc. Distilled water 60 cc. Ethyl alcohol 50 cc. Copper chloride 10 grams

The solution is swabbed on continuously until the numbers appear. This may take several hours (Modern Criminal Investigation by Harry Soderman, p. 229).

5. Ballistics Examination:

Ballistics is the study of physical forces reacting on projectiles or missiles.

Forensic ballistics is conventionally known as firearm identification. It deals with the examination of fired bullets and cartridge cases in a particular gun to the exclusion of all others.

Ballistics May Be Subdivided into Three Separate and Distinct Area of Study, Namely: 1. Interior Ballistics (Internal Ballistics) — It is a branch of the

science of Ballistics which deals with what happened to the cartridge and its bullet from the time the trigger of the gun is pulled until the bullet exits from the barrel. It deals with the study of what happened in the chamber and gun barrel after the pull of the trigger.

2. Exterior Ballistics (External Ballistics) — It deals with what happened to the bullet or projectile from the moment it leaves the gun barrel to the moment of impact on the target or object. It is concerned with the flight of the bullet and the influence of all factors in its flight.

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Ballistic comparison microscope

3. Terminal Ballistics — This concerns with the effect of the bullet

on the target or until it comes to rest.

Medical Ballistics — A form of terminal ballistics wherein the target is a person. It is concerned with the penetration, severity and appearance of the wound due to bullet or missile.

Basic Principles Involved in Firearm Identification:

1. The quality of metal in the manufacture of the firearm is very much harder and resistant to deformity as compared with the quality of metal used in the manufacture of the cartridge, so that in the process of contact between the part of the gun involved and the cartridge, the surface condition of the part of the gun can easily be impressed on the shell or bullet.

2. For reasons known only to the manufacturer, firearms have

GUNSHOT WOUNDS 385

certain physical characteristics of certain type of caliber which differentiate it from others. This includes the number of lands and grooves, the direction of the twist, width of the individual land or groove, style of the cannelure, etc., which become the basis of class characteristics in firearm identification.

3. No two firearms can be manufactured with identical surface characteristics. Each firearm on close examination will show the differences. Marks on the different bullets or shells fired from one firearm have similar characteristics when viewed in the comparison microscope. Marks on different bullets or shells fired from different firearms will show variation in the findings. This is referred to as individual characteristics.

Instruments Use in Firearm Identification:

1. Comparison Microscope — This is an instrument which consists of two compound microscopes which allows comparison of two objects by looking through a single eyepiece. On each of the stages, the compound microscope is placed on the object to be compared and by manipulation of the mechanical rack and pinion gear the class characteristics of the object may be observed. When two objects are being compared, the individual or accidental characteristics may be compared. There is an attachment for photographic camera to facilitate the taking of pictures of the findings.

2. Bullet Recovery Box — It is an instrument or device for the purpose of recovering the test bullet and shell. In the N.B.I. , it is a long cylindrical container filled with cotton and an open shooting end. The suspected firearm is fired at the open end and the bullet may be recovered in the layers of cotton and the shell may be found in the area where it is fired, in cases of automatic firearm or in the cylindrical magazine inside the cases of the revolver. The test shell and bullet may be used for comparison with the evidence bullet or shell.

There are other ways of recovering test bullet which are used in other countries, it may be: a. Shot may be fired on a box with oil and sawdust. b. Vertical or horizontal shot on a water tank. c. Shot-fired on a block of ice.

3. Hand lens.

4. Sharp pointed instrument for scraping I.D. marks.

5. Caliper.

6. Analytical Balance.

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GUNSHOT WOUNDS 387

Types of Marking on the Examination through the Comparison Microscope:

1. Impression Type Mark (Stamp Mark) — This is the forcible application of a hard surface against a softer one leaving an impression on the harder surface.

Example:

a. The striking of the firing pin on the percussion cap.

b. The impact of the base of the cartridge on the breach block of the gun.

2. Striation or Serration Mark — These are produced by a harder surface scraping, dragging, sliding or slipping across a softer one leaving a series of abrasions, serrations and scrapes.

Example:

a. The bullet surface may show rifling marks on its surface as it passes the spiral landings and groovings of the inner surface of the barrel.

b. The extractor produces striations as it slips over the cartridge groove.

c. The ejector may cause striation markings on the cartridge case in the process of ejection of the spent shell.

When a cartridge is fired from a firearm, the following marks may be found in the shell and from the bullet, a. Marks Found in the Shell:

(1) Marks of the Firing Pin:

The firing pin leaves impressions in the percussion cap. The depth, location and the size may be the individual characteristic of a firearm, although the hardness of the metal in the cap may cause certain degree of variation of the impression.

(2) Marks from the Extractor:

The extractor mark is found in front of the rim of the shell. The scratch impressed by the extractor is a characteristic in a particular firearm.

(3) Marks of the Ejector:

This mark is found at the head of the shell. Generally the ejector mark has a position opposite the extractor mark, although it is not always the case.

(4) Marks from the Breechblock: The impact of the shell to the breechblock in the recoil

impresses the ridges of the breechblock and often gives identification marks characteristic of a firearm.

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(5) Marks on the Cylindrical Surface of the Shell:

The marks are brought about by the surface of the firing chamber or by the magazine,

b. Marks Found in the Bullet: (1) Number of Lands and Grooves:

The number of grooves, depth, and width depend upon the manufacturer of the firearm.

(2) Direction of the Twist of the Rifling Marks:

The direction of the spiral lands and grooves may be a twist to the right or to the left.

Manufacturers of firearms made certain marks which may distinguish firearms manufactured by them from that of the other manufacturers. Each manufacturer makes specific number of spiral grooves and direction of the twist in the barrel of the firearm. A bullet recovered at the scene of the crime or from the body of the victim may show those marks in the examination, the examiner may have a presumption to where the firearm came from. Thus, if in the examination of the recovered bullet, it was found out that there are 6 grooves and the rifling marks are twisted to the left, then it is possible that it came from a Colt firearm.

In the firearm identification, the examiner must take into consideration the following:

1. Gross examination or examination with the use of magnifying lens:

a. Caliber of the bullet — this may be determined by:

(1) Simple inspection by an experienced examiner. (2) Weighing of the bullet. (3) Determining the diameter of the bullet by the use of a

caliper.

b. Presence or absence of deformity or loss of part.

c. Presence of foreign elements, like blood, flesh, connective tissues, soil, etc.

d. Identifying marks placed by previous possessor.

2. Examination with the use of comparison microscope:

This is a comparison between evidence shell or bullet with the test shell or bullet.

a. Determination of the class characteristics — Physical characteristics of a certain caliber of firearm used by the manufacturer:

(1) Number of riflings. (2) Direction and rate of the rifling marks.

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(3) Dimension of the lands and grooves. (4) Depth of the grooves. (5) Style of the cannelure.

b. Determination of individual or accidental characteristics:

(1) The rifling of the barrel is reflected in the bullet as it passes through it. Repetition of the fire will cause the same marking, except those where the rifling of the barrel has been changed.

(2) Firing Pin mark — When the base of the cartridge is hit by the firing pin, the pin produces distinct markings which can be reproduced by succeeding shots.

(3) Breechblock Mark — As the bullet is propelled forward by the force of the expanded gas, the casing is forcibly moved backward against the breech face or recoil plate. The backward force transfers the marking on the breechblock to the base of the cartridge.

(4) Extractor Mark — The mark made by the extractor on the cartridge rim when pulled away from the firing chamber.

(5) Ejector Mark — Mark produced by the ejector in the process of throwing away the spent shell.

G U N S H O T W O U N D S IN DIFFERENT

PARTS OF THE B O D Y

Head and Neck:

1. Cranium:

Close or near contact fire in the head may produce marked laceration of the skin, burning and tattooing of the surrounding skin. The skull is fractured without any definite shape with linear extensions to almost all of the bones comprising the cranial box.

Fire from a distance with the bullet having a right angle of approach to the skull, the fracture is oval at the outer table. There will be radiating linear fractures from the point of entrance. The wound of exit will be clean-cut oval or round opening at the inner table with a bevelled fracture at the outer table.

Grazing approach of the bullet may produce an elongated gutter-like depressed fracture of the cranium. The tangential impact of the bullet may cause it to split and it is not uncommon to see a fragment lodging in the brain substance while the other ricochette outside hitting other objects nearby:

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2. Brain Substance:

Bullet wound in the brain substance is usually a rugged tunnel with a diameter larger than that of the caliber of the bullet, with marked ecchymosis of the surrounding area and filled with fresh and clotted blood. Fragments of bones may be felt in the tunnelled bullet tract. In most cases, injury of the brain causes sudden loss of consciousness and incapable of voluntary movement.

Laceration of the brain en route of a gunshot

Injury of the cerebral hemispheres is as a rule not immediately fatal and the victim may survive the injury, however, a bullet course which includes the medulla, pons and other vital centers causes immediate death. Some victims may live for sometime but may develop epileptiform convulsions as a sequela.

3. Face:

Firearm wound on the face may not cause serious trouble except that it becomes a potential avenue of infection and may cause marked deformity.

In suicidal shot, the muzzle of the firearm may be placed inside the mouth or nostrils that no visible wound of entrance is appreciable. The course of the bullet is usually upwards and in most cases the brain is involved.

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4. Neck:

The bullet may pierce the front portion of the neck and may involve the cervical portion of the spinal cord; thus causing instantaneous death if the upper portion is involved. The course of the bullet may involve the carotid or jugular vessels and death may be due to profused hemorrhage. The anterior wall of the esophagus may be perforated and the bullet may enter into the gastrointestinal tract and expelled through the bowel. Injury to the trachea and upper bronchi may cause asphyxia or aspiration pneumonia.

Chest: 1. Chest Wall:

The bullet wound on the chest wall usually has an upward course and may involve both sides. The bullet may strike the rib, sternum or the body of the vertebra and may cause deformity or deflection of its course. When the intercostal or mammary vessels are injured, there will be profused hemorrhage. Hemothorax of more than a liter is observed in fatal cases.

2. Lungs:

The passage of a bullet in the lungs produces a cylindrical tunnel much larger than the diameter of the projectile with bloody contents and ecchymotic borders. When the pulmonary vessels are involved, profused hemorrhage is observed which produces death before medical or surgical intervention can be instituted. If only one lung is involved, the profuse hemorrhage may cause collapse of the lung, displacement of the heart, and mediastinum towards the uninjured side. Emphysema is present when there is marked injury to the air sacs. Involvement of the bigger bronchi may cause asphyxia with the lung partially atelectatic and emphysematous. The victim may not die immediately but later may develop aspiration pneumonia or cerebral embolism.

3. Heart:

Bullet wound of the heart may be circular or stellate witn subepicardial hemorrhage in the surrounding tissue. The course may be of any direction but the right ventricle is often involved because of the large surface area of exposure in front.

Gunshot wound of the heart as a general rule does not prevent the victim from running, walking, climbing stairs, or do other forms of volitional acts for death-is not usually instantaneous. Wound of the auricle is more rapidly fatal as compared with the wound of the ventricle on account of the thickness of the musculature of the latter which produces temporary closure of the wound. Bullet may lodge in the musculature of the ventricle and

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becomes encapsulated by fibrous tissue. Death in firearm wound of the heart may be due to the loss of blood or tamponade.

Abdomen: Abdominal gunshot wounds are quite frequent but not as serious

as those of the chest and head because of its amenability to surgical operation. In most cases injuries are not only limited to one organ but to several organs. Injuries to the visceral organs may not be found along the course of the bullet on account of their mobility and their capacity to change their forms. Involvement of the vertebral column may cause injury to the spinal cord. The mesenteric vessels, aorta, vena cava, and other big abdominal blood vessels may be lacerated and cause severe hemorrhage.

Bullet wound of the liver and other parenchymatous abdominal organs may cause stellate perforations which are usually larger than the caliber of the bullets that cause them. The tunnel which is also wide may contain fragmented tissue, fresh and clotted blood. On account of the richness of the blood supply of the parenchymatous organs, profuse hemorrhage is the natural sequela. Loss of function, especially of the kidneys, pancreas, etc. may lead to fatal results.

Bullet wounds of the stomach and other hollow organs are usually small on account of the contractility of the walls. The wound of entrance is smaller than the wound of exit. Grazing injury may simulate a lacerated wound. Injury of the viscus is usually multiple and with less hemorrhage except when it involves the mesenteric vessels. Timely surgical intervention may prevent untoward complications. However, death due to peritonitis is not rare on account of the spilling of its contents into the abdominal cavity.

Spine and Spinal Cord: Injury of the spine may not involve the spinal cord, but injury

of the spinal cord may be due to:

1. The bullet may directly affect the canal and the spinal cord causing either partial or complete severance.

2. The bullet may not hit directly the spinal cord but may cause injury in the body or other parts of the vertebra and contusion, concussion or compression on account of the impact. Injury of the upper cervical spinal cord may cause immediate death because the vital nerve tracts may be involved. Lower spinal cord injury may cause motor or sensory paralysis and may later succumb to hypostatic pneumonia, suppuration or other complications.

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Extremities:

Bullet wounds in the extremities may show the characteristic lesion of gunshot wounds. Usually the wound is not so serious except when it involves the principal blood vessels and nerves. The bony tissue may be involved producing comminuted fracture of the bone and deflection of the course of the bullet. Septic infection, thrombosis, hemorrhage, deformity are not unusual after-effects.

Chapter XIV

THERMAL INJURIES OR DEATHS

^ffiermal injuries are those caused by an appreciable deviation from normal temperature, capable of producing cellular or tissue changes in the body. Thermal death is one primarily caused by thermal injuries.

Exposure to severe cold may cause frost-bite, while exposure to high temperature may cause burning or scalding.

I. DEATH OR INJURY FROM COLD

Death or injury due to a cold is not common in tropical countries. The primary cause of death is attributed to the decreased dissociation of oxygen from hemoglobin in the red blood cells and diminished power of the tissue to utilize oxygen. Cold produces a vascular spasm which results to anemia of the skin surface followed by vascular dilatation with paralysis and increased capillary permeability. Prolonged exposure may cause necrosis and gangrene.

The degree of damage depends upon the severity of the cold, the duration of exposure, area of the body involved, sex and humidity. Cold damp air is more fatal than cold dry air. A short exposure to cold temperature may not be deleterious to the body as long exposure to low but not to freezing temperature. Children and aged individuals are more susceptible to cold weather on account of their limited thermotaxic reserved. Individuals whose vitality have been diminished by fatigue, lack of food, alcoholism, and previous ill-health are less able to withstand the effects of cold. Women are more resistant to cold than men on account of their greater deposits of subcutaneous fat.

The action of cold in the body is partly local and partly reflex in the circulatory system. Exposure to cold will diminish the dissociation power of oxygen from hemoglobin, thus starving the brain and other nervous center with oxygen.

The effect of low temperature consists of a local damage to the exposed tissue and systemic change involving the whole body

Effects of Cold:

y . Local Effect (Frostbite; Immersion foot; Trench foot):

First — There is blanching and paleness of the skin due to vascular spasm.

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THERMAL INJURIES OR DEATHS 395

Second — The vascular spasm is followed by erythema, edema and swelling due to vascular dilatation, paralysis and increased capillary permeability.

Third — In advanced stage of vascular paralysis, there will be blister formation.

Fourth — Continued exposure to severe cold will later lead to necrosis, vascular occlusion, thrombosis and gangrene.

On account of the expansion of the tissue and individual cells in the process of solidification, the cell membrane may rupture, tissue and organ may rupture, and the skull may be fractured. Microscopically:

There is vacuolization and degeneration of the epidermal cells, necrosis of the collagen of the subcutaneous tissue, perivascular exudates of red and white cells, occlusion of vessels lumen by clump of red blood cells, and prolification of the endothelium.

2. Systematic Effects:

The systemic effects are reflex in nature brought about by the stimulation and paralysis of the nerves. Respiration, heart action, metabolic processes are slowed down on account of cerebral anoxia. There is a cold stiffening of the body with blister formation and gangrene of the exposed part of the body.

Signs and Symptoms: 1. Gradual lowering of the body temperature is accompanied by

increasing stiffness (cold stiffening), weariness and drowsiness.

2. The person may be lethargic, passing the stage of coma to death.

3. Person may suffer from delusion, convulsion and delirium.

4. Palpation of the cutaneous surface shows hardening and coldness.

Post-mortem Findings: 1. Externally: Nothing characteristic.

a. Cold stiffening.

b. Surface of the body is pale. c. Reddish patches especially in exposed portions of the body

(frost-erythema). d. Onset of rigor mortis delayed.

2. Internally: Nothing characteristic. a. Blood is generally fluid in the heart and blood vessels with a

bright red color. b. Parenchymatous organs are congested with occasional petechial

hemorrhage.

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c. Audible cracking sound on flexing the knee and other big joints apparently due to the breaking down of the frozen synovial fluid.

d. Petechial hemorrhage in the lungs, brain and kidneys.

e. If death occurs after sometime, pathological findings related to complications, like bronchopneumonia, toxemia due to gangrene, etc. may be found.

The body tissue fluid evaporates slowly if the body is frozen, hence, mummification develops later. However, the individual cell, tissues and organs are well-preserved.

II. DEATH OR INJURY FROM HEAT

The effects of heat in the body may be local at the application, or general when the whole body is affected.

Classifications of Heat Injury:

1. General or Systemic Effects:

a. Heat cramps. b. Heat exhaustion. c. Heat stroke.

2. Local Effects:

a. Scald. b. Burns.

(1) Thermal. (2) Chemical — acids and alkalies.

(3) Electrical and lightning. (4) Radiation — X-ray, ultraviolet, etc.

G E N E R A L O R SYSTEMIC EFFECT:

1. Heat Cramps (Miner's Cramp, Fireman's Cramp, Stoker's Cramp): This is the involuntary spasmodic painful contraction of muscles

essentially due to dehydration and excessive loss of chlorides by sweating. This is seen among laborers working in rooms with high temperature and with profused perspiration.

Symptoms:

a. The -onset is usually sudden as muscles cramp with agonizing pain.

b. The cramp is accompanied by headache, dizziness and vomiting.

c. The face is flushed, pupils are dilated with tinnitus and abdominal pain.


d. The amount of chloride excretion through the urine is markedly diminished.

Usually, the condition does not end fatally. A liberal administration of fluid with chlorides relieves the patient. However, intravenous administration of saline solution rapidly restores the patient to normal.

2. Heat Exhaustion (Heat Collapse, Syncopal Fever, Heat Syncope, Heat Prostration):

This is due to a heart failure primarily caused by heat and precipitated by muscular exertion and warm clothing.

Symptoms:

a. Sudden attack of syncope, general body weakness, giddiness and staggering movement.

b. The face is pale, the skin is cold, and the temperature is subnormal.

c. The pupils are dilated, pulse weak and thready, and respiration is sighing.

d. There may be diarrhea, dimness of vision and dilated pupils.

e. Exhaustion comes gradually with throbbing in the temple.

f. The patient usually recovers, if made to rest, but occasionally

the condition may become worse and the patient dies of heart

failure.

The treatment is purely symptomatic and removal from heated area.

Post-mortem finding is nothing typical, except probably cloudy swelling of the heart musculature.

3. Heat Stroke (Sunstroke, Heat Hyperpyrexia, Comatous Form, Thermic Fever):

This usually occurs among those working in ill-ventilated places with dry and high temperatures or due to a direct exposure to the sun.

Symptoms: a. Sudden onset that may be followed by premonitory symptoms

of headache, malaise, giddiness and weakness of the legs. b. Temperature rises suddenly and the skin becomes dry, with

burning sensation and flushed skin and complete cessation of sweating.

c. Face is congested. d. Pulse is full and pounding .

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e. Respiration later becomes irregular.

f. The pupils are usually contracted.

g. Death occurs in 1/2 to 1 hour after the onset of symptoms.


a. Cadaveric rigidity comes soon and passes off soon.

b. Putrefaction occurs early.

c. Lividity is marked. d. Petechial hemorrhages may be found in the brain and in the

heart. e. Congestion of the internal organs.

f. The temperature may rise after death.

Medico-Legal Importance of Heat Cramps, Heat Exhaustion and Heat Stroke:

If ever death occurs, it is most often accidental. Laborers who are working under the sunshine, in a heated room, or in a poorly ventilated place may suffer from any of the conditions. Alcoholism, ill-health, disease and fatigue may be some of the predisposing factors. Although mostly accidental, physician must perform the necessary post-mortem examination in the bodies to eliminate the possibility of foul play. However, it may be homicidal or suicidal in rare instances. Children may be victims of infanticidal acts when subjected to conditions promoting their development.

L O C A L EFFECTS O F H E A T :

Scald (caused by hot liquid):

Scalds are injuries produced by the application to the body, liquids at or near boiling point, or in its gaseous state. The term applies to tissue destruction by moist heat. The injury by scalding is not as severe as burns because (a) the scalding liquid or vapor runs on the body surface, thereby distributing its heat, (b ) the scalding material easily cools off, and (c) the temperature of the scalding substance is not as high as those producing burns, except oils and molten metals. The effect on scalding is the same as burns.

a. Scalds often have a distribution called a "geographical lesion." It follows the portion involved in the splashing of the scalding fluid together with the rule of gravity.

b. The skin lesion may be located in covered portions of the body without affecting the clothings.

icteristics of Scalds:


Extensive scalding

c. There is neither burning of the hair nor deposit of carbonaceous material on the skin surface.

d. The lesion is usually first, second or third degree, except in cases of heated oil or molten metals.

e. Inhalation of the heated vapor may lead to inflammatory reaction in the air passage which may lead to respiratory obstruction due to edema of glottis.

f. Usually, there is redness of the skin immediately after the application, later a blister is formed. Pricking of the blister and removal of the epidermis will show a pink raw surface from which the fluid will ooze. The base will later become red in about six hours. There will be leucocytic infiltration and granulation tissue will develop.

g. Sepsis with development of pus may appear in one or two days. Healing may be accompanied by the formation of scars, which may result in contracture or keloid formation.

Scalds are usually painful specially the second and third degree types.

It is less fatal as compared with burns except when it involves a great area of the body surface.

Death is usually due to septic complications which occur after a day.

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Scalding is usually accidental in kitchens. Homicidal scalding caused by throwing boiling water on the face and body is quite rare.

2. Thermal Burns (dry heat):

Burns are lesions which are caused by the application of heat or chemical substances to the external or internal surfaces of the body, the effect of which is destruction of the tissue of the body. It includes all lesions produced by fire, radiant heat, solid substances, fire, friction and electricity.

Most burns caused by localized source of heat are accidental. It may occur in the kitchen, by contact with heated solids or live flame.

Most of the victims of burns are recovered in conflagration of buildings which are either accidental or intentional.

Purposes of Intentional Fire:

a. Destruction of the victim of a criminal act to conceal identity and true cause and manner of death.

b. The building was set on fire to kill or with homicidal intent (torch murder).

c. To perpetuate insurance fraud both property and life.

d. A person might have committed suicide by other means and tried to hide the cause and manner of death by setting fire on the surroundings.

e. Victim might have been trapped in the building set afire accidentally or intentionally.

f. A person in pursuance of a cause may soak himself with an inflammable substance (accelerant) and burn himself to death.

Classification of Bums:

a. Thermal b. Chemical c. Electrical d. Radiation e. Friction

Characteristics of Bums:

a. The lesion varies from simple erythema to complete carbon

ization of the body.

b. Usually, there is singeing of the hair and carbon deposits on the area affected.

c. The area involved is general and usually without any demarcation line of the affected and unaffected parts.


Burns with carbonization of the b o d y

d. Lesions in covered portions of the body, also involved burning of the clothings over it.

e. In death by burning in a conflagration, it is necessary to identify the victim and determine whether burns are ante-mortem or post-mortem.

Classification of Bums by Degree (Dupuytren's Classification):

a. First Degree:

There is erythema or simple redness of the skin associated with superficial inflammation and slight swelling which may subside after a few hours or may last for several days. It may be produced by momentary application of flame, or hot solid or liquid much below boiling point. It is also produced by mild irritant.

b. Second Degree:

There is vesicle formation with acute inflammation. If the burns are caused by flame or heated solid substance, the skin is blackened and the hair singed at the seat of lesion. The vesicle can be produced by strong irritants or vesicants. Scars are not present after healing. The superficial layers of the epithelium are destroyed,

c Third Degree:

There is destruction of the cuticle and part of the true skin. The burned area is very painful owing to exposure of the nerve

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endings. Healing may leave a scar which contains all the elements of the true skin, consequently without contracture.

d. Fourth Degree:

The whole skin is destroyed with formation of slough which is yellowish-brown or parchment-like. The surface is ulcerated and on healing a dense fibrous scar tissue develops. The scar may subsequently contract and cause deformity of the part. On account of the complete destruction of the nerve endings, this kind of burn is not very painful.

e. Fifth Degree:

There is involvement of the deep fascia and muscles. This may result to severe scarring effect and deformity.

f. Sixth Degree:

There is charring of the limb involving subjacent tissues, organs and bone. If death does not ensue immediately inflammatory changes may develop in the surrounding tissues.

Distinctions Between Burns and Scald:

Burns

a. Caused by dry heat (flame, heated solid or radiant heat).

b. Occurs at or above the site of contact of the flame.

c. Singeing of hair is present.

d. Boundary of the affected and unaffected area is not so clear.

e. Injury may be severe.

f. Clothings are involved.

Scalds

a. Caused by application of moist heat (liquid, steam at or near boiling point).

b. Occurs at or below the site of the application or contact with liquid.

c. Singeing of hair is absent.

d.-Boundary distinct, usually like a geographical relief map of the affected area.

e. Usually, limited on account of the dissipation of heat in the tissue.

f. Clothings are not usually burned.

Factors Influencing the Effect of Bums in the Body:

a. Degree of Heat Applied:

The effect in body tissue by heat varies with the temperature of the heated object causing it. The effect will be more severe, if the heat applied is great.

b. Duration of Exposure or Contact:

The longer is the time of exposure or contact, the greater


will be the destruction. The underlying tissue will be liable to be subjected to the high temperature.

c. Extent of the Surface Involved:

Involvement of more than one-third of the body surface to a second and third degree burns usually ends fatally. This is due to pain, hemoconcentration and shock.

d. Portion of the Body Involved:

Burns of the extremity is not as serious as that of the head, neck and trunk. Burns of the genital organs and that of the lower portion of the abdomen are usually serious. Burns in serous cavities are graver than in the skin.

e. Age of the Victim:

Adults can withstand burns longer than the children and the aged individuals. Children can withstand suppuration.

f. Sex of the Victim:

Men can resist burns better than women.

g. Septic Infection:

This may bring about complication in other parts of the body and may lead to death.

h. Depth of Burns:

In 6th degree burns, whereby the muscles and bones are involved, it is more likely that a person is terminated due to shock.

Healing of extensive burns with leucoderma, epidermal desquamation and formation.

404 LEGAL MEDICINE

Causes of Death in Bums and Scalds:

a. Immediate Fatal Result:

(1) Death from shock. (2) Death from concomittant physical injuries with burns. (3) Suffocation.

b. Delayed Fatal Result:

(1) Exhaustion. (2) Dehydration with hemoconcentration. (3) Secondary shock. (4) Hypothermia. (5) Complications:

(a) Septicemia. (b ) Pneumonia. (c) Nephritis. (d) Inflammation of serous cavities and internal organs.

( 6 ) Changes in the blood due to heat:

In conflagration, the early death is due to a primary or neurogenic shock, following a painful irritation of the multiple nerve endings in the skin.

The suffocation is brought about by the formation of carbon monoxide, hemoglobin or by the action of other noxious gases of the fume.

Death may occur from an accident occurring in an attempt to escape from the burning house or from injuries inflicted by the wall and timbers falling on the body.

The loss of body fluid, blood plasma, chlorides and other substances of the blood is due to evaporation from the raw skin surface.

Absorption of toxic materials from the site of the injury may lead to necrosis of the liver, renal tubular degeneration, and cloudy swelling of other organs.

Inhalation of the fumes may cause inflammatory reaction of the respiratory passages.

Secondary infection of the wound may lead to septicemia and inflammation of other organs and serous cavities.

Time Required to Completely Bum a Human Body:

The time required to transform the human body to ashes is dependent upon several factors, namely:

a. Degree or intensity of heat applied. b. Duration of the application of heat. c. Physical condition of the body.


d. Presence of clothings and other protective materials.

About 72% of the human body weight is. water and this is responsible for the delay in its combustion, however, there is about 5% fat which may enhance combustion on account of its combustibility.

In a gas furnace incinerator, it requires about four hours of continuous application of heat to transform the body into ashes.

Age of the Burns:

A very recent burn will show no pus, or much healing, or edema.

When the pus is already present and the red inflammatory zone has disappeared, it is about 36 hours or a few days old.

There is a superficial sloughing in a third degree burn in about a week.

The deeper sloughs are thrown off in two weeks and are attended with suppuration.

When the red granulation tissue is present, it is about two weeks old.

The age of older burns is estimated by the amount of granulation tissue present, by its depth, and by the extent of the growth of epidermis from circumference.

Proofs that the Victim was Alive Before Bumed to Death:

a. Presence of smoke in the air passage — There is grayish-black or black amorphous material adherent to the mucosa of larynx, trachea, and bronchi. The quantity of the soot in the air passage depends on the type of fuel, amount of smoke produced and duration of survival in the smoke contaminated atmosphere.

b. Increase carboxy-hemoglobin blood level — Carbon monoxide enters the body through the respiratory tract. The presence of carboxy-hemoglobin is responsible for the cherry-red color of the fire victim.

c. Dermal erythema, edema and vesicle formation — Erythema and edema show that circulation was present when heat was applied.

d. Subendocardial left ventricular hemorrhage.

Is Burning the Cause of Death? The physician must determine whether the lesions due to

burning are by themselves sufficient to cause death. He must

406 LEGAL MEDICINE

also determine whether there are evidences of other lesions which may account for the death.

The following findings may prove that death is due to burning:

a. Presence of vital reaction at the heated areas.

b. Presence of carboxyhemoglobin in the blood.

c. Presence of carbon particles in the tracheo-bronchial lumina.

Scars of Bums:

Scars of superficial burns are thin and pliant. In severe burns, these are irregularly thick with patches and bonds of fibrous tissue causing contractions. Keloid formation is common in scars from burns.

Distinction Between Ante-mortem from Post-mortem Bums:

The principal basis of the distinction is the presence or absence of vital reaction, like inflammation, vesicle formation, congestion and granulation tissue. The principal points of distinctions are:

a. The blister formed in ante-mortem burns contains abundant albumen and chlorides, while in post-mortem burns, the blister contains scanty albumen and chlorides.

b. There is an area of inflammation around an ante-mortem bum which is not present in the case of post-mortem bums.

c. The base of the vesicle is red in ante-mortem bums while there is not much change in color in the case of post-mortem burns.

d. In burns due to conflagration, the tracheo-bronchial lumina may contain particles of soot or carbon, while in the case of post-mortem burns there is no finding.

e. Blood will show presence and abundance of carboxyhemoglobin in cases of ante-mortem burns, but not in cases of post-mortem burns.

The absence of signs of vital reactions at the site of the bums does not necessarily indicate that the lesion is post-mortem. Death may have occurred too quickly for those changes to develop, or the injuries might be ante-mortem but the body resistance is so diminished to produce the vital reactions.

Distinctions Between Ante-mortem from Post-mortem Blisters:

a. Ante-mortem blisters contain fluid rich with albumen and chlorides, while post-mortem blisters may contain air or scanty amount of albumen and chlorides.

b. Heating the fluid contents of an ante-mortem blister will cause solidification, while heating of a post-mortem blister will show slight cloudening but not solidification.


c. The base of an ante-mortem blister is reddish with signs of inflammatory changes in the periphery, but there is no such finding in case of post-mortem blister.

d. Fluid content of an ante-mortem blister is abundant, while in the case of post-mortem blister is scanty.

Differential Diagnosis of Blister Due to Heat:

a. Blister Due to Putrefaction:

The fluid content is blood-stained watery fluid and accompanied by putrefactive changes in other parts of the body.

b. Blister Due to Disease:

This can be differentiated from blister due to heat by the size, distribution and absence of other signs of the effect of heat application.

c. Blister Due to Friction:

History and absence of signs of the application of heat in the neighborhood will differentiate it from blister due to burns.

Heat Rupture:

This is the splitting of the soft tissues of the body, like the skin, due to exposure before or after death of the body to considerable heat.


a. Incised Wound — A heat rupture may be mistaken for an incised wound. It may be distinguished by the absence of blood inasmuch as heat coagulates blood inside the blood vessels. In heat rupture, the blood vessels and nerves are kept intact at the point of the rupture. On close inspection, the margins are irregular unlike those in the case of incised wounds.

b. Lacerated Wound — In lacerated wound, there is contusion and other vital reactions at the margin, which is not present in cases of heat rupture. The roasted condition of the skin is prominent in cases of heat rupture.

Heat Stiffening: This condition is found in dead bodies which have been sub

jected to heat. The heat coagulates the albuminous materials inside the muscle making it stiff and contracted. The limbs are flexed and the fingers partially clenched simulating a "pugilistic" position of a boxer. There is flexion of the limbs and fingers on account of the fact that the flexor muscles are stronger than the' extensors. The heat stiffening remains for sometime until the body softens due to the onset of decomposition.

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Investigation of Death in a Conflagration:

Examination of the burnt body should be directed to obtain the following informations:

a. Identity, which may be established from:

Clothing. Careful handling must be stressed, as charred materials can yield considerable information in expert hands, but can also be easily destroyed. The size of footwear may be of importance.

Property in the pockets such as key, money, papers and the like.

Height — Sex — Age — Color of eyes — Color of hair.

Natural disease or stigmata such as scars, old deformities or injuries and dentition.

b. Whether the person was alive in the fire, which can be decided from the presence of carbon particles in the air passages, and the estimation quantitatively of carbon monoxide in the blood.

c. Cause of death.

d. Information indicating a possible cause of the fire, as shown by examination of the deceased. Evidences of the following should be noted.

Alcoholic intoxication (Blood and urine estimation for alcohol).

Natural disease which might have caused collapse, such as epilepsy, hypertension, myocardial fibrosis.

Site of origin of the fire, as shown by maximal effects in relation to position of the body.

Demonstration of injuries which could have been sustained before the fire commenced.

(From: Practical Forensic Medicine by Camp & Purchase, p. 236).

Post-mortem Findings (Burns and Scald):

a. External Findings:

(1) Presence of external lesion depending upon the degree of burning and scalding of the body.

(2) "-Pugilistic position" or "fencing posture" of the body.

(3) Blackening of the body surface in case of burns.

(4) Rupture of skin, muscles, or destruction of limbs or skull.

(5) Exposure of internal organs.

( 6 ) Singeing of the scalp and other hairs of the body.


b. Internal Findings:

(1) Blood is cherry-red in color owing to the presence of carboxyhemoglobin.

(2) Increase in the lymphoid tissue, especially of the intestine and lymph glands.

(3) Marked dehydration.

(4) Hemoconcentration with increased capillary permeability.

(5) Congestion of visceral organs.

(6) Cloudy swelling of liver and kidneys.

(7) Enlargement of the adrenal glands with hemorrhagic infarcts.

(8) Lungs are shrunken, mucous membrane of the bronchi are congested and sub-serous hemorrhages present.

(9) Intestinal mucous membrane are congested especially the Brunner's glands of the duodenum.

(10) Spleen enlarged and soft.

(11) Brain and spinal cord shrunken and hyperemic.

(12) Presence of carbon particles in the respiratory tract.

(13) Fatty degeneration in the liver.

Medico-Legal Aspect of Burns and Scalds:

During the ancient and medieval times, branding is a means to secure identity. Red-hot metals shaped in letters or figures are pressed in the arm and thigh. With the improvement of the present method of identification, branding is now only made on domestic animals.

Extraction of confession by burning the fingers, application of heated metals on the skin, or pouring boiling water on the body is now punishable.

Killing of a person and setting afire the building for the purpose of concealing the crime or for the purpose of destroying the body of the victim is quite common. It is in this connection that the physician must exert all efforts to determine the true nature of the case.

Burning and scalding is usually accidental, but occasionally homicidal or suicidal.

Accidental cases are common among women and children on account of their loose garments which easily catch fire. Children, mentally deficient persons and intoxicated individuals may expose their bodies to boiling water or live flame.

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A number of persons may die from burns when fire breaks out in an inhabited house, or when an explosion occurs in a factory.

The Revised Penal Code considers the killing of a person by means of fire as murder. The setting of a building on fire must be an intentional means to kill the person inside the building to make it a murder (Art. 248). There should be the actual design to kill and that the use of fire should be purposely adopted as a means to that end (People v. Burns 41 Phil. 418).

It is claimed by some authorities that the human body can ignite itself spontaneously and bum itself to death. This is hardly possible on account of the high percentage of water in the human body. Spontaneous combustibility may be utilized as a defense in cases of homicidal burns if it is really probable.

It is claimed that the human body is inflammable on account of the presence of gases which easily ignite. The gases are said to be the products of the action of microorganisms in the body. This explains the presence of phosphorescent light in the graveyard during night time. If ever the theory is true, then there can only be a partial combustion of the human body.

Chemical burns are the action of strong acids and alkalies and other irritant chemicals which cause extensive destruction of the tissue. Healing is quite slow and may require plastic surgery. The most common of the chemicals are concentrated sulfuric acid, nitric acid, hydrochloric acid, caustic soda and potash, lysol, etc. Chemical burns may be followed by keloid scars.

Characteristics of Lesions:

a. Absence of vesication.

b. Staining of the skin or clothing by the chemical.

c. Presence of the chemical substance.

d. Ulcerative patches of the skin.

e. Inflammatory redness of the skin surface.

f. Healing is quite delayed on account of the action of the chemicals to the underlying tissue.

Distinctions Between Thermal and Chemical Burns: a. There is an absence of blister in case of chemical bums while

blister may be present in thermal burns.

ontaneous Combustibility:

-eternatural Combustibility:

Chemical Burns (Corrosive Burns):

Extensive burns by strong acid

b. The skin and clothings may be stained with chemical in case of chemical burns, but there is no such staining in thermal burns.

c. Analysis of the substances around the lesion will show the chemical causing the corrosion. Nothing of this nature is found in thermal burns.

d. In thermal burns, the lesion is diffused while in chemical burns the borders are distinct and simulating a geographic appearance.

Characteristic Lesions by Different Chemicals:

a. Sulphuric Acid (Oil of Vitriol), which has the most intense action, causes a considerable amount of destruction of the tissues with the formation of a blackish-brown sloughs. The face or other part will show splash marks where the acid has fallen, and usually there will be lines of ulceration where the acid run down the surface of the body.

The clothing will be destroyed in the places where the acid has spilled.

b. Nitric Acid causes a yellow or yellowish-brown slough, and the spot of yellow color will be seen .on the skin. The clothing is destroyed and the color becomes brown.

c Hydrochloric Acid, though not so destructive as either sulphuric or nitric acid, causes as intense irritation and localized ulceration of a red or reddish-gray color.

412 LEGAL MEDICINE

d. Caustic Soda and Potash have a corrosive action on the tissues, giving a bleached appearance and greasy feeling to the skin. The skin subsequently becomes brown and parchment-like.

(From: Taylor's Principles & Practice of Medical Jurisprudence by S. Smith, 10th ed., p. 327).

Severe burning and staining of the skin of the face in suicidal poisoning

by muriatic acid.

Treatment:

a. Neutralization of the corrosive substances.

b. Protection of the eye from involvement.

c. Prevention of infection of the lesion.

d. Other supportive or symptomic treatments.

Burns from corrosive fluids are quite rare and are usually due to accidents in chemical laboratories. Vitriol throwing is common in England. Intentional spilling or throwing of corrosive fluid causes physical injury and on account of the deforming scar it produces, it becomes a serious physical injury. Corrosive burns are commonly observed in suicidal ingestion with spilling of the chemical around the mouth and neck.

4. Electrical Bums:

There are three kinds of electrical burns, namely: — contact burns, spark burns, and flash burns. The characteristic feature of all of them is that their depth is greater than the surface appear-


ance this would suggest that severe sloughing of the tissues may occur later.

a. Contact Burn — due to a close contact with an electrically live object, and the degree will vary from small and superficial lesion to charring of skin if contact is maintained.

b. Spark Burn — due to a poor contact and the resistance of dry skin and shows a pricked appearance with a central white zone (parchment) and surrounding of hyperemia. This burn, which may be essential to the proof of electrical contact, can be very difficult to identify, and sections should be cut in an attempt to establish their nature.

c. Flash Burn — the appearance varies from the arborescent pattern of lightning burns to the "crocodile skin" appearance of high voltage flash (From: Practical Forensic Medicine by Camp and Purchase, p. 238-239)

5. Radiation Burns:

a. Burns from X-ray:

The burns from X-ray depends upon the degree of intensity and period of exposure. Slight-exposure will produce reddening and inflammation of the skin which will pass away within a short period of time leaving a bronze color on the skin. Higher degree of over-exposure may produce blister, atrophy of the superficial tissue and obliteration of the superficial blood vessels. In very severe cases, there may be ulceration of the tissue which may later lead to malignancy.

b. Ultraviolet Light Burns:

Overdose of ultraviolet light may lead to severe and persistent dermatitis. There is uncomfortable irritation of the skin and may later develop into a blister.

Chapter XV

PHYSICAL INJURIES OR DEATH BY LIGHTNING AND ELECTRICITY

D E A T H O R PHYSICAL I N J U R Y B Y L I G H T N I N G :

slAghtning is an electrical charge in the atmosphere. Its place of occurrence and intensity are unpredictable. The flash of lightning is due to the passage from a thunder cloud to the earth of a direct electric current of enormous potential, amounting to something like 1,000 million volts and about 2,000 amperes. Along the path of the current, a great portion of its energy is liberated, most of which is converted into heat. The size of the tract is variable and may produce branching flash along its course. Because of the enormous power of destruction, it is capable of producing injury to the human body.

Elements of Lightning that Produce Injury:

1. Direct effect from the electrical charge:

The electrical charge of lightning may pass to the body producing electrocution. The human body especially its nerves, is a good conductor of electric current.

2. Surface "flash" burns from the discharge:

Some of the electrical energy in a lightning is transformed to heat energy. The superheated air may cause burning of the skin of the victim. The flash burn may produce arborescent marking but are by no means typical.

3. Mechanical effect:

The expansion of the air on account of the superheated atmosphere may bring about mechanical injury. It may result to laceration of the body surface, severe tearing of the clothings and displacement of parts of the body.

4. Compression effect:

The compressed air pushed before the current with superheated atmosphere may produce a backward wave. This causes the "sledge hammerblow" on the body of the victim, thereby producing concussion, shock, or unconsciousness to the victim.

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DEATH BY LIGHTNING AND ELECTRICITY 415

Points to be Considered in Making a Diagnosis of Death from Lightning:

1. History of a thunderstorm that took place in the locality.

2. Evidences of the effects of lightning are found in the vicinity, like damages to houses, trees, and other objects; death of other person and animals nearby.

3. Metallic articles are fused and magnetized.

4. Fusion of glass materials on account of severe heat.

5. Absence of wound and other injuries indicating suicidal or homicidal death.

6. Skin often shows arborescent markings due to superficial erythema which disappear in a day or two if the person lives.

7. Burns may be present, but may be limited to the part under the pieces of metals such as watch, knife or bunch of keys. The burns are superficial or may be very deep.

Classes of Burns Due to Lightning:

1. Surface burns — These are superficial burns usually seen under metallic objects worn or carried by the victim.

2. Linear burns — These are found where areas of the skin offer less resistance, notably in the moist creases and folds of the skin and may vary in length from one to twelve inches.

3. Arborescent or filigree burns — These are radiating burns from a point, similar to electrocution.

Effects of Lightning in the Human Body:

Death is usually the immediate effect due to the involvement of the central nervous system. The shock is produced by the instantaneous anemia of the brain brought about by the spasmodic contraction of the cerebral vessels. The lightning may cause immediate loss of consciousness and because of the intense disturbance of the air, the clothings may be removed from the body or severely torn.

Occasionally, a person may recover from the effect of the lightning stroke but in most cases suffer from certain degree of neurological disturbances. 1. Symptoms of Mild Attack:

a. External lesion of almost any description.

b. Unconsciousness.

c. Slow, deep and interrupted respiration.

d. Pulse is slow and weak.

e. Pupils are dilated and sensitive to light.

f. Relaxation of the entire muscular system.

416 LEGAL MEDICINE

A victim of lightning

g. Headache, dizziness and noise in the ears.

h. In severe cases, it may lead to blindness, deafness and loss of speech.

2. Delayed Effects:

a. Insomnia and defective memory.

b. Irritability and inability to concentrate.

c. Paralysis or an increasing weakness of the limbs with pro

gressive wasting of the muscles.

d. Hemiplegia, aphasia, deafness, epilepsy.

e. Progressive cerebellar syndrome.

Treatment:

1. Artificial respiration.

2. Air passage must be kept free.

3. Lumbar puncture to release the tension in the cerebrospinal fluid.

4. Rectal hypnotic to combat delirium.

5. Treatment to combat shock.

6. Treatment to build resistance of the victim.



1. External:

— Marked tearing of the wearing apparel.

— Burns of different degrees on the skin surface.

— Wounds of almost any description.

— Magnetization of metals in the wearing apparel.

— Fusion of metals and glasses.

— Singeing of the hair of the scalp and other parts of the body.

2. Internal:

— Fracture of bones.

— Hemorrhage due to the laceration or the rupture of organs.

— Petechial hemorrhages of the lungs, pericardium, brain.

— Rupture of the blood vessels and the internal organs.

Medico-Legal Aspect:

Investigation of death due to lightning is not by itself of any medico-legal interest for it is an accidental death. No one can be held responsible to the effect of a fortuitous event. However, its investigation may be useful to eliminate the possibility that death is due to the felonious act of another person.

D E A T H O R P H Y S I C A L INJURIES F R O M E L E C T R I C I T Y :

The main cause of death in electricity is shock. Ordinary domestic line is from 100 to 250 volts and it is sufficient to produce death. The effect of 300 volts and above may be similar to lightning stroke. Voltage is not only the factor causing the injury. As a matter of fact, amperage or intensity of the electrical current is the principal factor.

The damage to the body by an electrical discharge depends upon several factors which may increase or decrease the electrical conductivity of the body. The presence of moist skin, wet floor, barefoot and proximity of metals, increase the conductivity of the body to electricity. Dryness of the skin, presence of rubber boots or shoes, dryness of the floor and better insulation of the metallic conductor increase the resistance. An increase in the conductivity of the body will promote more injury.

Factors which Influence the Effect of Electrical Shock: 1. Personal idiosyncracy — Individual personality, physical con

dition, and the existence of mental or bodily distress at the time, influence the effect of a shock.

2. Disease — A person suffering from cardiac disease is predisposed to death from electrical shock.

418 LEGAL MEDICINE

3. Anticipation of a shock — When a person is aware of the possibility of a shock, the victim can withstand one which might otherwise be dangerous.

4. Sleep — Sleep increases the resistance to an electrical current.

5. Electrical voltage or tension — Most fatalities are followed by a shock from a current at a tension of 220 — 250 volts, although 50 volts which are used for therapeutic purpose also show fatality.

6. Amperage or intensity of electric current — This is the principal factor. This is determined by dividing the voltage with the resistance of the conductor. Amperage of 70-80 in alternating current or 250 in direct current is dangerous to man.

7. Density of the current.

8. Resistance of the body — Factors that will reduce the resistance of the body to electrical flow will promote more injury.

9. Nature of the current — It is claimed that the alternating current is more dangerous than direct current.

10. Earthing— The development of shock is enhanced, if the victim is grounded or earthed. Earthing will promote continuous flow of electric current.

11. Duration of contact — Low tension may kill when contact is maintained for several minutes. A shorter duration of contact is enough for high tension to produce death.

12. Kind of electrodes — Some electrodes conduct a free flow of electric current while others do not.

13. Point of entry — Contact of the left side of the body is claimed to be more dangerous than that of the right side.

Mechanism of Death in Electrical Shock:

1. Ventricular fibrillation which may lead to the rupture of some of the muscle fibers and focal hemorrhages in low voltage.

2. Respiratory failure due to bulbar paralysis in high voltage.

3. Mechanical asphyxia due to violent and prolonged convulsion.

Nature of Electrical Burns: The electrical burns is sometimes called "electrical necrosis/'

Some calls it electric marks or "current markings," and may be seen at the point of entrance and exit to the current. The skin is puckered with gray color and traversed by deep impressions arranged at right angle.

The electric marks are painless and show no vital reaction. When unaccompanied by burns, the hair in the region of the mark is intact.


Repair is by a process of aseptic necrosis, followed by luxuriant granulation and healing leaves a smooth, thin, pink scar.

The absence of mark does not exclude electrocution but the presence raises a strong presumption of death from electrocution.

Microscopically:

There is compression of the stratum corneum. There is also superficial carbonization. It is deeper in the epidermis and there is a focal cavitation due to the sudden production of steam by the current. The papillae of the corium are flattened with vascular contraction, especially at the center of the mark.

Symptoms:

If death does not occur after contact, the person may show the following symptoms:

— Surface of the body is cold and moistened. — Breath is stertorous. — Pulse is rapid, filiform and may be irregular. — Pupils are dilated and insensitive. — Pale face.

Metallization:

This is claimed to be a specific feature of electrical injury. The metal of the conductor is volatilized and particles of the metal are driven into the epidermis. Extensive areas of the body may be darkened by metallization. The color may vary from brown to black. If the conductor is iron, it is usually yellow-brown while if it is copper, copper salts may be produced to yield a blue mark.

Delayed Effects of Electrical Injuries: Necrosis of the area involved, may later develop into gangrene.

Because of the arterial damage, the gangrenous area may be far more extensive than the electrical injury.

The damaged arteries may become brittle and friable that it is liable to a rupture at a slight provocation causing a severe hemorrhage.

The late nervous injuries may be manifested in the form of retrograde amnesia, changes in personality, hemiplegia, aphasia, and post-concussional syndrome.

The current might have entered the head and produce cataract of the lens in the form of flaky opacities.

Post-mortem Findinge: There is nothing specific, or may show no lesion at all.

420 LEGAL MEDICINE

— Electrical arborization. — Bums with metallization. — Intense vascular congestion of the dura mater. — Eyes congested and pupils dilated. — Trachea may be congested. — Lungs deeply engorged and edematous. — Congestion of visceral organs.

Treatment:

1. Remove the victim from live wire installations. Close the switch and remove the victim and in which case, care must be exercised by the rescuer.

2. Artificial respiraton which must continue for about an hour until positive proof of death is present.

3. Treatment of shock or coma. As soon as spontaneous respiration is established, raise the temperature of the patient by the application of hot water in bottles and blankets. Cerebral edema may be treated by lumbar puncture. Stimulant may be given to improve the health.

Medico-Legal Aspect:

Death by electrocution is mostly accidental. They are very rarely, suicidal or homicidal. Accidental electrocutions usually occur in grounded laundry line, electric stoves and outlets.

Chapter XVI

DEATH OR PHYSICAL INJURIES DUE TO CHANGE OF ATMOSPHERIC PRESSURE (BAROTRAUMA)

The normal atmospheric pressure at sea level is 760 millimeters of mercury. A person is subjected to an increase of atmospheric pressure as he goes deeper in a body of water and a decrease as he ascends higher in the atmosphere.

INCREASE OF ATMOSPHERIC PRESSURE (Hyperbarism):

This condition is observed underwater by scuba divers, pearl divers, salvage divers, treasure hunters, pleasure swimmers, etc..

Henry's law provides that "at constant temperature, the amount of gas dissolved in a liquid is directly proportional to the pressure." As the diver goes deeper into the body of water, the atmospheric pressure he is subjected to increases. The atmospheric pressure is doubled at 10 meters and this increases further as he goes deeper. As a consequence of this, there is an increase in the amount of gas dissolved in the blood and other body fluids.

Before a diver enters a body of water he breaths deeply to fill up his lungs with an estimated volume of six liters. This air is gradually absorbed by the body fluid so that at a depth of six meters the diver needs twice the volume of air normally required when on the surface with an increase fourfolds at a depth of 33 meters.

The longer the diver remains under pressure and the deeper is the descent, the greater is the degree of gas saturation of the tissue and the greater the length of time required for subsequent decompression.

In the process, nitrogen, an inert gas which constitute approximately 80% of the air in the lungs is also dissolved in the body fluid and this causes the so-called "nitrogen narcosis" (rupture or drunkenness of the deep). This condition is preceded by a feeling of euphoria.

The absorption of gas in the lungs will cause decrease pressure on the pulmonary tissue as compared with that of the pulmonary circulation and this difference in pressure will cause transfer of fluid from the pulmonary capillaries into the alveolar space causing pulmonary edema. A rapid descent may cause rupture of the blood vessels and hemorrhage.

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422 LEGAL MEDICINE

The ear drum may bulge inward resulting to stretching, pain, hemorrhage and ultimate perforation of the tympanic membrane.

Aside from the effects of the increase atmospheric pressure, the diver may suffer from:

1. Cerebral anoxia due to a prolonged stay under water;

2. Muscular cramp;

3. Physical injuries in the process of diving and hitting hard objects;

4. Injuries caused by aquatic animals, like shark or stings of venomous fish and coelenterates;

5. Effects of the changes of atmospheric pressure in a pre-existing disease like hypertension or a coronary affection.

During Ascent from a High Atmospheric Pressure of the Deep Sea to the Surface Atmosphere:

If ascent is made gradually, the chances of untoward effects may not be observed. However, if ascent is made rapidly, the diver may suffer from the effects of the sudden release of the gases from the body fluid. Released air bubbles may be present in the circulation and become potent emboli in different parts of the body.

In the chest, it may cause interstitial emphysema at its wall and also at the neck and face. Pneumothorax and pulmonary air embolism may also be present.

Air emboli during decompression may lodge in the capillaries of the big joints causing it to adopt a semi-flex position, hence called "bends." The affected areas by the air embolism cause ischemia, pruritus and pain. Air embolism may be fatal if it lodges in the vital organs of the body.

Post-Mortem Findings:

1. If Death has been Immediate:

Subcutaneous emphysema, generalized visceral congestion and the presence of gas bubbles.

Extra-vascular bubbles and hemorrhages in adipose tissues, like the mesentery and omentum.

2. If Death Occurred After a Lapse of Several Days.

Degeneration and softening of the white matter of the spinal cord.

Fat necrosis of the liver. Osteonecrosis.

DECREASE OF ATMOSPHERIC PRESSURE (Decompression):

1. Hypobarism — At a higher altitude the atmospheric pressure

ATMOSPHERIC PRESSURE (BAROTRAUMA) 423

becomes lower and more gas will be liberated by the body fluid. The release of gases from the body fluid will cause:

a. "Bends" — Joint and muscular pain due to the presence of air bubbles.

b. "Chokes" — Substernal distress, a non-productive coughing and respiratory distress. This is the result of bubble formation in the pulmonary capillaries or from the effects of extravascular mediastinal bubbles exerting pressure on the mediastinal contents and adjacent pulmonary tissue.

c. Substernal emphysema — Accumulation of bubbles underneath the skin and is observed as a crepitation on palpation of the skin.

d. Trapped gas — may result in the doubling of the size of hollow viscus, like the stomach and intestine at 18,000 feet level. The size quadruples at 33,000 feet. Expansion of the size of the stomach may cause diaphragmatic herniation.

Modern aircraft flying at high altitude have been pressurized to remove the ill-effects of low atmospheric pressure.

2. Anoxia — At higher altitude the oxygen content of the atmosphere becomes lesser and lesser. Hypoxia will be felt between 8,000 to 15,000 feet level. Aircraft flying beyond 34,000 feet above sea level must be provided with oxygen to maintain the human demand.

A I R C R A F T INJURIES A N D F A T A L I T I E S :

Causes of Injuries and Fatalities in Aircraft are:

1. During the Flight:

a. Altitude:

Hypobarism (Decompression).

b. Speed — Passengers and crew may suffer from spatial disorientation and windblast.

The sudden change of direction at a speed of 500 miles tends to drain blood from the brain to the lower parts of the body resulting to a momentary black-out or unconsciousness.

c. Toxins — Carbon dioxide, carbon monoxide, and other irres-pirable gases may saturate the cabin compartment and cause asphyxia.

d. Temperature — At high altitude, the temperature falls and at the height of 25,000 feet, it is 40° below zero.

Death may be due to frostbite or freezing of the body.

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e. Pre-existing disease — Coronary disease or hypertension may cause fatality due to the sudden change of environment.

2. During the Crash:

Most of the aircraft fatalities occur during the take-off and landing. During the crash, the whole plane bursts into flame due to its high octane fuel content. If a passenger or crew survives the crash, he will suffer from severe thermal injuries.

Modern high speed turbojet or jet aircraft have a velocity of not less than 500 miles per hour as much as that of the terminal velocity at the time of the impact which causes widespread destruction of the aircraft and also of the ground. Potential survivor may be those who were trapped within the cabin but are rescued before a fire develops or those who are fortuitously thrown from the aircraft.

a. Fracture of the tibia and fibula is due to the presence of the horizontal bar at the rear of the front seat;

b. Fracture of the femur is due to the high vertical force and the front bar of the seat;

c. In the chest, the common site is the upper half and is frequently associated with sternal injuries indicating that it is of a flexion type;

d. Cranio-facial injuries is due to the impact of the head to the seat in front when subjected to a vertical hit. There may be a fracture of the classical ring type surrounding the foramen magnum due to the vertical force.

e. Rupture of the heart or aorta is quite common as this is due to compression of the heart between the sternum and spine during the flexion or the mobile heart is torn from the static aorta during deceleration of the body in the vertical fall of the body.

HELICOPTER:

A helicopter is a rotary-wing airplane. The rotor is the source of power and its aerodynamics causes its lift. The bulk of its weight is on the rotor, gear box and gear train and* engine. All of these parts are located above the center of gravity of the helicopter so that when the helicopter drops down, the aircraft will be in an inverted position.

Most of the helicopter accidents are due to structural failure, engine and control failure. Other causes are the unseen obstacles such as wire, weather and error of judgment. Because of the low speed, accidents do not take place during take off or landing, but during flight.

Chapter XVII

DEATH BY ASPHYXIA

'•Asphyxia is the general term applied to all forms of violent death which results primarily from the interference with the process of respiration or the condition in which the supply of oxygen to the olood or to the tissues or both has been reduced below normal level.

Types of Asphyxial Death:

1. Anoxic Death:

This is associated with the failure of the arterial blood to become normally saturated with oxygen. It may be due to:

a. Breathing in an atmosphere without or with insufficient oxygen, as in high altitude.

b. Obstruction of the air passage due to pressure from outside, as in traumatic crush asphyxia.

c. Paralysis of the respiratory center due to poisoning, injury or anesthesia, etc.

d. Mechanical interference with the passage of air into or down the respiratory tract due to:

(1) Closure of the external respiratory orifice, like in smothering and overlaying.

(2) Obstruction of the air passage, as in drowning, choking with foreign body impact, etc.

(3) Respiratory abnormalities, like pneumonia, asthma, emphysema and pulmonary edema.

e. Shutting of blood from the right side of the heart to the left without passage through the lungs as in congenital anomalies like potent foramen ovale.

2. Anemic Anoxic Death:

This is due to a decreased capacity of the blood to carry oxygen. This condition may be due to:

a. Severe hemorrhage. b. Poisoning, like carbon monoxide. c. Low hemoglobin level in the blood.

3. Stagnant Anoxic Death:

This is brought about by the failure of circulation. The failure of circulation may be due to:

426

DEATH BY ASPHYXIA 427

a. Heart failure. b. Shock.

c. Arterial and venous obstruction, incident to embolism, vascular spasm, varicose veins, or the use of tourniquet.

4. Histotoxic Anoxic Death:

This is due to the failure of the cellular oxidative process, although the oxygen is delivered to the tissues, it cannot be utilized properly. Cyanide and alcohol are common agents responsible for histotoxic anoxic death.

Phases of Asphyxial Death:

1. Dyspneic Phase:

The symptoms are due to the lack of oxygen and the retention of carbon dioxide in the body tissue. The breathing becomes rapid and deep, the pulse rate increases, and there is a rise in the blood pressure. The face, hands and fingernails become bluish, especially in the case of infants.

2. Convulsive Phase:

This is due to the stimulation of the central nervous system by carbon dioxide. The cyanosis becomes more pronounced and the eyes become staring and the pupils are dilated. Examination of the visceral organs shows small petechial hemorrhages, commonly known as Tardieu Spots. The TardieuSpots are caused by the hemorrhage produced by the rupture of the capillaries on account of the increase of intra-capillary pressure. It usually appears in places where the tissue is soft and the capillaries are not well supported by the surroundings, as in visceral organs, skin, conjunctivae, and capsules of glands.

The victim may become unconscious during the convulsive stage.

3. Apneic Phase:

The apnea is due to the paralysis of the respiratory center of the brain. The breathing becomes shallow and gasping and the rate becomes slower till death. The heart later fails.

Recovery at this stage is almost nil due to the permanent damages inside the brain on account of prolonged cerebral anoxia.

Classifications of Asphyxia:

1. Hanging. 2. Strangulations:

a. Strangulation by ligature. b. Manual strangulation or throttling.

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c. Special forms of strangulations: (1) Palmar strangulation. (2) Garroting. (3) Mugging or yoking. (4) Compression of the neck with stick.

3. Suffocation:

a. Smothering or closing of the mouth and nostrils by solid objects.

b. Choking or closing of the air passage by obstruction of its lumen.

4. Asphyxia by submersion or drowning.

5. Asphyxia by pressure on the chest (Traumatic crush asphyxia).

6. Asphyxia by irrespirable gases.

A . A S P H Y X I A B Y H A N G I N G

Asphyxia by hanging is a form of violent death brought about by the suspension of the body by a ligature which encircles the neck and the constricting force is the weight of the body.

It is not necessary that the whole body will be left suspended. The victim may be sitting or lying with the face downward provided that the pressure is present in front or in the side of the neck.

Classification of Asphyxia by Hanging:

1. As to the location of the Ligature and Knot:

a. Typical — When the ligature runs from the midline above the thyroid cartilage symmetrically encircling the neck on both sides to the occipital region.

b. Atypical — When the ligature is tied or noosed and present on

one side of the neck, in front or behind the ear, or on the chin.

2. As to the Amount of Constricting Force:

a. Complete — When the body is completely suspended and the constricting force is the whole weight.

b. Partial — When the body is partially suspended as when the victim is sitting, kneeling, reclining, prone or in any other positions.

3. As to Symmetry:

a. Symmetrical — When the knot or noose is at the midline of the body either at the occiput or just below the chin.

b. Asymmetrical — When the knot or noose is not in the midline but on one side, with the head tilted to the side opposite the location of the noose or knot.


Suicidal hanging with the use of barbed wire

Mechanism of Death:

There is a ligature around the neck with a knot or with a sliding noose, and the other end is fastened to an elevated object like peg, nail, window casing, door knob, tree, etc..

Upon suspension of the body, the weight causes the noose or band to tighten, producing pressure at the region of the neck.

The pressure of the band will cause the air passage to constrict, the larynx is pushed backwards and its opening is closed by the contact of the anterior to the posterior laryngeal wall producing asphyxia.

The pressure of the ligature may also cause compression of the superior laryngeal nerve, carotid arteries and jugular veins producing cerebral anoxia.

The form of furrow that develops in the neck depends upon the type of ligature, the number of loops around the neck and the point of suspension.

Protrusion of the tongue depends upon how pressure is applied around the neck. If above the larynx and in an upward direction, the tongue will be pushed outward and will protrude from the mouth, but if the pressure is below the larynx, the tongue is kept inside the buccal cavity.

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Ligature in Hanging: 1. Materials used in Ligature:

The thinner the ligature and the tougher the material, the more pronounced will be the mark on the skin of the neck. If the material is soft and broad the ligature impression on the neck is less marked.

If hanging is done with evident premeditation as in the case of suicide, a special quality of material may be used. Rolled beddings, leather belts joined together, rope, electric wire and vines are oftenly used. The rope is commonly used as a ligature because it is easily available and strong.

2. Noose:

There may be no sliding noose at the end of the ligature. It may be tightened after it has been encircled around the neck and the pressure on the air passage, blood vessels and nerves of the neck is established when the body is suspended. Metal buckle, ring, or sliding noose may be attached to the end to make it slide.

3. Mode of Application of the Ligature:

The ligature may be placed around the neck with a single loop or with two or more loops. This can be distinguished on the nature of the ligature marks. In single loop, there is but one ligature furrow, but if there are several loops, there will be several ligature marks with an intervening redness between the furrows. There is more tendency to have more pressure in single loop ligature on account of the concentration of force at the weight as compared with two or more loops.

4. Position of the Knot:

The knot or joint is usually located on either side of the neck. The head is flexed opposite the location of the knot. The level of the ligature around the neck may differentiate hanging from strangulation by ligature. In hanging, the ligature is usually found above the thyroid cartilage on account of the upward pull of the constricting force, while in case of strangulation by ligature, the loop is found below the thyroid cartilage. It is not easy to retain the knot beneath the chin."

5. Course of the Ligature around the Neck:

The .usual appearance is that the groove or ligature mark is deepest opposite the location of the knot. However, if the knot is just underneath me chin, the groove at the back of the neck is not deep on account of the firmer skin and muscular tissue. The course of the ligature forms an inverted V-shape with the vertex as the location of the knot.


Symptoms:

1. Gradual loss of sensibilities.

2. Sensation of constriction of the neck.

3. Loss of consciousness and muscular power.

4. Numbness of the legs and clonic convulsion.

5. Sensation of ringing inside the ear.

6. Sensation of flash of light before the eyes.

7. Face becomes red, with eyes prominent and feeling of heat in the

head.

If the victim is timely rescued and revived after artificial respiration,

he will suffer the following symptoms:

1. Whistling sensation inside the ear.

2. Watering of the eyes.

3. Difficulty of breathing and swallowing.

4. Sensation of numbness of both legs.

All of the above symptoms may last for 12 days after the rescue.

Amount of tension in the ligature sufficient to occlude the vital structures of the neck:

Jugular veins 2 kilos (4.4. lbs.).

Carotid artery 5 kilos (11.0 lbs.).

Trachea 15 kilos (33.0 lbs.).

Vertebral artery 30 kilos (66.0 lbs).

Causes of Death in Hanging:

1. Simple asphyxia by blocking the air passage.

2. Congestion of the venous blood vessels in the brain.

3. Lack of arterial blood in the brain due to pressure on the carotid arteries.

4. Syncope due to pressure on the vagus and carotid sinus which leads to reflex irritation and paralysis of the medullary autonomic centers.

5. Injury on the spinal column and spinal cord. 6. It may be any combination of the above-mentioned causes.

Time Required in the Process of Death: The time required to produce death in hanging is influenced by

the following factors.

1. Severity of the Constricting Force: If the constricting force is only sufficient to occlude the wind

pipe, death may be delayed; but if the pressure is sufficient to

432 LEGAL MEDICINE

occlude the carotid arteries, jugular veins and vagus nerve, then unconsciousness develops immediately and death is accelerated.

2. Point of Application of the Ligature:

When the ligature is made below the larynx, death is almost instantaneous, but when applied above the larynx, death may not occur for three to five minutes. Hanging with the knot situated on one side of the neck may delay death because the closure of the cerebral vessels cannot be completely maintained. If the knot is just below the jaw, maximum pressure is at the back of the neck causing merely partial occlusion of the windpipe and blood vessels of the neck, thereby delaying death.

3. Other Factors:

a. Physical condition of the subject.

b. The rate of consumption of oxygen in the blood and tissues.

The loss of sensibility is due to the pressure of the ligature on the blood vessels causing disturbance in the cerebral circulation. Ordinarily'respiratory movement may persist one to two minutes and the heart action for 15 to 30 minutes so that artificial res-Diration mav successfully revive the victim.

Ligature mark in hanging with the use of thin tough material.

Treatment:

1. Induce the Natural Acts of Respiration:

a. Ligature must be loosened and the mouth must be wiped to


remove all obstacles' to free air.

b. Tongue must be pulled forward and the body must be laid on back rest.

c. Place the patient where there is a free current of fresh air.

d. Electrical stimulation of the phrenic nerve.

e. Administration of respiratory stimulant, like ammonia.

2. Stimulate the Heart to Renew Action if it Ceases to Beat:

a. Apply heat at the region of the precordium.

b. Hypodermic injection of coramine, strychnine, or other stimulants.

c. Administration of brandy.

3. Maintain the Natural Body Temperature:

a. Cover the body with blanket.

b. Place the patient in a warm room.

Post-mortem Findings in Death by Hanging:

1. General External Appearance:

a. Neck elongated and stretched with the head inclined on the side opposite the knot or noose.

b. Eyes closed or partially opened with pupils usually dilated on one side and small on the other side (facies sympathetic).

c. Lividity or pallor of the face with swelling and protrusion of the tongue.

d. Hands are clenched firmly and purple colored fingernails.

e. Lips livid or blue.

f. Saliva dribbled from the mouth with froth.

g. State of erection or semi-erection of the penis with seminal fluid in the urethral meatus.

h. Post-mortem lividity with ecchymosis are mostly marked at the legs.

i. Urination or defecation due to the loss of power of the sphincter muscles.


a. Engorgement of the lungs.

b. Venous system contains dark-colored fluid blood.

c. Right side of the heart and the big blood vessels connected with it are distended with blood.

d. Blood vessels of the brain is generally congested.

e. Kidneys are congested. f. Sub-pleural, sub-pericardial punctiform hemorrhages (Tardieu

spots).

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3. Findings in the Neck:

a. Neck is flexed opposite the side where the knot is located.

b. Ligature mark which forms a groove and deepest mark opposite the knot. The width of the groove is about or rather less than the width of the ligature. The skin of the groove is pale o'r parchment-like. Microscopically, there is a characteristic abrasion with slight desquamation and flattening of the cells of the epidermis.

c. The course of the ligature is inverted V-shape with the apex of the " V " at the site of the knot. There may be an interruption of the ligature marks.

d. The skin at the site of the ligature is hard with red line of congestion and hemorrhage in some points.

e. Ecchymosis of the neck depends upon the width and softness of the ligature.

f. There may be rupture of the underlying blood vessels, muscles and other soft tissues.

g. The lining membrane of the blood vessels may be lacerated.

h. The fracture of the upper cervical vertebrae and the injury of the spinal cord is due to long drop hanging or to judicial hanging.

i. Fracture of the hyoid bone or the tracheal rings.

Ligature mark in hanging with the use of soft and broad ligature.



1. Fold markings on the neck of an obese individual — In this case the marks are not continuous and removed on stretching the skin of the neck.

2. Marks of tight neckwear — The location and history will differentiate this from ligature marks.

Determinations Whether Hanging is Ante-mortem or Post-mortem:

The principal criterion in the determination whether hanging is ante-mortem or post-mortem is the vital reaction. But, hanging made immediately after death may also show to a certain extent vital reaction, while hanging of a living subject whose bodily resistance has been markedly weakened may show only slight vital reaction.

The Following Findings Show that Hanging is Ante-mortem:

a. Redness or ecchymosis at the site of ligature.

b. Ecchymosis of the pharynx and epiglottis.

c. Line of redness or rupture of the intima of the carotid artery.

d. Subpleural, subepicardial punctiform hemorrhages.

It is advisable to look for other injuries which are capable of producing death to eliminate the possibility of hanging as the cause of death.

Determinations Whether Hanging is Accidental, Homicidal or Suicidal:

1. Evidence in support of homicidal hanging:

a. Nature of the windows and doors — See whether the entrance was forcibly opened or have been used as an escape by the offender in homicidal case.

b. Presence of signs of struggle in the clothings, furniture, and beddings — The furniture and beddings may be disturbed whenever there was previous struggle before hanging.

c. Presence of stains, bodily injuries in the body of the victim.

d. Presence of defense wounds in the body of the victim.

"Lynching" is a form of homicidal hanging usually found in southern states of the United States. It is usually practiced by Americans against the Negroes who commit crime against the white-American. Whenever, the colored offender are apprehended, they are hanged by means of a rope on a tree or some similar objects. The Negroes are executed without due process of the law.

j . Contusion of the inner wall of the trachea.

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2. Evidences in support of suicidal hanging:

a. Findings at the place where the dead body was found is compatible with self-suspensions.

A chair may be found where he can stand to tie the rope at a higher level. The chair or stool may be kicked away and the body becomes suspended on a rope. A hammer to fix the nail may be found near the place where the body was found.

b. Unusual position of the body when found:

The feet or the knees may be found partially touching the floor if the body was found in a reclining position to make part of the body weight as the constricting force on the neck. The clenching of the hand and absence of signs of struggle to free himself from the effects of ligature may infer the desire of self-destruction.

c. Absence of signs of struggle:

There are no marks on the body that may cause unconsciousness to infer homicidal hanging.

d. Signs of vital reaction in the ligature marks around the neck:

The furrow may be deep, congested and papyraceous with abrasions on account of the slide of the ligature as pressure on the neck is produced by the weight of the body.

e. Signs of previous ineffective suicide attempt.

Like incised wound at the wrist, cutting the throat, ingestion of poison may be present.

f. Presence of a suicide note written by the victim.

g. The materials used are those that are easily accessible, like handkerchief, mosquito net, beddings, etc..

h. The history of reverses in life, like financial loss, love, studies, etc. his mental condition,

i. The presence of suicidal note infer that hanging is suicidal,

j . No disturbance in the place where death took place.

k. The rule is that hanging is suicidal unless there are evidences to show that it is not.

3. Accidental hanging is very rare.

B . A S P H Y X I A B Y S T R A N G U L A T I O N

STRANGULATION BY LIGATURE:

Strangulation by ligature is produced by compression of the neck by means of a ligature which is tightened by a force other than the weight of the body. Usually, the ligature is drawn tight by pulling


the ends after crossing at the back or front of the neck, or several folds of the ligature may be around the neck tightly placed and the ends are knotted, or a loop is thrown over the head and a stick inserted beneath it and twisted till the noose is drawn tight.

If the ligature is made of a soft material and is applied smoothly around the neck, no visible mark will be observed after death. Hard rough ligature applied with force more than that required to kill may produce extensive abrasion and contusion at the area of application.

Strangulation by ligature may be observed in infanticide using the umbilical cord as the constricting material. This must be differentiated from accidental strangulation by- the umbilical cord during child birth. In accidental strangulation during child birth, the umbilical cord is abnormally long and there is no disturbance in the wharton's jelly.

Strangulation by ligature is commonly observed in rape cases, but the presence of findings in the genitalia and other physical injuries are the distinctive findings.

Distinctions in the Post-mortem Findings in the Neck between Death by Hanging and Death by Strangulation with Ligature:

Hanging

1. Hyoid bone is frequently injured.

2. Direction of the ligature mark is inverted V-shape with the apex as the site of the knot.

3. Ligature is usually at the level of the hyoid bone.

4. Ligature groove is deepest opposite the site of the knot.

5. Vertebral injury is frequently observed.

Strangulation with Ligature

1. Hyoid bone is frequently spared.

2. Ligature mark is usually horizontal and knot is on the same horizontal plane.

3. Ligature is usually below the larynx.

4. Ligature groove is uniform in depth in its whole course.

5. Vertebral injury is not observed.

Causes of Death in Strangulation by Ligature:

1. Asphyxia due to the occlusion of the windpipe.

2. Coma due to arrest of cerebral circulation.

3. Shock or syncope. 4. Inhibition of the respiratory center due to the pressure on the

vagus and sympathetic nerves.

Treatment: 1. Removal of the ligature.

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2. Artificial respiration, and if there is a block in the laryngeal passage, tracheotomy must be performed.

3. Prevention of complications:

a. Edema of the glottis. b. Pneumonia. c. Abscess formation at the site of injury.


1. External Examination:

a. Face is livid and swollen.

b. Eyes are wide open, prominent, congested and pupils are dilated.

c. Tongue swollen, dark colored and protruded.

d. Bloody froth may escape from the mouth and nostrils.

e. Tardieu's Spots are found beneath the conjunctivae, face, neck, chest and lungs.

2. Internal Examination:

a. Intense venous congestion of both lungs with numerous petechial hemorrhages.

b. Blood-stained froth is found in big bronchi.

c. Right side of the heart is filled with dark fluid blood.

d. Congestion of the brain.

e. Congestion of the visceral organs.

3. Examination of the Localized Lesion in the Neck:

a. Mark of violence on the neck is in the form of ligature mark, abrasion, or ecchymosis.

b. Fracture of the larynx or tracheal rings.

c. Laceration of the tunica intima of the carotid and jugular vessels.

Accidental, Homicidal or Suicidal Strangulation by Ligature.

Homicidal strangulation is the most common of the three forms of strangulation by ligature. Aside from the ligature mark in the neck, there are evidences of struggle or marks of violence in other parts of the body. A person may be rendered helpless by a blow, intoxicating liquor or by initial throttling. The ligature may be passed around the neck and then the feet and hands are bound together. Smothering may be done by placing a handkerchief gag in the mouth.

Suicidal strangulation by ligature is quite rare. It may be done by placing a ligature around the neck and tightened by means of twisting a piece of stick.


There are a few instances of strangulation which are accidental and most of the victims are children or epileptics who are helpless and incapable of extricating themselves.

M A N U A L S T R A N G U L A T I O N O R T H R O T T L I N G :

This is a form of asphyxial death whereby the constricting force applied in the neck is the hand.

Methods of Throttling:

1. Using one hand, the neck may be grasped in front with the thumb exerting pressure on one side and the other fingers on the other side. The palm may exert pressure in front of the neck.

2. Using both hands with assailant in front. The thumbs digging in over the anterior part of the larynx and pressing the air passage back while the rest of the fingers are pressing on the sides and back of the neck.

3. Using both hands with the assailant at the back. The fingers of both hands grasp the throat in front and exerting a backward and medial compression while the thumbs press against the side and back of the neck.

Manners of Death in Manual Strangulation:

1. The air passage may be blocked and death is due to asphyxia.

2. The pressure on the neck may cause compression of the blood vessels and disturb the blood supply of the brain.

3. The nerves of the neck may be traumatized especially the superior laryngeal branch of the glossopharyngeal, hypoglossal nerves and the plexus surrounding the bifurcation of the common carotid artery or of the vagus producing shock.


1. Cyanosis of the face.

2. Subpleural and subpericardial hemorrhage is not so conspicuous.

3. Heart, especially the right side is distended with blood.

4. Overdistention of the lungs with interstitial emphysema is occasionally observed in children.

5. Findings on the neck:

a. There may be no external injury on the skin but there may be contusion with the form and shape of the fingers.

b. With curved thumb nail or a group of fingernails, abrasions may be found in front or at the back of the neck.

c. Interstitial hemorrhages in the muscles of the neck. d. Fracture of the laryngeal cartilage may occasionally be found.

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e. Petechial hemorrhages and congestion of the larynx and pharynx.

f. There may be bruising of the tongue at its anterior border and the tongue itself may be bitten and protruded.

g. Hemorrhages present in the capsule of the thyroid, submaxillary and even in the parotid glands.

Accidental, Homicidal or Suicidal Manual Strangulation:

1. Suicidal throttling is not possible because the pressure of the person's own hand must be maintained for sometime but when unconsciousness begins, the hands are relaxed and the victim recovers.

2. Accidental throttling may occur but the victim never died of asphyxia but of some other causes. A sudden application of manual pressure in the neck during the moments of excitement or passion may cause cardiac inhibition or cerebral apoplexy.

3. Homicidal manual strangulation is the most common. It is a method of choice in infanticide. In most cases there are evident signs of struggle.

Special Forms of Strangulation:

a. Palmar Strangulation:

The palm of the hand of the offender is pressed in front of the neck without employing the fingers. The pressure must be sufficient to occlude the lumen of the windpipe.

2. Garroting:

A ligature, a metal collar or a bowstring is placed around the neck and tightened at the back. The subject may be placed with the back to the post and a spike may be placed in the post to force into the nape of the neck when the constricting band is tightened.

Garroting is a mode of judicial execution during the 19th century and it is still being practiced in Spain and Turkey.

3. Mugging (Strangle-hold):

This is a form of strangulation with the assailant standing at the back and the forearm is applied in front of the neck. The pressure on the neck is brought about by the pressure of the flexed elbow.

Mugging may be the cause of death in wrestling. The knee may also be used and it will produce the same effect as that of the elbow. The foot or knee may be applied on the victim's neck.


4. Compression of the Neck with a Stick;

The victim may be forced to place his back behind a post. The assailant with a piece of stick placed in front of the neck pulls with two hands passing on both sides of the post backwards with sufficient strength to occlude the trachea.

C. A S P H Y X I A BY S U F F O C A T I O N

Asphyxia by suffocation is exclusion of air from the lungs by closure of air openings or obstruction of the air passageway from the external openings to the air sacs.

S M O T H E R I N G :

This is a form of asphyxial death caused by the closing of the external respiratory orifices, either by the use of the hand or by some other means. The nostrils and mouth may be blocked by the introduction of foreign substances, like mud, paper, cloth, etc..

If the buccal and nasal orifices are occluded by the hand, there may be abrasion and contusion of the nose and mouth. The findings in death by smothering will be that of asphyxia.

Suicidal smothering by means of his own hand is not possible. The moment the victim becomes unconscious, the instinctive release of the pressure will save him.

Homicidal and accidental smothering is frequent. Accidental smothering may occur when a person is under the influence of alcohol, epilepsy or in any other helpless state. Accidental smothering is common among children.

Overlaying is the most common accidental smothering in children. The children may be suffocated either from the pressure of the beddings and pillows or from the pressure of unconscious or a drunk mother.

Accidental smothering of epileptic — A person may suffer from epileptic or epileptiform fit and accidentally bury his face on soft object like pillow, bedding or sand and die.

The same is true with pregnant women who may suffer from eclamptic fit.

Gagging — The application of materials, usually handkerchief-, linen or other clothing matters to prevent air to have access through the mouth or nostrils. The pressure might be so severe that it may cause injury to the buccal mucosa arfd teeth. It is homicidal.

Plastic bag suffocation — Plastic bags are made of synthe'tie polyethylene that is transparent, tough and waterproof material commonly used as a container. Children may place the bag over

442 LEGAL MEDICINE

their head and go down to the face covering the nostrils and mouth and consequently cause suffocation because of the inability of the children to extricate themselves by tearing it.

CHOKING:

This is a form of suffocation brought about by the impaction of foreign body in the respiratory passage.

The most common foreign bodies impacted are:

a. Vomitus, especially when the person is under the influence of alcohol.

b. Regurgitation of food from the stomach, as coagulated milk in children.

c. Bolus of food.

Cafe' coronary — A restaurant patron apparently has a sudden heart attack in the middle of his dinner and dies without much untoward symptoms. Autopsy may reveal a large mass of food lodged in his throat and the cause of death is in.fact asphyxia by choking. This usually happens when the person has a high blood alcohol level which apparently anesthetized his gag reflex. It is an accidental rather than a natural death.

d. Detached membrane in diphtheria.

e. False set of teeth.

f. Blood in tonsillectomy operation.

g. Respiratory hemorrhage as in tuberculosis.

Most of suffocation by choking is accidental, although it may be utilized in suicide or in homicide.

The post-mortem finding in suffocation by choking is the same as other forms of asphyxia plus the presence of the foreign body in the respiratory tract.

D . A S P H Y X I A B Y S U B M E R S I O N O R D R O W N I N G

This is a form of asphyxia wherein the nostrils and mouth has been submerged in any watery, viscid or pultaceous fluid for a time to prevent the free entrance of air into the air passage and lungs. It is not necessary for the whole body to be submerged in fluid. It is sufficient for the nostrils and mouth to be under the fluid. Children may be drowned in an ornamental pool or "tilapia" pond, and an epileptic or a drunk person may be found drowned in a shallow creek.

Mechanism of Drowning:

When a person does not know how to swim and falls into a deep body of water, his body will sink on account of the momentum of


the fail and because the specific gravity of the human body is slightly more than that of the water. Later, the body will be buoyed because of the instinctive movement of the individual, coupled with the presence of air underneath his clothings. While under water, the breath is held but upon reaching the surface there i6 an attempt to breathe. Air and water then gets into the mouth and nostrils. Then, he will endeavor to raise his hand which will cause him to sink under water. He then alternately appears and disappears on the surface and everytime he attempts to breathe, water will get in. Because of the entrance of the fluid, there will be violent coughing which will expel the air in the lungs and creates an imperative desire to breathe, during which more water is drawn in. The drawn-in water may go to the lungs or to the stomach. The water fills the bronchioles forcing the residual air to be in the lung surface and causing the lungs to balloon and become soggy and edematous. Death usually occurs 2 to 5 minutes later.

Phases of Drowning:

1. "Respiration de surprise" occurring at the moment when the mouth and nose are covered with fluid consisting of one deep inspiration.

2. Phase of resistance which consists* of a short period of apnea due to the irritation of the sensory laryngeal nerve endings by the cold water.

3. Dyspneic phase with a forceful respiratory movement.

4. Another apneic phase.

5. Terminal respiration, after which the breathing stops permanently. (Brouandel cited on Gradwohl's Legal Medicine by Camps, p. 277).

Causes of Death in Drowning:

1. Typical Drowning: The primary cause of death in ordinary submersion in water is

asphyxia. The water interferes with the free exchange of air in the air sacs.

2. Atypical Drowning: In atypical drowning cases, the causes of death may be due to

the following: a. Cardiac inhibition following submersion due to the stimulation

of the vagus nerve. b. Laryngeal spasm due to submersion. The inhaled water may

cause spasm of the larynx.

444 LEGAL MEDICINE

c. Submersion when unconscious. A person may be drunk, or suffering from cerebral aneurysm, cerebral hemorrhage, heart disease, and suddenly collapse and falls in a body of water and be unconscious when submerged. A complete picture of drowning may not be found at the autopsy table.

3. Other Conditions Associated with Drowning:

a. The person might have fallen into the water and his body strikes on a solid hard object which is capable of producing death by itself.

b. The person might be under the influence of alcohol or other depressants and incapable of helping himself.

c. Cramps might have prevented him from saving himself.

d. Shock due to fright or sudden exposure to cold might have caused sudden heart failure.

e. The person might have died of some other causes independent of drowning, like apoplexy, cardiac failure, etc..

f. The person might have been dead and thrown into the water.

Time Required for Death in Drowning:

Submersion for 1-1/2 minutes is considered fatal, if ordinary efforts for respiration is made, however, a person may survive even after 4 minutes of submersion. The average time required for death in drowning is 2 to 5 minutes. It has been claimed that the length of survival in drowning is proportional to the amount of froth in the respiratory tract.

The power of recovery of human beings in drowning is inversely proportional to the amount of froth in the air passage and the penetration of water into the lung tissue. The amount of mucous froth and the degree of penetration of water into the lungs as well as the degree of subpleural ecchymosis is proportional to the effort made to save himself.

If a dead body was recovered in water, the physician must be able to answer the following questions:

1. Did death occur prior to entry in the water? If so, what was the cause of death?

2. Did drowning cause death? If so, was it fresh or salt water?

3. Were there any ante-mortem injuries? If so, did they play any part in the death?

4. Were there any post-mortem injuries? If so, did they play any part in the death?

5. Was there any natural disease or any evidence of poisoning? If so, did the findings contribute to the death in any way?


6. What was the manner of death?

Emergency Treatment in Drowning:

Remove the bodily clothings especially the tight ones and wrap the body with blanket.

Place the face down and perform artificial respiration, using any of the following methods:

1. Schaefer's Method:

With the face down, the patient must be in a prone position. The operator kneels astride the body and exerts pressure on the lower ribs at the rate of 12 to 15 times a minute.

2. Sylvester's Method:

With the patient lying on his back, and the operator astriding over the body, swinging the arms forward up and then pressing the chest wall. This is repeated every 3 to 5 seconds.

Administration of stimulants as ammonia, aromatic vinegar, etc..

Injection of strychnine, coramine, caffeine, etc..

Inhalation of oxygen combined with 5% to 8% carbon dioxide to stimulate respiration.


1. External Findings:

a. Clothes are wet, face is pale and with foreign bodies clinging on the skin surface.

b. Skin is puckered, pale, contracted in the form of "cutis anse-rina," or "goose-skin," or "gooseflesh" particularly those of the extremities and when the body is submerged in cold water. This is due to the contraction of the arector pili muscles. This is not diagnostic of drowning because it may appear before or after death. The arector pili muscles may contract during the process of rigor mortis so that "cutis anserina" may develop after death.

c. Penis and scrotum may be contracted and retracted especially when the body is found in cold water.

d. Washerwoman's hand and feet. The skin of the hands and feet, is bleached, corrugated and sodden in appearance. This is not diagnostic of drowning but proves only that the body has remained in water for some time without reference as to the cause of death.

e. Eyes are half-opened or closed, with eyelids livid, conjunctivae injected and pupils dilated.

446 LEGAL MEDICINE

f. The mouth may be closed or half-opened with the tongue protruding.

g. Post-mortem lividity is mostly marked in the head, neck and chest. This is due to the gravitation of blood in those areas when the body was immersed in water.

h. Presence of firmly-clenched hands with objects as weeds, stones, sand, etc., indicative that the person was alive when placed in the water (cadaveric spasm). This is also indicative that there was struggle of the victim for life.

i. Physical injuries may be present on the body surface which may be indicative of previous struggle with an offender, effort of the victim to save himself, hitting on hard and rough objects while in water by the force of the current, or some other causes.

j. In suicidal drowning, pieces of stone or other heavy objects may be recovered in pockets or clothings to facilitate submersion.


a. Respiratory System:

(1) "Emphysema aquosum" — The lungs are distended like balloons, overlapping the heart, with rib markings on the surface and protruded out of the chest upon removal of the sternum. This is due to the irritation made by the inhaled water on the mucous membrane of the air passage which stimulate the secretion of mucous. The lungs are progressively distended and the emphysema is due to the fact that the air is driven by the fluid on the lung surface.

(2) "Edema aquosum" — This is due to the entrance of water into the air sacs which makes the lung doughy, readily pits on pressure, and exudes water and froth on section.

(3) "Champignon d'ocume" — This is the whitish foam which accumulates in the mouth and nostrils. It is due to the abundant mucous secretion of the respiratory passage which by respiratory movement whips up the substance into foam. Removal of the foam and followed by pressure on the chest will produce further foam in the mouth and nostrils. This finding is considered to be one of the indications that death was due to drowning.

(4) Tracheo-bronchial lumina is markedly congested and filled with fine froth with foreign bodies that are also found in the fluid medium where the body is recovered.

(5) Blood-stained fluid may be found inside the chest cavity and this is due to the permeation of water trapped inside the air sacs.


(6) The whole lung field may be congested but if there is an abundance of water in the air sacs, it may appear pale.

(7) Section of the lungs shows the presence of fluid with bloody froth.

b. Heart:

(1) Both sides of the heart may be emptied or filled with blood. The right side may be distended with blood while the left may be emptied on the account of the distention of the air sacs, thereby limiting the capillary flow.

(2) If drowning took place in salty water, the blood chloride content is greater in the left side of the heart than in the right, but if drowning took place in fresh water, the blood chloride is more in the right than in the left. This is one way to determine the place where a victim was drowned.

Gettler's Test:

This is a quantitative determination of the chloride content of the blood in the right and left ventricle of the heart. The demonstration of the difference of at least 25 mg. proves that death occurred in fresh or salt water pool and drowning is the cause of death.

Basis of the Test:

Normally, the chloride contents of the blood is the same in both sides of the heart. But when water enters the alveoli it goes with the circulation and is diffused with the blood. So that if drowning took place in salty water pool the chloride content in the right side of the heart will be less as compared with the left, and the reverse is true when the victim was drowned in fresh water. The test will not only determine the cause of death as drowning but also where such drowning took place — in fresh or salty water pool.

Fallacies of the Test:

(1) The victim might have been drowned in a salty water pool where the chloride content of the water is quantitatively similar as that of the blood. Inhalation of such fluid will not make any difference in the chloride contents of the left or right side of the heart. However, the cellular count and hemoglobin percentage may be different.

(2) Reduction of blood chloride after death is a common post-mortem phenomena. It could be possible that the rate of reduction may not be the same on the right and on the left side of the heart, thereby producing a difference although death was not due to drowning.

448 LEGAL MEDICINE

(3) Blood chloride estimation obtained twelve or more hours after death from drowning in fresh water are of little diagnostic value on account of the diffusion of the fluid on both chambers of the heart.

c. Stomach:

There are plenty of fluid and other foreign materials that are also found in the case of drowning. The absence of water shows that death is rapid or submersion is made after death. It is impossible for water to get into the stomach if the body is submerged after death.

d. Brain:

The brain is congested and the big blood vessels are engorged.

e. Blood:

Aside from the difference in the chloride contents, the blood becomes dark on account of the absorption of all its available oxygen. There is a reduction of its hemoglobin contents on account of dilution. The red blood cells may be crenated.

f. Other Organs:

The liver is engorged with dark fluid blood. The spleen and the kidneys are dark in color and congested. Water may be present in the middle ear due to violent inspiration when the mouth is full of water.

Findings Conclusive that the Person Died of Drowning:

1. The presence of materials or foreign bodies in the hands of the victim. The clenching of the hands is a manifestation of cadaveric spasm in the effort of the victim to save himself from drowning.

2. Increase in volume (emphysema aquosum) and edema of the lungs (edema aquosum).

3. Presence of water and fluid in the stomach contents corresponding to the medium where the body was recovered.

4. Presence of froth, foam or foreign bodies in the air passage found in the medium where the victim was found.

5. Presence of water in the middle ear.

Floating of the Body in Drowning:

The body may not immediately be recovered after drowning because it is under the water. The specific gravity of the human body is slightly more than that of the water. Within 24 hours, on account of the decomposition which causes the accumulation of gas in the body, the body floats. The floating of the body is markedly influenced by the weather, condition of the fluid medium where

0


drowning took place, presence of wearing apparel, age, sex and body built. The body when recovered, floats usually with flexed extremities. This is due to the dominance of the flexor muscles over the extensors in the process of rigor mortis. The head is submerged because it has a higher specific gravity than the rest of the body. And because the head is now the most dependent portion of the body, more blood accumulates in the face. This explains the dark bloated condition of the face during the early stage of decomposition, otherwise known as "fete de negri" or the bronze color of the head and neck of a person who died in water during the process of decomposition.

Determinations Whether Drowning is Suicidal, Homicidal or Accidental:

1. Suicidal Drowning:

a. Heavy articles or weight may be found in the pocket of clothings.

b. Presence of a suicidal note.

c. Determination of the strong reason for him to commit suicide.

d. Mentality of the person.

e. Study of the character and manner of the person previous to the commission of suicide.

f. History of previous attempt to commit suicide.

2. Homicidal Drowning:

a. There are evidences of struggle like physical injuries and destruction of the clothings of the victim.

b. Articles belonging to the assailant may be found near the place where the deceased was recovered.

c. Presence of a motive for the killing.

d. Presence of ligature on the hands or legs which could not possibly be applied by the victim himself.

e. Presence of physical injuries which could not have been self-' inflicted, like gunshot wound at the back, severe injuries in the

head, etc..

J f. Testimony of witnesses.

I 3. Accidental Drowning: \ a. Absence of mark of violence on the body surface. \ b. Condition and situation of the victim immediately before death

which may make one inclined to believe that it is accidental. c. Exclusion of suicidal or homicidal nature of the drowning.

d. Testimony of a witness or witnesses who saw the incident happened.

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E. COMPRESSION ASPHYXIA, (TRAUMATIC OR CRUSH ASPHYXIA)

This is a form of asphyxia whereby the free exchange of air in the lungs is prevented by the immobility of the chest and abdomen due to external pressure or crush injury.

In homicidal cases, the assailant may kneel on the chest of the victim or squeeze the victim between the arms and legs as in wrestling.

In accidental cases, the body may be pinned between two big objects or collapsing building on the ground.

Very rarely is traumatic asphyxia attempted in suicide.

It may be caused by:

1. Sudden fall of earth or masonry or when the victim is buried under a pile of sand.

2. The victim might be pinned under the rubble of a collapsed building.

3. Crushed in a highway accident.

4. Sudden fall of materials from the roof of a road in mines.

5. Crushed in a crowd, usually accidental.


1. The body exhibits a purplish-black cyanosis of the face and neck.

2. Clothings may produce irregular pattern on the skin and areas where buttons are located may look pale.

3. Small subcutaneous petechial hemorrhages on the skin of the face, chest, shoulder and neck.

4. Congestion and petechial hemorrhages of the sclera and conjunctiva.

5. Compression might be sufficient to fracture the ribs.

6. Heart and big blood vessels engorged with dark fluid blood.

7. Contusion with petechial hemorrhage of the lungs.

8. Other signs of physical injuries brought about by the compressing material.

Burking:

This is a form of traumatic asphyxial death invented by Burke and Hare for the purpose of murdering people to be sold to medical schools for dissection. The murderer kneel or sit on the chest and with his hands close the nostrils and mouth of the victim. By this method, there will be no external marks to indicate how respiration has been obstructed. Internal examination may show signs of asphyxia.

DEATH B Y ASPHYXIA 451

Death by Crucifixion — When a person is nailed on a cross the weight is supported by the nailed feet. In order to breathe, the person had to raise his body and then throw his weight on his feet. When on the cross, the intercostal muscles are stretched and the chest cage is fixed. The alternative raising and lowering of the body lead to exhaustion, unconsciousness and death from asphyxia. Because of the difficulty of the chest movement, this type of death may be classified as traumatic asphyxia.

F. A S P H Y X I A BY B R E A T H I N G IRRESPIRABLE GASES

CARBON MONOXIDE (CARBONIC OXIDE GAS, CO "SILENTKILLER "):

Carbon monoxide is formed from the incomplete combustion of carbon fuel. The fatal carbon monoxide poisoning usually involves burning of wood, oil, coal, kerosene and charcoal used in heating or cooking, or gasoline engines in cars.

Carbon monoxide, is sometimes called the "silent killer", it is a colorless gas, insoluble in water and alcohol. When inhaled it combines with hemoglobin to form carboxyhemoglobin. Carboxyhemoglobin is 250 times more stable than oxyhemoglobin. When carbon monoxide is in circulation, aside from limiting the oxygen carrying capacity of the blood, it further prevents the release of oxygen from oxyhemoglobin, thereby increasing the insufficient oxygen supply to the tissue. The occurrence of symptoms in carbon monoxide poisoning depends on the rapidity of intoxication, ability of the individual to tolerate the lack of oxygen and the presence of other depressant drugs, usually alcohol. The main action of carbon monoxide is oxygen deprivation and not its toxic manifestation, so the oxygen deprivation of the tissue is the degree of saturation of hemoglobin with the gas.

Accidental and suicidal death by carbon monoxide poisoning is common. Victims may be accidentally imprisoned or deliberately enclose themselves in a room or garage with motor engine running or slow burning is present.

Judicial death execution by gas chamber is utilized in some states of the United States. Sudden exposure to high concentration of the gas will cause almost a painless death.

Relationship of Carboxyhemoglobin and Symptoms:

Level of CO-H in a Symptoms % Saturation

Less 10 None. 10 — 20 Tightness across the forehead, mild headache,

breathlessness on exertion.

452 LEGAL MEDICINE

5 0 - 6 0

6 0 - 7 0

7 0 - 8 0

Above 80

3 0 - 4 0

2 0 - 3 0 Throbbing headache, emotional instability, irritability, fatigue, lethargy (may be mistaken for intoxication).

Severe headache, nausea and vomiting, dizziness and confusion, ataxia, dyspnea.

Syncope, coma with convulsion, tachycardia.

Increasing coma with incontinence.

Profound coma with convulsion.

Rapid death from a respiratory arrest. (From: GradwohVs Legal Medicine by Camps, Robinson & Lucas, 3rd ed., 1976, John Wright & Sons Ltd.).

Qualitative Test for Carbon Monoxide in the Blood: 1. KunkeVs Test — The suspected blood, diluted with 4 volume of

water is mixed with three times its volume of 1% tannic acid solution and shaken well. If carbon monoxide is present, a crimson-red coagulum which retains its color for several months will develop. Normal blood forms a coagulum, which is, at first red, and becomes brown in the course of one to two hours and then gray up to 24 to 48 hours.

2. Potassium Ferrocyanide Test — 15 cc. of blood is mixed with equal amounts of 20% potassium ferrocyanide solution and 2 cc. of dilute acetic acid and shaken gently. A bright red coagulum will be formed if the blood contains a carbon monoxide, while a dark brown coagulum will be formed if the blood is normal.

3. Examination Through a Spectroscope — The characteristic bands of car boxy hemoglobin will be shown.

4. Gas Chromatograph.

5. Infra-red Analysis.

CARBON DIOXIDE (C02, CARBONIC ACID GAS):

Carbon dioxide is the gas blown out of the lungs during respiration, product of complete combustion of carbon containing compounds, and the end result of fermentation and decomposition of organic

It is a colorless, heavy gas often mixed with carbon monoxide and hydrogen sulfide and is often found in drainage pipes, deep wells, sewage taftks and other places where decomposing organic matters are present. Some refrigerants and dry ice is composed of carbon dioxide.

A small amount of gas which is mixed with air (2%) is a potent stimulant to increase rate and depths of breathing, however, stronger

matters.


concentration (10% or more) may cause ataxia, fall of blood pressure, loss of reflexes, anesthesia, diminished respiration, dyspnea, discomfort and muscular weakness. Greater concentration (60%) may cause immediate loss of consciousness, with or without convulsion and death. The inhalation of pure carbon dioxide may cause immediate vagal inhibition with spasm of the glottis and death. Ordinarily, the cause of death is asphyxia due to deficiency of oxygen supply to the brain (anoxia).

The concentration of carbon dioxide is more in manhole, deep well, brewery bat and poorly ventilated rooms.

Tests for the Presence of Carbon Dioxide:

1. Barium nitrate gives a white precipitate of barium carbonate with carbonic acid.

2. Silver nitrate gives a white precipitate of silver carbonate when carbonic acid is added.

Post-mortem Appearance:

Face is cyanosed, markedly blue and may be swollen, mouth may be frothy and with congestion of the eyes.

Pupils are dilated and lungs is markedly congested.

Right side of the heart contains dark fluid blood with venous

engorgement.

Ecchymotic patches in small intestine, pericardium, pleura and

galea of the scalp.

Internal organs are dark in color and congested.

Blood examination shows quantitative increase of carbon dioxide

content.

Blood shows an increase amount of carbon dioxide.

HYDROGEN SULFIDE (SULPHURETTED HYDROGEN, H£):

Hydrogen sulfide is formed during a decomposition process of organic substances containing sulphur. It is found in large quantities in a sewer, septic tanks, drainage pipes, and deep wells. It may be a by-product in some industries, like tannery, rayon factories, petroleum refineries, sulfur dye work, etc..

It is a colorless, transparent gas, sweetish taste and emiting an odor similar to a rotten egg. The gas is soluble in water to form carbonic acid and it burns in the air with a pale blue flame.

A dilute solution produces irritation of the eyes, nose, throat and air passages, followed by dizziness, headache, nausea, vomiting, abdominal pain, cyanosis, dilated pupils, cold extremities and labored

454 LEGAL MEDICINE

breathing. Prolonged exposure on a diluted atmosphere may cause tetanic convulsion, delirium, stupor, coma and death.

Inhalation of a very dilute amount of gas may pass into solution in the blood where it is rapidly oxidized by the oxygen of hemoglobin to form a harmless or relatively non-toxic substance. Concentrated solution may cause immediate death.

Detection:

1. The offensive odor may be recognized even if the dilute gas is one part in 10,000 part of air.

2. A piece of filter paper moistened with lead acetate will turn black if it was brought in contact with the stomach or other organs containing the gas.


Putrefaction sets rapidly.

Offensive odor is noticed on opening the body.

Blood in fluid state, dark-brown in color is due to conversion of

hemoglobin to sulmethemoglobin.

Lungs are congested and edematous.

Other organs are congested and dark colored.

HYDROGEN CYANIDE:

Hydrogen cyanide is one of the most toxic and rapid acting gases. It is formed by addition of acid to potassium or sodium salt of cyanide. It is naturally found in leaves of cherry-laurel, in bitter almond, in kernels of common cherry, plum, peaches, in ordinary bamboo shoots, and in certain oil seed and beans. These plants contain a crystalline glucoside known as amygdalin which, in the presence of water and natural enzyme, called emulsin, is readily decomposed into hydrocyanic acid, glucose and benzaldehyde.

Orally, the equivalent of 60 — 90 mg. of hydrogen cyanide is fatal. As a vapor cyanide produces the following symptoms at different level:

Amount in ppm Effect and Duration of Life

10 ppm Maximum permissible concentration. 20 ppm Slight symptoms after several hours.

100 ppm Very dangerous within 1 hour. 200 — 400 ppm Lethal within 30 minutes.

2,000 ppm Lethal immediately.

In a large dose, the symptoms appear within a few seconds or even during the act of swallowing. It is rarely delayed beyond one or two minutes.


In smaller dose, the patient may be able to walk and speak or perform volitional acts before death takes place.

In still smaller dose, the patient may still manifest symptoms such as loss of muscular power, giddiness, slow and stertorous breathing, with loss of consciousness which may or not be preceded by convulsion before death. The average span of life after partaking the drug is two to ten minutes. It is possible that life may be prolonged for two to three hours, but in most cases the patient will recover, if death does not occur within an hour.

For reasons that only a small quantity is needed to end ones life, hydrogen cyanide is often used for suicide purpose.


Body is livid or violet in color.

Post-mortem lividity is bright red or pink due to the formation of cyanmethhemoglobin.

Fingers are clenched, fingernails are blue and jaws are firmly closed.

Eyes are bright and glistening and pupils are dilated.

Odor of the acid may be noticed on opening the body.

Heart is engorged with bright red blood.

If the chemical is taken orally, mucous membrane of the esophagus and the stomach may be congested and covered with froth.

S U L F U R DIOXIDE: Sulfur dioxide is a colorless gas, which is heavier than air and with

pungent odor. It is employed as a disinfectant, as a bleaching agent, a powerful reducing agent, and found usually in eruption of volcanoes.

The gas produces irritation of the respiratory passage, thus causes sneezing, coughing, spasm of the glottis and suffocation.

It also irritates the eyes and causes congestion and lacrimation.

Post-mortem findings is not characteristic. There may be cyanosis, with signs of asphyxia.

W A R GASES

Although, the term signifies its use in time of war, it may be also used in riots, mobs or in any other situation where control or suppression of the activities of the people on a specific area is desired. Some of the agents included may cause death, however, when applied in a lesser concentration it may only cause irritation, inconvenience, weakening of resistance of defense and physical damages on the victims.

456 LEGAL MEDICINE

Although, the term signifies true gas it may be a smoke, volatilized liquid or finely divided solids.

Essential Characteristics of a Substance to be Considered as War Gas:

1. It must be a substance heavier than air. If it is lighter than air then it will have the tendency to concentrate at a higher level of the atmosphere, thereby it serves not its purpose.

2. It must be capable of spreading rapidly on the area where the chemical effects is desired.

3. It must be capable of producing effect even in low concentration on a specified area.

4. It may be a true gas, smoke, volatilized liquid or finely divided solid.

5. It can be manufactured in big quantity in a relatively cheap price.

6. It must be a stable substance or not easily made non-toxic by rapid chemical reaction.

7. It is capable of storage for an ample length of time. It must not react freely with the container in which it is stored.

Classification Based on the Physiological Action:

1. Lacrimator or Tear Gas:

An exposure of the eye to the substance will cause irritation with copious flow of tears. The most commonly used during the last wars were:

a. Chloracetophenone (C .A .P . ) — Finely divided powder with sour fruit odor;

b. Bromobenzyl Cyanide (B.B.C. ) — Heavy oily, dark brown liquid with penetrating bitter-sweet odor;

c. Ethyl Iodoacetate (K.S .K. ) — Dark brown, oily liquid with pear odor.

They are fired from an artillery shell and an exposure to the substance causes severe lacrimation, spasm of the eyelids, congestion of the conjunctivae and temporary blindness.

In high concentration, the vapor causes irritation of the respiratory passages and lungs and produces a burning sensation in the throat and discomfort on the chest.

A lo"rjg time exposure may cause vomiting, nausea, bronchitis and blistering of the skin.

Gas mask may be used as a preventive measure and washing of the affected eyes with boric acid solution. Sodium bicarbonate solution may be applied in other affected areas.


2. Vesicant or Blistering Gas:

Contact with the skin may cause bleb or blister formation.

a. Mustard Gas (Diehlordiethyl Sulfide, Yellow Cross, "Yperite"):

It is a heavy, oily liquid, having a mustard-like or garliky odor and gives vapor at an ordinary air temperature. It is insoluble in water but dissolves freely in paraffin, ether, benzene, alcohol, acetone and carbon disulfide and it readily penetrates clothings, leather, wood or brick, etc..

Contact with the liquid or vapor causes profuse lacrimation and nasal secretion, laryngitis, nausea, vomiting and gastric pain. It enters deeply into the clothings and skin causing intense itching, redness, vesication and ulceration. Axilla, groin, perineum and scrotum which are moist due to perspiration were chiefly attacked. Exposed parts of the body, like the face, neck and hands are also affected.

b. Lewisite (Chlorovinyl-dichlorarsine):

This is a heavy liquid having an odor of geraniums. It is insoluble in water but rapidly dissolves in benzene, oil and other organic solvents.

Contact with the skin causes erythema, vesicle with cloudy fluid containing arsenic and leucocytes. As an asphyxiant it acts more rapidly than mustard gas and produces more discomfort.

3. Lung Irritants (Asphyxiant or Choking Gas):

These substances are released from tanks, canisters and gas shells. When inhaled, they cause dyspnea, tightness of chest and coughing, varying degree of conjunctival irritation, vomiting, coma and death.

a. Chlorine (Cty ~~ A yellowish-green gas, about 2-1/2 times heavier than air, with pungent and irritating odor.

Exposure to the gas produces irritation of the conjunctivae. It causes laryngeal spasm, irritative cough, dyspnea, pain in the chest, cyanosis, asphyxia, weak pulse and collapse. Death may occur rapidly due to the spasm of the larynx.

Autopsy reveals massive edema of the lungs, with scattered areas of pneumonic process. Pulmonary edema may cause obstruction of the pulmonary circulation. Mucous membrane of the air passage may show catarrhal inflammation.

b. Phosgene (COCI2) — It is a colorless gas, 3-1/2 times heavier than air, decomposed in water into hydrochloric acid and carbonic acid. It is ten times more toxic than chlorine, but owing for its poor solubility its action is delayed.

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c. Chloropicrin — An oily liquid, smells like chlorine and about four times more toxic than chlorine.

d. Dipho&gene — An oily liquid, heavier than phosgene and an intense lacrimator.

Treatment consists of the removal of the victim from the vitiated atmosphere, absolute rest, administration of oxygen by inhalation aside from the symptomatic approach.

4. Sternutator (Nasal Irritants or Vomiting Gases):

Any person inhaling the air or swallowing food or water contaminated with the chemical would be stricken with coryza, nausea, malaise, headache, vomiting, salivation and pain in the chest, and prostration.

Some of the Compound Used During War Time are:

a. Diphenyl chlorarsine (D.A.) — Colorless, crystalline solid, slightly soluble in water but dissolves in diphosgene and dichlo-ropicrin.

b. Diphenylamine chlorarsine (D.M.) or Diphenylarsine-chlorasine — yellowish crystalline solid.

c. Diphenyl (cyanarsine (D.C.) — White, odorless crystalline solid.

5. Paralysants (Nerve Gas):

New drugs which cause inactivation of cholinesterase and consequent increase of acetylcholine causing paralysis at the myoneural junction. The manner of action is similar to organophos-phates and carbamates insecticides.

6. Blood Poisons:

a. Hydrocyanic Acid (Hydrogen Cyanide or Prussic Acid) — a powerful protoplasmic poison that prevents the tissue from utilizing the oxygen of the blood.

b. Hydrogen Sulfide (Sulphurated Hydrogen) — When inhaled, it passes into solution in the blood to form a harmless and relatively non-toxic substance. If in a pure form or at a higher concentration, it causes paralysis of the respiratory center, giddiness, nausea, abdominal pain and irregular heart action.

c. Carbon Monoxide (Carbonic Oxide, CO) — This gas is combined with hemoglobin of the red blood cells to form a stable compound known as carboxyhemoglobin and reduces the oxygen-carrying capacity of the blood.

Chapter XVIII

DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE CRASH OR ACCIDENT

A U T O M O T I V E C R A S H :

Factors Responsible to an Automotive Crash:

1. Human Factor (Driver):

a. Mental Attitude — reckless driving, showing of, inattention, fatigue, inexperience.

b. Perceptive Defect — Defective vision incapable of seeing an impending crash or defective hearing, unable to perceive whistle of train or automotive horn.

c. Delayed or Sluggish Reaction Time — Reaction time is the space of time the driver perceives an impending danger and the actual application of the brake. A quick reaction time may prevent the occurrence of a crash by sudden deceleration before the impact occurs.

d. Disease — The driver may develop an epileptic fit or suffer from a heart attack while on the steering wheel.

e. Chemical Factor — Alcohol is the most common. It blurs and diminishes the field of vision, blunts the senses of hearing and makes sluggish response to an impending danger.

Depressant drugs, like sedatives, tranquilizers, and narcotics do prolong the reaction time, impairs the power of decision and rational thinking.

Smoking marijuana may interfere with time and space perception, and attention to complicated task of driving.

A leak in the exhaust system of the vehicle may cause entry of carbon monoxide into the passengers compartment, especially in the air-conditioned cars, and may cause unconsciousness of the occupants including the driver due to poisoning.

Other drugs, especially psychotrophic, may cause delirium, unconsciousness which may cause impairment of reaction to a traffic situation.

2. Environmental Factor: Bad or poorly maintained roads, poor visibility, atmosphere,

rain, blind intersection, parked vehicle obstructing the view, trees too close to the road, absence of road signs, etc. have contributed

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to the occurrence of crash. In highways, the absence of railing on the side of the road beside a deep ravine, precaution signs and speed limits, curve or narrow strip have been responsible for many fatalities.

Stiff and slippery road may prolong the sked time. Sked time is the space of time between the actual application of the brake and the stopping of car. Sked time is influenced by the condition of the tire, condition of the ground and the amount of weight of the load. Cars moving with worn out tires, on a sloping and slippery road have the tendency to prolong the sked time.

3. Mechanical Factor:

Defect in the steering wheel, poor brake, transmission failure, worn out tires, unstable body are potential source of vehicular crash. The advent of modern high power engine and high octane fuel are conducive to high speed sometimes beyond the control of the driver. This is further enhanced with automatic transmission which diminishes human factor in the control of the vehicle.

4. Social Factor:

a. Speed is an added dimension in our life. Modern car manufacturers develop high compression, fuel economy and high speed which are improvements of their new cars.

b. Does car insurance develop "devil may care" attitude on the driver inasmuch as he will not be financially held liable for damages as a consequence of a crash? Statistics has shown that automotive accidents have increased tremendously recently.

5. Pedestrian.

Injuries and Death on the Driver and Passengers.

In automotive crash, there are two collisions that take place, namely:

1. First Collision — the impact of the moving vehicle with another vehicle or a fixed object. The moving vehicle rapidly decelerates and stops after the impact. The degree of damage on the vehicle depends on the speed and part of the vehicle involved.

2. Second Collision — This is the impact of the unrestrained occupants with the interior of the vehicle. Immediately, after the first collision, the occupants move in the same direction and at the same velocity towards the point of impact. That is, in the front impact, the occupants moves forward and in the side impact the passengers or driver moves towards the side that was involved in the first collision. If the vehicle is not put into a stop after the first collision, the unrestrained occupants will continue to strike to some parts of the interior of the vehicle.

AUTOMOTIVE CRASH OR ACCIDENT 461

Factors Responsible for Passenger and Driver Injury:

1. Displacement of the occupants within the vehicle with impact against structures.

2. Ejection.

3. Distribution of the passengers in the compartment resulting in direct impact injuries.

Front Impact Crash:

1. Driver — The driver may strike, the steering wheel, the hub of the steering column, the windshield, the rear view mirror, the column between the windshield and the side window, or the dashboard.

Severe impact of the driver's head on the windshield may cause laceration of the scalp, face or neck. Skull fractures are often observed.

The windshield glass is manufactured as two glass shields separated by and adherent to a sheet of plastic. It is so made to prevent breaking into pieces when force is applied on it.

Impact of the lower extremities against the dashboard may cause fracture of the tibia, fibula, femur or pelvis as well as lacerations and abrasion of the skin of (he area.

When the car is running with a high velocity before the impact, the front portion of the car may be shortened or "accor-dioned" and the steering wheel may be driven back into the passenger compartment. As a result this may cause severe chest, neck or facial injury. The impact of the face to the circular rim of the steering wheel may cause fractures of the teeth, jaw and facial bones.

2. Front Seat Passenger — Like the driver, the front seat occupant may strike the dashboard, windshield, rear view mirror, radio, air conditioner or the windshield wiper knobs which may protrude from the dashboard.

Pattern of Injuries on the Front Occupants:

a. Abrasion of the face and scalp. b. Laceration of the face and scalp. c. Fracture of the skull. d. Crashing injury of the neck. e. Laceration or rupture of the heart. f. Laceration and contusion of the lungs. g. Fracture of the ribs and sternum. h. Laceration of the liver and/or spleen.

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3. Rear Seat Occupants:

They may strike the back of the front seat, the pillar between the front and rear side doors, or may be propelled over the front seat striking the front seat passenger and driver, dashboard or windshield.

Side Impact Crash:

Side impact crash may occur when a vehicle strikes on the side of another vehicle or when a vehicle 6kids sideways into another fixed object. This is a common impact in street intersections. The injuries are more severe because the car has less crushable structural components to absorb the force of the impact and the side of the car are less rigid to prevent intrusion into the passenger compartment.

Since the side glass windows are not laminated with plastic control layer, any force applied on it will result to large pieces of glasses which cause laceration of the skin area in contact with it.

Since the passengers during the impact move towards the side of the impact, the passenger nearest to it will suffer most. The lateral impact to the chest may cause fracture of the ribs, contusion with laceration of the lungs. Laceration of the spleen and kidneys and pelvic fracture may also be observed in side impact.

Rear Impact Crash:

High velocity rear impact may occur following change of lane in an express way or crash at the rear of a parked vehicle. With the impact at the rear, the head moves backward or hyperextended. Then, the head will move forward until the chin strikes the front portion of the chest and with the neck hyperflexed. The backward and forward movement of the head is known as "acceleration-deceleration injury" or "whiplash". It may result to muscle spasm or injury to the ligament of the neck resulting to pain.

The rear impact crash may involve the gas tank. It may deform or puncture the tank, dislodges its connection and causes spillage of the gas on the road. The spark from a metal part dragging on the road may ignite the leaking fuel and consequently burns the car.

The striking vehicle may intrude into the passenger compartment and causes injury to the persons at the back seat.

Roll Over Crash (Tum-turtle Impact):

In the process of rolling, the occupants may be pinned, crushed or may be thrown away and fall on the ground.

On account of the long period of the process of rolling, the passenger usually does not sustain severe injuries. The rolling process causes the different sides of the vehicle to absorb the force of the impact.


While rolling, the unrestrained passenger may tumble inside the vehicle and may sustain injuries from striking the interior of the vehicle.

Ejection of the Occupant:

The primary impact of the vehicle may forcibly open the unlocked door. Ejection may increase further the injury sustained by the occupant. The acceleration of the body after the second collision may subject a person to his impact on the ground.

Means Employed to Minimize Injury to Driver and Passenger:

1. The interior surface of the car is so designed to be less hostile to the person striking them. The use of soft padded dashboard, windshield safety glass, dashboard with perforation to allow metal to deform easily, enlarged and padded central steering wheel hub and collapsible steering column are now parts of modern built cars.

2. The interior of the passenger compartment, including the steering wheel, dashboard, side doors are prevented from intruding into the passenger compartment and strike the occupants.

3. The fender, bumper and other parts of the car commonly involved in the impact are made of metal which can absorb energy, dissipate such force and prevent its transmission to the driver and passengers.

4. Special restraint to the occupants are being applied to reduce the severity of the second collision in the forms of lap and shoulder belt and air bag.

But, the use of seat belt is not absolutely considered as a safety device. It may cause injuries to the abdominal wall, visceral organs and vertebral column. The acute flexion of the trunk (jacknifing) with the belt as the central fulcrum may cause fracture of the trunk with the visceral organs in forward motion, may stretch the mesentery and causes injury to the intestine and mesentery itself. There may be abrasion, contusion and hematoma of the lower portion of the abdomen. All of these possible injuries is known as seat belt syndrome.

Suicidal Crash: This i6 usually a single vehicle and single occupant crash. It is a

head on collision with roadside object, pole or bridge support at a high speed. There is no evidence of any effort to apply the brake or to avoid striking the object. Crime scene investigation may show the foot still on the accelerator pedal. History may reveal previous attempts to commit suicide, as the presence of incised wounds,

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scars at the wrist or stab wounds in the chest and abdomen. Prior psychiatric evaluation may reveal pathological findings and suicidal tendency.

Homicide by Motor Vehicle:

Death by motor vehicle is usually on account of negligence and rarely intentional. The driver may be reckless, lack the necessary skill, aggressive, under the influence of drugs as the proximate cause of the crash.

The simulation of a crash may occur to conceal a prior homicide. Victim of other means of violent death (stabbing, shooting, mauling) may be placed on the road to simulate that he is a victim of "hit and run".

The driver may be shot while driving and lost control of the vehicle to crash with another vehicle or fixed objects.

A careful investigation and post-mortem examination will reveal the manner of death.

PEDESTRLAN-VEHICLE C O L L I S I O N :

Death or Physical Injuries to Pedestrian:

Pedestrian's injury or death is usually the result of two impacts both of which are capable of causing severe trauma.

1. Primary Impact:

This is the first violent contact between the pedestrian and the motor vehicle. Usually, the front bumper hits the leg of the victim. The severity of the injury depends on the position of the victim when the impact occurred, speed of the moving vehicle, and the amount of bodily support (clothings and other apparel the victim was wearing).

The movement of the body after the primary impact depends on the location of the impact. If the contact is below the center of gravity, the tendency of the body is to move backwards to hit the hood, windshield or even the top of the car. The average height of the bumper is 40 to 60 cms. from the ground and considering the pedestrian with shoes on, the most common site of the impact is the upper portion* of the leg. However, if the driver had effectively applied the brake before the impact occurred, the place of contact will be on a much lower level. This is due to the downward dive of the front end of the vehicle immediately following the application of the brake.

Fracture of the leg bones as a consequence of the primary impact is called bumper fracture. The leg carrying the body weight has more tendency to be fractured. If the victim is stand-


ing and the body weight is supported by both legs, there is more chance for the bones of both legs to be fractured. The end of the fracture usually protrudes through the skin opposite the place of contact of the leg with the bumper.

If the primary impact is above the center of gravity of the pedestrian, the tendency of the body is to move away from the vehicle and fall on the ground.

If the brake was applied during or immediately after the crash the car slow down faster than the movement of the pedestrian who continues moving forward and land on the road. If no brake was applied during the accident and at high speed, the pedestrian will pass over the top of the hood, windshield and windshield frame.

2. Secondary Impact:

This is the subsequent impact of the pedestrian to .the ground after the first impact. The injury sustained by the pedestrian depends mostly on the force of the ground impact, nature of the road and part of the body involved. It is the secondary impact that accounts for the multiple abrasions and contusions on the body of the pedestrian-victim.

3. Run Over Injuries:

Children who receive the primary impact above the center of gravity may fall on the ground with the car wheel passing over the body. The pedestrian may be run over by the moving vehicle during the initial impact or thereafter. Crash fracture, skid or tire marks, rupture of organs and internal hemorrhage may be seen at autopsy. Usually, the victim dies of shock and death that in most cases it is instantaneous, especially when there is a crashing injury on the head.

4. Hit-and-run Injuries:

A fast moving vehicle may run over, hit or side-swipe a pedestrian or collide with another vehicle or fixed object and get away from the scene without regard to the unfortunate victim. This usually happens when the driver is drunk or "high", at night time, in an isolated road and with no eyewitnesses or someone who could take note of the identity of the vehicle.

Tire thread marks, abrasion prints of parts of the vehicle in contact with the victim and paint detached from the vehicle found in the crime scene or body of the victim may be submitted for laboratory analysis, for comparison with that one of the suspect car.

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The suspected car may be examined for the presence of blood stains, hair or clothings of the victim for comparison with that one of the victim.

If the car has been damaged as a result of the impact, the investigator must make a diligent search of it in the motor shops. Eyewitness may be able to take note of the plate number and the identity of the vehicle can be checked at the Land Transportation Commission.

Evidences in Vehicular Crash:

1. From the Scene of the Crime:

a. The area of the road where the collision took place and the point of impact on the vehicle. A photograph or sketch must be taken to determine who violated the traffic rules and regulation.

b. The skid and tire marks on the road must be noted and preserved to determine identity of the vehicle and whether the driver stepped on the brake immediately before the crash.

c. Condition and position of the victim (pedestrian or occupants).

d. Condition of the vehicle involved in the crash and of other structures in the vicinity.

e. Blood, paint stains, pieces of clothings that may be found in the body of the victim, ground or on the vehicle.

f. Narrations of witnesses as to how the incident took place including the identity of the vehicle and the victims.

2. From the Driver:

a. Fitness to drive — Capacity to manipulate the steering wheel, step on the brake and accelerator, visual and hearing perception, reflex time, heart condition, history of epileptic seizure, etc..

b. Alcoholic drunkenness — A person with at least 0.15% alcohol in the blood is considered drunk. Some countries consider it a crime driving with only 0.05% blood alcohol.

Examination for the presence of psychotropic, sedative or narcotic drugs in the blood may be useful.

c. Injuries due to second collision — Like steering hub imprint, fractured skull, multiple abrasions and laceration of the face and scalp, fracture of the leg bones, ribs and sternum.

3. From the Victim in Vehicle-Pedestrian Collision:

a. Crush Injury:

The victim may manifest crushing injuries on the head with multiple fractures at different parts of the body. Usually, the


injuries are localized in certain areas of the body, especially when the victim is run over by the vehicle. All ribs may be fractured. Injuries of whatever description may be found.

b. Tire Thread Marks:

The pressure of the tire on the body surface may produce abrasion marks. This may be utilized in the identification of the vehicle in "hit and run" cases.

c. A brasion Marks:

The most common is the mark of the radiator, if the portion of the body of the victim hits the radiator of the vehicle.

d. Paint Marks:

Occasionally, the portion of the car that produces the injury leaves its paint on the skin or clothings of the victim. The paint may be scraped for the purpose of comparing it with the suspect's car.

e. Blood, Hair or Clothings of the Victim:

These may be found sticking on the part of the vehicle which hit the victim. A careful removal and submission to the laboratory for comparison with that of the victim's is important.

f. Physical Defects of the Victim:

This may diminish the power of the victim to prevent the injury like poor eyesight, sluggish response to a given stimulus, etc..

g. Inebriation of the Victim:

The victim might have been under the influence of alcohol and other depressant drugs. If dead, the organs principally the blood and brain must be submitted for quantitative determination of alcohol.

Purposes of the Autopsy of Victims of Vehicular Accidents:

Although, it may appear incontrovertibly clear as to the cause of death of a victim of vehicular crash, it is still imperative to perform the routine post-mortem examination for the following reasons:

1. The examiner can give his opinion as to the deceased's position in the vehicle or the pattern of the injuries correlated to the point of contact with the vehicle.

2. Examination will determine whether death occurred as a result of the crash and not due to a natural disease, poisoning, gunshot wound or other causes prior to the crash.

3. In cases when more than one member of the family died in a crash, the examiner can form an opinion as to who from among

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them survived the longest. The question of survivorship may be important in the settlement of the estate.

4. The size of the monetary reward in a civil suit may depend on the nature and extent of the injuries suffered. The injuries that was found will determine the pain and suffering of the victim and may be one of the basis of damages.

M O T O R C Y C L E CRASH:

Reasons Why there is a High Percentage of Motorcycle Crash:

1. A motorcycle can attain a high speed compared with other ordinary road vehicle.

2. It has a small profile that the driver of other vehicles may fail to see it.

3. At high speed and frequently in curves, the cyclist may lose control of the bike. It may hit a fixed object, the tire may skid, or the cyclist may be drunk.

Whenever the motorcycle strikes another vehicle or a fixed object the injuries is quite severe because:

1. There are so little crushable materials to absorb the impact that the motorist himself is subjected to the severe force.

2. No restraint system is available to keep the operator and the passenger on the bike and as a result, ejection from the motorcyle is common.

The most common injuries sustained are on the head and legs. Fracture of the skull and fractures of the leg bones are quite common. Most of the injuries are caused by the impact of the cyclist on other objects.

Inasmuch as the cyclist i6 exposed to crashes, the only alternative approach is the protective wearing apparel.

1. Leather jacket, thick pants, and gloves to protect the skin from injuries that result from ejection.

2. Leather boots to protect from injuries of the bones of the feet and legs.

3. Motorcyclist helmet which must be buckled to protect the head.

Chapter XIX

DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS

In line with the physical fitness program, an appreciable number of people are now involved in athletic sports of their own choice. This incidentally increases the number of injuries and fatalities. Although most injuries and fatalities are, as a rule, due to accident or from natural cause, inquiries as to the adequacy of the medical supervision, sufficiency of training of the contestants, utilization of the safety measures and proper observation of the rules may be the subject-matters of medico-legal investigation.

Some Aspects of Sport Development:

1. Training Method:

To develop weight-lifting, a lifter must lift a very heavy weight during his practice. To develop speed, a runner must run very fast during his practice.

Besides, two or three intense workout each week, an athlete also needs one endurance workout.

2. Injuries:

If the athlete is injured, he is rehabilitated by not allowing him to participate in the sport that caused the injury and by finding another sport that does not cause pain.

Every time the muscles are exercised intensely, injuries occur and it will take at least 48 hours for the muscles to heal.

Future recurrence is being prevented by correcting the cause of the injury. Although, continuous exercise despite the pain will result in further injury, neither is it necessary to stop exercising altogether. For in every week without exercise, it may take several weeks of training to regain prior condition.

3. Nutrition: Muscle endurance depends on how much glycogen can be

stored in the muscle cells. The glycogen storing capacity can be increased by exercising the muscles until most of the glycogen is depleted. Depletion, in the average top runner, occurs at 1-1/2 to 2 hours while on a bicycle racer it is 3 to 5 hours.

Competitive athletes need to eat large amount of carbohydrate-rich foods to help them store glycose as liver and muscle elvrn«w»n

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Increase glycogen storage in muscle results in an increase of muscle endurance.

The pre-game meal should be eaten 3 to 5 hours before competition. The liver can store enough glycogen to last for 12 to 15 hours. Skipping breakfast before competition can result in hypoglycemia and tiredness during competition.

Food should be eaten within 3 hours before competition because postprandial hyperinsulinemia last for 2 to 3 hours. Hyperinsulinemia at the start of exercise can cause hypoglycemia and fatigue. Athletes' greatest nutritional need is fluid. Athletes should drink cold water because it is absorbed faster and less likely to produce cramps (JAMA, Oct. 25, 1985).

A. BOXING

Boxing as a sport is sometimes described as an "organized brutality", "slaughter" and "carnage". Unlike other sports, the primary objective of the combatants is to knock out or win by decision by delivering a stunning or weakening punches. Generally, in most 6ports, the infliction of physical injuries are purely accidental but in boxing, it is the direct and primary objective of the combatants. So in this respect, boxing is considered to be one of the most brutal among the athletic sports.

Consequently, the public has a varied reaction as to whether it must be legalized or prohibited a6 an athletic sport.

1. Reasons Why Boxing Should Not Be Prohibited:

a. It takes wayward youths who are victims of the educational

system off the streets;

b. It teaches them self-discipline and controls and reinforces the adage that nothing of value is acquired without hardwork and sacrifice.

c. Self-confidence can only be promoted through an individual sport where the athlete must rely in his own talent and believes in his own ability. Only through conflict can hidden resources surface.

2. Reasons Why Boxing Should be Prohibited:

a. There is too much risk of death or injury to the participants.

b. Unlike other sports, the intention of the combatants is to produce injury as a principal way to win the contest. So, young men should be discouraged from a pugilistic career.

DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS 471

A Rotational

Acceleration

B

Linear Acceleration

C Injury to Carotid

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3. Potential Injuries Suffered by Combatants in Boxing: a. Inasmuch as the face is the target of the attack by the com

batants, the most common site of lacerated wound is the region of the eyebrow and the cheek (malar region). Bleeding comes from the small blood vessels which are crushed between the superficial bone and the force applied. Bleeding from the eyebrow may drip downwards to the eye and causes irritation and blurring of vision. If bleeding cannot be controlled on account of the severity of the injury, the referee may stop the bout.

Protagonist may be knocked down or accidentally fall on the canvass causing laceration of the scalp.

b. Serous effusion on the loose tissue around the eyeball and in the eyelid may cause puffiness and closing of the eye. Hemorrhage due to the rupture of the blood vessels or the fracture of the orbital plate of the frontal bone may cause swelling and discoloration in or around the eye, known as spectacle hematoma may develop.

c. Trauma on the pinna of the ear may produce hematoma with subsequent necrosis of the auricular cartilage. After healing and scarring process, the pinnas appear to be thick and irregular, known as cauliflower ears.

d. Fracture of the nasal septum, mandible and maxillary bone may develop as a consequence of a hard hook or a straight blow. Fracture of the skull is quite unusual to develop because of the difficulty to do so with a gloved fist. However, an unconscious fall on the canvass may cause it.

e. Retinal detachment is one of the serious hazards of boxing as it may cause partial or complete loss of vision.

f. Muscle cramps, sprain and dislocation may occur and may force the boxer to give up the fight.

g. A kidney punch may cause peri-renal hemorrhage or laceration of the kidney that causes it to lose its function and subsequent uremia.

h. A blow on the face may cause laceration of the lip and buccal mucosa with loosening or detachment of the teeth.

i. Intracranial injuries may cause serious sequelae of death to the boxer.

(1) Cerebral concussion or the transitory period of unconsciousness is a result from a blow on the head that may last for a few seconds or longer. The loss of consciousness should


never be dismissed lightly because recovery may only be an interlude to some serious intracranial changes.

(2) Subdural hemorrhage is the most common injury which may be localized or extensive. The most common site of hemorrhage is the middle cranial fossa. A blow on the jaw is transmitted to the temporo-mandibular joint and then to the middle cranial fossa. Repeated trauma on the skull cause tearing of the dural emmissary veins.

(3) Pontine hemorrhage, known to some as boxers hemorrhage may be the result of severe beating. The acute flexion and extension of the head during a series of blows may cause the brain stem to be pinched over the tentorium causing hemorrhage.

The effect on the brain of a boxing blow depends on the location, direction, intensity, velocity and number of blows.

(1) Rotation (angular) Acceleration:

A blow which causes the rotation of the movable head will cause the inert brain to lag behind the accelerated skull. This is particularly true to a groggy fighter who has lost control of his neck muscles in the head which is most susceptible to sudden acceleration. The effects are:

(a) Subdural Hematoma — The bridging veins that connects the brain with the superior saggital sinus of the dura mater is tightly bound to the skull. These veins are stretched when the skull accelerates. In turn, blood accumulates in the subdural space causing compression, edema and herneation of the brain.

(b ) Intracerebral Hemorrhage — The rotational movement of the brain within the accelerated skull may tear vessels within the brain. Such hemorrhage may develop in the para-saggital regions of the cortex and subcortical white matter. It may develop in the deeper white matter, the corpus callosum and the cerebral peduncle.

(c) Diffused Axonal Injury — Damage to the axqn of the white matter is common to head trauma. Microscopically, it is recognized by spherical enlargement of the proximal and distal stumps. A few severed axons may not be sufficient to produce clinical symptoms but their number will increase with each bout and eventually clinical deficits become apparent..

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(2) Linear (Translational Acceleration):

A straight blow on the face may cause focal ischemic lesions, notably in the cerebellum. Vascular spasm associated with focal ischemia are known to occur after subarachnoid hemorrhage and often manifest themselves a few days after bleeding. In groggy boxers, sudden linear acceleration also may produce hyperextension of the neck, which is known to damage axons of the medullary-pontine angle and the reticular substance, resulting to a knockout.

(3) Injury to the Carotid:

Blows to the neck can damage the carotid. Dissecting aneurysm or occlusion by thrombus may follow. Pressure on the carotid sinus induces reflex mechanism that causes hypotension and bradycardia associated with decrease bloodflow to the brain. A loss of muscle tone and brief fainting spell will contribute to a boxer's groggyness, and increases his susceptibility to head acceleration by successive blows.

(4) Impact Deceleration:

After a knockout, the boxer hits the rope or mat. Fall on the back produces rapid deceleration which typically results in contre-coup contusions of the orbital surface of the frontal lobes and the tips of the temporal lobes. The crest of the convolutions are torn apart, which is associated with parenchymal and sub-arachnoidal hemorrhage. Furthermore, the inert brain will glide within the cranial cavity, causing para-saggital gliding contusion (small hemorrhage in the cortical and subcortical white matter as well as subdural hematomas).

Cerebral Edema, Ischemia and Herneation:

Severe trauma on the head is usually followed by cerebral edema. It increases pressure on the swollen brain within a confined space of the cranial cavity which affects the blood flow. The vessels are squeezed resulting in ischemia which further contributes to edema.

The mounting pressure intracranially causes the brain to herneate over the edge of the tentorium and through the foramen magnum. Hemorrhagic necrosis of the brain at the point of herniation (inferior temporal lobes and cerebellar tonsils) develops rapidly. Death results from ischemia and hemorrhage in the midbrain and upper pons after such herniation.


Cerebral Atrophy, Enlarged Ventricle and Septal Cavum:

Gross examination of the brain from punch-drunk boxer reveals enlarged ventricle, widened sulci and narrowed gyri. The most typical finding is the presence of a large cavum septi pellucidi with multiple fenestration. The septal cavum is not infrequently observed as an incidental finding in autopsy, but in boxers the width of the cavum is much larger, and fenestrations are unusual in non-boxers. The repetitive rotational acceleration of the head, in boxers, is believed to tear the septal wall and causes spinal fluid to collect within the cavum. Ventricular engorgement and atrophy are expected to develop as a consequence of axonal and neural degeneration (JAMA, Vol. 251, No. 20, p. 2676 (May 25, 1984).

Delayed Consequence of Brain Damage:

The delayed sequelae of intracranial damages in boxing is summed up to what is commonly known as punch-drunkenness or traumatic or pugilistic encephalopathy. This is characterized by slurred speech, slow clumsy movement, unsteadiness of gait, tremor, progressive dementia, poor tolerance to alcohol and symptoms of progressive ventricular dilatation.

In case of thr> hypothalamus, and the pituitary gland are involved on account of the fracture of the base of the skull, the boxer may suffer from diabetes inspidus when the neuro-pituitary gland is involved and hypothermia if the hypothalamus suffered injury.

Post-Mortem Findings:

(1) In case of death after the injury due to intracranial hemorrhage:

(a) Generalized edema of the brain.

( b ) Presence of intracranial hemorrhage usually subdural.

(c) Compression of the brain on account of massive hemorrhage.

(d) Petechial hemorrhage in the white matter.

(e) Compression of the brain stem at the region of the foramen magnum.

(f) Small areas of contusion on the brain surface.

(g) Histologically: i. Perivascular and pericellular space.

ii. Capillaries show congestion with endothelial swelling.

iii. Axons are swollen and poorly stained.

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iv. Astrocytes appear swollen and nerve cells show chromatolysis and cytoplasm vacuolated.

(2) In case of death after a chronic sequelae:

(a) Abnormality in the septum pellucidum.

(b) Cerebellar and other scarring.

(c) Small areas of scarring in the cerebellar tonsil and medulla oblongata.

(d) Reduction of the brain weight.

(e) Lateral ventricle widely dilated with thinning of the corpus callosum.

(f) Loss of pigmented nerve cells in the substantia nigra.

4. Measures Which Are Adapted to Minimize Injuries in Boxing:

a. Use of an effective gum shielding to avoid injury to the structures of the buccal cavity.

b. Use of heavier or well-padded gloves.

c. Use of preliminary binding of the hands with cotton or zinc oxide adhesive plaster to reduce incidence of fracture and displacement of the metacarpal bones.

d. A boxer who is "knocked out" or is stopped from fighting to prevent further punishment must be thoroughly examined with an electrocardiogram and his license to participate in any ring combats must be suspended until a new certificate of fitness is issued.

e. Spacing between matches, usually not less than a month, to avoid too much muscular strain and it should be a part of the regulation.

f. Amateur bout must not last more than five minutes and there is a move to reduce title bout from fifteen to only ten rounds.

g. Blow on the genital region is considered a foul.

h. The use of stimulants is prohibited.

B. WRESTLING

1. Common Injuries Suffered by Combatants:

a. Injury to the cervical spine (fracture and/or dislocation) especially when the wrestler forms a bridge during the contest. There is a bridge when the trunk and neck is hyper-extended and the Dody weight is supported by the head which touches the ground and the feet.

b. Knee injury, usually meniscus or ligament tear that follows hyperextension and rotation of the leg.


c. Injuries to the shoulder joint and a rotator cuff result from twisting of the trunk and upper extremities.

d. Facial injuries and mat burns due to contact of the face to the floor.

e. Abdominal hemorrhage due to rupture of organs in violent fall.

2. Regulations to Minimize Injuries:

a. Pulling of hair, ears and genitals, twisting of the digits, blows with the fist, and kicking are forbidden.

b. Each contestant must have a medical examination immediately before the combat.

c. A five minutes rest period must be allowed after any fall on the head or any sign of bleeding from the nose.

d. The competitors must be freshly shaven, the hair must be short and no grease or lubricant may be used in the body.

Chapter XX

CHILD ABUSE OR NEGLECTED CHILD

(Battered child, Battered child syndrome, Maltreatment syndrome,, Maltreated child, Physically abused child, ni-treated syndrome.)

It is the physical and mental injury or maltreatment of a child by a person who is responsbile for the child's welfare, under circumstances which will indicate that the child's health or welfare is harmed or threatened thereby. The infliction must be willful and not accidental.

The victim is of tender age, usually less than 3 years old. It occurs in all levels of the economic strata. Usually, only one child is involved. Parents are frequently immature, self-centered, impulsive and with poorly controlled aggression.

Duties of Parents:

Art. 46, The Child and Youth Welfare Code — General Duties:

Parents shall have the following general duties toward their children:

(1) To give him affection, companionship and understanding;

(2) To extend to him the benefits of moral guidance, self-discipline and religious instruction;

(3) To supervise his activities, including his recreation;

(4) To inculcate in him the value of industry, thrift and self-reliance;

(5) To stimulate his interest in civic affairs, teach him the duties of citizenship, and develop his commitment to his country;

(6) To advise him properly on any matter affecting his development and well-being;

(7) To always set a good example;

(8) To provide him with adequate support, as defined in Article 290 of the civil Code:

Support is everything that is indispensible for sustenance, dwelling, clothing and medical attendance, according to the social position of the family.

Support also includes the education of the person entitled to be supported until he completes his education or training for some profession, trade or vocation, even beyond the age of majority. (Art. 290, Civil Code).

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CHILD ABUSE OR NEGLECTED CHILD 479

(9) To administer his property, if any, according to his best interest, subject to the provision of Article 320 of the Civil Code:

The father, or in his absence the mother, is the legal administrator of the property pertaining to the child under parental authority. If the property is worth more than two thousand pesos, the father or mother shall give a bond subject to the approval of the Court of First Instance (Art. 320, Civil Code).

Rights of Parents:

1. Under the Child and Youth Welfare Code:

Art. 45, Right to Discipline the Child — Parents have the right to discipline the child as may be necessary for the formation of his good character, and may therefore require from him obedience to just and reasonable rules, suggestions and admonitions.

2. Under the Civil Code:

Art. 316 — The father and the mother have, with respect to their unemancipated children:

(1) The duty to support them, to have them in their company, educate, and instruct them in keeping with their means, and to represent them in all actions which may redound to their benefit;

(2) The power to correct them and to punish moderately.

Act or Omission Affecting the Child's Health or Welfare:

1. Physical Abuse — The law allows chastisement for discipline but it may be physical abuse when it involves the use of instrument or fist blow. It may include the act of physical or emotional persuasion that forces or places the child in a potentially dangerous situation in which the subsequent and significant physical injuries are severe enough to require medical treatment.

2. Physical Neglect — It is the failure to provide the child with the necessities of life. It may include inadequate or insufficient medical care, nourishment, clothings, supervision, housing, or the like. The failure to provide must be willful.

Causes of Child Abuse or Neglect:

1. Unwanted Child:

a. Husband disputing the paternity of the child. b. Illegitimacy:

(1) Child born of unmarried woman. (2) Wife committed adultery.

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(3) Child born as a consequence of rape.

c. Congenital or acquired deformity of the child. d. Child allegedly giving "bad luck" to the family.

2. Abusive Parent:

a. Uncontrollable abuse by psychotic, pervasively angry or temperamental parent.

b. Controllable abuse by compulsive disciplinarian or impulsive but generally inadequate parents.

3. Child as a center of a triangle — In the case of a couple or mother "live-in" boyfriend, more often the child is placed in the middle of an emotional triangle. When resentment builds between them, the child commonly becomes the target of man's hostility.

4. Child may be a hindrance to the socio-economic activities of the parents.

Classification of Child Abuser:

1. Intermitent Child Abuser — Parents who periodically batter a child with periods of proper care between battering. They do not intend to hurt the child, but they are driven by panic or compulsion into abusive behavior. Apparently they become sincerely remorseful afterwards.

2. One-time Child Abuser — Parents who manhandle their children for a time and never repeat the act. However, there is more likehood for a one-time abuser to repeat the act until the child is killed or had experienced a sudden surge or self-restraint.

3. Constant Child Abuser — Parent who actually hates his or her child and callously and deliberately beats and miscares for it. Parent had the intention to hurt the child and be indifferent to the child's sufferings. These parents often have personality disorders and are cooly indifferent to the destructive nature of their action.

4. Ignorant Abuser — This group is perhaps the most tragic because the parents "mean" well, but their attempts at rearing their children result in a permanent injury or death of their children, and they are "truly sorry" when the child dies (Battered Child Syndrome, Legal Medicine 2980 Wecht & Lorkins, p. 32).

Medical Evidence Tending to Show Injuries Due to Abuse:

1. Skin imprints from forcefully striking objects — Hand, cord, chain.

2. Multiple bruises and/or scars, particularly on the trunk, head and face.

3. Multiple small burns or emersion burn levels — cigarette. i ™ n

boilir>tr n r a + m .

CHILD ABUSE OR NEGLECTED CHILD 4R1

4. Multiple fresh healing fractures; "twist" fractures.

5. Trauma to the mouth, nose, ears and eyes.

6. In case of sexual abuse, injuries to the genitalia, peri-rectal and peri-vaginal may be present.

7. In case of child neglect, signs of mainourishment, poor hygiene, infection, poor growth and development may be observed.

Facts to be Considered to Suspect that a Child is a Victim of Abuse:

1. The child is emotional, fearful and with a vague history of injury.

2. The parents present a vague and defensive detail of the child's "illness" or "injury".

3. Too many previous unexplained signs of injuries or history of previous illness.

4. Parents have extended delay in seeking medical cure.

5. Poor growth and development of the child.

Social Reaction To Child Abuse and Neglect:

1. Report of Maltreated or Abused Child: Art. 166, Child and Youth Welfare Code (P.D. 603):

All hospitals, clinics and other institutions as well as private physicians providing treatment -shall, within forty-eight hours from knowledge of the case, report in writing to the city or provincial fiscal or to the Local Council for the Protection of Children or to the nearest unit of the Department of Social Welfare (Ministry of Social Service and Development), any case of a maltreated or abused child, or exploitation of an employed child contrary to the provisions of labor laws. It shall be the duty of the Council for the Protection of Children or the unit of the Department of Social Welfare to whom such a report is made to forward the same to the provincial or city fiscal.

Violation of this provision shall subject the hospital, clinic, institution, or physician who fails to make such report to a fine of not more than two thousand pesos.

According to Administrative Order No. I — A, series of 1981 of the Ministry of Health, dated July 6, 1981:

The report shall be submitted directly to the nearest Ministry of Social Services and Development Office copy furnished the police authority concerned and the Provincial/City Fiscal. The report shall include the following information:

a. Name of child. b. Date of birth, age and sex. c. Date and time of admission.

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d. Name of person who brought the child to the health institution. e. Address and relationship to the child. f. Name and address of the father /mother /guardian of the child

if other than the person who brought the child. g. Tentative date of discharge. h. Medical findings/case summary relative to the maltreatment/

abuse/exploitation of the child.

i. Evidence of parent's/employer's negative attitude towards the incident.

The health authority concerned shall ensure that the report is acknowledged in writing by the Ministry of Social Services and Development Office within 24 hours."

Art. 167, Child and Youth Welfare Code — Freedom from Liability of the Reporting Person or Institution:

Persons, organizations, physicians, nurses, hospitals, clinics and other entities which shall in good faith report cases of child abuse, neglect, maltreatment or abandonment or exposure to moral danger shall be free from any civil or criminal liability arising therefrom.

The provision of the Child and Youth Welfare Code (P.D. 603), Art. 166 requiring mandatory reporting of child abuse by physician and medical institution has its advantages and disadvantages.

a. Advantages:

(1) It compels the hesitant physician or medical institution to report such child abuse or neglect so that proper remedial measures can be applied to protect the child.

(2) The fact that the child under treatment due to the act of the parent(s) was known by the physician in the process of history taking, makes such information privileged or confidential and the physician normally has no right to disclose such information. But Art. 167 of the Code provides for freedom from liability of the reporting person, thereby placing the traditional right of the child above the parent's right to the privileged communication.

b. Disadvantages:

(1) It increases the health hazard of the child as the abusing parents will be reluctant to seek medical aid for the abused child.

(2) The law's concentration on one child as seen by a physician fails to concern itself with the possibility of danger to the other siblings within the family.

(3) If the reported parents are exonerated, released and reunited with the family, the pent-up anger felt against the

CHILD ABUSE OR NEGLECTED CHILD 483

authority may be released against the vulnerable child.

2. The court may deprive parents of their authority over the child or adopt other measures for the welfare of the child: Art. 332, Civil Code:

The court may deprive the parents of their authority or suspend the exercise of the same if they should treat their children with excessive harshness or should give them corrupting orders, counsels or examples, or should make them beg or abandon them. In these cases, the court . . . or adopt such measures as they may deem advisable in the interest of the child.

The court has a wide range of powers designed to give the highest practicable degree of flexibility in making dispositional decision.

The judge may simply warn parents or counsel them. He may order medical and psychiatric treatment for the child and/or for the parents. He may order the child to be in a protective supervision in a welfare home. Although the parents have the right of custody of their children, the children have also the right to live. The judge must exercise sound discretion in balancing their respective interests.

3. Establishment of public and private welfare institutions for the care of abused, neglected, abandoned, infirmed, or other conditions which require aid, support or treatment.

4. Abuse, neglect or abandonment of children is made a criminal act or omission:

a. If the child dies, then the offender is guilty of parricide:

Art. 246, Revised Penal Code — Parricide:

Any person who shall kill his father, mother or child, whether legitimate or illegitimate, or any of his ascendants, or his spouse, shall be guilty of parricide and be punished by the penalty of reclusion perpetua to death.

b. If the child did not die but was a victim with physical injuries, the offender can be charged with frustrated parricide, or physical injuries:

c. If the child is abandoned or neglected, the offender can be charged for abandonment of minors: (1) Art. 276, Revised Penal Code —Abandoninga minor:

The penalty of arresto mayor and a fine not exceeding 500 pesos shall be imposed upon anyone who shall abandon a child under seven years of age, the custody of which is incumbent upon him.

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When the death of the minor shall result from such abandonment, the culprit shall be punished by prision correccional in its medium and maximum periods; but if the life of the minor shall have been in danger only, the penalty shall be prision correccional in its minimum and medium periods.

The provisions contained in the preceding paragraphs shall not prevent the imposition of the penalty provided for the act committed, when the same shall constitute a more serious offense.

(2) Art. 277, Revised Penal Code — Abandonment of minor by person entrusted with his custody; indifference of parents:

The penalty of arresto mayor and a fine not exceeding 500 pesos shall be imposed upon anyone who, having charged with the rearing or education of a minor, shall deliver the said minor to a public institution or other persons, without the consent of the one who entrusted such child to his care or in the absence of the latter, without the consent of the proper authorities.

The same penalty shall be imposed upon the parents who shall neglect their children by not giving them the education which their station in life requires and their financial condition permits.

Other Battered Victims:

1. Battered wife — The wife may be periodically subjected to maltreatment by the husband on the account of jealousy, infidelity, or incompatability of character. Attempt of the husband on the life of the wife is one ground for a legal separation.

2. Battered grannies (battered grandfather or battered grandmother) — Elderly persons may be extremely demanding, seeking more attention from the caring descendant or with child-like behavior which may be irritating and which may cause infliction of physical injuries. The same situation may happen where an over-demanding boarder may suffer maltreatment from the overworked caretaker of the home for the aged.

Chapter XXI

MEDICO-LEGAL ASPECTS OF

SEX CRIMES

V I R G I N I T Y A N D D E F L O R A T I O N

A . V I R G I N I T Y

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 a "virtuous female" if her body is pure and if she has never had any sexual intercourse with another, though her mind and heart is impure (Thomas v. State, 19 Ga. App. 104, 91 S.E. 247, 250).

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 (U.S. V. Alvarez, 1 Phil. 242). A woman is presumed to be a virgin when unmarried and of good reputation.

A defendant has the previous sexual intercourses with the victim before he was charged'with consented abduction for acts committed thereafter. The woman was considered "virgin" within the meaning of the law (U.S. v. Casten, 34 Phil. 808). However, in another case, it was established that the defendant's character, before the alleged seduction, was opened to question. The woman

considered no longer a virgin (U.S. v. Suan, 27 Phil. 12).

of Virginity: 1. Moral Virginity — 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.

There are no conclusive medical findings to show that a woman is physically virgin. Reliance is given to the absence of laceration of the hymen, but a woman might have had previous sexual

485

486 LEGAL MEDICINE

intercourse and yet the hymen was unruptured while others might not have the experienced of sexual relations but have laceration of the hymen.

If the findings show absence of laceration of the hymen, distinction should be drawn between true and false physical virginity.

a. True Physical Virginity — A condition wherein the hymen is intact with the edges distinct and regular and the opening small to barely admit the tip of the smallest finger of the examiner e. n if the thighs are separated.

b. 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 a 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 a 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 breasts to be fondled, her private organ to be held and other lascivious acts. The woman allows sexual intercourse 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 a 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.

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

1. Breasts — The breasts (mammary glands) 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 conr>active tissue name-work with variable amount of adipose tissue.

On the ventral surface of each breast is a cylindrical projection called nipple and at its rounded tip are perforations which are the openings of the ducts draining the milk glands. The nipple is surrounded by a pigmented area called areola which becomes dark brown during pregnancy.

VIRGINITY AND DEFLORATION 487

The size, consistency and shape of the female adult breast varies with age, degree of physical development, stage in the menstrual cycle, pregnancy, nutrition and hormonal factors.

A fully developed breast may be classified according to shape as follows:

a. Hemispherical Breast — The breast is like a hemisphere. The contour lines are not straight but form part of a circle or half of a sphere.

b. Conical Breast — The breast has the shape similar to a cone. The outline consists of two converging lines which meet at the region of the nipple.

c. Infantile or Flat Breast — The breast is only slightly elevated from the chest without distinct boundary and showing no definite shape.

d. Pendulous Breast — The skin of the breast is loose making it capable of swinging in any direction. This is commonly observed among parturient breast-feeding mothers. A pendulous breast may be:

(1) Hemispherical pendulous breast — It has the shape of a hemisphere but with loose skin.

(2) Conical pendulous breast — It has the shape of a cone and is capable of swinging sidewise.

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. 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 other so as to cover the labia

488 LEGAL MEDICINE

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 labia is not a reliable basis in determining virginity. A woman may be a virgin but with a 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 minora 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.

Classification of Hymen:

a. As to shape and size of the opening:

(1) Annular or circular — The opening is oval or circular located at the center of the hymen. There may be indentation of the borders.

(2) Infantile — The opening is small, usually linear, fleshy and resistant.

(3) Semilunar or crescentric — The concavity may be facing either side or upwards or downwards. The tapering ends of the crescent may be the frequent sites of laceration.

(4) Linear — The opening is slit-like and usually running vertically.

(5) Cribiform — The hymen presents several openings instead of a single one. In several instances the openings are quite small and will require the use of a hand lens to make them visible.

( 6 ) Stellate — hymenal opening is like a star.


(7) Septate — There are two openings which may be of equal or different sizes separated by a bridge of hymenal tissue. After a sexual act there may be complete rupture of the bridging tissue or marked distention of one to make the other opening almost invisible.

(8) Fimbriated — The border of the opening shows small irregular protrusion towards the opening. In some instances the fimbriation may be big enough that the examiner may mistake it to be a superficial laceration.

(9) Imperforate — There is no opening on the hymen. When a woman starts to menstruate, surgery may be necessary to open the hymen to allow free passage of menstrual blood.

b. As to structure and consistency:

(1) Firm and with strong connective tissue and plenty of blood vessels — This type has more tendency to lacerate during the first sexual act and the laceration may produce relatively more hemorrhage.

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Thin hymen

(3) Membranous hymen — Hymen is parchment-like, may be transparent and may lacerate without pain or appreciable bleeding.

c. As to number of opening:

(1) Single orifice — Having one opening. (2) Septate — Having two openings. (3) Multiple — Having several openings. ( 4 ) Imperforate — Without orifice.

Virginity is Not Synonymous with Chastity:

A woman may resort to many forms of homosexual as well as heterosexual practices without losing her virginity, yet she may be unchaste.

A woman may have a ruptured hymen and other signs of loss of physical virginity, yet she is chaste.

She may resort to masturbation with rupture of the hymen and dilatation of the vaginal canal causing it to appear that she has had several sexual intercourses, yet she may still be a virgin.

'efloration is the laceration or rupture of the hymen as a result of sexual intercourse. All other lacerations of the hymen which are not caused by sexual act are not considered as defloration.

B. DEFLORATION


Parts of the female genitalia that must be examined to 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 genitalia. After defloration, the labia may gape exposing the introitus vulvae.

The finding may not be relied upon because some females 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 walls with rounding of the 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 insertion of a medium size tube during the medical examination can be done with slight resistance.

The changes in the vaginal rugosities or the laxity of its wall cannot be relied upon as a proof of defloration because instrumentation during medical examination, masturbation or insertion of foreign bodies or other similar or related acts will cause the development of such condition.

The vaginal wall, together with the vulva, may suffer injury during defloration or some other causes.

Predisposing causes of vulvo-vaginal injuries during sexual act:

a. Virginity — Sex organ does not have previous experience to stretching or coital act.

b. Prepuberty — The genital organ is not yet fully developed to subject it to full physiological function.

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c. Genital disproportion — The male organ is unusually big or female organ infantile in size in spite of adult age.

d. Unprepared or unaroused female — The vaginal secretion is absent, causing more friction.

e. Position during the sexual act — Dorsal decubitus position with the thighs hyperflexed predisposes to deep penetration by the male organ and is contributory to vaginal vault lacerations. Vaginal position may not be in harmony with the movement of the penis.

f. Brutality of the male partner during the sexual act.

g. Recent vaginal surgery — The canal may become narrow and fibrous scar may replace the muscular vaginal wall at the site of surgery.

h. Excessive active involvement of the female partner.

i. Multiple sexual act among sex deviates (Nymphomaniac or satyriatic) or multiple consort — Continuous stretching and friction may weaken its wall.

j . Renewed sexual activity after prolonged abstinence.

k. Post-menopause.

1. Uterine retroversion.

4. Hymen:

The hymen is lacerated during the initial sexual act. However, it is not always the case. Some hymen 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 that the hymen is intact does not prove absence of previous sexual intercourse and the presence of laceration does not prove defloration.

Other Causes of Hymenal Laceration:

a. Passage of clotted blood during menstruation. b. Ulceration due to disease, like diphtheria. c. Jumping or running. d. Falling on hard and sharp object. e. Medical instrumentation. f. Local medication. g. Self-scratching due to irritation. h. Masturbation. i. Insertion of foreign bodies, j. Previous operation.

In the medical examination of the hymen, the following facts must be included:


a. General condition of the hymen:

This includes the width, thickness, elasticity, vascularity, and laxity. It may include pathological condition, like inflammatory changes, signs of previous trauma, developmental abnormality and foreign elements.

b. Original shape of the orifice (opening):

In case laceration is present, try to reconstruct the hymen by means of a probe and determine the original shape of the opening. It may be linear, circular, stellate, cresentric, septate, cribiform, imperforate and fimbriated.

c. If lacerated, the following must be noted:

(1) Degree of laceration:

This refers to the extent of damage to the hymen which may be:

(a) Incomplete laceration — Rupture or laceration of the hymen is considered incomplete when it does not involve the whole width or height of the hymen. Incomplete laceration may be:

i. Superficial — The laceration does not go beyond one-half of the whole width of the hymen.

ii. Deep — The laceration involves more than one-half of the width of the hymen but not reaching the base.

( b ) Complete laceration — The hymenal laceration involves the whole width but not beyond the base of the hymen.

(c) Compound or complicated laceration — The laceration involves the hymen and also the surrounding tissues. It may involve the perineum, vaginal canal, urethra or rectum.

Notches — Indentation of the hymen simulating lacerations. They may be symmetrical and may extend to the vaginal wall. The mucous membrane over the notch is intact. Notches may be mistaken for laceration.

(2) Location of laceration: For the purpose of locating the site of the laceration, the

hymenal orifice is related to the face of a watch while the subject is in lithotomy position. With the examiner facing the female genitalia, the location of the laceration will be described corresponding to the time in the face of a watch. By this procedure, a laceration at the region of the fourchette may be described as a laceration at 6:00 o'clock position in the face of a watch while on the horizontal

494 LEGAL MEDICINE

sides may be termed 9:00 (left side) and 3:00 (right side) positions.

(3) Duration of the laceration:

The determination as to how long the laceration took place can be approximated by the changes observed in the lacerated tissue.

(a) Fresh bleeding laceration — The laceration is of recent origin.

( b ) Fresh healing with fibrin formation and with edema of the surrounding tissue — Usually after 24 hours.

(c) Healed laceration with congested edges and with sharp coaptible borders — Depending upon the degree of laceration and the presence or the absence of complications, the said laceration could have occurred 4 to 10 days. Sometimes, the said finding is termed "recently healed" laceration.

(d) Healed laceration with sharp coaptible borders without congestion — Some times have passed by after the laceration has healed. Ordinarily it can be inferred that hymenal laceration took place approximately more than ten days or 2 to 3 weeks.

(e) Healed laceration with rounded non-coaptible borders and retraction of the edges — Laceration took place long before the date of the examination which is probably more than a month's time.

(4) Complications of laceration:

A vast majority of laceration of the hymen healed uneventfully, although in rare instances complications set in. The following are the possible complications:

(a) Secondary infection — There may be activation of the bacterial flora in the vaginal canal or a superimposed infection may set in, especially among women with poor hygienic habit. Gonorrheal infection is not uncommon when the offender is suffering from the disease at the time of the sexual act.

( b ) Hemorrhage — This is a rare complication but this may be present in severe compound laceration of the hymen. Surgical intervention may' be necessary to control the bleeding. Blood analysis to determine the presence of blood disease may be indicated when there is disproportion between the injury and the amount of hemorrhage. Blood transfusion may be required when the


condition of the patient demands replacement of the blood loss.

(c) Fistulae formation — Recto-vaginal or vesico-vaginal fistula may develop in the case of compound laceration. This may require the services of a competent gynecologist to subject the patient to surgery.

( d ) Stricture — Hymenal laceration alone will not produce stricture but in case of involvement of the vaginal wall it may consequently result in narrowing of the canal on account of the scar formation.

(e) Sterility — Trauma and infection may further involve the upper part of the female generative organ and may cause loss of procreation power.

PHYSIOLOGIC C O N S I D E R A T I O N :

A. During Sexual Excitement:

1. Local Changes:

The parasympathetic innervation of the sex organ is from the 2nd, 3rd and 4th spinal sacral segments, and the sympathetic innervation is from the 11th thoracic down to the 1st lumbar. In the male, the stimulus may be central or somesthetic or local tactile in origin.

In the male, stimulation will cause erection of the penis due to active dilatation of the arteries through the nervus origentis. The erection is also brought about by the contraction of the ischiocavernous muscle producing compression of the dorsal vein of the penis, thus causing accumulation of blood under pressure.

More sexual stimulus will be attained through friction during the sexual act coupled with the physical activities of the partner.

In the female, sexual stimulation will cause tomescence of the clitoris, vestibule and labia minora.

There is spontaneous vulvar lubrication. The lubricant is a transudate coming from the vaginal wall and its production ceases when the stimulus is removed. The lubricant dries quickly.

There is labial engorgement and vaginal lengthening and widening. During the excitement, the vaginal canal increases in length from 7 to 8 cm. to 9.5 to 10.5 cm. At the level of the cervix there is a transverse expansion of the vaginal canal from 2 cm. to 4 cm. to 6.25 to 6.75 cm.

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2. Systemic Effects: a. An increase in the pulse rate;

b. Marked increased in blood pressure making its peak during orgasm;

c. An increase of peripheral flow of blood experienced as an increase of body warmth;

d. Tomescence (engorgement of blood), which is the consequence of this peripheral flow concentrating on erectile tissue;

e. Increased respiration;

f. A decrease in bleeding during arousal, which is reversed subsequently;

g. A decrease in sensory perception;

(1) There is blunting of the sense of touch.

(2) Pain may be largely lost; sensation which could be sharply painful may only be experienced as no more than a mild touch stimulation.

(3) Alertness of hearing and vision is clearly decreased.

B. During Orgasm:

In the male, orgasm is the sensation resulting from the contraction of the smooth muscles of the genitalia and the striated muscles of the pelvic floor coinciding with ejaculation.

Seminal emission is carried on by the peristaltic action of the vas deferens, seminal vesicle and prostate.

Ejaculation results from the contraction of the pelvic floor muscle and the bulbospongiosus and ischiocavernosus muscles.

In the female, during orgasm, there is contraction of the smooth muscles of the uterus and rhythmic contraction of the vaginal sphincter, the ischiocavernosus and the pelvic floor musculature.

The physiological changes are similar in both male and female. The difference is only in the speed of response. In the male, sexual arousal is psychological followed by physical, while in the female it is primarily physical.

D E A T H R E L A T E D T O S E X U A L A C T

1. Death of the Male Partner:

a. Death from natural cause:

During sexual intercourse, the male as an active subject develops increase blood pressure, tachycardia and hyperventilation due to emotional response and muscular exertion. If he is suffering from cardio-vascular disease or insufficiency


of cardiac reserve, the increase demand on the cardiovascular system may not be met and he may die. This is also true in masturbation.

If a person died outside his conjugal home, the dead is generally referred to as "D.I.S." or "death in the saddle". Sometimes it is jokingly claimed that "he died with his boots on" or "he died planting the Philippine flag". If death took place in a prostitution house, the children's comment is "Daddy died in the arms of a scarlet woman".

b. Death may be due to the defensive act of the woman-victim: In cases of rape, the victim may be able to take hold of a

sharp instrument and inflict injuries to the offender which may cause his death.

2. Death of the Female Partner:

Women almost never suffer death from natural causes during the normal sexual act. The reason may be that they are less susceptible to cardio-vascular disease and that they play a passive role in sexual intercourse. Women can control their tendencies to over-excitement and they exert less physical effort in a sexual act than men do.

Death of the female partner is usually accidental and not on account of a natural disease:

a. The sexual intercourse might be done in a relatively confined space like the back seat of a car. Accidental strangulation or suffocation of the female partner may be due to the undue pressure applied on the chest, neck or face. The struggle of the female partner may remain unnoticed on account of the height of sexual excitement, and this may cause her death.

b. In case of oral sex (fellatio) wherein the male penis is placed in the mouth of the female partner, the size and length of the penis may cause partial or total block of the air passage, causing asphyxia. Ejaculation of seminal fluid may oclude the lumen of the respiratory tract as in drowning.

c. In case of cunnillingus (a perverted sexual act wherein the male licks the female genital organ), the male partner may blow air in the vulva and may cause air embolism especially when the woman is pregnant. The air may enter the blood circulation and causes immediate death.

d. Saddists who may not be sexually satisfied by sexual intercourse but by inflicting physical injuries to the partner may cause death of the female partner.

498 LEGAL MEDICINE

e. Death of the female partner may be deliberately done by the male to conceal the crime of rape he has committed. The male partner may inflict physical injuries, or may cause asphyxiation by strangulation or by other means.

f. The female partner may die of shock as a result of extreme physical and mental trauma in case of rape.

g. Hemorrhage.

h. Infection.

3. Death of Both Partners:

a. Almost simultaneous death of both partners during sexual intercourse may be due to the performance of the sexual act in an enclosed place with carbon monoxide or other asphyxiant gas. Examination of their respective blood will reveal the presence of the gas incompatible with life.

b. Homicide— suicide pact.

^SEX CRIMES

Criminological Characteristics:

1. It is one of the ancient and universal crimes. It existed since the dawn of history. Although considered a crime by almost all countries of the world, society's reaction to its repression depends on the moral value and its gravity as a social problem.

2. There is a close physical contact between the offender and the victim. Murder and homicide may be committed with the offender at a distance from the victim. Estafa and many other crimes may be committed even without the physical presence of the victim.

3. As a general rule, it is a crime committed by one sex against the opposite sex.

4. Sex is an inborn instinct. Any person without sex desire is considered abnormal. Satisfaction of the sexual instinct must be, in a way, acceptable by the moral standard. What is punishable is the anti-social means of attaining sexual gratification.

In other crimes, no man is normally born with such criminal instinct. Murderers, defrauders, and other violators of the criminal law are not inborn characters of individuals.

5. Except probably the crime of rape and forcible abduction, most of the sex crimes do not belong to the so called conventional crimes. Considering other sex acts as crime depends on the moral value existing in a society. Seduction and consented abduction are considered as crimes in the Philippines but not in other countries.

SEX CRIMES 499

6. Many sex crimes are committed but not reported; if reported not investigated; if investigated, not prosecuted. This is on account of the fact that undue publicity may be prejudicial to the reputation of the victim.

7. It is a crime committed in strict privacy. If committed in public the offender must be a mental deviate. Reliance must therefore be made by the investigating officer or court on the testimony of the victim corroborated by the medical findings.

8. Although it is more frequent among the lower socio-economic class those who belong to the middle and upper classes are not immune in the commission of the crime.

9. Unlike other crimes, pardon, forgiveness or marriage between the offender and the victim will extinguish the criminal liability of the offender.

10. There is a seasonal variation in the frequency of commission. It is not the season that causes the variation but the social forces that may be present in a specific season. The month of May, for example, has more cases of sex offenses because Mayflower festivals, fiestas, picnics, excursions, etc. are frequent during this month.

11. The severity of punishment does not deter its commission. Its frequency has not been appreciably reduced by Martial law.

12. Its occasional consequence (pregnancy) becomes a legal problem, e.g. support, abortion, legitimacy, unwanted child, inability to find a means of livelihood, etc.

13. If the offender is of past middle age, usually the victims are children. The primary reason is that old men will be ignored by elderly women so they focus their attention on children who can easily be enticed by candies or other things of value.

14. The psychic trauma suffered by the victims of sex crimes varies with the moral standard of the victim. Women of the "Maria Clara" type with morality of the Puritan Standard, may inflict fatal or serious injuries on the offender. Some may develop a feeling of worthlessness and as a consequence, may lead to self-destruction, while others may be mentally deranged. Others may have a strong belief in the machinery of justice and file the complaint, but a great number of those who seek justice later become amenable to an amicable settlement.

i

Other victims suffer from fear of unfavorable consequence, like pregnancy, social degradation and maltreatment by parents and other relatives.

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When and How Rape is Committed — Penalties: Art. 335, Revised Penal Code:

Rape is committed by having carnal knowledge of a woman under any of the following circumstances:

1. By using force or intimidation;

2. When the woman is deprived of reason or otherwise unconscious; and

3. When the woman is under twelve years of age, even though neither of the circumstances mentioned in the two next preceding paragraphs shall be present :

The crime of rape shall be punished by reclusion perpetua.

Whenever the crime of rape is committed with the use of a deadly weapon or by two or more persons, the penalty shall be reclusion perpetua to death.

When by reason or on the occasion of rape, the victim becomes insane, the penalty shall be death.

When the rape is attempted or frustrated and homicide is committed by reason or on the occasion thereof, the penalty shall be likewise death.

When by reason or on the occasion of the rape, a homicide is committed, the penalty shall be death (As amended by Rep. Act 2632 and Rep. Act. 4111).

Elements of the crime:

a. The offender had carnal knowledge of the woman. The victim of the crime must always be a woman while the offender must inferentially be a man because sexual act must be done by a man and a woman.

b. The carnal relation must be made under any of the following circumstances:

(1) Use of force or intimidation;

(2) The woman is deprived of her reason or otherwise made unconscious; or

(3) The woman-victim is less than 12 years of age.

Meaning of Carnal Knowledge:

Carnal knowledge is the act of a man in having sexual bodily connection with a woman. There is carnal knowledge if there is the slightest penetration in the sexual organ of the female by the sexual organ of the male. It is not necessary that the vagina be entered or

SEX CRIMES 501

that the hymen be ruptured (Black's Law Dictionary by Henry C. Black, 4th ed., p. 268).

For the consummation of the crime of rape, it is not necessary that there is rupture of the hymen. It is enough that the labia of the female organ was penetrated (People v. Oscar, 48 Phil. 527).

Slightest penetration is enough, proof of emission is not necessary. The absence of spermatozoa in the vagina does not negate the commission of the crime of rape (People v. Canastre, 82 Phil. 480).

Character of the Offended Party:

The fact that the offended party may have been unchaste before alleged sexual act was consummated with force and intimidation constitute no defense. The person is guilty of rape if force and violence were used regardless of the good or bad morals of the offended party (People v. Blance, 45 Phil. 13).

Evidences of Force or Intimidation:

The mere initial reluctance of the offended party or verbal refusal alone will not prove force. It must be a manifested and tenacious resistance that is required by law (People v. Lago, C.A. 45 O.G. 1356).

When force is an element in the crime of rape, it need not be irresistible. As long as it brings about the desired result, all consideration whether it is more or less irresistible are beside the point.

When the offeflftied girl stated that she defended herself against the accused as long as she could, but he overpowered her and held her till her strength yielded, then accomplished his desire, there is evidence of sufficient force (People v. Mono, 56 Phil. 86).

The offended woman shouted, struggled and kicked the accused but the offender pressed a hunting knife on her throat, overcame her resistance and succeeded in having sexual intercourse with her. Rape was committed (People v. Lago, C.A. 45 O.G. 1356).

If the offender is the father of the girl who is of a tender age, it is not necessary that there are signs that she put up a determined resistance (People v. Alinea, C.A. 45 G. 140).

The employment of force is established not only by the testimony of the injured girl but also by the signs of finger grips on the front part of her neck, on the arms and the fact that the garments worn at the time were torn and heavily stained with blood (People v. Lucero, 61 Phil. 361).

A strong evidence of force is the presence of physical injuries found on the person of the victim in the course of medical examination. Contusions may be found on the face, arms and thighs.

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When a woman has been forcibly made to lie down, she will utilize her elbow as the fulcrum so that abrasions will be observed on both elbows. In the attempt of the victim to stand, she will flex her neck forward. The offender will then push her head backwards, causing hematoma at the region of the occiput. To prevent penetration of the male organ she will try to flex her thighs and knees. The offender will give a strong blow to the inner aspects of both thighs so that the victim will be compelled to straightened them.

The victim may suffer all types of physical injuries depending upon the resistance offered by her and the degree of force applied by the offender.

Rape Committed by Employment of Intimidation:

The application of threat will cause fear in the victim of the untoward consequence. If she will not accede to the will of the offender, the crime may constitute intimidation.

Inasmuch as intimidation is purely subjective it cannot be proven by medical evidence.

Rape Committed by Depriving the Victim of Her Reason or Other

wise Made Unconscious:

1. Deprival of Reason:

a. Rape committed on insane or mentally deficient woman:

The fact that the victim is a woman, 14 years of age, feebleminded and can only speak mono-syllables is sufficient to constitute the act committed to be rape (People v. Doing, C.A. 49 O.G. 2331).

Sexual intercourse with an insane woman is considered rape (People v. Layson, C.A. 37 O.G. 318).

But, sexual intercourse with a deaf-mute woman is not rape, in the absence of proof that she is an imbecile (People v. Nava, C.A. 40 O.G. 4237).

The proof of the mental condition of the victim is the medical findings of the physician who must certify whether the woman-victim of rape is suffering from insanity or mental deficiency which is sufficient to deprive her of her reason.

b. Rape committed while the woman is under the influence of alcohol or other depressant drugs:

Inasmuch as the woman is not in possession of her rational mental faculties, in the absence of a decided case, this may also be rape.

c. Sexual act on a woman under the influence of sex stimulating drugs:

SEX CRIMES 503

In the case of U.S. v. Lung (28 p. 235, 37 A.M. St. Rep. 505), cited by Reyes, where the consent of the woman was induced by the administration of drugs which incited her passion and the drug dose did not deprive her of her reason, the accused was not guilty of rape. But if this case should happen in the Philippines and would be decided by our local court, I think it would be a rape case because the stimulating drug actually deprived her of her reason.

2. The woman-victim is unconscious:

a. Sexual act committed while the woman is on her natural sleep:

The woman while asleep felt the weight of a man in carnal relation with her. Believing that he was her husband, she called him by his name but received no answer. She again called him and found out that the voice was different from that of her husband. She then pushed him and then ran after him. The offended party was a deep sleeper in the first hour of the night and it was not impossible for the accused to insert his organ into her genitalia before she awoke. The crime of rape was committed (People v. Gorcino, 53 Phil. 234).

b. Sexual act on a woman suffering from sleeping sickness is also rape because the woman is unconscious.

c. Sexual act on a woman who is unconscious because she was knocked-out:.

If the offender inflicted physical injuries on a woman sufficient to make her unconscious before the sexual act was done, it is rape.

On seeing a lavishing figure of a woman taking a bath, the accused hit her and after she became unconscious, he had sexual intercourse with her. The accused was found guilty of rape (People v. Sanico, C.A. 46 O.G. 98).

d. Sexual act after administration of narcotics or other "knockout" drugs:

The sexual act made on a woman while she is under the influence of narcotics or other depressant drugs is rape because the woman is unconscious.

3. When the woman is under 12 years of age: If the carnal relation is made on a female below 12 years of

age, it is always rape regardless of whether or not force or intimidation is applied or the child is.not deprived of her reasons or otherwise unconscious. Rape of a woman below 12 years old is also called statutory rape. The sexual act is still rape even if the child consented or even if the child is a prostitute.

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The reason for penalizing carnal relation is that one must not take advantage of the meager intelligence and incomplete physical development of a child below the age of 12.

When the offended party is a girl less than 12 years old, rape is committed although she consented to the sexual act (People v. Villamora C.A. 37 O.G. 497). It is also rape even if the girl less than 12 years of age is a prostitute (People v. Perez, C.A. O.G. 6337).

Multiple rapes committed by each accused was independent of the others, because the essence of the crime of rape consists of carrying out carnal act of the offender with a woman against her will and each carnal access consummated is a complete attack on the honor, person and liberty of the offended woman (People v. Bernardo, 38 O.G. 3479).

The victim and the accused must immediately be examined by the physician to have a strong medical evidence of rape, but the lack of medical examination of the victim is not an indispensible element in the prosecution of the crime of rape. Whether or not it will prosper will depend upon the evidences offered. As long as the evidences convince the court, a conviction of the crime of rape is proper (People v. Suarez, C.A. 40 O.G. 28).

When the defendant has sexual intercourse twice in succession with the complainant, no evidence having been presented that

Perineal laceration on a sexually abused child

SEX CRIMES SOS

there was any resistance on her part or that the defendant had used force, violence and intimidation, the defendant was acquitted (U.S. v. DeDios, 8 Phil. 279).

The defendant attempted to commit the crime of rape in an open field on a woman whom he has courted for 2 years and in the presence of other persons. The offended party allowed the defendant to visit her after the attack. The defendant was acquitted (U.S. v. Estacio, 18 Phil. 432).

A complaint in the prosecution of rape is not valid unless it is a complaint of the offended party. The complaint signed and sworn to by the chief of police is not valid in the prosecution for rape (People v. Manaba, 58 Phil. 665). An information not signed by the offended party is insufficient to confer jurisdiction on the court to hear and determine a charge of attempted rape (People v. Trinidad, 59 Phil. 163). The filing of the complaint by the father of the offended party who is a girl only fourteen years of age which alleges the commission of the offense is a sufficient compliance of the Revised Penal Code to confer jurisdiction for trial of the offense charged (People v. Imas, 65 Phil. 419).

i

Instances When Rape is Punishable by Death: 1. When by reason or on the occasion of the rape, the victim be

comes insane; 2. When the rape is attempted or frustrated and a homicide is com

mitted by reason or on the occasion thereof; and 3. When by reason or on the occasion of the rape, a homicide is

committed. Death of a woman from peritonitis as a result of having been

infected with a venereal disease by a man having sexual intercourse with her against her will, will constitute the complex crime with homicide (People v. Acosta, 60 Phil. 158).

Medical Evidences in Rape:

1. Evidences from the victim: Before actual examination is made on the subject, it is necessary

to have a written consent from the subject herself or from her guardian if the victim is not of age. If the woman is confined in a correctional institution the consent may be given by the head of the institution.

A short history of the alleged rape must be taken and it is advisable to reduce it in writing. The history must include all the circumstances leading to the abuse, the age of the victim at the time of the alleged commission of the offense and also the men-

506 LEGAL MEDICINE

strual history. It may be used as a guide to the examining physician as to the different points that must be emphasized in the course of the examination. Aside from the history, the following points must also be recorded by the physician.

a. Date, time and place of alleged commission of rape:

This is necessary in order to determine how long a time has elapsed after alleged commission of the offense before the victim filed the necessary complaint or subjected herself to the medical examination. If several days have gone by before the filing of the complaint, let her explain the cause of the delay.

The place where the alleged offense was committed is necessary to determine which court can acquire jurisdiction over the case.

b. Date, time and place of the examination:

The date of the examination is material to the determination of the possible findings of the physician on the victim. A long interval of time between tha date of commission and the examination will remove the possibility of finding the effects of a recent sexual intercourse.

c. Condition of the clothings:

If force is applied in the commission of the offense, there will be tearing, staining with blood and semen, and soiling of the clothings. The clothings must be preserved after they have been thoroughly dried for further laboratory examination.

d. The physician must observe the gait, the facial expression and the bodily and mental attitude of the subject. If the victim suffered from genital injuries she may walk with legs apart and slowly, with the face manifesting signs that she is suffering from pain.

e. Physical and mental development of the victim:

The height, strength and degree of muscular development of the woman must be noted to determine whether she has the capacity to resist any unlawful aggression. If the victim is a child, examination of the physical condition is usually not necessary because it is apparent to the age. In most cases, children are "bribed" or lured by attractive articles such as candies by the offender.

The examiner must observe the mental state of the victim. She may be in the state of mental shock, under the influence of depressant drugs, alcohol or sex stimulants. The offender might have taken advantage of her insanity or mental deficiency.

SEX CRIMES 507

The victim may appear exhausted, despondent on account of the public humiliation she will suffer, or may be hostile to the investigator. Care and more psychologic approach is necessary in order to get her full cooperation and consent.

f. Examination of the body for signs of violence:

If actual force was applied in the commission of the crime, there must be signs of physical violence on the body of the victim. Her whole body must be subjected to inspection. Physical injuries must be described and the exact location must be determined. Areas of tenderness or swelling must not be overlooked and if necessary X-ray pictures must be taken to determine bone lesions.

Determination of the probable age of the physical injuries found is material. Does it correspond to the alleged date of commission? .

g. Examination of the genitalia, including the breast:

The breasts must be examined for the presence of finger marks or application of pressure. They might have been roughly handled or the nipples bitten.

The vulva may show swelling, tenderness, contusion, abrasion, laceration or may be smeared with blood, semen and other foreign bodies.

The hymen may show fresh laceration, swelling or bruising. There may be healed lacerations or signs of physical virginity.

In the pubic hair, the following medical evidence may be gathered:

(1) Pubic hair of the offender. (2) Semen and spermatozoa. (3) Blood stains. (4) Body louse.

Abrasion which is normally found in the posterior commissure is usually brought about by friction or a violent attempt of insertion. The vaginal canal may show obliteration of the rugosities or even purulent discharge.

2. Examination of the alleged offender:

a. Physical development, mental condition and strength:

The relative physical development and strength of the victim and the offender must be compared to determine whether the offender can overpower the resistance offered by the victim.

b. Evidence of physical injuries: The whole body must be examined. The victim, in the

course of the struggle, may inflict bodily harm to the offender.

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Fingernail marks on the neck, arms and chest may be found. The frenum of the penis may be abraded or lacerated on account of the violent insertion on a relatively small vulvar or vaginal opening.

c. Condition of the sex organ:

Aside from the examination of the frenum, washing from the surface of the penis may reveal blood, seminal stain, vaginal epithelium and doderleins bacillus. The urethral meatus may be moist on account of the recent discharge.

d. Evidence from the pubic hair:

The pubic hair may be matted together due to blood stains or from seminal fluid discharge. Examine carefully for the presence of body louse.

e. Potency of the offender:

The offender may put up a defense that he is impotent and that it could have been hardly possible that he had committed the crime. It may be necessary to subject the offender to a strong sex stimulus sufficiently under normal condition to produce erection.

f. Evidence of genital infection — If the offender is suffering from venereal disease which is transmitted to the victim during the criminal act, the crime committed is rape with physical injuries because infection in law is a physical injury.

3. Evidences from the companion of the victim:

a. A history of the incident must be taken from the companion of the victim. Try to see whether they are consistent with the narration of facts by the victim.

b. If the companion helped the victim when force was applied by the offender, the companion must be subjected to a physical and medical examination for physical injuries.

c. Examination of the clothings may be necessary for signs of struggle.

d. Investigation must be made to determine whether the companion might have participated as an accomplice to the crime.

e. The mental condition, physical power, age and emotional state must be taken into consideration to determine the capacity to resist unlawful aggression from the offender.

f. Examination must be made as to the presence of alcohol or other depressants which may diminish the companion's capacity to defend the victim from the offender.

SEX CRIMES 509

Investigation of the Crime Scene:

1. Disturbances in the place of commission may infer or affirm the statement of the victim that she did offer resistance.

2. Strands of hair, blood, seminal and other stains may be recovered to prove consummation and struggle.

3. Pieces of personal belongings of the offender and /or victim may be recovered to prove identity and physical struggle.

4. Investigation of witnesses who may possibly be material to the prosecution of the case may be conducted.

E X A M I N A T I O N F O R S E M I N A L F L U I D A N D S P E R M A T O Z O A

The semen is the viscid, albuminous fluid with faint grayish-yellow color, having the characteristic fishy odor, and containing spermatozoa, epithelial cells, lecithin bodies and other substances.

Spermatozoon is a living organism, normally present in the seminal fluid consisting of a head, neck and tail. It is from 50 to 55 microns in length. The head is ovoid and flattened when viewed in front and pearshape when viewed on the profile. The head is about 5 microns in length while the neck is very short. The tail is the longest part of the spermatozoon and consists of a long slender filament with tapering end. The ciliary movement of the tail is responsible for the forward movement of the spermatozoon.

There are 2.5 to 5.0 cubic centimeters of semen per ejaculation. The semen contains 60 million spermatozoa per cubic centimeter, 80% of which are motile after 45 minutes. After 3 hours not more than 20% become abnormal in forms.

The following specimens may be examined for seminal fluid and spermatozoa:

1. Wearing apparel of the victim and of the alleged accused.

2. Vaginal smear from the victim.

3. Stains on the body of the victim and of the accused.

4. Stains found at the site of the commission of the offense.

PROCEDURE:

1. Gross Examinations: a. Inspection by means of the naked eye or with the use of the

hand lens: The stain is grayish-white to faint yellow in color. In fabrics,

the area occupied is slightly depressed. It usually has a maplike contour with silvery appearance of the surface. It is hardened with shiny borders.

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b. Inspection by means of Ultraviolet light:

This method is resorted to in order to make visible, small seminal stains or patches. Determine the side of the clothings where the stains are located. Under ultraviolet radiation, the seminal discharge shows bluish fluorescence.

2. Micro-Chemical Examinations:

Moisten a portion of the stained fabric with very diluted hydrochloric acid solution (one drop in 50 cc. of water) and let the soaking stay for 1/2 to 5 hours depending upon the age of the stain. Allow the liquid portion to dry on the slide. Perform any of the following:

a. Florence Test:

Place a cover slip over the dried stain on the slide glass.

Allow a drop of Florence solution to run under the slip.

Place the preparation under the microscope and if semen is present, a group of crystals appears similar in color and in shape as the hemin, but larger in size. The crystals are dark brown, in clusters, rosettes, crossing over the microscopic field.

Composition of the Florence Solution:

Potassium iodide 1.65 gms. Iodine 2.54 gms. Distilled water 30.00 cc.

Value of the Test:

This test is produced by the action of iodine on choline, a natural base found in many cells. It is not a specific test for spermatic fluid. The test is not a proof of seminal fluid but only of the presence of some vegetable or animal substance. A positive result is merely a presumptive evidence of seminal fluid; a negative result means, in all probability, it is not that of the seminal fluid.

b. Berberio's Test:

To the spermatic stain on the slide glass, a saturated solution (alcoholic or aqueous) of picric acid is added.

The preparation is placed under the microscope and needle-shape crystals with yellow color is produced.

Some allege that this test is specific for spermatic fluid.

The reaction probably depends-on the presence of spermatic secretion.

c. Puramen Reaction:

This is based on the presence of spermine in the prostatic fluid. A small part of the stain is extracted with a few drops

SEX CRIMES 511

of saline and put into a micro tube and to the extract is added a few drops of Puramen's reagent (5% solution of 2.4 dinitro l-naphthol-7-sulfonic acid, flavianic acid). The tube is then placed in a refrigerator for a few hours. In a positive reaction, a yellow precipitate of spermine flavianate can be seen at the bottom of the tube. When examined microscopically, the precipitate is found to consist of small cross-like crystals of a characteristic shape. Puramen reaction is found to be very reliable and rather characteristic of seminal fluid (Modern Criminal Investigation by Soderman, p. 250).

d. Acid Phosphatase test:

The semen produces a very high acid phosphatase activity as compared with other body fluids (saliva, perspiration, urine, etc.) and common vegetable and fruit juice stains. The method of estimating the activity of a stain on clothings or other materials is to extract with distilled water and perform the acid phosphatase determination on the filtered extract.

The following solutions are necessary in the performance of the test:

(1) Citrate buffer solution — pH 4.9 to 5.2:

Citric acid monohydrate 18.9 g. dissolve in 500 ml. distilled water.

Sodium hydroxide 1 N 180 ml.

Hydrochloric acid 0.1 100 ml.

The pH adjusted sodium hydroxide and hydrochloric acid to 4.9 to 5.2. A liter is prepared and stored in a refrigerator. The solution is stable for six months.

(2) A suitable substrate: A saturated solution of sodium alpha-naphthanil phosphate.

(3) A diazonium salt (Naphthanil Diazo Blue B)

Reaction: If acid phosphatase is present, the substrate is hydrolized to produce alpha-naphthol, which is coupled with a diazonium salt to produce a highly colored dye. In the absence of the enzyme, the reaction does not appear.

Procedure: There are three glass slides placed side by side on top of a white paper. Slide one (1) is the negative control with filter paper. Slide two (2) is the positive control with filtered paper impregnated with seminal stain. Slide three (3) is with the suspected material.

512 LEGAL MEDICINE

To each is added a drop of buffer solution followed by a drop of the substrate solution and finally a drop of the diazonium salt in solution.

Result — The negative control 1 will remain yellow;

Slide two with known seminal stain will turn deep purple immediately;

Slide three will also become deep purple if semen is present but will have no change in color if semen is absent. The test is conclusive of the presence of semen.

3. Microscopic Examinations:

a. A dried spermatic fluid stain on the slide is stained with hematoxylin or methylene blue and counter-stained with eosin. Examined under the microscope, under high power and under oil immersion, spermatozoa and bacterial infection can be seen. The presence of a complete spermatozoon will undoubtedly infer the presence of seminal fluid, although semen may be present without spermatozoa, such as in cases of aspermia (semen without spermatozoa) or oligospermia (semen with few spermatozoa).

b. Dr. Hankin's Method:

The fabric with seminal stain is boiled with tannin solution before dissolving in a solution of potassium cyanide so as to render the spermatozoa capable of removal. The fabric is then placed on a slide, teased with carbol-fuchsin. This is examined with a medium power lens.

c. GangulCs Method:

The same procedure as that of Dr. Hankin but the staining is with erythrocin and malachite green. This is claimed to be the best way to stain spermatozoa in India.

4. Biological Examinations:

a. Precipitin Test (Biological test of Farnum):

This is a test to determine whether the semen is of human origin or not. A rabbit is immunized with human semen for four to six weeks. After a time the blood is drawn and the blood serum is taken and its potency made at different dilutions.

This is used for the test of unknown semen in the same way as blood precipitin is done.

The presence of a white ring at the point of contact between unknown semen extract and the anti-human semen serum shows that the unknown is of human origin.

SEX CRIMES 513

b. Seminal Grouping:

Specific agglutinable substances A and B are present in the semen, like that of the blood. Seminal grouping is similar to that of the blood. The test is of value for elimination. A positive result does not definitely imply that the person is the owner of the semen in question. A negative result will totally exclude the alleged accuse as the possible owner of the semen.

The mere presence of speunatozoa on the stain shows the presence of spermatic fluid, but the absence of spermatozoa does not prove that the stain is not seminal. The semen may be present without spermatozoa.

The presence of one complete, unbroken spermatozoon is sufficient to make the conclusion that the stain or fluid is seminal.

It is quite necessary also to examine for infectious disease in connection with the laboratory examination for semen and spermatozoa.

How long after sexual intercourse can spermatozoa be found in the vaginal canal?

Authorities differ in their opinions in this respect:

1. ". . . but, there is every reason to believe that the life of the effective sperm in the maternal passage is very short, probably less than thirty hours" (Taylor's Principles and Practice of Medical Jurisprudence by K. Simpson, 12th ed.. Vol 2, p. 32).

2. "There has been a great number of observations this latter point, and the evidence points to a comparatively short life of the sperm in the female tract and the period appears shorter with the number of observations. It is a present belief that the life of the sperm in the vagina is a matter of hours and its total life in the female tract is a matter of two or three days at most" (Forensic Medicine by S. Smith, 10th ed., p. 311).

3. ". . . that spermatozoa may survive less than two hours in the vagina, but tfiey live as long as forty-three hours both in the cervix and uterus where the secretion are more favorable" (Medical Jurisprudence & Toxicology by J. Glaister, 12th ed., p. 325).

4. "Spermatozoa may remain motile in the vagina up to 17 days" (A Synopsis of Forensic Medicine & Toxicology by C. Thomas, 2nd ed., p. 97).

5. "Fertilization of the ovum does not necessarily occur immediately after coitus, as it is known that spermatozoa can remain alive in

514 LEGAL MEDICINE

the upper recesses of the vagina for more than two weeks" (Coy\ p. 246).

6. "Some observers have reported finding spermatozoa in the vagina after seven hours while others have reported finding them as long as 48 hours after intercourse" (Homicide Investigation by L. Snyder, 1st ed., p. 327).

Can a woman be raped while she is on her natural sleep?

Occasionally, it may happen, but highly improbable. To a normal virgin it is hard to conceive that such act could ever be committed without her knowledge, inasmuch as she has never experienced it. But, such act may be possible to a woman who has had several sexual intercourses and to those who have given birth.

Can a woman commit the crime of rape on a man?

In the definition of the crime of rape, it is "committed by having carnal knowledge of a woman." The law specifically states that it can only be committed on a woirian and not on a man (inclusio unius et exclusion alterios). She committed acts of lasciviousness.

Can rape cause death?

Although it may not be usual, the introduction of a matured male sex organ into the vagina of a young girl may produce local injury sufficient to produce death. The death may be due to hemorrhage brought about by the laceration of the vaginal canal, shock, subsequent infection such as gangrene or peritonitis.

Laceration of the vagina with accompanying hemorrhage can also occur even in adult women if the man's sex organ is exceptionally big, especially when the sexual act was done roughly.

Can the husband commits the crime of rape on his wife?

The husband cannot be guilty of rape committed on his wife. Marriage is a license of the husband to have sexual intercourse with his wife. The purpose of marriage is procreation and there can be no procreation if there is no sexual intercourse.

However, if there is a decree of legal separation by the court, the husband may be guilty of rape on his wife. Legal separation does not dissolve the matrimonial tie between the husband and wife, but merely separation in bed.

The husband may be guilty also of rape on his wife if he is a principal by cooperation or by inducement for the act committed by another man.

SEX CRIMES SIS

O T H E R CRIMES A G A I N S T C H A S T I T Y

A. SEDUCTION

Seduction is the act of a man enticing women to have unlawful intercourse with him by means of persuasion, solicitation, promises, bribes, or other means without employment of force (Van de Velde v. Colle, 8 N.J. Misc. 782, 152 A. 615, 646).

Not all countries recognize seduction as a criminal act but only a ground for civil liability.

There are two kinds of seduction punishable under the Revised Penal Code:

1. Qualified seduction 2. Simple seduction

*• Art. 337, Revised Penal Code — Qualified seduction — The seduction of a virgin over twelve years and under eighteen years of age, committed by any person in public authority, priests, house-servant, domestic, guardian, teacher, or any person who, in any capacity, shall be entrusted with the education or custody of the woman seduced, shall be punished by prision correccional in its minimum and medium periods.

The penalty next higher in degree shall be imposed upon any person who shall seduce his sister or descendant, whether or not she be a virgin or over eighteen years of age.

Under the provisons of this Chapter, seduction is committed when the offender has carnal knowledge of any of the persons and under the circumstances described herein.

/Types of Qualified Seduction:

1. Ordinary Qualified Seduction:

Seduction of a virgin over twelve years and under eighteen years of age, committed by any person in public authority, priest, house-servant, domestic, guardian, teacher or any person who in any capacity, shall be entrusted with the education or custody of the woman seduced.

2. Incestuous Qualified Seduction: This includes seduction wherein there is blood relationship

between the seducer and the seduced. Father seducing daughter or other descendants, or brother seducing sister.

In this type of seduction, the woman seduced need not be a virgin or may be more than eighteen years of age. The penalty

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imposed is one degree higher than that of ordinary qualified seduction.

The reason for the reduction of the requirements and the imposition of a higher penalty is that the father or ascendant and the brother are obliged to lead the descendant or sister to the path of rectitude and morality, but instead virtually persuaded her to become immoral or be a party to the condemn-able act.

Elements of ordinary qualified seduction:

a. The offended party must be a virgin;

b. The offended party must be over twelve but under eighteen years of age;

c. There must be sexual intercourse between the offender and the offended party; and

d. The sexual act was done through abuse of authority or confidence.

(1) Those who acted with abuse of authority:

(a) Person in public authority ( b ) Guardian (c) Teacher (d) Person who in any capacity is entrusted with the

education or custody of the woman seduced.

(2) Those who seduced through abuse of confidence:

(a) Priest (b ) House-servant (c) Domestics

Elements of incestuous qualified seduction:

a. Sexual act between the offender and offended party; and

b. Blood relation between the offender and offended party.

(1) Brother who seduces his sister, or (2) Ascendant who seduces his descendant.

A public school teacher who is in charge of education had sexual intercourse with a student, is guilty of qualified seduction (People v. Cariaso, 50 Phil. 884). The accused need not be the teacher of the woman seduced. Suffice it is if the accused is a teacher in the same school who has moral influence over the student (Santos u. People, 40 O.G. supp. 6, 23).

The offended party went to the catholic church to confess. The accused priest embraced and kissed her and in spite of her resistance she was brought to the store-

SEX CRIMES 517

room of the convent where he was able to have sexual intercourse with her. The acts of the priest were proven in the trial court to constitute the crime of qualified seduction (U.S. v. Santiago, 41 Phil. 1 793).

Sexual intercourse with the cousin of the wife who is living in the house and a virgin, under 18 but over 12 is guilty of qualified seduction because he took advantage of his authority and there is abuse of confidence (People v. Lauchengco, C.A. 45 O.G. 3845).

Art, 338, Revised Penal Code — Simple seduction — The seduction of a woman who is single or a widow of good reputation, over twelve but under eighteen years of age, committed by means of deceit, shall be punished by arresto mayor.


1. The offended party is over twelve but less than eighteen years

2. The offended party must be single or a widow of good repu-

3. There must be sexual intercourse done by the offender with her; and

4. The sexual act was committed by means of deceit.

The statute making simple seduction a crime is not to punish illicit intercourse, but to punish the seducer who by means of his promise of marriage, destroyed the chastity of an unmarried female of previous chaste character, and who thus draws her aside from the path of virtue and rectitude, and then fails or refuses to fulfill his promise, a character so despicable in the eye of every decent honorable man (People v. Iman, 62 Phil. 92).

Deceit is a fraudulent and cheating misrepresentation, artifice, or device, used by one or more persons to deceive and trick another, who is ignorant of the true facts, to the prejudice and damage of the party imposed upon (French v. Vining, 102 Mass. 132, 3 Am Rep. 440). Deceit may be:

a. Suggestion, as a fact, of that which is not true, by one who does not believe it to be true;

b. The assertion, as a fact, of that which is not true, by one who has no reasonable ground for believing it to be true;

c. The suppression of a fact, by one who is bound to disclose it, or who gives information of other facts which are likely to mislead for want of communication of that fact; or

B. •E S E D U C T I O N :

of age;

tation;

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d. A promise made without any intention of fulfillment. , The most common form of deceit is the promise of marriage, but if the seducer is known to the victim to be married, even if the previous promise of marriage cause her to accede to the sexual act, the crime of simple seduction is not committed.

Virginity is not an element of simple seduction. It is sufficient that the victim is a single or a widow of good reputation.

Medical Evidences in the Crime of Seduction:

Medico-legal investigation of a victim of seduction is practically the same as in the case of rape insofar as proof of sexual intercourse is concerned. However, medical proofs on account of the application of force, and conditions that will cause the victim to be deprived of her reason or otherwise unconscious are no longer relevant.

Sometimes, the issue of the age of the victim becomes a problem and its determination through medical proofs may be necessary. The woman may claim to be less than 18 years old although she is more than that at the time of the alleged commission of the offense.

If the alleged criminal act developed into pregnancy and birth of the child, the question of paternity may be necessary.

Acts of lasciviousness are acts which tend to excite lust; conduct which is wanton, lewd, voluptuous or lewd emotion (Black's Law Dictionary).

Acts Considered Lascivious:

1. Embracing, kissing and holding the woman's breast (People v.

Collado, 60 Phil. 610).

2. Placing of the man's private organ over a girl's genital organ (People v. Domondon, C.A. 364 O.G. 1977).

There are two articles in the Revised Penal Code penalizing acts of lasciviousness, namely:

3. Art. 336, Revised Penal Code — Acts of lasciviousness.

4. Art. 339, Revised Penal Code — Acts of lasciviousness with the consent of the offended party.

A. ACTS OF L A S C I V I O U S N E S S :

Art. 336, Revised Penal Code — Acts of lasciviousness — Any person who shall commit any act of lasciviousness upon other persons of either sex, under any of the circumstances mentioned

CTS OF LASCIVIOUSNESS

SEX CRIMES 519

in the preceding article (rape), shall be punished by prision correccional.


1. The offender commits any act of lasciviousness;

2. The lascivious act is done under any of the following circumstances

a. By using force or intimidation. b. By depriving her of her reasons or otherwise unconscious. c. When the woman is under 12 years of age.

3. The offended party must be a person of either sex.

The victim owed the defendant one peso. The defendant sent policemen to her house and arrested her. The victim was brought to the house of the accused and after beating her with a stick, the defendant compelled her to take off her clothes and dance before the defendant and many other persons. Such acts constitute the crime of acts of lasciviousness (U.S. v. Bailoses, 2 Phil. 49).

Acts of lasciviousness had been committed by the defendant who held the offended party by the waist, touched her breast, hugged her with the intention of kissing her, and touched her private part against her will (People v. Famularcano, C.A. 43 O.G. 1721).

The accused went to the house of the woman and found her to be alone. The accused gained admission to the house under the pretext of asking for a drink of water, and while inside the house, he embraced her against her will. The defendant threatened to kill her if she refused to submit to his desire. The acts constitute the crime of acts of lasciviousness (People v. Collado, 60 Phil. 610).

B. ACTS OF LASCIVIOUSNESS W I T H THE CONSENT OF THE O F F E N D E D P A R T Y :

Art. 339, Revised Penal Code — Acts of lasciviousness with the consent of the offended party — The penalty of arresto mayor shall be imposed to punish any other acts of lasciviousness committed by the same persons and under the same circumstances as those provided in article 337 (qualified seduction) and 338 (simple seduction).

Elements of the Crime: 1. The offender commits acts of lasciviousness; 2. The offended woman must be over 12 but under 18 years of

520 LEGAL MEDICINE

age, except when the Victim is the sister or descendant of the offender;

3. The offender commits the act by abuse of authority, confidence, relationship or deceit;

4. The victim must be a woman, virgin, single, or widow of good reputation, except when she is the sister or descendant of the offender where virginity is not required.

A man who embraced and kissed his girlfriend (lover) is not guilty of the crime of acts of lasciviousness with the consent of the offended party because consent was not obtained through abuse of confidence, authority, relationship, or by means of deceit.

Medical Evidences in the Crime of Acts of Lasciviousness:

Like in the crimes of rape and seduction, medico-legal investigation is involved in proving the lascivious act itself and the other elements to constitute the crime. Physical injuries may be suffered by the victim on the part of the body where the lascivious act was committed by insertion of his finger into the private part of the victim or through the application of bodily force with the consequent production of physical injuries.

Abduction is the carrying away of a woman by an abductor with lewd design.

Lewd design is the intent of the abductor to have sexual intercourse with the woman abducted. This can be inferred from the acts of the offender.

There are two types of abduction punishable under the Revised Penal code:

1. Forcible abduction (Art. 342) 2. Consented abduction (Art. 343)

A. Forcible Abduction:

Art. 342, Revised Penal Code — Forcible abduction — The abduction of any woman against her will and with lewd designs shall be punished by reclusion temporal.

The same penalty shall be imposed in every case, if the female abducted is under twelve years of age.


1. The victim abducted is a woman; 2. The abduction is against her will; and

SEX CRIMES 521

3. The abduction is with lewd design.

The civil status, reputation and age of the woman abducted are not the ingredients of the crime, however, in case the woman is under 12 years of age, the crime committed is still forcible abduction even if the woman consented.

If there are several abductors, it is sufficient that one of them had lewd design.

Inference of lewd design may be deduced when the offender kissed and embraced the offended party, took the victim farther to an uninhabited place to perform lascivious acts on her.

In forcible abduction, the act of the offender is violative of the personal liberty of the woman abducted, her honor and reputation, and of public order (U.S. v. de Vivar, 29 Phil. 458).

B. Consented Abduction:

Art. 343, Revised Penal, Code — Consented abduction — The abduction of a virgin over twelve and under eighteen years of age, carried out with her consent and with lewd designs, shall be punished by the penalty of prision correccional in its minimum and medium periods.

Êlements of the Crime:

1. The offended party must be a virgin; 2. The offended party must be over 12 but under 18 years old; 3. The carrying away of the offended party is with her consent;

and 4. The taking away must be with lewd design.

Rationale of the Provision: The purpose of the law is not to punish the wrong done to the

girl, because she consents thereto, but to prescribe punishment for the disgrace to her family and the alarm caused therein by the disappearance of the one who is, by her age and sex, susceptible to cajolery and deceit (U.S. v. Reyes, 20 Phil 510).

^ a . ADULTERY AND CONCUBINAGE

A. Adultery: Art. 333, Revised Penal Code — Who are guilty of adultery —

Adultery is committed by any married woman who shall have sexual intercourse with a man not her husband and by the man who has carnal knowledge of her, knowing her to be married, even if the marriage be subsequently declared void.

522 LEGAL MEDICINE

Adultery 6hall be punished by prision correccional in its medium and maximum periods.

If the person guilty of adultery committed this offense while being abandoned without justification by the offended spouse, the penalty next lower in degree than that provided in the next preceding paragraph shall be imposed.


1. The woman is married;

2. She has had sexual intercourse with a man not her husband; and

3. The man with whom she had sexual intercourse knows her to be married even if the marriage has subsequently been declared void.

Reason for the Provision:

Adultery is made a crime to avoid introduction of foreign blood in the family. Adultery may cause introduction of spurious heirs into the family wherein the right of the real heirs may be impaired (U.S. v. Mata, 18 Phil. 490).

Blood examination of the children born by such adulterous act may be material in the presecution of the crime.

If the married woman and the paramour were caught "in flagrante delicto", medical examination of the woman may be necessary to determine the presence of semen and spermatozoa in the vaginal canal. Biological seminal grouping may be done to prove the identity of the semen found.

B. Concubinage:

Art. 334, Revised Penal Code — Concubinage — Any husband who shall keep a mistress in the conjugal dwelling, or, shall have sexual intercourse, under scandalous circumstances, with a woman who is not his wife, or shall cohabit with her in any other place, shall be punished by prision correccional in its minimum and medium periods.

The concubine shall suffer the penalty of destierro.

Ways of Committing the Crime:

1. Keeping a mistress in the conjugal dwelling; or

2. Having sexual intercourse, under scandalous circumstances, with a woman who is not his wife; or

3. Cohabiting with her in any other place.

A married man committing concubinage violates the marital vow.

SEX CRIMES 523

P R O S T I T U T I O N

Prostitutes are women who, for money or profit, habitually indulge in sexual intercourse or lascivious conduct (Art. 202, No. 5, Revised Penal Code).

Requirements to be satisfied before a woman may be considered a prostitute:

1. She habitually indulges in sexual intercourse or lascivious acts.

A single isolated sexual intercourse or lascivious act for money profit will not make a woman a prostitute. There must be habituality or repeated acts. This makes prosecution for the crime difficult. Medical evidence on this matter is purely presumptive.

A woman may still be considered a prostitute although she does not indulge in the habitual sexual intercourse because habitual indulgence in lascivious acts also makes her a prostitute.

2. When the habitual sexual intercourse or lascivious act is done for money or profit.

Habitual sexual intercourses with several men but not for money or profit will not make a woman a prostitute.

The penalty imposed on a woman who has been proven to be a prostitute is arresto menor or a fine not exceeding 200 pesos, and in case of recidivism, by arresto mayor in its medium period to prision correccional in its minimum period, or a fine ranging from 200 to 2,000 pesos, or both, in the discretion of the court (Art. 202, last par., Revised Penal Code).

Reasons why some women become prostitutes:

1. Physiological and psychological traits — Prostitutes are seldom nymphomaniac, although nymphomaniacs may become prostitutes. Some of them are found to be emotionally unstable, psychopathic, neurotic, suggestible, or addicted to the use of tobacco, alcohol and narcotic drugs. They may be lonely and may lack association with the intimate family circle.

2. Economic factors — They are financially hard up and indulge in the business for fear of starvation. Their earnings are meager and cannot maintain a decent life or cope with the domestic needs.

3. Home and neighborhood — A great number of them comes from broken homes, over-crowded homes with members of both sexes sleeping in the same room, or having a male border or roomer. In some instances the mother is a prostitute, and

524 LEGAL MEDICINE

the father is a pimp and their daughters are allowed to roam in the streets and being initiated in sexual intercourse.

4. Influence of contraceptives — The availability of contraceptives and prophylactic treatment for infection make it possible to indulge in sexual relationship without fear of pregnancy and infection.

(Criminology by Taft and England, p. 266).

Medico-legal Aspects of Prostitution:

1. Prostitution is one of the venues in spreading venereal and other diseases.

2. Evidences may be gathered to prove sexual or lascivious acts.

Types of Prostitutes:

1. Call Girl — Receives telephone calls from the selected group of customers and makes arrangements to meet them at a designated place.

2. Hustler: a. Bar or tavern "pick-up" — Frequent places where liquor is

sold, sometimes with the knowledge of the management, b. Street walker — She finds her customers in various places and

makes the contact herself, but she may walk with taxicab drivers.

3. Door Knocker — A newcomer in the field of prostitution. She frequents small hotels and furnished rooms or roams in the hall room of these places.

4. Factory Girl — She works in regular house of prostitution. She accepts all comers and has nothing to do with the selection and solicitation of customers. She is under the direct supervision of a "madam" or "mama-san" (Criminology by R.G. Caldwell, 2nd ed., p. 125).

Personnel Associated with Prostitution:

1. "Madam" or "Mama-san" — She is the general manager of the prostitution den. She handles cash, meets customers and transacts all business for the house.

2. Procurer — The person is charged with the duty of getting girls to work as prostitutes.

3. Transporter — The man or woman who takes prostitutes from town to another.

4. Pimp or "Bugao" — one who gets customers. He may be a taxicab driver, bartender, or a girl's own husband. He earn's by percentage basis.

SEX CRIMES 525

Types of Prostitution Houses:

1. Disorder House - Employs only 4 to 8 girls in the business This type is gradually disappearing as it is an easy target of organized program against prostitution.

2. Furnished Room House — This is operated by experienced madams. The house has 2 to 3 girls and also rooms for rent to legitimate roomers in order to maintain the appearance of respectability.

3. Call House — It is merely a place where a telephone is maintained by a madam. The customer calls, and the madam sends the girl out to meet him.

Other Reasons for Indulging in Prostitution:

1. Poor social background with personality handicaps. 2. Previous sexual experience in or out of wedlock. 3. Contact with a person in or in the fringe of prostitution. 4. Desire for money or forced by loneliness, desertion or broken

promises.

Effects of Prostitution:

1. Arrest and imprisonment. 2. Venereal infection. 3. Social ostracism. 4. Poor personal hygiene. 5. Excessive use of alcohol. 6. Irregular habit of eating and sleeping. 7. Demoralization and physical deterioration.

Medical Evidence in Prostitution: Genital examination required is the same as in any other sexual

offense.

Can rape be committed on a prostitute? Yes, virginity or chastity of character is not a necessary element

of the crime of rape. However, medical proof of sexual intercourse is not a legal proof of the commission of rape.

The fact that the offended person has been a person of unchaste character constitutes no defense to the charge of rape, provided that it is proven that the illicit relations complained of were committed with violence or force. The defendant in a criminal action for rape is guilty of the crime if force or violence was used, regardless of the good or bad character of the offended party (People v. Blance, 45 Phil. 113).

526 LEGAL MEDICINE

Vulva of prostitute with leucoderma

Methods of Control:

1. Legalized but regulated: a. Segregation of prostitute in a restrictive area. b. License given to the house of prostitution. c. Periodic examination ol the prostitutes.

Defects of the Method:

a. Segregation does not segregate.

b. Many prostitutes fail to register, either through negligence or desire to avoid the stigma which registration creates.

c. The medical inspection does not protect.

d. Regulations create a false sense of security (overconfidence). e. Regulations promote prostitution, foster immorality, corrupt

officials and increase crime.

2. Strict prohibition:

a. Strict enforcement of legislation against prostitution and all activities connected with it.

b. Education of the public regarding sex, prostitution and venereal disease.

c. Adoption of medical measures and establishment of medical facilities for the diagnosis and treatment of venereal disease.

d. Rehabilitation of prostitutes.

SEX CRIMES 527

e. Adoption of codes of self-regulation and organization of community cooperation.

Other persons involved in the business of prostitution are punished by the following provisions of the Revised Penal Code:

A. Corruption of Minors: Art. 340, Revised Penal Code:

Any person who shall promote or facilitate the prostitution or corruption of persons under age to satisfy the lust of another, shall be punished by prision correccional in its minimum and medium periods, and if the culprit be a public officer or employee, including those in government owned or controlled corporations, he shall also suffer the penalty of temporary absolute disqualification (as amended by B.P. 92).

Habitually or with abuse of authority or confidence was removed from the original provision as an element in promoting or facilitating the prostitution or corruption of persons under age to satisfy the lust of another. A single act without abuse of authority or confidence is now a crime. A mere proposal to promote or facilitate the prostitution or corruption of a person under age is already a consummation of the crime.

The term under age presumably means below the age of 18, inasmuch as 18, insofar as sexual offenses are concerned, is the age of legal consent.

B. White Slave Trade: Art. 341, Revised Penal Code:

The penalty of prision correccional in its medium and maximum periods 6hall be imposed upon any person who, in any manner, or under any pretext, shall engage in the business or shall profit by prostitution or shall enlist the services of women for the purpose of prostitution.

Ways of Committing the Crime:

a. Engaging in the business of prostitution. b. Profiting by prostitution. c. Enlisting the services of women for the purpose of prosti

tution. Any one of the above mentioned act is sufficient to constitute

offense which need not be habitual.

Abuse Against Chastity

Art. 245, Revised Penal Code: The penalties of prision correccional in its medium and maxi-

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mum periods and temporary special disqualification shall be imposed:

1. Upon any public officer who shall solicit or make immoral or indecent advances to a woman interested in matters pending before such officer for decision, or with respect to which he is requested to submit a report to, or consult with, a superior officer;

2. Any warden or other public officer directly charged with the care and custody of prisoner or persons under arrest who shall solicit or make immoral or indecent advances to a woman under his custody.

If a person solicited by the wife, daughter, sister or relative within the same degree by affinity of any person in the custody of such warden or officer, the penalties shall be prision correccional in its minimum and medium periods and temporary special disqualification.

Ways of Committing Abuse Against Chastity:

1. By soliciting or making immoral or indecent advances to a woman interested in matters pending before the offending officer for decision or with respect to which he is required to submit a report to, or consult with a superior officer.

2. By soliciting or making immoral or indecent advances to a woman under the offender's custody.

3. By soliciting or making immoral or indecent advances to the wife, daughter or relatives with the same degree by affinity of any person in custody of the offending warden or officer.

Solicit means to propose earnestly and persistently something immoral or indecent. Mere proposal is sufficient. It is not necessary that the woman solicited yields to the solicitation of the offender.

But proof of solicitation may no longer be necessary when there is sexual intercourse. A warden of a woman prisoner entered the cell and had illicit relation with her. On appeal the appellant argued there was no proof of solicitation. Absence of sufficient solicitation is not necessary when the act solicited was consumated (U.S. v. Morales, 29 Phil. 572).

U N N A T U R A L S E X U A L OFFENSES A N D S E X U A L A B N O R M A L I T I E S

Unnatural sexual offenses are not only a deviation to the normal course of nature but also uncommonly observed manifestations of sexual perversion. Most of those persons suffering from the con-

SEXUAL ABNORMALITIES 529

ditions do not exhibit criminal intent but manifesting mental aberrations which may be a subject-matter for the psychiatrist to treat. Environment, degree of education, degree of morality, habits, etc. are some of the factors responsible for such sexual maladjustments.

There is no specific provision of our Revised Penal Code on any of the unnatural sexual offenses, although certain provisions of the code may be made applicable.

Municipal ordinances of cities and towns may penalize unnatural sexual offenses in consonance with the power to promulgate rules and regulations necessary for the promotion of public safety, moral and welfare.

Provisions of the Penal Code which may be Applicable to Unnatural Sexual Offenses:

1. Grave Scandal:


The penalties of arresto mayor and public censure shall be imposed upon any person who shall offend against decency or good customs by any highly scandalous conduct not expressly falling within any other article of the code.

Requisites of the Crime:

a. The offender performs act or acts;

b. Such act or acts is/are highly scandalous and offending against decency and good customs;

c. It is also necessary that the act or acts be committed in a public place or within the view or knowledge of the public (U.S. v. Samaniego, 16 Phil. 663).

2. Immoral doctrines, obscene publications and exhibitions:


That penalty of prision correccional in its minimum period or a fine ranging from 200 to 2,000 pesos, or both, shall be imposed upon: a. Those who shall publicly expound or proclaim doctrines openly

contrary to public morals; b. The authors of obscene literature, published with their know

ledge in any form, and the editors publishing such literature; c. Those who in theaters, fairs, cinematographs or any other place

open to public view, shall exhibit indecent or immoral plays, scenes, acts or shows; and

d. Those who shall sell, give away or exhibit prints, engravings, sculptures or literature which are offensive to morals.

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3. Vagrants and Prostitutes: Art. 202, Revised Penal Code:

The following are vagrants:

1 2. Prostitutes.

For the purposes of this article, women who, for money or profit, habitually indulge in sexual intercourse or lascivious conduct, are deemed to be prostitutes.

Any person found guilty of any of the offenses covered by this article shall be punished by arresto mayor or a fine not exceeding 200 pesos, and in case of recidivism, by arresto mayor in its medium period to prision correccional in its minimum period or a fine ranging from 200 to 2,000 pesos, or both, in the discretion of the court.

4. Unjust vexation or any other coercion: Art. 287, 2nd paragraph, Revised Penal Code:

Any other coercions or unjust vexations shall be punished by arresto menor or a fine ranging from 5 to 200 pesos, or both.

Unjust vexation includes any human conduct, although not productive of some physical or material harm would, however, unjustly annoy of vex an innocent person (Guevarra).

S E X U A L A B N O R M A L I T I E S :

As to the Choice of Sexual Partner:

1. Heterosexual — Sexual desire towards the opposite sex. This is a normal sexual behavior, socially and medically acceptable.

2. Homosexual — (Michaelangelo, Shakespeare, Oscar Wilde, Waltz Whiteman), — Sexual desire towards the same sex.

a. Kinds of Homosexuals:

(1) Overt — Persons who are conscious of their homosexual cravings, and who make no attempts to disguise their intention. They make advances towards members of their own sex.

(2) Latent — Persons who may or may not be aware of the tendency in that direction but are inclined to repress the urge to give way to their homosexual yearning.

Tribadism (Lesbianism) — A special name for female homosexuals wherein a woman has the desire to have sexual intercourse with another woman. The "masculine


woman may be the active subject during the sexual act. Most lesbians have antipathy towards men.

3. Infanto8exual — Sexual desire towards an immature person.

a. Pedophilia — A form of sexual perversion wherein a person has the compulsive desire to have sexual intercourse with a child of either sex. Children of various ages participate in sexual activities, like fellatio, cunnilingus, fondling with sex organs, or anal sexual intercourse. Usually committed by a homosexual, between a man and a boy the latter being a passive partner.

A Pedophile may be:

a. Homosexual pedophile — may attempt either oral or anal intercourse with his victim.

b. Heterosexual pedophile — may attempt either oral, vaginal, anal, intracrural intercourse as well as cunnilingus, but attempts at vaginal penetration are most common.

Offenders entice their victim through promise of money, candy, etc.

Reasons Why Physicians Fail to Detect Child Sexual Abuse:

a. The lack of "hard" physical evidence of abuse; b. A belief that sexual abuse does not exist; c. A fear of antagonizing parents; and d. Ignorance of how to obtain a detailed sexual history from the

child.

Theories Why Adults become Interested in Children:

a. Emotional congruence — Children are sexually attractive to adult for a number of reasons:

(1) Children are nondominant;

(2) Adults have low self-esteem, immaturity, socialization to male dominance or narcissism; and

(3) Unconscious impulse, compulsively to repeat child-adult sex contact to master, and his or her own early experience of child-adult sexual abuse.

b. Conditioning Modeling — Behavioral modeling begins with early childhood experience, positive or negative, and is conditioned by hormonal abnormalities, child pornography and the mis-attribution of arousal as being only from children.

c. Blockage — Alternative sexual gratification may become blocked due to poor social skills with adults of the opposite sex, anxiety about sex, unresolved oedipal conflicts, unavailability of or

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conflict with a committed partner, as well as repressive social-sexual norms.

d. Disinhibition — Sexual controls may become disinhibited due to senility, dementia, mental retardation, psychosis, drug or alcohol, impulse disorders, situational stress, failure of incest avoidance, a general cultural acceptance. (JAMA, Vol. 254, No. 16, Oct. 25, 1985).

4. Bestosexual — Sexual desire towards animals.

a. Bestiality (Zoophilia) — Sexual gratification is attained by having sexual intercourse with animals.

5. Autosexual (Self gratification or masturbation) — It is a form of "self-abuse" or "solitary vice" carried without the cooperation of another person.

Relation of Masturbation to Health and Sex Crime:

a. It serves as a sedative for a variety of neurotic disposition. Many persons who suppress the urge to masturbate and give up the habit often develop an anxiety neurosis.

b. It serves as an adequate form of sexual gratification.

c. It prevents the development of homosexuality.

d. It prevents the development of suicidal tendency on account of the absence of sexual gratification.

e. It protects certain persons from committing sex crimes.

Types of Masturbation:

a. Conscious Type — The person deliberately resorts to some mechanical means of producing sexual excitement with or without orgasm:

Ways of Masturbation:

(1) In male:

(a) By manual manipulation to the point of emission. (b ) Ejaculation produced by rubbing his sex organ against

some part of the female body without the use of the hand (frottage).

(2) In female:

(a) Manual manipulation of the clitoris. ( b ) Introduction of the penis-substitute.

Medical evidences cannot go beyond to prove the emission of semen, and unless caught "in flagrante delicto," it is not likely that a person could be brought to trial. It may be a criminal act if done in public places or within the knowledge and view of the public. Psychiatric evaluation of the offender may be necessary.


b. Unconscious type — The release of sexual tension may come about via the mechanism of nocturnal stimulation with or without emission, which may also be considered as "masturbation equivalent". The explanation is that the conscious urge to masturbate is repressed during the waking state and expressed during the sleep when we are less apt to censor our thoughts and desires.

7. Gerontophilia — Sexual desire with elder person.

8. Necrophilia — A sexual perversion characterized by erotic desire or actual sexual intercourse with a corpse.

9. Incest — Sexual relations between persons who, by reason of blood relationship cannot legally marry.

As to Instinctual Strength of Sexual Urge:

1. Over Sex:

a. Satyriasis — Excessive sexual desire of men to intercourse.

b. Nymphomania — Strong sexual feeling of women. They are commonly called "hot" or "fighter". Both satyriasis and nymphomania are general expression of compulsive neurosis.

2. Under-sex (Sexual frigidity):

a. Sexual anesthesia — Absence of sexual desire or arousal during sexual act in women.

b. Dyspareunia — Painful sexual act in women.

o. Vaginisimus — Painful spasm of the vagina during sexual act.

d. Old age — Weakening of sexual feeling in the elderly. There may be the desire but there is difficulty of accomplishment. It may be accompanied by aberrant behavior, like exhibitionism, incest, or homosexuality.

As to Mode of Sexual Expression or Way of Sexual Satisfaction:

1. Oralism — The use of the mouth as a way of sexual gratification.

a. Fellatio (Irrumation) — The female agent receives the penis of a man into her mouth and by friction with the lips and tongue coupled with the act of sucking initiates orgasm.

b. Cunnilingus — Sexual gratification is attained by licking or sucking the external female genitalia.

c. Anilism (anilingus) — A form of sexual perversion wherein a person derives excitement by licking the anus of another person of either sex.

2. Sado-masochism (Algolagnia) — Pain or cruel act as a factor for gratification.

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Flagellation — A sexual deviation associated specifically with the act of whipping or being whipped.

a. Sadism (Active Algolagnia) — A form of sexual perversion in which the infliction of pain on another is necessary or sometimes the sole factor in sexual enjoyment.

(1) Cannibalism — Sexual gratification attained by biting without flesh eating but with presumed unconcious wish to consume.

(2) Love bites — These are superficial punctate contusions seen most frequently at the side of the neck, overlying or anterior to the sternomostoid muscle, breast and other parts of the body. The bitten tissue must be loose and the mark is caused by forcible sucking applied to tissue seized by the mouth. Usually during the act the teeth are guarded by the lips. Because of the sucking, contusion develops.

The infliction of such injury although amorous may be a part of the sadistic attitude of the offender.

It is called necrosadism or lust murder if the victim dies. The deviate has a strong homicidal urge, quite often suffering from organic brain disease or may be schizophrenic, epileptic or psychopath.

b. Masochism (Passive algolagnia) — The pain and humiliation from the opposite sex is the primary factor for sexual gratification.

3. Fetishism — A form of sexual perversion wherein the real or fantasied presence of an object or bodily part is necessary for sexual stimulation and/or gratification.

Kinds of Fetishes:

a. Anatomic — Where particular portions of the anatomy, such as the breasts, or buttocks are the target of interest for sexual stimulation.

b. Clothing — The deviate may have interest centered on shoes, handkerchief, undergarments, either on a sexual partner or stolen from a neighborhood washline.

c. Necrophilic — The deviate has the desire to be near a dead body and may or may not violate the dead person for sexual gratification.

d. Odor (Ospresiophilia) — Fetish whose stimulus is pleasant odor or foul odor for sexual stimulation or gratification.

(1) Urolagnia — A sexual deviation in which sexual excitement is associated with the sight of women urinating. In some instances, there is a desire to drink the urine.


(2) Coprolognia — A form of sexual deviation wherein sexual gratification is attained by seeing women defecate.

(3) Mysophilia — Sexual response to filth or excretion.

e. Pygmalionism — A sexual deviation whereby a person has sexual desire for statues.

f. Mannikinism — Sexual desire with mannikins.

g. Narcissism — A person has extreme admiration and love of one's self. Sexual gratification is attained by looking at the mirror and appreciating his or her own self.

h. Negative fetish — The marked dislike for things, like eyeglasses, beard, hair cut, as the sole stimulus for gratification.

i. Saboteur fetish — A deviate does damage while he gets satisfaction, like cutting clothes or hair.

j. Incendiarism — Deviate derives sexual pleasure from setting fire. (Did Nero belong to this category? ) .

k. Vampirism — Deviate attains sexual stimulation or gratification at the sight of blood.

As to the Part of the Body:

1. Sodomy — Sexual act through the anus of another human being.

2. Uranism — Sexual gratification attained by fingering, fondling with the breast, licking parts of the body, etc.

3. Frottage — A form of sexual gratification characterized by the compulsive desire of a person to rub his sex organ against some parts of the body of another. They generally achieve their erotic gratification by rubbing or pressing their organs against the buttocks of women in crowded subways, buses, theaters, or streetcars. The frotteur often pretends that the rubbing is accidental.

4. Partialism — A form of sexual deviation wherein a person has special affinity to certain parts of the female body. Sexual libido may develop in the breast, buttock, foot, legs, etc. of women. Usually, sexual intercourse is merely secondary to satisfy the sexual desire.

A person may prefer rubbing his penis against the woman's breast or may prefer his partner to lie prone and kiss the buttocks or perform cunnilingus.

Frottage differs from partialism in the sense that in the former there must be rubbing at certain parts of the body to arouse sexual stimulation, while in the latter the act may not only be rubbing but actual intercourse.

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As to Visual Stimulus:

1. Voyeurism — A form of sexual perversion characterized by a compulsion to peep to see persons undress or perform other personal activities. The offender is sometimes called "Peeping Tom". Usually after peeping, he masturbate in excess.

2. Mixoscopia (Scoptophilia) — A perversion wherein sexual pleasure is attained by watching couple undress or during their sex intimacies.

As to Number:

Normal sexual relation is only between a man and a woman, but deviation in sexual behavior may attain gratification when more than two persons are participating.

1. Troilism (Menage a trois') — A form of sexual perversion in which three persons are participating in the sexual orgies. The combination may consist of two men and a woman or two women and a man. The usual activity may be fellatio, kissing the buttock, sucking the breast, a "suixante-neuf" (sixty-nine) arrangement, or coitus combined with other sexual practices. Sexual gratification is attained in the "eternal triangle".

A husband may request his wife to invite another woman and spend their night in a room. In their nude condition, the husband may perform cunnilingus to the woman and at the same time performing coitus with his wife. The invited woman may remain doing nothing other than kissing the buttock of the husband.

2. Pluralism — A form of sexual deviation in which a group of person participate in the sexual orgies. Two or more couples may perform sexual act in a room and they may even agree to exchange partners for "variety sake" during the "sexual festival".

Other Sexual Deviates:

1. Coprolalia — A form of sexual deviation characterized by the need to use obscene language to obtain sexual gratification. Sometimes they go beyond uttering profane words by making some writings and sketches on the walls of toilets.

2. Don Juanism — The term applied by psychiatrists to describe a form of sexual deviation characterized by promiscuity and making seduction of many women as a part of his. career. The pervert cannot find anyone to be a permanent companion.

3. Indecent exposure (Exhibitionism) — This is the willful exposure in public places of one's genital organ in the presence of other persons, usually of the opposite sex. Usually, the exhibitionist is naked. It is the act of men whose sexual satisfaction is attained


principally by exhibition with or without performance of mas-turbatory act. Women may expose themselves naked in public as in "bubble and fan" dances and the "strip tease" acts in night clubs.

In civilized society, exhibitionism committed in public places is harmful to the sense of decency and good morals, hence it is punishable.

One evening two detectives and a reporter with a camera entered one of the burlesque shows and they found the theater dark with a dim light in the stage where a woman was seen swaying her hip to and fro and sometimes raising her feet one after another. She had on an "abbreviated" nylon panty and patches on her breasts to interrupt her stark nakedness. There were about 100 people inside the theater and while the girl (accused) was dancing the people shouted in Tagalog "Sigue, muna, sigue, nakakalibog".

The dancer was later apprehended and charged for immoral exhibition. H E L D : She was found guilty, because the act deprived or corrupted those minds which were susceptible to immoral influence. The object of the law is to protect the public. The reaction of the public during the show showed the act to be immoral (People v. Aparici, G.R. 13375).

Sexual Reversal:

1. Transvestism ("Sexo-esthetic inversion", "Psychical hemaphro-ditism" or "Metamorphosis sexualis paranoica") — A form of deviation wherein a male individual derives pleasure from wearing the female apparel. This condition is found sometimes in females who desire to dress themselves in male attire. The transvestite has a psychic identification with the opposite sex. A female transvestite may imagine that she possesses a penis. It is quite difficult to detect a female transvestite, since it is quite common for women to wear slacks or dress in masculine tailored ways.

Transvestites are, as a rule harmless insofar as they have no desire to assault anyone. Like exhibitionists they are merely interested in attracting attention. Transvestitism is a symptomatic expression of some deep underlying sexual maladjustment amenable to psychotherapy.

2. Transexualism — There is a dominant desire in some persons to identify themselves with the opposite sex as completely as possible and to discard forever their anatomical sex. So strong is the compulsion to have the opposite sex that they hate their genitalia as a persistent evidence that they are not what they want to be, and

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sometimes attempt to castrate themselves or mutilate their external genitalia. They may go to the extreme of taking for a long period of time sex hormones to develop secondary sex characteristics of the opposite sex. They may go to the extent of subjecting themselves to surgery to change their anatomical sex.

3. Intersexuality — A genetic defect wherein an individual show intermingling, in varying degrees, of the characteristics of both sexes including physical form, reproductive organs, and sexual behavior.

Classification of Intersexuality:

a. Gonadal agenesis — The sex organs (testes or ovaries) have never developed. This condition can be determined very early in fetal life.

b. Gonadal dysgenesis — The external sexual structures are present but at puberty the testes or the ovaries fail to develop.

(1) Klenefetter's syndrome — A male type of dysgenesis in which although the anatomical structure is entirely male, the nuclear sexing is female (Chromatin positive), characterized by the presence of small testes with fibrosis and hyalinization of the seminiferous tubules. It is associated with X X Y chromosomes.

(2) Turner's syndrome — Structurally and phenotypically female but the ovaries are small. There is sterility with the absence of the second X chromosomes.

c. True hermaphroditism — A state of bisexuality, having both ovaries and testicles. The nuclear sex is usually female. The character may be neutral or whichever is dominant.

d. Pseudohermaphrodite — Sex organ is anatomically of one sex but the sex characters is that of the opposite sex.

(1) Male pseudohermaphrodite — Gonads are testicles but the character is effeminate.

(2) Female pseudohermaphrodite — Gonads are ovaries but with masculine character.

Chapter XXII

PREGNANCY

Pregnancy is the state of a woman who has within her body the growing product of conception or a fecundated germ. It commences from the time the egg cell is fertilized and terminates at the time such product of conception is expelled or delivered. The average duration of pregnancy is 270 to 280 days from the first day of the last menstruation. There is no perfect way of determining its duration, although several methods are employed, none of the methods are perfectly reliable.

Legal Importance of the Study of Pregnancy:

1. Pregnancy is a ground for the suspension of the execution of the death sentence in a woman:


Suspension of the execution of the death sentence:

The death sentence shall not be inflicted upon a woman within the three years next following the date of the sentence or while she is pregnant, nor upon any person over seventy years of age. In this last case, the death sentence shall be commuted to the penalty of reclusion perpetua with the accessory penalties in article 40.

2. A conceived child is capable of receiving donation: Art. 742, Civil Code:

Donations made to conceived and unborn children may be accepted by those persons who would legally represent them if they were already born.

3. A conceived child may exercise civil rights: Art. 40, Civil Code:

Birth determines personality; but the conceived child shall be considered born for all purposes that are favorable to it, provided it be born later with the conditions specified in the following article.

Art. 41, Civil Code: For civil purposes, the foetus is considered born if it is alive at

the time it is completely delivered from the mother's womb. However, if the foetus had an intrauterine life of less than seven

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months, it is not deemed born if it dies within twenty-four hours after its complete delivery from the maternal womb.

4. Concealment of the woman that she is pregnant at the time of marriage is a ground for the annulment of marriage: Art. 85, Civil Code:

A marriage may be annulled for any of the following causes, existing at the time of the marriage:

(4) That the consent of either party was obtained by fraud, unless such party afterwards, with full knowledge of the facts constituting the fraud, freely cohabited with the other as her husband or his wife, as the case may be.


Any of the following circumstances shall constitute fraud referred to in number 4 of the preceding article:

(3) Concealment by the wife of the fact that at the time of the marriage, she was pregnant by a man other than her husband.

No other misrepresentation or deceit as to character, rank, fortune or chastity shall constitute such fraud as will give grounds for action for the annulment of marriage.


The action for annulment of marriage must be commenced by the parties and within the periods as follows:

(4) For causes mentioned in number 4, by the injured party within four years after the discovery of the fraud.

Instances Why Some Women Claim Pregnancy Even if None Exists:

1. Pregnancy is a ground for the suspension of the death sentence in a woman:

If a woman claims that she is pregnant at the time of execution, she may file for a motion or petition in court for the suspension of the execution of the death sentence, and if found to be pregnant, the execution will be deferred until she has delivered.

2. A lawful plea in mitigation when charged with theft:

A woman may be accused of the crime of theft. She may raise the plea in mitigation of kleptomania brought about by her temporary insanity due to conceptfon.

3. A ground for widow's larger claim:

A widow may claim larger damages as a result of the recent death of her husband on account of the negligence of another.

PREGNANCY 541

4. Claim for the posthumous child:

A widow may ask or petition the court for the share of the posthumous child in the estate of the deceased husband.

5. For black-mailing purpose:

A woman may claim that she is pregnant for the purpose of black-mailing a man or for the purpose of inducing a man to marry her.

Instances Why Some Women Deny the Existence of Pregnancy:

1. When there is no ground for them to become pregnant:

Women who are unmarried, or divorced, or who are living separately from their husbands for a time may be accused by someone that they are pregnant. To defend their moral and social reputation, they deny the existence of pregnancy.

2. Defense when accused of infanticide or abortion:

The absence of previous pregnancy may be used as a defense when a woman is accused of infanticide or abortion. Infanticide cannot be committed unless there has been previous pregnancy.

3. Marriage inducement:

A woman may deny the existence of pregnancy by another man, to induce the man to marry her.

M E D I C A L E V I D E N C E S O F P R E G N A N C Y :

Signs and symptoms of pregnancy may be divided into presumptive or probable and positive or certain:

A. Presumptive or Probable Signs and Symptoms:

1. Cessation of Menstruation:

A married woman who missed her menstruation is presumed to be pregnant, however, cessation of menstruation may be due to some other causes other than pregnancy. Emotional disturbance, anemia, systemic infection, disturbance in the function of the ovary, may bring about amenorrhea. It is also worthy of mention that a woman is capable of menstruating even though she is pregnant. This is possible during the first three months of pregnancy, but no longer possible during the later period on account of the fusion of the decidua vera to the decidua capsularis. A nursing mother may not menstruate during the period she is nursing the child.

2. Morning Sickness: This is the pernicious vomiting of a pregnant woman more

manifest in the morning. Although this is a frequent phenomena in the early stage of pregnancy, other conditions may

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also give rise to the same symptoms. The hypertonicity of the stomach, peptic ulcer, gastric hyperacidity may simulate morning sickness of pregnancy.

3. Changes in the Breast:

There is increase in size and sensation of tightness of both breasts. The pinkish-brown color of the areolae are changed into dark-brown or black. The tubercles of Montgomery are developed and the tissues are erectile. Colostrum is found on the third month. Secretion of milk may occur in a non-pregnant woman, as in tumor of the ovary.

4. Progressive Enlargement of the Abdomen:

At the end of the third month, the fundus of the uterus is at the level of the brim of the pubic bone. At later periods, there is gradual increase in size of the uterus capable of perception by palpation on the abdominal wall. The enlargement of the abdomen may be due to tumor of the uterus or ovarian cyst, or other abdominal pathology.

The relation between the age of the fetus and the level of the fundus of the uterus is as follows: 3 calendar months (complete) — 3 fingers above the pubic bone. 4 calendar months " — Between the symphysis and

Note: In some women the 9th month has the same level as the 8th month because sometimes the head of the fetus approximates the pelvic cavity so that fundus does not go so high.

5. Changes in color of the vagina and softening of the cervix:

There are different signs to show change in color of the vaginal wall and softening of the cervix.

a. Jacquemin-Chadwick's Sign:

There is a pale violet discoloration of the anterior wall of the vagina below the urethral meatus. The color changes to bluish as pregnancy advances and in some cases it becomes later very dark or black in color.

umbilicus. 5 calendar months 6 calendar months 7 calendar months 8 calendar months 9 calendar months

— 3 fingers below the umbilicus. — At the level of the umbilicus. — 3 fingers above the umbilicus. — 6 fingers above the umbilicus. — More than 8 fingers above the

umbilicus.

b. Hegar's Sign:

Bi-manual examination of the gravid uterus shows extreme softening of the cervix.

c. MacDonald's Sign: On account of the softening of the isthmus, the fundus of

the uterus is anteflex, so by bi-manual examination, there is an easy approximation of the fundus and the cervix.

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d. GoodelVs Sign:

When the cervix of the uterus feels as hard as the tip of the nose, pregnancy does not exist, but when it is as soft as the lips, the uterus is gravid.

6. Funic Souffle or Umbilical Souffle:

Funic souffle, sometimes called umbilical souffle, is the whistling sound synchronous with the fetal heart beat and is only of subordinate value owing to the possibility of other sounds being mistaken for it.

7. Ballottement:

This is the feeling perceptible to the fingers on giving sudden impulse to the child through the neck of the uterus. The child floating in liquor amnii is driven by the impulse against the other side of the uterus, and it is this blow against the womb that is perceptible to the hand placed on the abdomen.

8. Braxton-Hick's Sign:

This is the rhythmical contraction and relaxation of the uterus, perceptible to the hand when resting on the abdomen. The interval of contraction is usually five to twenty minutes and lasting from two to five minutes. Fibroid uterus may also give this sign.

9. Bladder Irritability :

Irritability of the bladder is a common occurrence among pregnant women. This is noticeable at the second month of pregnancy, manifested as frequent urination. However, it has of no diagnostic value because even a non-pregnant woman may manifest the same symptom.

10. Capricious Appetite:

Women during the early stage of pregnancy or even thereafter may have specially capricious appetite. The desire for a particular class or kind of food is shown by a conceiving woman. Not all women do manifest this sign and its presence will not conclusively show the presence of pregnancy.

11. Abnormality in Pigmentation:

The pregnant woman usually manifest pigmentations in some parts of the body especially in the abdomen and perineum. It may not be very prominent among colored people. Pigmentation may be present in some diseases, like Addison's disease.

PREGNANCY 545

12. Easy Fatigability:

A pregnant woman easily gets tired on slight effort. This may be due to the weight of the gravid uterus and insufficiency of nutrient and oxygen supply to the tissues of the body due to the deviation of a portion to the growing fetus. Easy fatigability is present also in cardiac and pulmonary diseases, debilitating affection and old age.

B. Positive Signs and Symptoms of Pregnancy:

The finding of any of the following signs or symptoms of pregnancy will show conclusively its existence:

1. Hearing of the Fetal Heart Sounds (Mayor's Sign):

The heart beat of the fetus is compared to the ticking of a watch under the pillow. The rate is 120 to 140 beats per minute. The location is at the anterior abdominal wall and is dependent upon the presentation and position of the fetus. Fat and amniotic fluid may interfere with the intensity of the sound,

2. Outlining of the Fetal Parts:

By palpation, we can determine the head, neck, arm, back and buttocks. If these parts could be outlined, the pregnancy is sure, however, it may be confused with irregular ovarian cyst.

3. Movement of the Fetus (Quickening):

The movement of the fetus may be felt by the woman and may be visible to other observers. This is an indisputable evidence of life, and is observed at the fifth month of pregnancy.

4. X-ray Examination:

Fetal skull and vertebra are visible with x-ray examination. This is positive at the fifth month of pregnancy. X-ray is also valuable to determine the presence of plural pregnancy, malformation and death of the fetus. However, this must not be used injudiciously for diagnostic purpose only on account of its bad effect on the fetus.

Laboratory Test for Pregnancy:

A.Pregnancy Slide Test: 1. Principle — An agglutination-inhibition reaction is used to

demonstrate the hormone human chorionic gonadotropin (HCG) which is excreted into the urine during pregnancy. HCG which is chemically bound to latex particles is agglutinated by HCG antibodies in the presence of free HCG, this reaction is inhibited because the antibodies are neutralized.

546 LEGAL MEDICINE

2. Reagents: a. Pregnancy Slide Test antiserum (human HCG antiserum from

rabbit)

b. Pregnancy Slide Test antigen (HCG latex suspension, chemically bound)

3. Procedure:

Place 1 drop of urine, then 1 drop of Pregnancy Slide Test antiserum 1 in one of the circles on the test slide and mix thoroughly with a disposable stirring rod.

Add 1 drop of Pregnancy Slide Test antigen 2 (shake well). Mix well with the stirring rod, distributing the mixture over the whole area of the circle.

Carefully agitate the slide with a circular motion to ensure that the fluid revolves slowly within the circle.

Read the result after two minutes.

4. Interpretation of result — If there is no agglutination (homogeneous) the urine tested came from a pregnant woman. If there is agglutination (granular), the urine came from a non-pregnant woman.

5. Sensitivity — HCG concentration of 1.5-2.4 IU/ml urine and over are detectable with "Pregnancy Slide Test". A positive reaction is often possible within 5 days of the missed menstrual period. Usually the pregnancy will be diagnosed 12 days after the missed menstrual period.

6. Remarks — Fresh urine preferably morning urine is suitable for use.

It is advisable to have controlled urine from known positive or negative subjects.

If the result is doubtful, it is advisable to repeat the test a few days later.

B. Gravindex HCG Slide Test — The principle involved and procedure is practically the same as the Pregnancy Slide Test. Gravindex is merely a trade name.

Characteristics of the fetus in various periods throughout pregnancy (Calendar Months):

End of first month —Length — 1.0 cm.; Diameter — 2.0 cm.; Eyes, ears and mesodermic segments are distinguishable; Limb buds are present.

End of second month—Length — 3.0 cm.; Diameter — 6.5 cm.; Weight — 15.5 gm.

End of third month —Length — 8.0 cm.; Weight — 85.0 gm.;

PREGNANCY 547

Chorion laeve has lost most of its villi, neck is develop, oral and nasal cavities are separated by the development of the paint* Sexual organs have appeared, fingers and toes are present, and nails can just be detected. Ossification has begun in most of the bones.

End of fourth month — Length — 13 cm.; Weight — 204 gm.; Sex can be distinguished; Skull partly ossified, with wide sutures and fontanelles.

End of fifth month —Length — 22.5 cm.; Weight — 450 gm.; Hair and lanugo have appeared; Skin begins to be covered with vernix caseosa.

End of sixth month — Length — 30 cm.; Weight — 900-1,100 gm.; Skin is still wrinkled, but subcutaneous fat is beginning to form; Eyebrows appear;

End of seventh month— Length — 37.5 cm.; Weight — 1 Vt kg.; Eyelids open; Testicle is beginning to descend unto the scrotum; nails do not reach the tip of fingers; Lanugo disappearing from the face; Child is viable (28 weeks).

End of eight month — Length — 42 cm.; Weight — 2 to 2lA kg.; Skin is only slightly wrinkled, and flesh colored; Lanugo beginning to be shed; Left testicle is generally in scrotum.

At term — Length — 50 cm.; Weight — 3 to ZlA kg.; Nails beyond or at the level of the finger tips; Hair of the scalp is 5 cm. long; Lanugo is only seen on the shoulder.

(Obstetrics and Gynecology by Aleck Bourne, 10th ed., p. 21-22).

Signs of Pregnancy in the Dead:

In addition to the objective signs already mentioned, the following additional findings are present if the pregnant woman dies:

1. Presence of Ovum or Fetus: Examination of the uterine content will reveal the product of

conception together with the placenta, amniotic fluid, and membrane.

2. Findings on the Uterus Itself: There is thickening, increase in size and capacity of the uterus.

The mark of placental attachment may be seen.

548 LEGAL MEDICINE

3. Corpus Luteum:

Corpus luteum may be well-developed and attains a certain size, however, it may gradually retrogress, but it is usually well-developed at the time of delivery. The changes in the corpus luteum may also be found in fibroid tumor or other pathological condition and even in cases of congestion.

Duration of Pregnancy:

The average duration of pregnancy is 270 to 280 days from the onset of the last menstruation. There is no means of determining it with certainty. The evidence derived from pregnancy following a single coitus is trustworthy, but inasmuch as some authorities consider more than two weeks as the life span of the spermatozoa in the vaginal canal, it is hard to ascertain the exact date of fertilization. There is no synchrony between coitus and fertilization.

Abnormally Prolonged Gestation:

Cases in which pregnancy extends to 300 days can now be regarded as well established. Many examples of longer duration have been recorded, but most of them are doubtful. Eden quotes sex cases which have been accepted as authentic in which the calculated period of gestation lay between 311 and 336 days, the weights of the infant ranging from 12-3/4 to 13-1/4 pounds. In all cases where the gestation much over 300 days is alleged, confirmatory evidence should be expected in the exceptional weight and size of the child (A Handbook of Medical Jurisprudence and Toxicology by W. Brend, 8th Rev. ed., p. 113).

Minimum Period of Gestation Compatible with Viability of the Child:

Most authors hold that a child born at one hundred and eighty days of gestation may live. A child may be born alive before this period, but it is not viable or capable of living. A fetus of three or four months development may exhibit signs of life, movements of the limbs, etc., but cannot continue to live, owing to the want of development of the breathing muscles and breathing center. Most 6 months old infants die immediately or within a few days of birth; occasionally one has been reared (Cox's Medico-Legal Court Companion by Bhattacharyya, 4th Revised ed., p. 248).

Methods of Estimating the Date of Expected Delivery:

1. From the date of the first day of the last menstruation, add seven days and count three months backwards.

2. Count forward nine calendar months from the date of the first day of the last menstruation and add one week.

PREGNANCY 549

3. Count forty weeks or ten lunar months from the date of the first day of the last menstruation.

4. Determination of the level of the fundus of the uterus, (supra, p. 542)

5. MacDonald Method:

Measure the distance from the symphysis pubis up to the fundus of the uterus in centimeters divided by 3.5 gives the age in month of gestation.

6. Date of the quickening. It is customary to count ahead 24 weeks in multigravidas and 22 weeks in primagravidas from the date of the quickening. This has been found not to be reliable.

Proofs of Previous Pregnancy:

1. Laxity of the abdominal wall.

2. Presence of striae of pregnancy on the abdominal wall.

3. Perineum is lax with a scar if there was previous laceration. Fourchette is markedly retracted.

4. Vestige only of the hymen is present (caruncula myrtiformis).

5. Breast is lax with enlarged nipples.

6. Vaginal examination shows previous laceration of the cervix.

Super fecundation:

This is the fertilization made by separate intercourses of two ova which have escaped at the same act of ovulation.

Superfoetation:

This is the fertilization of two ova which have escaped at different acts of ovulation. This is possible before the time the decidua vera has united with the decidua reflexa; that is, before the end of the third month of pregnancy.

Pseudocyesis or Spurious Pregnancy:

It is an imaginary pregnancy usually observed among women nearing menopause or in younger women who are very desirous of having children. The patient will present all the subjective symptoms of pregnancy, associated with an increase in the size of the abdomen due frequently to abnormal and rapid deposition of fat or to tympanism. The menses may not totally disappear but may present abnormalities which the patient may attribute to her supposed condition. The patient may imagine fetal movement which in reality is muscular contraction. There is great difficulty in persuading the woman to believe that she is not pregnant.

550 LEGAL MEDICINE

Diagnosis of Fetal Death:

The fetus inside the uterus must be presumed to be alive unless there are evidences to the contrary. The following are proofs that the fetus is dead: 1. Repeated examinations of the uterus show that the size remains

stationary even after a lapse of a number of weeks and months.

2. Endocrine test for pregnancy is negative on more than one occasion. Moreover, death of the fetus may not mean death of the placental tissue which manufacture gonadotrophin. As long as the placental tissue continues to manufacture the trophic hormone, it will be positive in the urine.

During the later months of pregnancy, the following are the additional proofs of death of the fetus:

3. Cessation of the fetal movement after they have been felt.

4. Absence of fetal heart sounds after a repeated and prolonged examination.

5. Positive signs of fetal death as shown by the palpation of softened macerated fetal head, with bones freely movable on each other and the scalp hanging over a loose sac.

6. The breasts cease to enlarge and become soft and flabby.

May a Woman Who Is Pregnant Be Unconscious of Her Condition?

It is hardly credible but may happen in rare instances. A woman after being married for several years and has dismissed in her mind the possibility of being pregnant may grow stouter or may entertain the possibility that the enlargement of the abdomen is due to some internal pathology or disease.

Is It Possible for a Child to be Born Without Human Form?

Following the principles of heredity, no child can be born without human form. Hereditary qualities are transmitted from parents to offsprings. Monstrosities and other forms of abnormalities of a child does not divorce from the child the human form. Close inspections of the monsters and congenitally deformed children will show human form. Our present civil code eliminated "human form" as a requisite for the personality of a new-born child.

Can Impregnation Occur When the Woman Is Unconscious?

This has been proven in many cases. A woman may be under the influence of narcotics, anesthesia, alcohol or other knock-out drugs during the sexual intercourse which resulted in her pregnancy.

PREGNANCY 551

When Does Menstruation Commence?

In the Philippines, menstruation used to commence at the age of twelve to fourteen. In colder countries, it may be established at the age of fourteen to sixteen.

When Does Menstruation Cease?

The average age when menstruation ceases is forty-five. However, there are records in literature wherein women menstruate at the age of seventy-three. The cessation of menstruation is also called climacterium or menopause.

What Is The Earliest Age When Pregnancy Is Possible?

As long as the woman is menstruating, she has also the potential capability of being pregnant. Some women have preconscious sexual development. Anna Mumenthaler menstruated regularly at the age of two, and gave birth to a full term child at the age of nine.

Chapter XXIII

DELIVERY

Delivery is the process by which a woman gives birth to her offspring.

Puerperhun is the interval between the termination of labor (delivery) to the complete return of the reproductive organ to its normal nonpregnant state. Puerperium usually lasts from 6 to 8 weeks.

The study of delivery is important because proof of delivery is necessary in judicial action on the following:

1. Legitimacy 2. Abortion 3. Infanticide 4. Concealment of birth 5. In slander or libel

Methods of Delivery:

1. Natural Route:

Expulsion of the products of conception through the normal passage; that is, through the vaginal canal.

a. Spontaneous:

When the products of conception passed out of the vagina without the aid of physician, midwife, instrumentation or surgical intervention.

b. Surgical Intervention:

When delivery is effected with the aid of surgery, e.g., Symphysiotomy.

c. Instrumentation:

The second stage of labor is modified by the use of instru

ments. Example: Forceps application.

2. Surgical Route:

The expulsion of the products of conception is not through normal openings of the female generative tract but through some artificial openings brought about by surgery, a. Abdominal Caesarian Section:

The child is delivered by opening the abdominal wall and the anterior wall of the uterus.

552

DELIVERY 553

b. Vaginal Caesarian Section:

The child is delivered thru the surgical opening made through the vagina.

c. Post-mortem Caesarian Section:

When the pregnant woman meet sudden death either naturally or through violence and there is no chance of life, any person may open the abdomen to get the viable fetus en utero.

A. SIGNS O F R E C E N T D E L I V E R Y :

1. Languid look, with pulse and temperature slightly increased:

This usually disappears normally in two or three days after delivery. However, these symptoms may be present in other conditions or sickness, hence cannot be conclusive.

2. Peculiar odor:

The characteristic odor of the lochial discharge is present up to the tenth day of confinement. The odor is fishy but sometimes the said odor is present on women who are menstruating normally.

3. Changes in the breast:

There is a sensation of tightness of the breasts and milk may be expressed. The presence of colostrum corpuscles in the milk suggests that parturition has just taken place.

4. Flaccidity of the abdominal wall:

The laxity of the abdominal wall is due to the distention when the uterus is gravid to accommodate the growing product of conception en utero. However, a previous ascites or cystic condition of the ovary or other internal pathology causing enlargement of the abdomen will also give rise to laxity of the abdominal wall.

5. Linea Albicantes present in the abdominal wall:

At first it is reddish in color and is called linea rubra. It is brought about by the breaking of the capillaries when the abdomen is distended. Later, a scar-like tissue develops from the area and is called "Linea albicantes." This is also called striae of pregnancy.

6. Presence of Linea Nigra: During the course and development of the gravid uterus,

there develops on the abdominal wall from the region of the symphysis pubis to the umbilicus or even above it a dark pigmentation of the skin. This pigmentation which is usually in the form of a straight line in the median line persists up to delivery. The origin of linea nigra is most probably hormonal.

554 LEGAL MEDICINE

7. Uterus is enlarged and palpable:

Immediately after delivery, the uterus does not return to its original size. It takes time for its sub-involution. Due to the flaccidity of the abdominal wall, the enlarged uterus is easily palpable.

8. Laxity of the perineum with possible tear:

The perineum is elastic and may yield to distention provided it is given ample time to stretch and provided the fetus is not so big in size. The passage of the fetus at the outer end of the birth canal is responsible for the relaxation of the connective tissue and muscles of the perineum. If there is abrupt distention, a perineal laceration may be produced. Laceration of the perineum is frequent when the second stage of labor is accentuated by push from the fundus of the uterus.

Vulva after Drevious childbirth and laceration of the perineum.

9. Vaginal canal is lax and with possible lacerations:

The normal rugosities of the wall of the vaginal canal is lost due to severe distention. Occasionally, in severe perineal laceration, there is also involvement of the wall of the vaginal canal.

10. Cervix of the uterus is flabby, patulous and may be torn:

The normal hard, doughly consistency of the cervix is lost, but instead it is soft "and flabby. In most cases there is laceration of the orifice.

DELIVERY 555

11. Presence of lochial discharge:

Lochia is the discharge from the vagina after delivery. First it is bloody but later it is almost colorless. When bloody, it is called "lochia rubra" and when colorless, it is called "lochia serosa." When there is infection of the uterus after delivery, the odor of the lochial discharge is foul and usually black.

12. Evidence of placenta, umbilical cord and new-born child.

13. Positive Pregnancy Slide Test (supra p. 545).

B. SIGNS OF REMOTE D E L I V E R Y IN THE L I V I N G :

1. Changes in the breast:

The breast becomes pendulous and linea albicantes are found on the skin on account of the retraction of its size. There is dark color of the areolae and the consistency is soft. The nipples are prominent due to the sucking of the child.

2. Vulva and perineum:

Scar of the previous laceration may be present. There is marked retraction of the fourchette and perineum.

3. Hymen:

Remains of the hymen may only be present in the form of carunculae myrtiformis. Very rarely is the hymen preserved after delivery.

4. Signs of previous laceration of the cervix:

The opening of the cervical canal may no longer be seen as a round hole but slit-like on account of the previous laceration during delivery.

5. Presence of striae of pregnancy or linea atrophica on the abdominal wall.

POST-MORTEM F I N D I N G S IN A W O M A N W H O DIED R E C E N T L Y

AFTER D E L I V E R Y :

1- Findings in the uterus:

a. Laceration or contusion of the cervix.

b. Uterus is enlarged and flabby.

c. The inner surface of the uterus is bloody and rugged-looking.

d. Dark color sloughy and gangrenous sinuses are evident at the endometrial lining at the site of the former placenta.

e. There is relative hypertrophy and increase in thickness of the uterine wall.

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2. Findings in the ovary:

There is presence of corpus luteum.

3. Findings in the other organs:

a. Hydremia of the blood.

b. Slight anemia. depending upon the amount of hemorrhage in the delivery and immediately thereafter.

c. Congestion and hypertrophy of the milk glands of the breast.

4. Pathology accountable for the cause of death:

a. Signs of eclampsia.

b. Findings of endometritis, peritonitis, toxemia, etc.

c. Signs of cardiac, renal or pulmonary affection.

d. Findings of rupture of the uterus.

e. Signs of severe loss of blood during delivery.

Chapter XXIV

ABORTION

The Revised Penal Code does not define abortion, but merely mentions circumstances which makes abortion criminal and punishable. Authorities differ as to the length of intra-uterine existence which may be considered abortion. Some define abortion as the expulsion of the contents of a gravid uterus anytime before full term while others consider it as the forcible expulsion of the product of conception anytime before the age of viability.

Viability is the point at which the fetus is "potentially able to live outside the mother's womb", albeit with respiratory aid. And, later, as when it is capable of meaningful life outside the mother's womb (The Rights of Doctors, Nurses and Allied Health Professionals by Annas and Glantz, p. 202).

In the legal viewpoint, abortion is(the willful killing of the fetus in the uterus, or violent expulsion of the fetus from the maternal womb and which results to the death of the fetus. According to Viada, as long as the fetus dies as a result of violence used or of the drug administered, the crime of abortion exists, even if the fetus is full term.

Whichever be the definition of abortion, the following are the principal elements of the crime:

1. That the expulsion of the product of conception is induced.

2. That the fetus dies either as an effect of the violence used, drug administered or the fetus was expelled before the term of its viability.

Clinical Types of Abortion: V *"uj V* * * w i

Ic Missed Abortion — An ovum destroyed by hemorrhage into the choriospace, usually before the fourth month of pregnancy. The hemorrhage takes place from maternal sinuses into the decidua. /This is usually followed by the death with maceration or absorp-tidfTof the product of the conception. J'Â

^Threatened Abortion — Hemorrhage without dilatation of the internal os. Hemorrhage in early stage of pregnancy may be due to causes other than a threatened abortion, e.g., ectopic pregnancy, cervical polyp, extensive erosion of the cervix, etc.

înevitable Abortion — Hemorrhage with dilatation of the internal os and presence of rhythmical pain. It may end by spontaneous

557

558 LEGAL MEDICINE

expulsion of the product of conception or may require medical intervention. Hemorrhage and infection are the potential complications.

A. Incomplete Abortion — Not all the product, of conception has been expelled from the uterus; fragments or portions of which is retained. This will prevent contraction of the uterus and consequently uncontrolled bleeding will develop. Removal of the retained fragment must be done to avoid too much loss of blood and potential infection. j ^ * W * r nj^^^

^Complete Abortion — The whole product of conception is expelled.

Causes of Abortion:

1. Death of the fetus — Congenital abnormality, poisoning by minerals like lead, disease of the decidua, chorion, placenta, amnion, etc.

2. Abnormality of the uterus.

3. Emotional condition — Fright, grief and anger.

4. Abortificient drugs — Ergot, purgatives,

5. Trauma — Direct or indirect.

6. Hormonal deficiency.

7. Acute specific fever and high temperature.

Provisions of the Revised Penal Code on Abortion:

1. Intentional Abortion:


Any person who shall intentionally cause an abortion shall suffer:

1. The penalty of reclusion temporal, if he shall use any violence upon the person of the pregnant woman.

2. The penalty of prision mayor if, without using violence, he shall act without the consent of the woman.

3. The penalty of prision correccional in its medium and maximum periods, if the woman shall have consented.

Elements of Intentional Abortion:

a. That the woman is pregnant.

b. That violence was applied, or drug was administered, or a person acts upon such pregnant woman.

c. That the effect of such violence, drug or acts of the offender, the fetus dies or is expelled.

d. That the offender has the intention to abort the pregnant woman.

ABORTION 559

Ways of Committing Intentional Abortion:

a. By application of violence on the pregnant woman.

b. By acting, but without use of violence, without the consent of the pregnant woman. This applies to the administration of drugs or beverages without her consent.

c. By acting, with the consent of the pregnant woman. This applies to the administration or use of drugs or beverages with the full knowledge and consent of the pregnant woman herself.

The purpose of the division of the crime into three paragraphs is to graduate the penalties depending upon the use of violence and knowledge of the pregnant woman. It is not based upon medical science.

The accused gave herb extract in order to induce abortion on a woman. The woman aborted at about two hours after the administration. The accused burned the product of conception because of the belief that it is a fish-demon. It was held that the act constitutes prima facie proof of the intent of the accused in aborting the woman (U.S. v. Boston, 12 Phil. 134).

If the intentional abortion resulted to the death of the pregnant woman, then the crime of abortion with homicide was committed.

2. Unintentional Abortion: Art. 2B7, Revised Penal Code:

The penalty of prision correccional in its minimum and medium periods shall be imposed upon any person who shall cause an abortion by violence, but unintentionally.

Elements of Unintentional Abortion:

a. The woman must be pregnant;

b. Violence was applied on such pregnant woman without the intention of aborting her;

c. The woman aborted as a result of the violence.

3. Abortion practiced by the woman herself or by her parents:

Art. 258, Revised Penal Code: The penalty of prision correccional in its medium and maxi

mum periods shall be imposed upon a woman who shall practice an abortion upon herself or shall consent that any other person should do so.

Any woman who shall commit this offense to conceal her dishonor, shall suffer the penalty of prision correccional in its minimum and medium periods.

If this crime be committed by the parents of the pregnant woman or either of them, and they act with the consent of said

560 LEGAL MEDICINE

woman for the purpose of concealing her dishonor, the offenders shall suffer the penalty of prision correccional in its medium and maximum periods.


a. The woman is pregnant. b. Abortion is intended to be committed. c. Abortion is induced by:

(1) The pregnant woman herself.

(2) Other persons with the consent of the pregnant woman herself.

(3) The parents of the woman, or either of them for the purpose of concealing her dishonor and with the consent of the woman herself.

If a woman does an act of inducing abortion on herself, there is mitigation of criminal liability if the purpose is to conceal her dishonor. Concealment of dishonor is not mitigating if the abortion was committed by the parents of the pregnant woman or either of them.

If a woman took poison for the purpose of committing suicide and because of the timely intervention of a physician she did not die but instead she aborted, she cannot be guilty of abortion because of the absence of intention to commit abortion.

4. Abortion practiced by a physician or midwife and dispensing of abortives: Art. 259, Revised Penal Code:

The penalties provided in article 256 shall be imposed in its maximum period, respectively, upon any physician or midwife who, taking advantage of their scientific knowledge or skill, shall cause an abortion or assist in causing the same.

Any pharmacist who, without the proper prescription from a physician, shall dispense any abortive shall suffer arresto mayor and a fine not exceeding 1,000 pesos.

Requisites of the Crime:

a. The woman is pregnant.

b. The physician induced or assisted in causing the abortion with the use of scientific knowledge.

c. The acts done by the physician or midwife was intended to cause an abortion.

There must be the intention of the physician to produce abortion and the absence of intention will not make the physician criminally liable for such consequence.

ABORTION S61

Problems Confronting the Provision of the Revised Penal Code Regarding Abortion:

1. If a woman or a third person induces abortion when pregnancy is beyond the period of viability. The child born as a result of such criminal act lives. Can there be a crime of abortion committed?

2. If a woman is not actually pregnant but she or a third person believes that she is pregnant. Abortion was induced on her by the third person and as a result of which she died. Is there a crime of homicide with intentional abortion?

Kinds of Abortion: — •

^Spontaneous or Natural Abortion:

Abortion which occurs without any form of inducement or intervention.

Înduced Abortion:

Abortion which will not take place had it not been for some form of inducement or intervention. Induced abortion may be:

X- Therapeutic Abortion:

Abortion purposely done to preserve the life of the mother. Preservation of the health of the mother may also be a ground to induce therapeutic abortion. The phrase "to preserve the life of the woman" does not only mean to preserve the life of the woman from death.

b\ Criminal Abortion:

Abortion done without any therapeutic indication but with criminal intent is punishable by law.

Post-mortem Abortion:

This is the expulsion of the product of conception after death of the pregnant woman brought about by the post-mortem contraction of the uterine muscles. It is possible during the early stage of preg-

• nancy when the fetus is small. During the later stage, the contraction of the uterus may cause its rupture and expel its contents of pregnancy into the abdominal cavity.

Reasons Why Some Women Procure Abortion: 1. To preserve the life and health of the pregnant woman. 2. To terminate prematurely illegitimate pregnancy in order to con-

i; ceal the dishonor of the woman. 3. Financial difficulty. Additional member means an added expense

in the family.

562 LEGAL MEDICINE

4. To preserve body form. Some women do not wish to make their pregnancies advance to full terms on fear that their bodies might be deformed.

How Abortion is Induced or Procured:

1. By General Violence:

This includes intentional violence, as exerting strong physical efforts in golf, horse riding, cycling, strong pressure applied on the abdomen, and other forms of strenuous and exhaustive exercises.

Modi (Medical Jurisprudence and Toxicology, 12th ed., p. 336) mentioned the following methods employed to induce abortion:

a. Severe pressure on the abdomen by kneading, blows, kicks, jumping and tight lacing.

b. Violent exercise, such as riding on horseback, cycling, jumping from a height, jolting caused by driving on rough roads, long walks, running up and down the stairs, and carrying or lifting heavy weights.

c. Cupping, usually by placing a lighted wick on the hypogastric region and turning a big glass bottle mouth downwards over it. It probably causes separation of the placenta or possibly injury to the uterine paries.

d. Application of leeches to the pudenda, perineum and the inner surface of the thighs.

2. By Means of Local Violence:

Local violence may be applied in any portion of the generative organ. This is usually resorted to when general violence and the use of drug fails to give the desired result.

Local violence may be applied by the pregnant woman herself, by the physician, midwife, or by the parents. The most common methods applied are:

a. Use of douche of warm and cold water.

b. Injection of fluid into the uterine cavity.

c. Use of luminaria tent or tangle tent to promote dilatation of the cervix.

d. Use of soft rubber inserted into the cervix.

e. Dilatation of the cervix by instrumentation.

3. By the Use of Drugs:

This is the most common method resorted to by women to produce abortion. There is no drug or combination of drugs

ABORTION 563

which when taken by mouth or parenterally will definitely cause the healthy uterus to empty itself without endangering the life of the woman.

Factors Responsible for Abortion After Ingestion or Administration of Poisonous Substances:

a. General severe intoxication of the mother resulting in impairment of her circulation, metabolism and vital functions, or producing anemia and hemorrhage.

b. Interruption or impairment of the placental blood circulation as a result of hemorrhage, vaso-spasm, thrombosis, lowering of the blood pressure, necrosis, and inflammation of endometrium and placenta.

c. General convulsion of the body.

d. Severe gastro-enteritis with vomiting and diarrhea.

e. Irritation of automatic and peripheral nerves leading to uterine contraction.

f. Direct transmission of the poison from the maternal through the placenta into the fetal circulation, thus damaging the fetus (Legal Medicine by R.H. Gradwohl, 1954, p. 812).

Drugs Commonly Used for Abortion:

a. Drugs acting directly on the uterus:

(1) Emmenagogues:

Emmenagogues are substances which increases the menstrual flow. The manner it promotes menstrual flow may be its direct effect on the uterus or indirectly by increasing bodily tone.

(a) Direct Emmanagogues — These are substances which act directly on the uterus or on the nervous system in close relation to it.

Examples: Ergot Potassium permanganate Apiol Aloes Pennyroyal Tamsy Cantharides Borax

(b ) Indirect Emmenagogues — These are substances which induce or increase menstrual flow by promoting and building the health of the person as a whole.

Indirect Emmenagogues may be Classified as:

i. Tonic — as iron, arsenic, strychnine. ii. Hematinics — as iron, copper, liver extracts.

iii. Purgative — as magnesium sulfate, castor oil.

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(2) Ecbolics:

Ecbolics are substances which when taken cause death or expulsion of the product of conception by stimulation of the uterine muscles. The Most Common Ecbolics are:

(a) Ergot (b ) Quinine (c) Pituitary Extract (d) Lead and Mercury

b. Drugs acting reflexly through the genito-urinory tract:

These are drugs which produce irritation of the genitourinary tract and reflexly incite uterine contraction. Large dosage of the drug may cause severe inflammatory changes in the kidney and may cause uremia due to suppression of its function. Diuretics may also cause reflex contraction of the uterus but in a very mild way.

The following drugs may act on the genito-urinary tract and may reflexly make the uterus to contract:

(1) Oil of Pennyroyal (2) Oil of Tamsy (3) Oil of Turpentine

c. Drugs acting reflexly through the gastro-intestinal tract:

These are drugs whose principal site of action is the gastrointestinal tract but may cause uterine contraction due to its reflex action. The following drugs may fall under this category:

(1) Castor oil (4) Gamboge (2) Magnesium sulfate (5) Aloes (3) Croton oil (6) Elatrium

d. Drugs having poisonous effects in the whole body:

These are drugs whose manner of action is not localized in certain tissues or organs but in the whole body. To this group are the animal, vegetable and mineral irritant poisons.

4. By Surgical Intervention:

This is a method of abortion by the application or the use of instrument by gynecologist or by surgeon. Surgical intervention may be:

a. Dilatation and curettage. b. Surgical abdominal route (hysterolaparotomy).

5. Modern methods of inducing or procuring abortion: a. Amniocentesis — Intrauterine injection of hypertonic saline

or glucose solution (20% saline or 50% glucose). The needle is

ABORTION 565

inserted in the abdominal wall or vaginal route. This method is applied when pregnancy is beyond 2 months. Expulsion of the uterine content usually occur 24 to 48 hours after injection,

b. Vacuum suction (commonly known as menstrual regulation) may be applied through the cervix. The suction apparatus will create a negative pressure of 0.4 — 0.6 kg. per cm. sufficient to detach and brake up the products of conception. The procedure is quite simple and usually applied to 12 — 14 weeks of pregnancy.

Complications of Abortion:

1. Immediate Untoward Effects:

a. Shock:

The shock may be due to the laceration of the uterus or the adjacent organ, like the bladder, rectum, intestine or blood vessels. The injury may be due to the introduction of instruments or the application of hot fluid or corrosive substances.

No definite autopsy findings may be seen, except the presence of the gravid uterus, remnants of the fetus and placenta, and the laceration or perforation. Secondary shock may develop later and may be due to hemorrhage, infection or corrosions.

b. Hemorrhage and Anemia:

Occasionally, big pelvic vessels are injured or failure of the uterine wall to contract is observed in abortion. The rupture of the blood vessels may be due to the injury of the uterine and vaginal wall of injudicious instrumentation. Adherent placental tissue, infection, presence of foreign bodies and atony of the uterus may cause hemorrhage for failure of the uterine muscles to contract.

c. Embolism:

(1) Air Embolism:

The air may enter the lacerated vessels of the vagina and uterine wall and carried by the blood to the inferior vena cava, heart and block the pulmonary circulation. In cases wherein the foramen ovale is potent, the air may escape pulmonary circulation and block the cerebral circulation.

(2) Fat Embolism: The injection of oily fluid or laceration of the adipose

tissue may cause the formation of fat emboli in the blood stream which may lodge in the heart, lungs and brain. Fat emboli may be observed in the renal glomeruli, coronary

566 LEGAL MEDICINE

vessels and also in the vessels of the choroid plexus of the brain.

(3) Thromboembolism:

Injury of the uterine wall may cause the formation of thrombus which may be detached and carried by the circulation to different parts of the body.

(4) Bacterial Embolism:

Infection of the uterus after an abortion may cause lump of bacteria to enter the circulation in the form of an embolus.

d. Infection:

Pathogenic organism may be introduced into the uterus and produce systemic symptoms. If death occurs, signs of toxemia may be observed at autopsy.

Causes of Death in Infection:

(1) Rapid development of bacteremia.

(2) Thrombophlebitis of uterine, pelvic and femoral veins with multiple infarctions and abscesses (pyemia).

(3) Bacterial endocarditis with multiple septic infarctions.

(4) Purulent metritis, parametritis, localized or generalized peritonitis, ileus.

(5) Purulent salphingitis, tubal or ovarian abscesses followed by peritonitis.

( 6 ) Diffusely spreading retroperitoneal cellulitis, toxemia and cachexia.

e. Poisoning:

Abortifacent irritants which may be locally applied may be absorbed into the circulation and produce systemic effects. Lysol, corrosive sublimate, iodine solution are frequently used for vaginal douche and may cause systemic poisoning.

f. Vagal inhibition:

Sudden dilatation of the cervix due to the introduction of some objects may cause sudden collapse due to reflex inhibition of the vagus nerve.

g. Perforation of the bladder or any of the neighboring organs:

In the insertion of the uterine sound to determine the position of the uterus or in the process of curretting, the bladder or the other surrounding organs may be perforated

' and which may eventually result to death due to hemorrhage or shock.

ABORTION 567

2. Delayed Untoward Effects:

a. Infection:

Infection may develop immediately or later on account of septic care. The infection may originate from the vaginal canal or from the blood stream coming from a focus of infection in the body.

b. Fistula Formation:

Communication between the vagina or the uterus with the rectum or bladder may be an after effect of perforation due to instrumentation.

c. Sterility:

Plugging of the fallopian tubes, infection of the ovaries may cause sterility,

d."Pelvic Adhesion:

Infection and trauma may cause the uterus or vagina to become adherent to the surrounding organs or tissues.

M E D I C A L E V I D E N C E S O F A B O R T I O N :

1. Medical Evidences of Abortion in the Living:

a. Presence of external signs of violence in the form of contusions, abrasions, hematoma, open wounds of whatever form on the body surface if induced by general violence. If violence is applied locally in the generative tract, injuries of whatever form or description may be seen therein.

b. Examination of the generative tract: ,

(1) Appearance of the external genitalia and vagina may show laceration, contusion, abrasions and other marks of instrumentation.

(2) Examine the external os for softness, tear, and discharge.

(3) Note the size of the uterus, its consistency and location.

c. Examination of the instrument used for the presence of blood, placental tissue or fetal parts.

d. History — Note the state of health beforehand after abortion. Inquire as to the motive of the abortion and history of having ingested or injected with abortives.

e. Signs of previous pregnancy: (1) Condition of the breasts. (2) Laxity of the abdominal wall. (3) Paleness of integument. (4) General body weakness. (5) Presence of characteristic lochial discharge and odor.

568 LEGAL MEDICINE

( 6 ) Palpability of the uterus and laceration of the cervix and perineum.

f. Examination of the expelled product of conception:

(1) Blood examination for maternity and paternity. (2) Marks of instrumentation. (3) Signs of physical violence. ( 4 ) Proof of viability or non-viability of the fetus. (5) Presence of abortives and other toxic materials in the fetal

blood. (6) Presence or absence of malformation. (7) Completeness of the placenta. (8) Other identifying marks.

A criminally aborted fetus about 5 to 6 months of intrauterine life.

g. Laboratory test for pregnancy.

h. Testimony of the physician who completed the abortion or of

other persons who witnessed the criminal act.

2. Medical Evidences of Abortion in the Dead:

Aside from the evidences of abortion in the living which may

be found in the dead, the following may be observed at autopsy:

a. Evidence of instrumentation:

This will include the presence of punctured wounds in the placenta, presence of remnants of the placenta inside the uterine cavity, presence of perforation of the uterus.

ABORTION 569

b. Examination of stomach and its contents:

Abortifacent. drugs and other irritants may be found inside the stomach upon chemical examination. It is advisable to submit the whole of the stomach with its contents to a chemical laboratory examination for such determination.

c. Examination of the kidneys and other organs for irritants:

Like the stomach and its contents, other organs like the kidneys, liver, spleen must be subjected to a qualitative and quantitative chemical examination for the presence of irritant poisons.

d. Examination of the uterine contents:

Remnant of the product of conception for the following:

(1) Infection. (2) Stage of pregnancy. (3) Other complication of abortion.

e. Biological test:

(1) Paternity test. (2) Test for pregnancy.

f. Examination of some untoward effects of abortion:

(1) Infection, toxemia or bacteremia. (2) Embolism. (3) Fistulae formation. (4) Pelvic adhesions.

T H E R A P E U T I C A B O R T I O N :

Therapeutic abortion is an abortion which the law allows under some specific justifications.

Legal Justification to Therapeutic Abortion: Art. 11, No. 4, Revised Penal Code:

Any person who, in order to avoid an evil or injury, does an act which causes damage to another, provided that the following requisites are present:

First. That the evil sought to be avoided actually exists;

Second. That the injury feared be greater than that done to avoid

it; Third. That there be no other practical and less harmful means of

preventing it.

In the performance of an abortion, Iwo lives are involved, namely, ! the life of the mother and the life of the fetus. One life must be • sacrificed to save the life of another in case of therapeutic abortion.

570 LEGAL MEDICINE

If both lives can be saved in accordance with the present state of medical science, then there is no justification to such abortion, hence the physician must be criminally liable.

A physician in performing a therapeutic abortion is doing an act to save the life or to preserve the health of the mother. In so doing, damage is done to the conceived child. The child is deprived of its future existence.

The evil sought to be avoided is the danger on the life of the mother if such pregnancy will be allowed to continue. Such evil may be infection, organic condition or abnormality existing on the person of the woman and which under ordinary course of event will cause death.

There is no practical and less harmful way of saving the life of the mother other than sacrificing the life of the conceived child. If there are other methods which may save both life, then the abortion cannot be considered justifiable.

In the evaluation as to whose life must be spared, it is a common concept that the life of the mother must be preferred than that of the unborn child. A conceived child is not definitely sure of its independent existence while the mother has already manifested real life.

Grounds for Therapeutic Abortion:

The following conditions have been considered by some authorities to be a justifiable ground for therapeutic abortion:

1. Cardio-vascular conditions as congestive heart failure, auricular fibrillations, repeated hemoptysis, paroxysmal tachycardia.

2. Renal conditions as chronic nephritis, previous eclampsia, pyelitis, tuberculosis.

3. Pulmonary conditions as advanced tuberculosis.

4. Blood condition as severe anemia.

5. Gynecological conditions as refractory chorea gravidarum.

6. Organic nervous conditions as psychosis.

7. Miscellaneous conditions as diabetes, exophthalmic goiter.

8. Hereditary conditions as insanity.

Modern diagnostic procedure can determine whether the conceived fetus en utero is suffering from defect or abnormality which may be severed to make independent existence not possible or ample assistance from other person during his lifetime is necessary. New drugs ( L S D , thalidomide, etc.) and non-conventional methods of reproduction ( in vitro fertilization, artificial ovulation ) may lead to the development of an abnormal fetus. If it can be proven

ABORTION 571

that the fetus is abnormal, will it not be a justifiable situation to induce an abortion? If the physician failed to induce abortion and the child born is abnormal, will it not be a ground for civil action against the physician for wrongful life?

I .U.D. (intrauterine device) as a method of contraception which allows the fertilization of the egg cell by the sperm cell but prevent the implantation of the zygote into the uterus because of the mechanical device. Abortion is the premature expulsion of the product of conception. If it were so, then I .U.D. is an abortive. Why is it allowed as a contraceptive method and not prohibited like another way of committing an abortion?

Is the eminent danger of committing suicide on account of her existing pregnancy be a ground to induce therapeutic abortion to save the life of the woman?

Occasionally, on account of her disgrace in society, fear of violent reactions from her parents for the sinful and immoral acts she has committed, or for some other reasons that may be prejudicial to her future life, a woman may attempt in several occasions to commit suicide. In this instance, may a physician institute necessary measures to deliberately terminate the existing pregnancy to save her life? There are divergent decisions on this point.

In the case of Hatchard v. State (48 N.W. 380 Wis.) a woman who threatened to commit suicide unless she could be relieved of the child with which she was pregnant does not present such a necessity for the performance of the operation to save the life of the woman. The intention of the law applies only to cases where death of the mother might reasonably be anticipated from natural causes unless the product of conception is destroyed.

However, in a case cited by Camp and Purchase (Practical Forensic Medicine, p. 32, 1957), a married woman with unstable character finding herself pregnant, threatened to commit suicide. The physician whom she repeatedly made her threat during her unexpected visits referred her to a psychiatrist who recommended abortion. The operation was carried on by a reputed gynecologist but unfortunately, the patient died of gangrene of the uterus. The coroner did not recommend prosecution because the operation was done to save the life of the mother.

Safeguards to be Observed by Physician in Performing Therapeutic Abortion:

1. The lawful abortion must be performed by a licensed physician or

surgeon.

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2. Abortion in order to be justifiable must be performed to save the life or to preserve the health of the mother. But modern advancement of medical science has reduced the number of diseases which will endanger the life and health if pregnancy is allowed to progress to full term. A physician must exercise due diligence in considering a disease or a combination of diseases or conditions as grounds for the therapeutic abortion.

3. Abortion must be performed openly in a hospital to avoid suspicion that it was done for some cause other than to save the life of the mother. Abortion performed in a private clinic wherein there are no sufficient facilities to cope with emergency which may arise in the course of the operation may be a ground for malpractice.

4. It is advisable to have the opinion of other competent physicians as to the justifiability of such therapeutic abortion. The opinion of one might be influenced by prejudice and misjudgment.

5. Enlightened and expressed consent must be obtained from the woman herself if she has no impediment to give consent. It is advisable to have also the consent of the husband, inasmuch as abortion will affect marital relationship.

Reasons Why It Is Difficult to Prosecute Physicians Committing the Crime of Abortion:

1. The crime is performed clandestinely by an intelligent being who is fully aware of his criminal act.

2. The physician has several medical reasons to justify his act. There is no hard and fast rule in medicine. He may claim that there is medical justification to such abortion because the woman is suffering from a disease which might imperil her life if pregnancy will be allowed to progress to full term.

3. In most cases, the products of conception removed which may be utilized as corpus delicti in the crime is lost.

4. The pregnant woman herself is in connivance with the physician and it is quite difficult to let her testify truthfully as to the actual happening. She, herself, is in pari delicto to the crime of criminal abortion.

5. Medical society seems to have a lukewarm attitude in helping the state prosecute the abortionist.

Pros and Cons — Restrictive Abortion Law:

A. Reason Justifying Restrictive Abortion Law:

1. From the moment of conception life begins to start and destruction of the growing product of conception will be con-

ABORTION 573

trary to the law of mankind. This is in line with the philosophy that God created man and only God can destroy it.

B. Reasons for Liberal Abortion Law:

1. Where abortion is illegal, the rich can resort to high-cost and illegal but safe abortion at home or to a pleasure trip abroad combined with an abortion. The poor can only stay at home and face the consequence of high-risk and illegal abortion. This causes discrimination against the poor and favor the rich. It raises the serious issue of justice and equal protection under the law.

2. It is no secret, in countries forbidding abortion under any circumstances, abortion operations continue to exist with very few or non-prosecution. In the Philippines, the draconian and

* restrictive abortion law has been accompanied in the recent years by non-prosecution, either of the woman or of the abortionists (In-depth Study on Law and Fertility Behavior: Preliminary Observation by Lee and Bulatao, 1972, p. 40).

3. Statistics has shown that children born as a consequence of denied abortion to terminate unwanted pregnancy are mentally and physically impaired. Any unsuccessful illegal attempt to cause on her abortion, may cause trauma to the developing product of conception. An overburdened multipara or a single girl without support may cause psychiatric disturbance and the children may be a social welfare problem. The children are abandoned by parents in overcrowded orphanage.

4. A strict anti-abortion law is violative of the right of privacy of a person. The right of privacy means the right of the individual to the possession and control of his own person free from all restraints or interference of others. A woman should have the right to decide whether or not to bear children and that this right includes the right to have an abortion.

5. Modern advances in medical diagnostic procedures can determine whether a developing fetus inside the uterus is suffering from physical abnormalities. Allowing such product of conception to reach full term will cause sufferings on the part of the parents and an overburdened social welfare institution of the government. It is also a factor for the deterioration of the genetic stock if the defective factor is familiar thus making an abnormal stock proliferate further.

6. Recent trend in Central Europe and in America is towards liberalization of their restrictive abortion laws. At present more than 70% of the total world population are living in

574 LEGAL MEDICINE

countries where abortion law is liberal. This trend is incon-sonance to solve a future problem of an over-populated world.

Religious Consideration of Abortion:

As a general rule, all induced abortion are considered sinful, illicit and against the tenets of the Catholic Church even if sanctioned by law. The principal basis is that every human being, even the child in the mother's womb, has the right of existence directly from God and that no human being has the right to destroy it. A conceived child has the right of existence as that of the mother.

However, the Catholic Church classified abortion into two main categories for the purpose of determining whether it may be allowable or not:

1. Direct A bortion — Deliberate expulsion of the product of conception. This is never permitted by the Catholic Church even if the purpose is to save the life of the mother.

2. Indirect Abortion — When the expulsion of the product of conception is not the primary objective of an operation to save the life of the mother, but merely incidental or unavoidable to an operation. This type of abortion is qualifiedly permitted to some extent by the Catholic Church. Thus, the abortion which occurred incidental to an operation to suppress hemorrhage or removal of new growth is permissible.

Among the Jews, destruction of the fetus for the purpose of saving the life of the mother is not only permissible but obligatory. To the Protestants, abortion is generally considered sinful.

Chapter XXV

BIRTH

Legal Importance of the Study of Birth: 1. Birth determines personality:


Birth determines personality; but the conceived child shall be considered born for all purposes that are favorable to it, provided it be born later with the conditions specified in the following article.


For civil purposes, the foetus is considered born if it is alive at the time it is completely delivered from the mother's womb. However, if the foetus had an intra-uterine life of less than seven months, it is not deemed born if it dies within twenty-four hours after its complete delivery from the maternal womb.

2. Appearance of a child is a ground for the revocation of donation: Art. 760, Civil Code:

Every donation inter vivos, made by a person having no children or descendants, legitimate or legitimated by subsequent marriage, or illegitimate, may be revoked or reduced as provided in the next article, by the happening of any of these events.

(1) If the donor, after the donation has legitimate or legitimated or illegitimate children, even though they be posthumous.

3. Proof of live-birth must first be shown before death of the child by the prosecution in the case of infanticide: Art. 255, Revised Penal Code — Infanticide:

The penalty provided for parricide (reclusion perpetua to death) in article 246 and for murder (reclusion temporal in its maximum period to death) in article 248 shall be imposed upon any person who shall kill any child less than three days of age.

In medicine, birth is the entire delivery of a child with or without its separation from the body of the mother. It is not necessary that the cord should have been cut or the placenta expelled. It is the cessation of the symbolic relation between the mother and the fetus. Birth may be:

575

576 LEGAL MEDICINE

A. STILL-BIRTH:

When the child has not breathed or has not shown any sign of life after being completely born.

Causes of Still-birth:

1. Immaturity.

2. Congenital diseases or malformation.

3. General debilitating diseases:

a. Acute specific infection. b. Toxemia. c. Kidney disease. d. Acute liver disease. e. Septicemia.

4. Local disease of the generative organ:

a. Syphilis.

b. Ablatio placenta, intra-placental hemorrhage, or extensive infarction.

c. Kind of the cord. d. Placenta previa.

5. Accidents in the delivery:

a. Disproportion of the birth canal and the fetus. b. Injudicious forcep application. c. Prolapse of the cord or strangulation of the cord. d. Hemorrhage. e. Abnormal presentation. f. Influence of narcotics, anesthesia or intoxicating liquor. g. Puerperal insanity. h. Prolonged labor. i. Hasty parturition. j . Spasm of the larynx, k. Hemorrhage of the cord.

6. Violence, either deliberate or accidental at birth.

B. LIVE-BIRTH.

In live-birth the child after birth exhibited clear signs of vitality and viability is not necessary. In law, the presumption is every newborn child found dead was born dead. The burden of proof lies on those who declare otherwise. To have a child acquire personality distinct as that of the mother, there must be proof of life after complete separation from the mother's womb.

BIRTH 577

Proofs of Live-Birth:

1. Presence of Heart Action and Circulation:

The presence of heart sound when the new-born is examined by means of a stethoscope is a sign of life. Sometimes the pulse is imperceptible by palpation especially when the child suffered much during labor.

2. Movement of the Child and Crying:

The first instinct of the child after birth is restlessness and crying. Children born after severe and prolonged second stage of labor, may be too weak to move or cry. After a while, they begin to move and later cry upon application of bodily stimulus.

3. Presence of Respiration:

Proofs that respiration has taken place:

a. There is arching of the chest. b. Fall of the level of the diaphragm:

Before birth, the diaphragm reaches the level of the 4th or 5th rib, but if respiration has taken place, it reaches to the level of the 6th or 7th ribs. This test is not conclusive but merely corroborative.

c. Expansion of the lungs:

Appearance of the lungs if respiration has taken place:

(1) The lungs fill the thoracic cavity and overlapping the heart and thymus gland.

(2) The lungs are voluminous, with rounded edges and pink-mottled color.

(3) The surface is covered with mosaic of expanded air vesicles, giving a marble appearance.

(4) On pressure, they crepitate, and on section they exude froth.

Appearance of the lungs before respiration has taken place:

(1) The lungs are found at the back of the thoracic cavity behind the heart and thymus gland.

(2) The lungs are smooth, small, of a uniform dark blue-red color, with sharp edges and present the appearance of a piece of liver.

(3) When squeezed between the finger and thumb they do not crepitate.

(4) On section they appear solid and exude blood but not froth.

578 LEGAL MEDICINE

Hydrostatic Test (Fodere's Test; Static Test):

Hydrostatic test is one of the tests to determine whether respiration took place on a newborn child before death. This test is based upon the principle that the specific gravity of the lungs becomes less as a result of the introduction of air in the air passages and air sacs.

Procedure of the Test:

Remove the entire lungs from the thoracic cavity and immerse them in water en bloc. If it floats, it shows that air has been driven in and the child has breathed; but if it sinks, the air sacs are not expanded and therefore breathing has not yet taken place.

The lung is cut in small pieces and again placed in water. If it floats, air has entered into the air sacs.

Value of the Test:

The hydrostatic test is not conclusive that respiration took place when it is positive (when the lungs float) or when it is negative (when the lungs did not float), because there are several fallacies attached to the test.

However, it is corroborative to other existing evidences.

Fallacies of the Hydrostatic Test:

a. Unexpanded lung may float if the child is subjected to artificial respiration or if gases due to putrefaction are present, even if the child is born dead.

b. The child may have respired or breathed before it is completely born if the head is at the external os, or if the head protrudes on the outlet in head presentation, but dead at birth.

c. The child may have breathed, but the lungs may not float on account of disease (atelectasis), or from' imperfect respiration, or on absolute persistency of foetal condition.

d. The child may utter audible cry while inside the uterus or in the vagina. In cases of vagitus uterinus, the child is usually born dead but the lungs are perfectly expanded.

To differentiate a naturally expanded lung from an artificially expanded lung, it is necessary to know the level of the diaphragm. If due to natural breathing, the level of the diaphragm reached the level of the 6th or 7th rib, while if artificially expanded, it may reach only the 5th rib.

To differentiate whether the floating of the lungs is due to putrefaction, note the color, consistency and condition of the bubbles. In putrefaction, the lung is green, soft with bubbles at edges, while a naturally expanded lung is bright vermillion in color,

BIRTH 579

mottled appearance, bright-red alternating with bluish patches with air cells on surface in groups of four.

When is Hydrostatic Test Not Necessary:

Hydrostatic test is no longer necessary in the following instances because of the presence of stronger proofs of live-birth or still-birth.

a. When the fetus is born less than 180 days of intrauterine life.

b. When the fetus is a monster which is not capable of living a separate existence.

c. When the umbilical cord is separated and the umbilicus is cicatrized.

d. When the stomach on dissection contains coagulated or half-coagulated milk as a result of digestion.

e. When the fetus shows signs of intrauterine maceration.

Differences Between Unexpanded and Expanded Lung

Expanded Lung

a. Volume is greater and fills the chest cavity.

b. Edges are rounded and cover the thymus and heart.

c. Color is bright vermillion and lungs show mottled appearance with bright red part alternating with bluish patches.

d. Feels spongy and crepitant.

e. On section, blood stained frothy serum exudes on squeezing.

f. Absolute weight is 900-1,000 gms.

g. Hydrostatic test —Positive.

h. Microscopic examination shows expanded air sacs and with blood vessels engorged.

4. Examination of the Stomach and Intestine:

a. On opening the stomach of a still-born child, it contains only mucous, but after respiration, the stomach will contain mucous, air bubbles and saliva.

Unexpanded Lung

a. Volume is small.

b. Edges are more or less sharply projected beyond the thymus and heart.

c. Color is dark brown or uniform purplish gray with no mottling.

d. Feels solid.

e. On section, a very little blood exudes.

f. Absolute weight is 450-650 gms.

g. Hydrostatic test — Negative.

h. Microscopic examination shows collapsed air sacs.

580 LEGAL MEDICINE

The normal content before birth is albuminous substances and mucous. The presence of sugar, starch or milk indicates live-birth.

b. Stomach-Bowel Test or Floatation Test or Breslau's Second Life Test:

Ligate the cardiac end of the stomach and the lower end of the intestine and remove. Place the whole mass of organs in water. If the organs float, breathing has taken place. Dip the organs under water and open the stomach and intestine. Note the liberation of air bubbles going up the surface of the water, if breathing has taken place.

5. Changes in the Middle Ear (Wredin's Test):

The middle ear of a child before birth is filled with gela-tinuous, embryonic connective tissue. This disappears after the birth of the child.

6. Condition of the Skin:

The skin of a newly born infant is bright red in color. This gradually changed to a lighter one. In 2 to 4 days, it darkens to brick-red, but may be yellow due to physiological jaundice. The normal appearance of the skin appears after a week.

7. Marks of Violence:

Violence applied to a child while living will show some degree of vital reactions. Such reaction will not be seen in cases of still-birth.

8. Changes in the Umbilical Cord:

The portion of the cord attached to the skin of the child begins to shrink and dry within 12 to 24 hours. There is inflammatory redness of the base from 36 to 48 hours. By the second or third day it shrivels up, mummifies, and falls on the fifth or sixth day. The healed cicatrix is seen within 10 to 12 days.

Pulsation seen or felt in the cord indicates live-birth. In 12 to 24 hours it dries and slowly becomes shrivelled in 3 to 5 days%ind the cord separates with cicatrization of the wound. The surrounding skin shows capillary congestion. The ring of inflammation around the site is an evidence of life of at least 36 hours duration. The wound heals in 2 or 3 days and the scar develops within 10-12 days.

Prolonged soaking of mummified umbilical cord can cause it to swell but not to return to its natural condition. If the child and the cord are submerged in a body of water after birth the cord will undergo liquifaction on account of decomposition.

BIRTH 581

9. Condition of the Heart and Blood Vessels:

Ductus arteriosus closes within 3 days. Ductus venosus also closes within 3 days after birth. The foramen ovale may close on the second or third month.

Proof of Live-Birth can be deduced in the following:

1. Well-developed signs of breathing. 2. Presence of air or food in the stomach. 3. Changes having taken place in the region of the umbilicus.

If Born Alive, How Long Did the Child Survive?

It is not possible to determine the exact length of time the child has lived after birth, but an approximate idea may be formed after consideration of the following points:

1. Changes in the Skin:

At birth the body of the new-born child is bright-red in color and covered with vernix caseosa which may be present up to two days. The normal color of the skin is resumed after a week's time. The exfoliation of the skin in the abdomen occurs on the first three days after birth.

2. Presence of Caput Succedaneum:

The caput succedaneum when present shows that the child was born with head presentation. There are color changes in the course of its absorption. The caput used to last up to the seventh day.

3. Changes in the Umbilical Cord:

The mummification of the cord does not occur if the child is submerged in water after birth. An already mummified cord may again become soft after continuous soaking in water.

4. Changes in the Circulation:

The umbilical artery begins to contract at about ten hours after birth. The umbilical vein and the ductus venosus obliterate on the 4th or 5th day and the ductus arteriosus on the 3rd day. The foramen ovale closes on the second or third month.

Signs of Maturity of the Child at Birth:

1. Length of the fetus — 50 centimeters. 2. Weight - 3.0 kilos. 3. Lanugo hair almost disappeared. 4. Limbs and body plump. 5. Face lost its wrinkles. 6. Skin covered with vernix caseosa. 7. Head covered with hair about 2 inches long.

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8. Nails project from the fingers but the toe-nails reach only to the end.

9. One or both testes are in the scrotum, or labia have close the vulva.

10. Lower end of femur may show center of ossification about 0.6 cm. in diameter.

(Gradwohl's Legal Medicine by Camps, 3rd ed., p. 416).

Chapter XXVI

/ I N F A N T I C I D E (Neonaticide)

InpaHticide is the killing of a child less than three days old.

Art. 255, Revised Penal Code, Infanticide:

The penalty provided for parricide in article 246 and for murder in article 248 shall be imposed upon any person who shall kill any child less than three days of age.

Jf the crime penalized in this article be committed by the mother of the child for the purpose of concealing her dishonor, she shall suffer the penalty of prision correccional in its medium and maximum periods, and if said crime be committed for the same purpose by the maternal grandparents or either of them, the penalty shall be prision mayor. '

If the~killing was done by the parents, grandparents or other direct ascendants, or either of them, the penalty to be imposed is the same as that of__parricide. However, if the killing was done by any other person, the penalty is the same as that of murder.

Lenient penalty is to be imposed when the killing was done by the mother or by the maternal grandparents, or either of them for the purpose of concealing her dishonor.

Problems:

lylnfancy is the period in the life of a child from birth up to one year.. Thereafter, it is called _childhood. This distinction is made on account of physiologic changes undergone by the child during infancy and childhood. Why is the crime of infanticide applied only to the killing of less than a three-day-old infant rather than within the first year of the life of the child?

2. During the process of delivery when the head and neck of the child are already out of the birth canal and the child has breathed spontaneously through the lungs, the child was deliberately put to death before expulsion of the other parts of the body. What crime was committed by the offender? The child was not yet capable of independent existence inasmuch as placental circulation was still maintained. Ideally it is foeticide, but it is not a crime in the Philippines. Can it be considered infanticide?

3. A child was born less than 7 months of uterogestation. Under ordinary condition, considering prematurity and underdevelop-

583

584 LEGAL MEDICINE

ment, there is more chance for the child to die, but with modern neonatal management the child had all the chances to live.

A few hours after birth the child was deliberately killed. Is the killing a case of infanticide? According to Art. 41, Civil Code . . If the foetus had an intra-uterine life of less than seven months, it is not deemed born if it dies within twenty-four hours after its complete delivery from the maternal womb", and birth determines personality. Can the crime of infanticide be committed on someone who is not yet a person as contemplated by law?

Motives for Committing Infanticide:

1. To conceal dishonor especially when there is no reason for her to give birth to a child. She may be single, widowed, estranged from the husband or living separately where access is not possible.

2. Financial reason — An added member to the family may cause increased financial burden. Care of the child may prevent the mother to pursue her means of livelihood.

3. Desired number of children has already been attained. Infanticide is made as a substitute for ineffective family planning.

4. Congenital abnormality of the child.

5. Parent is suffering from mental abnormality.

6. Belief that the child will bring bad luck to the family.

Criminological Characteristics:

1. It is most often committed by the mother.

2. The criminal act is almost always committed in the home.

3. The crime scene shows no manifest disturbance, no witnesses and no noise or outcry.

4LThe trauma applied is so minimal that when applied to an adult it will not even produce lethal effect.

5. A newly born child found dead was born dead. The burden of proof that a living child has been killed is placed on the prosecution.

Type of Evidences in Infanticide:

In cases of alleged infanticide the prosecution must show the following proofs:

1. That the child was born alive.

2. That the child was deliberately killed.

3. That the child killed was less than three days old.

INFANTICIDE 585

How the Crime of Infanticide is Committed:

The crime of infanticide may be committed in two ways^JKimely:

1. By omission or neglect:

a. Failure to ligate the umbilical cord:

If the umbilical cord is not ligatecUafter it is cut, the child may bleed to death. Fatal hemorrhage may also occur, if the

cord is not tightly ligated.

ifTFailure to protect the child from heat and cold:

The exposure of the child to heat and cold may cause the death of the child without leaving any mark of violence. This is usually done by depriving the child of necessary clothings.

Failure to take the necessary help of a midwife or a skilled

physician.

dr. Failure to supply the child with proper food:

The child may be deliberately starved to death. The stomach

and intestine must be examined'for the presence of food,

e. Failure to remove the child from the mother's discharge which resulted to suffocation.

2. By Commission:

a. Inflicting physical injuries:

A person with the use of kitchen utensils or any other hard or sharp objects may traumatize a child.

b. Suffocation:

The face of the child may be pressed into some soft tissues like a bed-sheet or a pillow.

c. Strangulation: This is commonly made by placing a tight cord or rope

around the neck. Manual strangulation is also common.

d. Drowning:

The child may be disposed of in a sewerage disposal in a creek, or in a deeper body of water with weight attached to the body to prevent floating.

e. Poisoning: Denatured alcohol, tincture of iodine, or any other drugs

which form a part of the household-remedies may be administered to the child. A thorough examination of the gastro-intestinal tract for irritation and an examination of the organs and its contents by a toxicologic are necessary to determine the kind of poison and the quantity taken.

586 LEGAL MEDICINE

f. Burning:

This form of killing an infant is not common. This may be resorted to with the simultaneous burning of the dwelling place to conceal offense.

g. Deliberate exposure to heat or cold:

The child may be exposed to direct sunshine or may be placed in a basin of cold water until death.

Post-mortem Findings in Cases of Infanticide:

1. Complete examination of the skin surfaces may show presence of marks of physical violence in the form of fingernail marks especially at the neck. There may be other forms as abrasion, contusion, hematoma, or lacerated wounds; ligature or pressure marks on the neck.

2. Examination of the mouth and upper portion of the alimentary tract may show signs of irritation if death is due to poisoning.

3. Laceration or other forms of injury of the upper portion of air passage with deformity of the trachea and larynx.

4. The lungs may show petechial hemorrhages, emphysema, or signs of drowning.

5. There may be fracture of the bones, laceration of the internal organs, cerebral hemorrhages, etc.

6. In cases of poisoning, the organs must be preserved and sent to a competent toxicologist for proper analysis.

Chapter XXVII

PATERNITY AND FILIATION

Paternity is the civil status of the father with respect to the child begotten by him. Filiation is the civil status of the child in relation to its mother or father (2 Sanchez Roman 952),

Legal Importance of Detemining Paternity and Filiation:

1. For Succession:

In legal succession, the right of the legitimate children is different from that of the illegitimate children. The law give more rights in the property of the deceased parent to legitimate children.

2. For Enforcement of the Naturalization and Immigration Laws:

Naturalized citizens give "ipso facto" Philippine citizenship to their minor children at the time of their naturalization under certain qualifications. Thus, the* minors, in order to avail themselves of the effects of naturalization, must prove that they are legitimate children of the naturalized citizen at the time of naturalization.

A minor child of a naturalized or permanent resident alien may be given the right to land into our shores upon proofs that such minor is a legitimate child of a naturalized Filipino or that of a permanent resident alien.

Kinds of Children:

A. Legitimate Children:

1. Legitimate children (proper). 2. Legitimated children. 3. Adopted children.

B. Illegitimate Children:

1. Natural Children:

a. Natural children (proper). b. Natural children by presumption. c. Natural children by legal fiction.

2. Spurious Children:

a. Adulterous children. b. Incestuous children. c. Manceres children. d. Sacrilegious children.

588 LEGAL MEDICINE

A. LEGITIMATE CHILDREN

A legitimate child is one who is born in lawful wedlock, or within a competent time afterwards.

1. Legitimate Children (Proper):

Legitimate children (proper) are those who were born in lawful wedlock or within 300 days after the dissolution of marriage. Presumption of legitimacy:


Children born after one hundred and eighty days following the celebration of the marriage, and before three hundred days following its dissolution or the separation of the spouses shall be presumed to be legitimate.

Against this presumption no evidence shall be admitted other than that of the physical impossibility of the husband's having access to his wife within the first one hundred and twenty days of the three hundred which preceded the birth of the child.

The physical impossibility may be caused by:

(1) The impotence of the husband;

(2) The fact that the husband and wife were living separately in such a way that access was not possible; and

(3) By the serious illness of the husband.

Requisites of the presumption:

a. There is a valid marriage.

b. The birth of the child took place after 180 days following the celebration of marriage or within 300 days following its dissolution or separation of the spouse.

c. There is no physical impossibility of the husband having access to the wife during the first 120 days of the 300 days preceding the birth of the child.

The presumption of legitimacy under Art. 255, Civil Code is conclusive:

The presumption of legitimacy above-mentioned (Art. 255, Civil Code) is conclusive because:

a. Sec. 4(a) of Rule 131 of the Rules of Court is a repetition of Art. 255 of the Civil Code.

Sec. 4, Rules of Court — Quasi-conclusive presumptions of legitimacy:

(a) Children born after one hundred eighty days following the celebration of marriage, and before three hundred days

PATERNITY AND FILIATION 589

following its dissolution or the separation of the spouses shall be presumed legitimate.

Against this presumption no evidence shall be admitted other than that of physical impossibility of the husband's having access to his wife within the first one hundred and twenty days of the three hundred which preceded the birth of the child.

b. The presumption in Art. 255, Civil Code is not qualified, while the presumptions in Art. 257, 258 and 259 of the same code qualified the presumption to be "prima facie" which infer that the presumption under Art. 255 is conclusive.

Children born after 180 days following the celebration of marriage:

a.JExample:

A and B were married in Jan.l, 1980. A child was born after 180 days following their marriage. If there is no impossibility of access between A and B, the child is conclusively presumed to be legitimate.

The law considers that in order that a child beviable, it must have at least 180 days of development from fertilization to birth. Ar child born before 180 days after the celebration of marriage is not viable, it must have been brought about by a sexual act which occurred before the celebration of marriage. A child born before 180 days following the celebration of marriage is premature and underdeveloped to withstand external environment. - -

Child born within 300 days following its dissolution or separation of spouse:

a. Example:

A and B are legally married. On Jan. 1,1980, B, the husband died. 230 days after A became a widow, a child was born. The child is conclusively presumed to be legitimate insofar as the deceased husband provided there was no physical impossibility of access between A and B during the latter's lifetime.

b. Reason for the presumption: The law based on medical science considers 300 days as the

length of uterine development of a child. Normally, it is 280 days as the period of utero-gestation. But, it is not uncommon for pregnancy to be prolonged up to 300 days or even more, although there may be signs of post-maturity. To include those

h/Reason for the presumption:

590 LEGAL MEDICINE

children who may be born more than the average duration of utero-gestation, the law extended the limit to 300 days.

M was married with X on September 28, 1944. The husband, M, died on October 11, 1944. A child was born on April 24, 1945 or 208 days after the celebration of marriage and within 300 days following its dissolution. There being no showing that M is impotent, the court held that the child born is conclusively legitimate (Menciano v. Neri San Jose, G.R. No. L-1967, May 1951).

Only evidence sufficient to rebutt the above presumption:

That there is "physical impossibility of the husband's having access to his wife within the first one hundred and twenty days of the three hundred days which preceded the birth of the child."

Example:

(1) A and B were married and 7 months after marriage a child was born. Considering that each month has thirty days, the child is considered legitimate if, anytime three months before up to one month after the marriage, there was possibility of access between A and B.

(2) A and B were legally married. Six months after A became a widow, a child was born. The child is presumed to be legitimate if B, the husband had access with his wife during the four months period before his death. If during the whole period of four months before he died he was living in a far distant place whereby access was not possible, then the child is not his own.

.Causes of physical impossibility:

(1) By the impotence of the husband.

(2) By the fact that the husband and wife were living separately, in such a way that access was not possible.

(3) By the serious illness of the husband (Art. 255, Civil Code).

The impossibility of access must not be construed in its literal sense. It means inability to perform sexual intercourse.

Impotency of the husband must be present during the first 120 days of the 300 days preceding the birth of the child. It must be an absolute impotency and not a relative one. It must be complete not partial.

The serious illness suffered by the husband must occur during the period of conception of the child. Serious illness means such condition which will prevent the husband to perform sexual act with his wife. The fact that the husband is suffering from tuberculosis does not prevent him from performing the


carnal act. The reputation of the tuberculosis towards eroticism (sexual propensity) is probably more dependent upon confinement than the consequences of the disease (Andal V Macaraig, G.R No. L-2474).


A child born within one hundred eighty days following the celebration of marriage is prima facie presumed to be legitimate. Such a child is conclusively presumed to be legitimate in any of these cases:

(1) If the husband, before the marriage, knew of the pregnancy of the wife;

(2) If he consented, being present, to the putting of his surname on the record of birth of the child; and

(3) If he expressly or tacitly recognized the child as his own.

Prima facie means the presumption is true and correct unless it can be shown by other proofs to the contrary.

A husband who knew of the existence of pregnancy of his wife before marriage and still married her, impliedly shows that he is the author of such pregnancy. If he is not responsible for such pregnancy, then he waived his right to contest its legitimacy.

The consent of the husband to place his surname on the record of birth of the child is also a recognition that the child is his own. A man with a normal sense will not allow his surname be attached to one with a blood foreign to his.

Expressed recognition may be made by the father of the child by telling other people that the child is his legitimate child. Tacit or implied recognition may be made by inference from the acts of the husband wherein recognition may be deduced. Allowing the child to live in the conjugal dwelling, giving the necessary support, furnishing the child of his daily needs imply that the child is his own.

Recognition shall be made in the record of birth, a will, a statement before a court or record, or in any authentic writing (Art. 278, Civil Code).

Art. 256, Civil Code: The child shall be presumed legitimate, although the mother

may have declared against its legitimacy or may have been sentenced as an adulteress.

Reasons for the provision: a. The status of a child must not be left at the mercy or the

passion of the parents. A wife may while in the fit of her

592 LEGAL MEDICINE

anger declare that the child is not that of the husband although it is not true.

b. The husband may connive with the wife and let her declare the child as illegitimate and thus decrease his right over the properties of the husband.

c. Between legitimacy and illegitimacy, the law is in favor of legitimacy. A child must not be punished by the wrongful acts of his parents.

Presumption of illegitimacy based on ethnic reasons: Art. 257, Civil Code:

Should the wife commit adultery at or about the time of the conception of the child, but there was no physical impossibility of access between her and her husband as set forth in article 255, the child is prima facie presumed to be illegitimate if it appears highly improbable, for ethnic reasons, that the child is that of the husband. For the purposes of this article, the wife's adultery need not be proved in a criminal case.

Example:

A and B, both white-Americans were legally married. During the period of conception for the child C, the wife had an illicit relation with X, a negro. The child born has dark skin, wiry and curly hair and with thick lips. There is no ancestor in A and B who is negro. The child C is prima facie presumed illegitimate.

Marriage of women within 300 days following death of husband, annulment of marriage or other forms of marital dissolution: Art. 84, Civil Code:

No marriage license shall be issued to a widow till after three hundred days following the death of her husband, unless in the meantime she has given birth to a child.

The Revised Penal Code penalizes a widow re-marrying before the expiration of 301 days following her widowed: Art. 351, Revised Penal Code — Premature marriages:

A widow who shall marry within three hundred and one days from the date of the death of her husband, or before having delivered if she shall have been pregnant at the time of his death, shall be punished by arresto mayor and fine not exceeding 500 pesos.

The same penalties shall be imposed upon any woman whose marriage shall have been annulled or dissolved, if she shall marry before her delivery or before the expiration of the period of three hundred and one days after the legal separation.


The purpose of the above provisions of law is to prevent disputed paternity of the child born after the subsequent marriage celebrated within the three hundred days following the dissolution of the first marriage.

However, where deceased husband was proven to be impotent or sterile, the widow who contracted a premature marriage was not held criminally liable (People v. Masinsin, C.A. G.R. 9157, June 1953).

Presumption of legitimacy if the widow marries within three hundred days following the death of the husband: Art. 259, Civil Code:

If the marriage is dissolved by the death of the husband, and the mother contracted another marriage within three hundred days following such death, these rules shall govern:

(1) A child born before one hundred eighty days after the solemnization of the subsequent marriage is disputably presumed to have been conceived during the former marriage, provided it be born within three hundred days after the death of the former husband;

(2) A child born after one hundred eighty days following the celebration of the subsequent marriage is prima facie presumed to have been conceived during such marriage, even though it be born within the three hundred days after the death of the former husband.

Example of No. (1):

A widow married 100 days after the death of her first husband. A child is born 175 days after the celebration of the second marriage. The child is disputably presumed to be legitimate insofar as the first husband because the child is born within 180 days following the celebration of the second marriage and within 300 days after the death of the first husband.

Example of No. (2) :

A widow married 80 days after the death of the first husband. A child is born 200 days after the celebration of the second marriage. The child born is prima facie presumed to be legitimate child of the second husband because the child was born after 180 days following the celebration of the second marriage.

Flaw of the presumption: A widow married 50 days after the death of the first husband.

A child was born 200 days following the celebration of the second marriage. Following the provision of the presumption, the child

594 LEGAL MEDICINE

is legitimate insofar as the second husband. But the child is born only 250 days after the death of the first husband. It is possible that the widow was pregnant for one month at the time of death of the first husband, yet the presumption made the child prima facie legitimate as that of the second husband.

Duty of a woman after annulment of marriage when she becomes a widow and pregnant: Art. 260, Civil Code:

If after a judgment annulling a marriage, the former wife should believe herself to be pregnant by the former husband, she shall, within thirty days from the time she became aware of her pregnancy, notify the former husband or his heirs of that fact. He or his heirs may ask the court to take measures to prevent a simulation of birth.

The same obligation shall devolve upon a widow who believes herself to have been left pregnant by the deceased husband, or upon the wife who believes herself to be pregnant by her husband from whom she has been legally separated. — .

The Revised Penal Code impose penalty for simulation of birth and usurpation of the civil status: Art. 347, Revised Penal Code — Simulation of births, substitution of one child for another and concealment or abandonment of a legitimate child:

The simulation of births and the substitution of one child for another shall be punished by prision mayor and a fine of not exceeding 1,000 pesos.

The same penalties shall be imposed upon any person who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status.

Any physician or surgeon or public officer who, in violation of the duties of his profession or office, shall cooperate in the execution of any of the crimes mentioned in the two next preceding paragraphs, shall suffer the penalties therein prescribed and also the penalty of temporary special disqualification.

Usurpation of Civil Status:


The penalty of prision mayor shall be imposed upon any person who shall usurp the civil status of another, should he do so for the purpose of defrauding the offended party or his heirs; otherwise, the penalty of prision correccional in its medium and maximum periods shall be imposed.


Child born after 300 days following dissolution of marriage or separation of the spouse: Art. 261, Civil Code:

There is no presumption of legitimacy or illegitimacy of a child born after three hundred days following the dissolution of the marriage or the separation of the spouses. Whoever alleges the legitimacy or the illegitimacy of such child must prove his allegation.

2. Legitimated Children:

Legitimation is defined as a remedy or process by which a child born out of lawful wedlock and are therefore considered illegitimate are by fiction of law considered legitimate by subsequent valid marriage of the parents.


Legitimation shall take place by the subsequent marriage between the parents.


Children who are legitimated by subsequent marriage shall enjoy the same rights as legitimate children.

Children can be legitimated:

a. Natural children (proper):

Natural children are those born outside lawful wedlock of parents who, at the time of the conception of the former, were not disqualified by any impediment to marry each other (Art. 269, Civil Code).

Example:

A and B are both single and are of age. There are no other impediments for them to marry one another. Although unmarried, they had sexual intercourse and as a result of which a child is born. The child is considered to be natural.

If the child is acknowledged by the parents to be then-own, then the child becomes an acknowledged natural child, and if the parents after acknowledgement subsequently married one another, the child becomes a legitimated child.

Requisites for legitimation of natural child (proper):

a/The child must be natural. b/The child must be acknowledged by both parents before mar

riage. c^There must be subsequent marriage of the parents.

596 PATERNITY AND FILIATION

3. Adopted Children:

Adoption is defined as the act or proceeding by which relations of paternity and filiation are recognized as legally existing between persons not so related by nature. The purpose of adoption is to establish a relationship of paternity and filiation and to afford persons who have no child of their own consolation of having one by legal fiction. The child wherein paternity and filiation is established is an adopted child and with all the legal rights as a legitimate child in relation to the adopting parents.

Persons who may be adopted:

a. The natural child, by the natural father or mother;

b. Other illegitimate children, by the father or mother;

c. A step-child, by the step-father or step-mother (Art. 338, Civil Code); and

d. Any person, even if of age, provided the adopter is sixteen years older (Art. 337, Civil Code).

Persons who cannot be adopted:

a. A married person, without the written consent of the other spouse;

o. An alien with whose government the Republic of the Philip

pines has broken diplomatic relations; and

c. A person who has already been adopted (Art. 339, Civil Code).

Persons who may adopt:

a. Every person of age, who is in full possession of his civil rights. (Art. 334, Civil Code)

Persons who cannot adopt:

a. Those who have legitimate, legitimated, acknowledged natural children or natural children by legal fiction;

b. The guardian, with respect to the ward, before the final approval of his accounts;

c. A married person, without the consent of the other spouse;

d. Non-resident aliens,

e. Resident aliens with whose government the Republic of the Philippines has broken diplomatic relations, and

f. Any person who has been convicted of a crime involving moral turpitude, when the penalty imposed was six months' imprisonment or more (Art. 335, Civil Code).


B. ILLEGITIMATE CHILDREN

Illegitimate children are those who were born out _of lawful wedlock or after a competent time after its dissolution.

1. Natural Children:

a. Natural Children (Proper):

Natural children are those born outside wedlock of parents who, at the time of the conception of the former, were not disqualified by any impediment to marry each other (Art. 269, Civil Code).

b. Natural Children by Legal Fiction:

Natural children by legal fiction are those children born of void marriages or those born of voidable marriages after the decree of annulment.

Example:

A was married with B, his own step-daughter. The marriage is void. A child was born thereafter. The child is natural by legal fiction.

c. Natural Children by Presumption:

Natural children by presumption are those natural children acknowledged by the father or the mother separately if the acknowledging parent was legally competent to contract marriage at the time of conception (Borres and Barza v. Mun. of Panay, 42 Phil. 643).

Example:

A, a married woman who is living separately from his husband, had an illicit relation with B. The child born has been recognized by B to be his own. The child is considered to be natural by presumption.

2. Spurious Children: Illegitimate children who are not natural are considered spurious.

Spurious children may be:

a. Adulterous Children: These are children conceived in an act of adultery or con

cubinage.

b. Sacrilegious Children:

These are children born of parents who have been ordained in sacris. In civil law, there is no such kind of illegitimate children because a priest or a nun can marry. There is no impediment in law for them to marry. It is only the regula-

598 LEGAL MEDICINE

tion of the church that prohibits it. In the Philippines, there is separation between the church and the state.

c. Incestuous Children:

These are children born by parents who are legally incapable of contracting valid marriage because of their blood relationship as marriage between brothers and sisters, father and daughter, etc..

d. Manceres:

These are children conceived by prostitutes. It is very difficult to determine the father because of the nature of the business.

Civil Liability of Persons Guilty of Crimes Against Chastity: Art. 345, Revised Penal Code:

Persons guilty of rape, seduction or abduction shall also be sentenced:

1. To indemnify the offended woman.

2. To acknowledge the offspring, unless the law should prevent him from so doing.

3. In every case to support the offspring.

The adulterer and the concubine in the case provided for in articles 333 and 334 may also be sentenced, in the same proceeding or in a separate civil proceeding, to indemnify for damages caused to the offended spouse.

In cases of multiple rape, when three persons, one after another raped a woman, the offenders may not be required to recognize the offspring as it is impossible to determine the paternity of the child (People v. Pedro de Leon, et. al, G.R. No. L-2094).

If the woman abused is married, the child born subsequently cannot be recognized by the offender (People v. Sanico, C.A. 46 O.G. 98) and if the woman who was raped was married and pregnant, the child born thereafter cannot be recognized and support cannot be demanded from the offender. The reason behind is that to allow the offender to give support and recognize the offspring will allow the offender to periodically visit the home of the offended party in order to comply with his duty and it will enhance disturbance in the family who are living in peace and tranquility (U.S. v. Yambao, 4 Phil. 204).


E V I D E N C E O F P A T E R N I T Y A N D F I L I A T I O N

A. Medical Evidences:

Is Parental Likeness:

Heredity transmits traits and characteristics from parents to the offsprings. There must be some gross manifestation of the children which may be in common with the father.

The following points may be considered by the examining physician to determine physically whether paternity and filiation exists between persons in question:

a. General feature p. Gait, speech, and movement b. Manner of gesture fr Color and texture of the hair c. Personal peculiarities gc Color of the eyes di Personal deformities K. General built and size

2. Blood Grouping Test:

The fact that the blood type of the child is a possible product of the parents, does not conclusively show that the child is born by such parents. But, if the blood type of the child is not the possible blood type when the blood of the parents are cross-matched, it shows definitely that the child is not that of the husband. A positive result is not conclusive, but a negative result is conclusive.

3. Evidences from the Mother:

a. Proofs of Previous Delivery:

The supposed mother may be subjected to an examination to determine the presence of signs of previous childbirth and which are compatible with the age of the child.

b. Proofs of Physical Potency and Fertility:

Although it is difficult to determine the physical potency in women inasmuch as a woman is a passive subject to a sexual act, the woman may be manifesting some acquired or congenital defect wherein impotency may be inferred. Atresia of the vaginal canal, imperforate hymen, etc. may be present. Fertility may be inferred from the presence of other pregnancies and the absence of organic abnormalities of the generative system.

c. proof of Capacity to have Access with the Husband: A general physical examination of the woman is necessary

to determine whether she is physically capable of having sexual intercourse with her husband.

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4. Evidences from the Father:

a. Proof of Physical Potency and Fertility:

Medical examination must be done whether the husband is capable of erection. A quantitative and qualitative examination of spermatozoa in the seminal fluid is necessary to determine fertility. The presence of disease, congenital or acquired abnormalities, etc. may be factors that may bring about impotency or sterility.

b. Proof of Access:

The physician must determine the health and vigor of the father, the presence of disease, which may bring about his incapacity to perform sexual intercourse.

B. Non-medical Evidences:

1. Record of birth in the Civil Registrar, or by an authentic document or a final judgment (Art. 265, Civil Code).

2. Continuous possession of the status of a legitimate child (Art. 266, Civil Code).

3. Any other evidences allowed by the Rules of Court and special laws (Art. 267, Civil Code).

Chapter XXVffl

PATERNITY AND FILIATION ON NON-CONVENTIONAL METHODS OF PROCREATION

The standard method of reproduction is the introduction of the male sperm into the generative organ of a female through sexual intercourse followed by fertilization, growth and development of the conceptus and its subsequent delivery. No technical manipulation or medication is employed as it is a physiologic process.

However, modern advancement of medicine modified the conventional method as a solution to some specific problems of reproduction. Artificial Insemination and In Vitro Fertilization as a modality of management has gone beyond the experimental stage of procreation and now recognized and used to solve problems. Other methods are still in their experimental stage and whatever problems (medical, legal or moral) that may develop will depend and will be solved in the future.

A. ARTIFICIAL INSEMINATION

Artificial insemination is a medical procedure by which the semen is introduced into the vagina by means other than copulation for the purpose of procreation. Some physicians consider the term "therapeutic insemination" as a more suitable term for the procedure (Sagall).

Artificial Insemination Classified According to the Source of Semen: 1. A.I .H. (Artificial Insemination Homologous, Artificial Insemination

Husband) — When the sperm comes from the husband.

2. A .I .D . (Artificial Insemination Donor, Artificial Insemination Heterologous) — When the sperm comes from a donor other than the husband.

3. A.I .H.D. (Artificial Insemination Husband Donor, Polled Donor Semen) — When the donor semen comes from the husband and a third party donor.

Medical Indications for Artificial Insemination :

1. For A.I.H.: a. When the deposition of the husband's semen within the vagina is

by coitus, this is prevented because of anatomic or psychologic

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602 LEGAL MEDICINE

difficulties on the part of either husband or wife;

b. When the infertility is due to poor motility, paucity or otherwise defective sperm cells or too small a volume of the ejaculant.

2. ForA.I.D. or A.I.H.D.:

a. Absolute male sterility (Azoospermia);

b. Oligospermia — Less than 10 to 15 million sperm per cc. of semen with infertility of long duration;

c. Hereditary disease in the husband making propagation inadvisable for eugenic reason; or

d. An Rh blood incompatibility is expected to cause an abnormal baby in situations where other techniques to overcome such incompatibility are not applicable.

Selection of Donor of Semen:

In A.I .D. the selection of the appropriate donor of semen resides in the physician. If the child born becomes defective which can be traced from a physician's negligence or carelessness in choosing the donor, the physician may be held liable.

The following are the obligations imposed on a physician in the selection of donors:

1. Proper screening must be made of the donor including chromosomes for genetic defects.

2. The donor must have the racial characteristic and physical proportion as those of the husband and wife and the blood type must be compatible with A . B . O . and Rh genotype of the wife.

3. The physician must ensure that the identity of the donor is not known to the parents and vice versa.

4. Complete physical examination with standard test for syphilis and gonorrhea is obtained not more than one week before the seminal fluid is collected.

Precautions to be Observed by the Physician in Performing Artificial Insemination:

1. The physician should make certain by reasonable testing that the procedure is medically indicated for the couple who has requested conception by this method. The husband is infertile and such condition is permanent.

2. The physician should establish by proper evaluation that the couple requesting artificial insemination is emotionally stable and psychologically suited for this type of parenthood, which carries with it the responsibilities of the very presence of the child. This

NON-CONVENTIONAL METHODS OF PROCREATION 603

will constantly attest to both partners and the husband's incapacity for biologic fatherhood.

3. The physician must use all reasonable precautions in selecting the donor; with thorough medical, psychologic and social screening to exclude donor with potential transmissible undesirable traits, features and details.

4. The physician must, under no circumstances except by court order, reveal the fact of artificial insemination or 'the identity of the donor or of the couple to each other or to other persons.

5. The physician must use freshly donated sperm or frozen semen that has been prepared and stored according to currently accepted methods with the source properly identified.

6. The insemination procedure must be performed by the physician in accordance with the currently accepted techniques.

7. Full and valid consents and releases should be obtained in writing from all parties involved, and each consent must be an "informed consent," particularly on the part of the prospective parents, who should be fully appraised of the psychologic and legal complication and the possibility of the birth of a defective child (Legal Medicine Annual 1973 by C. Wecht, p. 483).

Status of the Child Born by Artificial Insemination:

Artificial insemination as a remedy for reproductive infertility has been developed and recognized recently. The issue as to the status of the children born as a consequence of artificial insemination has never been brought squarely in our court. The following may be the possible status of the child born as a consequence of artificial insemination :

1. In A.I .H. , there is no doubt that the child is a legitimate child of the husband because the semen came from him. No foreign blood is introduced into the family.

2. In A.I .D. , with the consent of the husband, the child born must also be considered legitimate although the fertilization semen is not from the husband. His consent to the artificial insemination may be considered as a waiver to the illegitimate status of the child. Even if the child is considered illegitimate, the child can be adopted by him making the child's status legitimate.

3. In A.I .D. , without the consent or if it is against the will of the husband, the child must be considered illegitimate, specifically a child born because of adultery. This is an intrusion into the conjugal home of a foreign element against the will of the husband.

If the child is considered born because of adultery, did the wife commit adultery? Adultery is committed by "having sexual

604 LEGAL MEDICINE

intercourse with a man not her husband", but there is no sexual intercourse in artificial insemination and therefore no such crime is committed by the wife.

There are different ways a wife can commit adultery, like if she lies side by side with a man, kissing him, embracing and doing lascivious acts. But, the only lascivious act punishable by law is when sexual intercourse was done.

Consent on A. L D.:

In A.I .D. the consent and release for any future claim must be obtained by the physician from all parties in writing.

The consent of the wife is necessary to avoid being held liable for an assault.

The consent of the husband is necessary to avoid the wife being charged with adultery, or to ward the question of legitimacy of the child, issues of divorce, separation or inheritance.

The consent and release of the donor should be obtained for the unrestricted use of the semen supplied and he should also certify in writing that he will make no effort to ascertain the identity of the couple involved. If the donor is married, the consent of the wife must also be obtained to the giving of semen because her marital interest may be affected by the donation.

Foreign Court's Decisions:

Child born by artificial insemination without the consent of the husband constitutes adultery:

A woman attempted to obtain alimony from her divorced husband. The latter contended that his former wife committed adultery because the child born is not his biological child. The former wife claimed the child to he a product of artificial insemination. The court held that the artificial insemination without the husband's consent constitutes moral turpitude and adultery with the latter being defined as "the voluntary submission to another person of the reproductive powers or faculties of guilty person" (Osford v. Osford, 68Dom Law Reports, 251 Ont. Sup. Ct. 1921).

The British House of Lords concurred with a ruling that the conception of a child by a man other than the husband constituted adultery and that, therefore, the resulting offspring was illegitimate (Russel v. Russel, A.C. 687 (1924) at 148). Child born by artificial insemination is legitimate:

In a decree to a separation previously granted by the court, the husband was granted to have a weekend custody of the child born during the marriage. The wife petitioned for an amendment of the

NON-CONVENTIONAL METHODS OF PROCREATION 60S

decree arguing that because the child has resulted from A.I .D. , the husband is not the father of the child and therefore he is not entitled to visitation right. The court, however, predicted on the assumption that the procedure had been performed with the consent of the husband, rules that "the child has been potentially adopted or semi-adopted by the defendant and with the particular reference to visitation, he is entitled to the same right as those to which a natural parent under the circumstances would be entitled (Strand v. Strand 78N.Y.S. 2d 390(1918).

In an action for a divorce, the Wife alleged that her husband had no visitation right since the child had been conceived from a donor sperm. The court upheld an axiomatic legal principle: "When a child is born within marriage by whatever legal method, there is legal presumption that both marriage partners are its parents (Ohlson v. OhlsonNo. 54, S. 138, 875 (Super. Ct. Cook Country, Sept. 1955). Child born by artificial insemination is illegitimate:

The trial judge granted the divorce but denied the husband of visitation rights and the custody of an A. I .D . child declaring that "Heterologous artificial insemination", with or without the consent of the husband, is contrary to public policy and good morals, and constitutes adultery on the part of the mother. A child so conceived is not a child born in wedlock and therefore illegitimate. As such, the mother and the father have no rights or interests of the said child (Dornbus v. Dornbus, No. 51, S. 13 875 (Super Ct. Cook Country, No. 1954, appeal dismissed 12 III. App. 2d 473 (1956).

A child conceived by A . I .D . is illegitimate, but the husband at the time of birth was obliged to give support. The trial judge ruled that because the husband had consented to the artificial insemination procedure there arose "an implied contract to support the child although the court considered the child illegitimate (Gursky v. Gursky, 242 NnYlS. 2d 406, 39 Misc. 2d 1083 Sup. Ct. 1936).

Child born by artificial insemination is entitled for support:

The husband consented in writing for artificial insemination of the wife. A male child was conceived and born. The spouse later had a divorce and the wife was given custody of the child. The wife later became ill and disabled so she applied for a state support of the child. The District Attorney brought a criminal action against the husband to force him to provide for the child's support. The court ruled that "reasonable man who, because of his inability to procreate, actively participates and consents to his wife's artificial insemination, knows that such behavior carries with it legal responsibilities of fatherhood and criminal responsibility of non-support (People v. Sorenson, 66 Cal. Rptr. 7, 437 P. 2d 499 (1968).

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B. IN VITRO FERTILIZATION

In Vitro Fertilization (test tube baby) is the fertilization of the egg cell by the sperm cell extracted from the respective donors placed in an artificial medium and after reaching a certain stage of cellular division and development:

1. Implanted into a woman's uterus, or

2. Gestation (development of the embryo to a child) in an artificial womb.

Whenever the embryo is allowed to develop in an artificial womb, it is know as ectogenesis (extra corporeal gestation).

The first recorded child born by In Vitro Fertilization was Louise Brown who was born in England on July 24, 1978 (London Daily Mail). This was followed by the birth of the second in vitro fertilization child in Calcutta, India on October 6, 1978. Subsequent report followed from Scotland and Australia. In the United States, the first reported case was on February 1980 in Norfolk, Virginia. At present the total number is more than 2,000 children are already born through In Vitro Fertilization.

Procedure of In Vitro Fertilization:

The In Vitro Fertilization process begins with injections into the oocyte (ovum) donor of a hormone known as gonadotropin, which induces super-ovulation. Approximately 30 hours later, the oocytes are removed from the ovary by laparoscopy, a surgical procedure accomplished by inserting two thin glass tubes into the ovary through a small incision in the abdomen. The removed oocytes are placed in a Petri dish or a test tube containing growth medium simulating the environment of the woman's body. The medium is composed of a woman's blood, fluids from her reproductive tract, and nutrients. The oocytes are then fertilized by a sperm which has been held in vitro. The resulting conceptus is kept in a moist environment at room temperature where it divides and grows for a few days until it reaches the blastocyst stage, the stage at which the embryo normally enters the uterus. The conceptus is then picked up with a small hollow tube, inserted through the vagina and cervix into the uterus where it is implanted at a proper time in the menstrual cycle. After successful transplantation, the woman carried the blastocyst to term (Legal Medicine by Cyril Wecht, 1982, p. 240).

Possible Situations in In Vitro Fertilization: 1. The ovum removed from the wife is fertilized by sperm from the

husband and the resulting zygote is implanted into the wife's uterus.

NON-CONVENTIONAL METHODS OF PROCREATION

This process is done because (a) the wife cannot conceive on account of the occlusion of the fallopian tube, or (b ) although the couple can possibly have a child through normal intercourse but they want early screening of the conceptus for genetic defects, control the timing of the pregnancy or select a blastocyst with certain characteristics.

The closure of the fallopian tube may be due to complication of a pelvic inflammatory disease, bilateral salpingectomy on account of repeated caesarian section or ectopic pregnancy, tuboplasty failure or unsuccessful tubal anastomosis, or congenital aplasia or hypoplasia of the fallopian tube.

2. The ovum removed from the wife is fertilized by the sperm coming from a third party (sperm donor) and is implanted into the wife's uterus.

This situation may arise when (a) the husband is sterile, ( b ) the husband does not wish to transmit to the child a genetic defect, or (c) the wife cannot conceive through Artificial Insemination Donor ( A I D ) .

3. The ovum coming from a third party (ovum donor) is fertilized by the husband's sperm and the blastocyst is implanted into the wife's uterus.

This situation is necessary when (a) the wife is sterile or (b) the wife does not like to transmit genetic defect to the child.

4. The ovum taken from a third party (ovum donor) is fertilized by the sperm coming from a third party (sperm donor) and the blastocyst is implanted into the wife's uterus.

This procedure may be adopted when (a) both husband and wife are sterile, or ( b ) both of them refuse to transmit to the child their genetic defects.

5. The ovum removed from a single woman is fertilized by the sperm taken from a male donor; the blastocyst is implanted into the single woman's uterus.

The procedure may be done when the single woman wishes to have a child but she cannot conceive naturally or by artificial insemination.

6. The ovum removed from the wife is fertilized by the husband's sperm and the blastocyst is implanted to a "host" or surrogate. There is genetic link of the child to the parents by the gestational link with a third party.

7. The ovum coming from the wife is fertilized artificially by the sperm coming from a third party (sperm donor) and the blastocyst is implanted into the surrogate's uterus.

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8. The ovum coming from a third party (ovum donor) is fertilized by the sperm coming from the husband and the blastocyst is placed into the uterus of the surrogate's uterus.

9. The ovum coming from a third party (ovum donor) is fertilized by the sperm coming from a third party (sperm donor) and the blastocyst is implanted into the uterus of a surrogate.

Basis of Legality of In Vitro Fertilization:

The constitution provides that "No person shall be deprived of life, liberty, or property without due process of law, nor shall any person be denied the equal protection of the laws." (14th amendment of U.S. and Article IV, Sec. 1, Philippines).

From the term "liberty" emanates the right of privacy.

In Meyer v. Nebraska (262 U.S. 390), the right of privacy denotes not only freedom from bodily restraints but also the right of the individual to contract, to engage in any of the common occupations of life, to acquire useful knowledge, to marry, to establish a home and bring up children, to worship God according to the dictate of his own conscience, and generally to enjoy those privileges long recognized by law as essential to the orderly pursuit of happiness as a free man.

In Griswold v. Connecticut (381 U.S. 479, 1965), the right of privacy means the right to be left alone. It is the right of an individual to the possession and control of his own person, free from all restraints or interference of others, unless by clear and unquestionable authority of law. It is the right of parents or guardians to establish their family life as they see fit.

Other implications of the right of privacy which may be the basis of legality of in vitro fertilization:

a. Right of procreation — Procreation is fundamental to the very existence and survival of a race. A ban on the use of in vitro fertilization would prevent an individual from using means to fulfill his or her procreative mission. Inability to procreate is a malady and it is the duty of medicine to alleviate or cure the condition so as to make him enjoy life and realize his desire.

b. Right of marital privacy — Prohibition of in vitro fertilization as a way to have children will mean government intrusion into the marital bedroom in search of evidence for violating the law.

The freedom of personal choice in matters of marriage and family life is one of the basic liberties protected by the due process of law clause.

NON-CONVENTIONAL METHODS OF PROCREATION

c. Right to decide whether to bear or beget — This is the right of a person to determine whether to carry or not to carry a product of conception, to be or not to be a mother or to raise or not to raise a family.

d. Right of self-determination — "Every human being of adult age and of sound mind has the right to determine what shall be done on his own body (Schloendorff v. Society of New York Hospital 195 N.E. 92 N. Y. 1914). A modern definition of this concept is expressed in the case of Natanson v. Kline (350 P. 2d 1093 Kan. 1960) which stated that "a man is the master of his own body and he may expressly prohibit the performance of life-saving surgery..."

Problems in In Vitro Fertilization:

1. The probability that the child to be born will be defective:

Although there is no actual substantial proof that a child born through in vitro fertilization will in greater probability be defective, physicians are seemingly apprehensive to perform this non-standard procedure of procreation on fear that a civil suit for damage may be filed against them.

A couple embarked in "in vitro fertilization" with their obstetrician initiating a culture combining sperm and oocytes, but later, destroyed the culture when he was convinced that the risk of the procedure was too great. The plaintiff sued to recover for their emotional pain and sufferings and a $50,000 verdict was awarded the couple (Del Zio v. Presbyterian Hospital, 74 Civ. 3588, U.S. Dis. Ct., SouthernDis. NY. 1978).

Some of the probable causes of the birth of a defective child may be: a. Administration of hormone to the prospective source of ovum:

A gonadotropic hormone is administered to induce more production of oocytes to give the physician the privilege of selecting which among is the best for fertilization. This may cause production of chromosomal abnormality (trisomy). Inasmuch as the oocyte is mixed with a pool of sperm, a single ovum maybe fertilized by multiple sperm and lead to the production of an abnormal embryo (triploidy).

b. Mechanical manipulation of the oocyte and embryo: The mechanical removal from the ovum donor, the actual

fertilization process in an artificial medium and the physical act

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of insertion into the uterus may cause injury or deformity on the cells or zygote.

c. Mistake in the "screening process' or selection of the best ovum for fertilization.

d. Defective donors (sperm and ovum).

A physician need not fear too much of the possible liability on account of a defective child because:

a. The plaintiff will find difficulty in proving negligence. The plaintiff will have a hard time establishing connection between physician's negligence and infant's defect because birth defects are well known to occur in normal or natural pregnancies.

b. Prospective parents are normally briefed of the potential risks of the procedure before their consent is obtained.

c. In vitro fertilization is still in the experimental stage and has yet to evolve a clearly defined standard of care by which to determine whether the action of the physician is negligent.

d. The plaintiff is required to meet the difficult task of proving negligence.

Social Problem in In Vitro Fertilization:

The probability for a child born by in vitro fertilization to be defective is not remote for reasons stated (supra). Is our society willing to have this world to be inhabited by android, monsters, cyclopes, defectives and other forms of abnormalities? The progress of science must be geared towards improvement in the quality of men and not towards retrogression or deterioration.

2. Problem of surrogate mother:

A surrogate mother is a woman who is not the source of the ovum and in whose uterus the in vitro fertilized egg is implanted to develop up to full term and delivered child. The term also applies when fertilized egg is removed from the uterus of a woman and implanted to the surrogate mother. The surrogate become the gestational mother of the child.

Reasons why the services of a surrogate mother may be necessary:

a. Necessity:

(1) The genetic mother is unable to carry the child to term because of disease or injury.

(2) The genetic mother may believe either that she is too old to safely carry a child to term, or that the child may be born with abnormalities.

(3) The genetic mother may possess deleterious genetic traits which may be passed on to the child.

NON-CONVENTIONAL METHODS OF PROCREATION 611

(4) Couple is unable to adopt a child. Adoption is expensive and time consuming process. There is shortage of available children ready for adoption. The couple may express preference as to the age, race or religion they wish to adopt. These diminish the likelihood of having a child by adoption,

b. Convenience:

A woman may not want to interrupt her career during the gestational period and therefore seek a more convenient method of having one without changing her actual way of life.

Motivation of a woman to become a surrogate mother:

a. Altruistic motive — A woman may be willing to be a surrogate mother for the sake of humanity.

b. Material consideration — If the surrogate mother merely receives all expenses incurred in carrying the fetus to term and then delivered then the motive is altruistic. On the other hand, if the payment agreed upon is beyond the reasonable cost of pregnancy then it is tantamount to "rental" for the use of the uterus.

Problems that may arise in the agreement in the use of surrogate mother for gestational purpose:

a. If the surrogate mother decided to abort the child contrary to the wish of the genetic parents;

b. The surrogate mother may decide to keep the child after birth rather than surrender him to the genetic parents;

c. The parents may decide to abort the child because of the fear that abnormality may be present but the surrogate mother refuses to do so;

d. If the child was born with abnormality and the parents refused to take the child from the surrogate mother;

e. Can the couple enforce the contract in the event that the surrogate mother committed other breaches? ; and

f. Is there a need to go through the procedure of adoption in order to legitimatize the child at birth?

Potential solution to the problems of surrogate mother:

a. By contract — There must be a contract specifically mentioning the rights and duties of each party. But the mere fact that the rights and duties are specified do not guarantee that the specifications will judicially be recognized. Any term that the court finds to be contrary to public policy will be striken out. It cannot be assured that all specified term will be judicially enforced.

b. By legislation — The court is bound to enforce the legislation

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unless found to be unconstitutional. This method provides a better solution to the problem.

3. Problem of the status of the child born by in vitro fertilization (supra p. 607):

a. Situation 1 — There is no doubt that the child is legitimate because the wife is genetically and gestationally the mother and the sperm came from the husband. In case of situation 5, the child born must be considered illegitimate in view of the absence of marriage between the single woman source of the ovum and the sperm donor.

b. Situation 2 and 3 — Although one of the elements (ovum or sperm) in the fertilization process did not come from one of the spouses, the child may still be legitimate if there is consent of the sterile party to the in vitro fertilization. If the child is not considered legitimate, then the process of adoption may be done.

The status that the child may be a problem may change if the in vitro fertilization was done with the knowledge and consent or against the will of the sterile spouse.

c. Situation 4, 6, 7, 8 and 9 — The genetic parents are different fron the gestational mother. Adoption may be a legal remedy provide' there is no impediment to the application of the procedure, otherwise a special legislation may be necessary.

C. OTHER NON-CONVENTIONAL METHODS OF PROCREATION

1. Artificial Inovulation — The removal of an unfertilized egg from a woman and placing it on the reproductive tract of another woman.

2. Embryo Transplantation — The removal of a fertilized egg from a woman's uterus to transfer to that of another woman's uterus.

3. Parthenogenesis ("Virgin Birth") — A type of sexual reproduction whereby the unfertilized egg with 23 chromosome compliment doubled its content to become a diploid cell that starts dividing as if it is a fertilized egg without the intervention of a male sperm cell, the resulting offspring is thus a female. It has been speculated that virgin birth occurs naturally in human being at the rate of one per three billion pregnancies.

4. Cloning — A type of a sexual reproduction whereby the nucleus of a female egg is removed (enucleation) which contains the genetic material and replaced with the nucleus of a body (somatic) cell of the same or another woman (renucleation). The renucleated egg is then placed in a uterus for gestation and normal development. The resulting offspring is genetically identical to the parent.

Chapter XXIX

MEDICO-LEGAL ASPECT OF MARITAL UNION AND DISSOLUTION

A. A S T O REQUISITES O F A V A L I D M A R R I A G E :


Marriage is not a mere contract but an inviolable social institution. Its nature, consequences and incidents are governed by law and not subject to stipulation, except that the marriage settlements may to a certain extent fix the property relations during the marriage.


No marriages shall be solemnized unless all these requisites are complied with:

(1) Legal capacity of the contracting parties; (2) Their consent, freely given; (3) Authority of the person performing the marriage; and (4) A marriage license, except in a marriage of exceptional

character (Sec. la , Art. 3613).


Any male of the age of sixteen years or upwards, and any female of the age of fourteen years or upwards, not under any of the impediments mentioned in articles 80 to 84, may contract marriage. (Arts. 80 to 84 refer to void and voidable marriages).

Art. 61, Par. 2, Civil Code:

In case either or both of the contracting parties, being neither widowed nor divorce, are less than twenty years of age as regards the male and less than eighteen years as regards the female, they shall, in addition to the requirements of the preceding articles, exhibit to the local civil registrar, the consent to their marriage, of their father, mother or guardian, or persons having legal charge of them, in the order mentioned. Such consent shall be in writing, under oath taken with the appearance of the interested parties before the proper local civil registrar or in the form of an affidavit made in the presence of two witnesses and attested before any official authorized by law to administer oaths.

613

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Art. 62, Civil Code: Males above twenty but under twenty-five years of age, or

females above eighteen but under twenty-three years of age, shall be obliged to ask their parents or guardian for advice upon the intended marriage. If they do not obtain such advice, or if it be unfavorable, the marriage shall not take place till after three months following the completion of the publication of the application for marriage license. A sworn statement by the contracting parties to the effect that such advice has been sought, together with the written advice given, if any, shall accompany the application for marriage license. Should the parents or guardian refuse to give any advice, this fact shall be stated in the sworn declaration.

A physician may be required to determine the ages of the contracting parties whenever the question of the validity of marriage is at issue. Such determination of the age may be made by the analysis of the peculiarities connected with the age, e.g., growth of the pubic hair, presence of the third molar, development of the breast, height, character, and educational attainment of the person.


Marriages between the following are incestuous and void from their performance, whether the relationship between the parties be legitimate or illegitimate.

(1) Between ascendants and descendants of any degree;

(2) Between brothers and sisters, whether of the full or half blood;

(3) Between collateral relatives by blood within the fourth civil degree.


The following marriages shall also be void from the beginning:

(1) Between stepfathers and stepdaughters, and stepmothers and stepsons,-

(2) Between the adopting father or mother and the adopted, between the latter and the surviving spouse of the former, and between the former and the surviving spouse of the latter;

(3) Between the legitimate children of the adopter and the adopted.

B . AS TO M A R I T A L R E L A T I O N :

Art. 109, Civil Code: The husband and wife are obliged to live together, observe mutual

MARITAL UNION AND DISSOLUTION 615

respect and fidelity, and render mutual help and support.


The husband shall fix the residence of the family. But the court may exempt the wife from living with the husband if he should live abroad unless in the service of the Republic.

Art. I l l , Civil Code:

The husband is responsible for the support of the wife and the rest of the family. These expenses shall be met first from the conjugal property, then from the husband's capital, and lastly from the wife's paraphernal property. In case there is a separation of property, by stipulation in the marriage settlements, the husband and wife shall contribute proportionately to the family expenses.


The husband is the administrator of the conjugal property, unless there is a stipulation in the marriage settlements conferring the administration upon the wife. She may also administer the conjugal partnership in other cases specified in this Code.

Causes of Sexual Dissatisfaction After Marital Union:

1. Fear of consequence of repeated abortion. 2. Fear of unwanted pregnancy. 3. Faulty contraceptive methods. There is inadequate oppor

tunity for orgasm. 4. Dyspareunia (Vaginisimus, or improper sex technique). 5. Fear of coitus. 6. Emotional frustration due to fertility. 7. Ignorance of the reproductive process and genital anatomy. 8. Aversion to coitus (frigidity). 9. No sex desire (low basal metabolic rate found).

10. Anatomic cause of unsatisfaction in coitus:

a. Tight resistant septate hymen. b. Size and location of the clitoris. c. Extreme obesity of either husband or wife. d. Infantile genital development. e. Pelvic abnormality, e.g., parametritis, torn perineum.

11. Disparity in age. 12. Venereal disease. 13. Masturbation preferred to coitus. 14. Infidelity.

Reasons Why Patients Requested Contraceptive Advice:

1. Recent childbirth. 2. Desire to space offspring.

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3. Desired number of children already born.

4. Medical condition of the wife does not warrant pregnancy, e.g., hyperthyroidism, nephritis, tuberculosis, diabetes, heart disease, deaf-mutism, blindness or convalescence after acute illness such as typhoid fever or pneumonia, or after acute surgical procedure as appendectomy or rectal fistula.

5. Mental illness or emotional disturbance of husband and wife.

6. Economic conditions:

a. Unemployment of the husband. b. Wife sole or co-wage earner. c. Support or dependents. d. Desire to complete education or professional training.

7. Dissatisfaction of either or both partners with method of contraception employed.

8. Failure of other methods used.

Causes of Non-consummation of the Sexual Act:

1. Septate hymen. 2. Tight thick hymen. 3. Fear of pain or inability to stand pain. 4. Ignorance of genital anatomy. 5. Ignorance of sex technique. 6. Fear of pregnancy. 7. Sense of shame regarding genitals and coitus.

Contraceptive Methods:

1. Contraceptive Methods in General

Condom Coitus interruptus Douche Suppository Safe period Nothing Gold-stem wishbone pessary Vaginal diaphragm (rubber) French pessary (cervical

type) Lanteen pessary

2. Male Method of Contraception: Condoms with jelly, suppository or douche. Coitus interruptus with douche.

Contraceptive jelly alone Coitus interruptus and

douche Condom and pessary Condom and douche Condom and jelly External coitus Lactation Suppository and douche Abstinence


3. Female Methods of Contraception: Douche alone Douche and condom Douche with coitus

Jelly with diaphragm Jelly with cervical type

pessary Jelly with condom Suppository with douche Safe period Lactation

interruptus Douche with pessary Douche with diaphragm Vaginal diaphragm Cervical type pessary Stem pessary (intracervical) Jelly alone

4. Other Methods:

External coitus Abstinence Nothing used

Some Common Complaints After Marital Union:

1. Male sex inadequacy. 2. Prolonged debilitating disease of one of the partners. 3. Anxiety over economic security. 4. Manual clitoral stimulation preferred to coitus. 5. Too frequent pregnancy. 6. Lack of privacy (poor housing). 7. Husband's preference to perversion. 8. Cultural aesthetic inequalities between parties. 9. Faulty attitude of husband and wife toward normal sex and

marriage intimacies. (From: JAMA, Vol 115, No. 4, July 27, 1949, pp. 270-285, by Mario Pichel Warner, M.D.).

C. AS TO A N N U L M E N T OF M A R R I A G E :


A marriage may be annulled for any of the following causes, existing at the time of the marriage:

(1) That the party in whose behalf it is sought to have the marriage annulled was between the ages of sixteen and twenty years, if male, or between the ages of fourteen and eighteen years, if female, and the marriage was solemnized without the consent of the parent, guardian or person having authority over the party, unless after attaining the ages of twenty or eighteen years, as the case may be, such party freely cohabited with the other and both lived together as husband and wife;

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(2)

(3) That either party was of unsound mind, unless such party, after coming to reason, freely cohabited with the other as husband or wife;

(4) That the consent of either party was obtained by fraud, unless, such party afterwards, with full knowledge of the facts constituting the fraud, freely cohabited with the other as her husband or his wife, as the case may be;

(5)

(6) That either party was, at the time of marriage, physically incapable of entering into the married state, and such incapacity continues, and appears to be incurable.


Any of the following circumstances shall constitute fraud referred to in number 4 of the preceding article:

(1) (2) (3) Concealment by the wife of the fact that at the time of the

marriage, she was pregnant by a man other than her husband.

There are several grounds for the annulment of marriage which are of medico-legal interest. A physician may be requested to determine the ages of the contracting parties, if the ground for the annulment of marriage is age. He may be required to examine the mentality of the party and to determine whether she or he could have been of unsound mind at the time of the celebration of marriage. The phrase "physically incapable of entering into married state" includes impotency of a party. The court or any of the parties in interest to the contract of marriage must determine whether or not she is pregnant at the time of the celebration of marriage.

D . A S T O L E G A L S E P A R A T I O N :

Our law recognizes only relative divorce but not absolute divorce.


A petition for legal separation may be filed:

(1) For adultery on the part of the wife and for concubinage on the part of the husband as defined in the Penal Code; or

(2) An attempt by one spouse against the life of the other.

Art. 333, Revised Penal Code — Who are guilty of adultery?

Adultery is committed by any married woman who shall have sexual intercourse with a man not her husband and by the man


who has carnal knowledge of her, knowing her to be married, even if the marriage be subsequently declared void.

Adultery shall be punished by prision correccional in its medium and maximum periods.

If the person guilty of adultery committed this offense while being abandoned without justification by the offended spouse, the penalty next lower in degree than that provided in the next preceding paragraph shall be imposed.

Art. 334, Revised Penal Code — Concubinage:

Any husband who shall keep a mistress in the conjugal dwelling, or, shall have sexual intercourse, under scandalous circumstances, with a woman who is not his wife, or shall cohabit with her in any other place, shall be punished by prision correccional in its minimum and medium periods.

The concubine shall suffer the penalty of destierro.

Chapter XXX

IMPOTENCY AND STERILITY

I. IMPOTENCY

Impotency is the physical incapacity of either sex to allow or grant to the other legitimate sexual gratification. A person may be impotent but not sterile, or sterile but not impotent although both conditions may exist at the same time.

Legal Importance of Impotency:

A. Impotency, if proven, will overthrow the presumption of legitimacy: Art. 255, Civil Code:

Children born after one hundred and eighty days following the celebration of marriage, and before three hundred days following its dissolution or the separation of the spouses shall be presumed to be legitimate.

Against this presumption no evidence shall be admitted other than that of physical impossibility of the husband's having access to his wife within the first one hundred and twenty days of the three hundred days which preceded the birth of the child.

This physical impossibility may be caused:

(1) By the impotence of the husband;

(2) By the fact that the husband and wife were living separately, in such a way that access was not possible; and

(3) By the serious illness of the husband.

B. Impotency may be a ground for the annulment of marriage:


Marriage may be annulled for any of the following causes

existing at the time of marriage:

(5) (6) That either party was, at the time of marriage, physically

incapable of entering into the married state, and such incapacity continues, and appears to be incurable.

The physical incapacity referred to in the above provision includes impotency.

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IMPOTENCY AND STERILITY 621

In order that such impotency may be a ground for the annulment of marriage, the following requisites must be present:

1. One of the parties to the marriage is not aware of the existing impotency of the other party. If the other party to the marriage know of the impotency of the future spouse before the marriage, then it is considered a waiver on his part.

2. The impotency must be present at the time of the celebration of marriage.

3. The impotency suffered by the party must be incurable. If the impotency can be remedied by medical or surgical intervention, then it cannot be a ground for the annulment of marriage.

4. Such impotency must be absolute.

C. Impotency may be a defense in rape:

An accused in the crime of rape may claim of his inability to commit the offense on account of his impotency. Medical evidence must be shown in support of his allegation.

D. Impotency may be a cause to the development of abnormal sexual behavior:

An impotent may resort to uranism, cunnilingus, homosexuality or other lascivious acts to satisfy the sexual partner.

E. Impotency may be a cause for the development of suicide tendency:

A person who is not in a capacity to give gratification to the sexual partner may consider himself to be "biologically dead". This results in humiliation, or a feeling of uselessness. He may then resort to self-destruction.

Causes of Impotency:

A. General or Functional, Not Connected Directly with the Sexual Organs:

Any of the following factors lead to, cause, or produce permanent or temporary impotency.

1. Age: Inasmuch as the female is the passive agent in the sexual

intercourse, there is no limit for her age, except when she is below the age of sixteen. As long as there is erection in the male, he is considered to be potent.

2. Illness: Diseases attended by general debility may temporarily re

move the sexual power on the part of the male. Diseases of the brain and of the spinal cord may yield to permanent loss of potency. Mumps occasionally leads to the atrophy of the sex organs.

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3. Emotion:

Some females manifest vaginismus due to actual pain on contact or to the fear of pain on sexual intercourse. This condition is usually common among virgins. This is produced by the violent contraction of the constrictor muscles of the vaginal orifice and may also be brought about by the contraction of the adductor muscles of the thighs. Anesthesia may cure the condition and pregnancy may produce a permanent cure. In the male, emotion may lead or produce temporary impotency.

4. Hormonal dysfunction may also lead to temporary or permanent impotency.

B. Local or Organic, in Direct Connection with the Sexual Organs:

1. Congenital Defects:

a. In Males:

(1) Nondevelopment of the penis. (2) Maldevelopment of the penis. (3) Penis adherent to the scrotum. (4) Duplex organ.

b. In Females:

(1) Absence of vagina. (2) Vagina ill-developed, e.g., may be too small. (3) Vagina occluded by intrauterine disease.

2. Disease or Accident:

a. In the Males:

(1) Penis:

(a) Acute diseases of the penis, as gonorrhea. (b ) Chronic diseases as epithelioma. (c) Complete amputation of the penis.

(2) Testis:

(a) Removal of the testis. ( b ) Sexual abuse.

b. In the Females:

(1) Vaginal ulceration. (2) Diseases of the vulvae. (3) Obstruction of the vaginal canal due to tumor, cyst or

fibroid.

II. STERILITY Sterility is the loss of power of procreation and is absolutely

independent of whether or not impotence is present. A man or a woman may be sterile and yet not impotent, and impotent yet not sterile.

IMPOTENCY AND STERILITY 623

Causes of Sterility:

A. General or Functional, Unconnected Directly with the Sexual Organs:

Before puberty there is no spermatozoa in the seminal fluid, hence sterile, but as age increases, fertility also increases.

B. Local Causes of Sterility:

1. Congenital Conditions:

a. In the Male:

(1) Absence or nondevelopment of testicle. (2) Absence or nondevelopment of penis. (3) Maldevelopment of the testicle. (4) Misplacement of the testicle. (5) Malformation of the penis, as in epispadias or hypospadias.

b. In the Female:

(1) Absence or maldevelopment of the ovary. (2) Absence or maldevelopment of the uterus. (3) Absence of the vagina.

2. Acquired Conditions:

a. In the Male:

(1) Complete amputation of the penis. (2) Excision of the testicle. (3) Diseases of the testicle. (4) Atrophy of the testicle.

b. In the Female:

(1) Excision of the ovaries. (2) Diseases of the ovary. (3) Occlusion of the vagina from diseases. (4) Diseases of the vagina. (5) Occlusion of the Fallopian Tubes.

Methods of Sterilization:

A. On the part of the male:

1. The source of sperm production can be eliminated by removing both testicle (Orchiectomy).

2. The tubular passage (vas deferens) through which the sperm are transported from the testicle to the urethra where they combined with the seminal fluid elaborated by the prostrate gland to form the ejaculant, can be divided and the cut ends tied (vasectomy); thus newly produced sperm cannot join the ejaculant and the ability of the male to fertilize the female is lost.

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B. On the part of the female:

1. The source of eggs (ovary) can be removed (oophorectomy).

2. The tubular appendages of the uterus (Fallopian tube) through which the eggs enter the uterine cavity where fertilization takes place, can be divided and the cut ends tied (Tubal ligation or salpingectomy), preventing newly produced eggs from reaching the uterus for fertilization.

3. The uterus (womb) itself can be removed (hysterectomy), thereby eliminating the site of fertilization and pregnancy.

Chapter XXXI

MEDICO-LEGAL ASPECT OF

DISTURBANCE OF MENTALITY

I. INSANITY

Insanity may be defined in its sociological, medical and legal concept.

In the sociological viewpoint, insanity is the persistent inability through mental causes to adapt oneself to the ordinary environment. It is the loss of power of the individual to regulate his actions and conduct according to the rules of society in which he moves.

Insanity in medicine is the prolonged departure of the individual from his natural mental state arising from bodily disease.

Insanity in law covers nothing more than the relation of a person and the particular act which is the subject of judicial investigation.

The term insanity is commonly used to be synonymous with lunacy, madness, unsoundness of mind, mental derangement, mental disorder or mental aberration or alienation.

Legal Importance of the Determination:

1. In the Civil Code:

a. Insanity is a restriction on the capacity of a natural person to act:

Art. 38, Civil Code — Minority, insanity or imbecility, the state of being a deaf-mute, prodigality and civil interdiction are mere restrictions on capacity to act, and do not exempt the incapacitated person from certain obligations, as when the latter arise from his acts or from property relations, such as easements.

b. Insanity modifies or limits the capacity of a natural person to act:

Art. 39, Civil Code — The following circumstances, among others, modify or limit capacity to act: age, insanity, imbecility, state of being a deaf-mute. . . . The consequences of these circumstances are governed in this Code, other codes, the Rules of Court and in special laws. Capacity to act is not limited on account of religious belief or political opinion.

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c. Insanity at the time of marriage of any or both parties is a ground for the annulment of marriage:

Art. 85, Civil Code — A marriage may be annulled for any of the following causes; existing at the time of marriage:

(2) (3) That either party was of unsound mind, unless such party,

after coming to reason, freely cohabited with the other as husband or wife.

d. A testator must be of sound mind at the time of execution of a will:

Art. 7y8, Civil Code — In order to make a will it is essential that the testator be of sound mind at the time of its execution.

Art. 799, Civil Code — To be of sound mind, it is not necessary that the testator be in full possession of all his reasoning faculties, or that his mind be wholly unbroken, unimpaired, or unshattered by disease, injury or other cause.

It shall be sufficient if the testator was able at the time of making the will to know the nature of the estate to be disposed of, the proper objects of his bounty, and the character of the testamentary act.

Art. 800, Civil Code — The law presumes that every person is of sound mind, in the absence of proof to the contrary.

Succession is a legal mode by virtue of which the property, right and obligations which in life belong to a person is acquired by his heirs.

A will is a specie of conveyance whereby a person is permitted, with the formalities prescribed by law, to dispose of his property after his death with more or less freedom but limited to a certain degree by law (Riera v. Palmaroli, 40 Phil. 105).

A codicil is an addition or supplement to a will either to add to or to take from the provisions of the principal disposition of the will. It must be executed with the same formalities as the will itself and when admitted to probate, forms a part of the will. It is derived from the Latin "codex''.

e. A witness to* a will must be of sound mind: Art. 820, Civil Code — Any person of sound mind and of the

age of eighteen years or more, and not blind, deaf or dumb, and able to read and write, may be a witness to the execution of a will

f. Insanity of the testator is a ground for disallowance of a will: Art. 839, Civil Code — The will shall be disallowed in any of

the following cases:

DISTURBANCE OF MENTALITY 627

(1) (2) If the testator was insane, or otherwise mentally in

capable of making a will, at the time of its execution.

g. An insane cannot give consent to a contract:

Art. 1327, Civil Code — The following cannot give consent to a contract:

(1) Unemancipated minors:

(2) Insane or demented persons, and deaf-mutes who do not know how to write.

h. The guardian or the insane himself, if there is no parent or guardian shall be held liable for damages due to his insanity:

Art. 2180, Par. 3, Civil Code — Guardians are liable for damages caused by the minors or incapacitated persons who are under their authority and live in their company.

Art. 2182, Civil Code — If the minor or insane person causing the damage has no parents or guardian, the minor or insane person shall be answerable with his own property in an action against him where a guardian ad litem shall be appointed.

A guardian ad litem is a guardian appointed by the court to prosecute or defend a suit on behalf of a party incapacitated because of minority or insanity.

2. In the Revised Penal Code:

a. Insanity exempts a person from criminal liability: Art. 12, Revised Penal Code — Circumstance which exempt

from criminal liability — The following are exempt from criminal liability:

(1) An imbecile or an insane person, unless the latter has acted during lucid interval.

b. A person who becomes insane after final sentence: Art. 79, Revised Penal Code — Suspension of the execution

and service of the penalties in case of insanity — When a convict shall become insane or an imbecile after final sentence has been pronounced, the execution of said sentence shall be suspended only with regard to the personal penalty, the provisions of the second paragraph of circumstances number 1 of article 12 being observed in the corresponding cases.

If at any time the convict shall recover his reason, his sentence shall be executed, unless the penalty shall have prescribed in accordance with the provision of this Code.

The respective provisions of this section shall also be observed if the insanity or imbecility occurs while the convict is serving his sentence.

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3. In the Rules of Court:

a. A guardian on the person of the insane must be appointed: Rule 92, Sec. 2, Rules of Court — Meaning of word "in

competent" — Under this rule, the word 'incompetent" includes. . . .those who are of unsound mind, even though they have lucid intervals.

Rule 93, Sec. 1, Rules of Court — Who may petition for appointment of guardian for resident — Any relative, friend, or other person on behalf of a resident minor or incompetent who has no parent or lawful guardian. . . .An officer of the Federal Administration of the United States in the Philippines may also file a petition in favor of a ward thereof, and the Director of Health, in favor of an insane person who should be hospitalized, or in favor of an isolated leper,

b. An insane cannot be a witness in court:

Rule 130, Sec. 19 (a) , Rules of Court — Physical disqualification — The following persons cannot be a witness: (a) Those who are of unsound mind at the time of their pro

duction for examination, to such a degree as to be incapable of perceiving and making known their perception to others.

Factors Having Positive Correlation with the Development of Mental Disorder:

1. Heredity — This is the most frequent and history reveals mental illness manifested by ascendants.

2. Incestuous marriage, blood incompatability of parents, maternal infection during the early stage of pregnancy.

3. Impaired vitality — Mental worry, grief, physical strain, unhygienic surroundings, infection, birth trauma may predispose a person to mental disorder.

4. Poor moral training and breeding — Improper breeding and moral training according to the social status, particularly on free will and self-control, undesirable association, etc.

5. Psychic factors — Emotional disturbance, such as love, hatred, passion, disappointment.

6. Physical factors: a. Non-toxic — Exhaustion resulting from severe physical and

mental strain, illness, cerebral hemorrhage, trauma on the skull affecting the brain.

b. Toxic — This may be produced by excessive formation or deficient elimination of waste product of metabolism; by microbic infection, or excessive use of certain drugs.


Some Manifestation of Mental Disorders:

The condition of insanity cannot be considered clinically by the manifestation of one sign or symptom, but it is essential to appreciate the condition of the mind as a whole. Although certain behavior may be observed in certain types of insanity, they may also be observed in the clinically non-insane.

1. Disorder of Cognition (Knowing):

a. Disorder in Perception:

(1) Illusion — a false interpretation of an external stimulus. It may be manifested with the sense of sight, hearing, taste, touch and smell.

Example: A dragonfly may be considered a vampire bat. A whistle sound may be considered a bomb

explosion. A normal person may also suffer from illusion

but further investigation by oneself may prove that his judgement is wrong.

(2) Hallucination — An erroneous perception without external object of stimulus.

Some Types of Hallucination:

(a) Visual — Seeing things although not present. ( b ) Auditory — Hearing voice in absolute silence. (c) Olfactory — False perception of smell. (d) Gustatory — False perception of taste. (e) Tactde — False perception of touch, as feeling that

a worm is creeping on the skin. (f) Kinesthetic — False perception of movement. (g) Hypnagogic — False sensory perception occurring mid

way between falling asleep and being awake.

(h) Lilliputian — Perception of object as reduced in its size.

b. Disorder of Memory: (1) Dementia — A form of insanity resulting from degeneration

or disorder of the brain characterized by general mental weakness, forgetfulness, loss of coherence, and total inability to reason but not accompanied by delusion or uncontrollable impulse (Hibbard v. Baker, 104 N.W. 339, 141 Mich. 124). Some Types of Dementia: (a) Acute Dementia — a form of temporary dementia,

occurring in young people and induced by conditions

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likely to produce that state, like malnutrition, overwork, dissipation or too rapid growth.

( b ) Dementia Paralytica(General Paralysis of the Insane) — Degeneration of physical, intellectual and moral power leading to paralysis ("cirrhosis of the brain").

(c) Dementia Praecox (Schizophrenia) — Dementia of the adolescence and characterized by loss of memory.

(d) Senile Dementia — Occurring in advanced age and characterized by loss of memory, with childish and silly behavior and physical degeneration.

(e) Toxic Dementia — Characterized by weakness of mind or feeble cerebral activity resulting from continuous administration or use of toxic chemicals.

(2) Amnesia (Loss of Memory):

(a) Anterograde Amnesia — Loss of memory of recent event.

( b ) Retrograde Amnesia — Loss of memory of past events and observed in trauma of the head.

c. Disorder of Content of Thought:

(1) Delusion — A false or erroneous belief in something which is not a fact. A person suffering from delusion is not always insane. If he can correct his wrong belief by later experiences, by logic or information from other sources, then such delusion is not a proof of insanity. Some Types of Delusion:

(a) Delusion of Grandeur ("Delirium of Grandeur', Megalomania or "folie de grandeur") — Erroneous belief that he is in possession of great power, wealth, wisdom, physical strength, etc. It is not always a sign of insanity.

A person may think he is a king and dresses and acts as such.

( b ) Delusion of Persecution — A false belief that one is being persecuted. A person may feel that he is being poisoned and prepares for his coming end.

(c) Delusion of Reference — One thinks that he is always the subject-matter of conversation, news, speech or action although it is not a fact.

(d) Delusion of Self-accusation — A false belief to have committed a crime or hurt the feeling of others.

(e) Delusion of Infidelity — A false belief derived from pathological jealousy that one's lover is unfaithful although she is chaste, and tries to assault her.


(f) Nihilistic Delusion — A false belief that there is no world, that one does not exist, and that his body is dead. This condition may occur in involutional melancholia.

(g) Delusion of Poverty — A false belief that one is financially ruined and that he has no money, is starving, sick or even dead.

(h) Delusion of Control — A false feeling that one is being controlled by other persons.

(i) Hypochondriacal Delusion — A false feeling that one is suffering from an incurable disease, some parts of his body are not functioning, or that he is not physically capacitated to do a thing on account of the disease.

(j) Delusion of Depression — patient experiences feelings of uneasiness, worthlessness and futility.

(k) Delusion of Negation — feeling that some parts of the body are missing.

(2) Obsession — Thought and impulse which continually occur in the person's mind despite all his attempts to keep them out. It is an idea constantly obtruding on the consciousness inspite of efforts to drive them away from his mind.

A person may lock the door of his bedroom and go to bed. While in bed he may get up to see if he has locked the door. He may go to bed again and again think and see whether the door is locked. He may repeat the act the whole night.

Obsession is a condition of the mind bordering on sanity and insanity. It is sometimes associated with some sort of fear and usually occurs in persons suffering from nervous exhaustion.

d. Disorder on the Trend of Thought: (1) Mania — A state of excitement accompanied by exaltation

or a feeling of well-being which is out of harmony with the surrounding circumstances of the patient. The mind is hyperactive, with "flight of ideas" which may amount to incoherency. Delusion may be present, but it is usually fleeting in character. The increased mental activity also finds expression in increased muscular activity; the patient is restless and always occupied. His finer instincts are blunted; he becomes untidy with his clothing even to the extent of indecency. He is impatient, irritable, antagonistic and violent if interfered with. He is sleepless but his phy-

632 LEGAL MEDICINE

sical health is not greatly affected. (Forensic Medicine, Sydney Smith and Frederick Fiddes, 10th ed., p. 387).

(2) Melancholia — Intense feeling of depression and misery which is unwarranted by his physical condition and external environment. He is absorbed by his miserable thought. Aural hallucination is common. Every patient suffering from melancholia is a potential suicide case.

The alternative condition of mania and melancholia is known as manic-depressive psychosis, hence called "folie circulaire." In between attacks of mania and depression is a period of cessation of symptoms of psychosis known as lucid interval. Any person who committed a criminal act during lucid interval is criminally liable.

2. Disorder of Emotion (Feeling):

a. Exaltation — Feeling of unwarranted well-being and happiness.

b. Depression — Feeling of miserable thought, that a calamitous incident occurred in his life, something has gone wrong with his body functions and prefers to be quiet and in seclusion.

c. Apathy — Serious disregard of the surrounding environment.

d. Phobia — Excessive, irrational and uncontrollable fear of a perfectly natural situation or object.

Some Types of Phobia:

(1) Fear of Specific Objects:

(2) Fear of Specific Situation:

Childbirth — Tocophobia Going to bed — Clinopbobia

Flowers — Anthophobia Men — Andro phobia

Birds — Ornithophobia Blood — Hematophobia Books — Bibliophobia

Robbers — Harpaophobia Sacred things — Hierophobia Sharp objects — Belonophobia Sun — Heliophobia Trees — Dendrophobia

Crossing a bridge — Marriage — Gamophobia Open space — Agarophobia Pregnancy — Maieusiophobia Sexual intercourse —

Gephyrophobia Daylight — Phengophobia Drinking — Dipsophobia Height — Acrophobia Coitophobia

(3) Fear of Place: Churches — Ecclasiophobia Crowds — Ochlophobia Empty room — Kenophobia Sea — Thalassophobia Enclosed room — Home surroundings —

Claustrophobia Ecophobia

School — Scholionophobia _ River — Potamophobia


Railways — Siderodro 13 at table — Trikaideka-phobia mophobia

(4) Fear of Illness or Death: Death — Thanatophobia Disease — Pathophobia Germs — Spermophobia Heart disease — Cardio-

Inf ection — Mysophobia Infirnity — Apeirophobia Microbes — Bacilliphobia Snakes — Ophidiophobia Veneral Disease — phobia

Illness — Nosemaphobia Cypridophobia

The fear of specific objects, situations, or places may develop as a result of an incident, while the fear of illness may start when a friend contracted an illness. Fear of death may develop when one nursed a dying patient and became morbidly convinced that he will in the future be in the same condition.

3. Disorder of Volition or Conation (Doing):

a. Impulsion or Impulse (Compulsion) — Sudden and irresistible force compelling a person to the conscious performance of some action without motive or forethought. The person has no power to control it, however bad the consequence may be. Some Types of Impulsion (Compulsion Neurosis):

(1) Pyromania — An irresistible impulse to set things afire.

(2) Kleptomania — An irresistible impulse to steal articles of not much value.

(3) Mutilomania — An irresistible impulse to maim animals.

(4) Dipsomania — An irresistible impulse to indulge in intoxi cation either in alcohol or drugs. Repeated intoxication for a number of years with alcohol or drugs which is voluntary is not dipsomania. One having power to refrain from the use of intoxicating liquor or drugs and who becomes intoxicated voluntarily is not a dipsomaniac (Black's Law Dictionary by H. C. Black, 3rd ed., p. 933).

(5) Homicidal Impulse — An irresistible inclination or impulse to commit homicide prompted usually by insane delusion either as a necessity of self-defense or avenging for justice, or as to the patient being the appointed instrument of a superman justice (Com. v. Sayre, 5 Wkly Notes Cas (Pa) 452).

(6) Sex Impulse — This includes all irresistible acts of sexual perversion.

(7) Suicidal Impulse — A strong desire to terminate one's life. This impulse may be present in acute depression.

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Distinction between Feigned and True Insanity:

1. Feigned insanity develops suddenly while true insanity develops insidiously, usually with the observance of some predisposing to an exciting cause if careful history of the case is taken.

2. There is no peculiar facial expression in feigned insanity which is commonly observed in true insanity.

3. Symptoms of insanity may only be observed in feigned insanity when he is conscious that he is under observation and becomes normal when he is alone and unobserved. There is such remission of symptoms in true insanity.

4. In feigned insanity the symptoms may be complete, numerous and may clinically refer to a specific clinical disease. In true insanity, although in some instances the symptoms may not refer to a specific clinical disease, there is more tendency to point to a specific clinical entity.

5. Violent exertion of feigned insanity usually leads to an early exhaustion while in true insanity the patient can withstand violent exertion without any sign of exhaustion and fatigue.

6. A feigned insane usually observes rules of personal hygiene and does not look dirty and filthy. A true insane is filthy, dresses dirtily and does not observe hygiene. (From: Medical Jurisprudence A Textbook of Toxicology by Modi, 12th ed., p. 382).

Steps in the Diagnostic Procedure of Mental Affection:

1. Anamnesis:

a. Family History: (1) Inquire on the medical condition of the parents and other

ascendants, uncles, brothers, and sisters. (2) Inquire whether anyone of them suffered from nervous

diseases, cerebral affection, suicide, syphilis, etc.

b. Personal History:

(1) Detailed characteristic from childhood to his present state.

(2) Determine excess use of intoxicating drugs.

(3) Sexual life, occupation, mental strain, head injury and early nervous affection.

c. Information from relatives, friends and neighbors:

Change of conduct and behavior, habit, previous conduct or maniacal episode.


2. Physical Examination.

3. Instrumentations:

X-ray, electroencephalogram, scanning and other modern apparatus.

4. Mental Examination:

Psychologic Testing Psychiatric Evaluation

INSANITY AND CRIMINAL RESPONSIBILITY:

Fundamental Principles in Criminal Responsibility:

1. A sane man is assumed to be wholly responsible for the consequence of his criminal act.

2. A person who commits a criminal act is presumed to be sane. The burden of proof lies on the accused to prove that he is not sane and cannot be held responsible for his criminal act.

3. The crime is always considered to be an affair of the mind as well as the body and to make an act or omission of a crime, there must be a criminal act (actus reus) and a criminal mind (mens rea). This is inconsonance with the legal maxim that "actus facit reum nisi mens sit rea" (There cannot be a guilty act unless there is a guilty mind).

Mental Illness may be an Exempting or Mitigating Circumstance to Criminal Liability:

1. As an Exempting Circumstance: Art. 12, Revised Penal Code — Circumstances which exempt

from criminal liability — The following are exempt from criminal liability:

1. An imbecile or an insane person, unless the latter has acted during a lucid interval.

When the imbecile or an insane person has commited an act which the law defines as a felony (delito), the court shall order his confinement in one of the hospitals or asylums established for persons thus afflicted, which he shall not be permitted to leave without first obtaining the permission of the same court.

Case Where Defense of Insanity were Upheld by Court: An accused who committed homicide and has been known to be

suffering from dementia praecox with delusions that he was being molested sexually, or that his property was being taken, was considered insane and exempted from criminal liability (People v. Bonoan, 64 Phil. 87).

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The wife of the accused and her cousin testified that the accused was continuously out of his mind for many years. The assistant district health officer who examined the accused testified that he was suffering from violent mania and that condition could be present at the time he killed the deceased. There was no motive for the accused to kill the deceased. The court considered the accused insane (People v. Bascos, 44 Phil. 204).

The accused was suffering from malignant malaria when she attacked, wounded and killed her husband. It has been shown that malaria affected the nervous system and caused complications like acute melancholia and insanity at times. The accused was considered not criminally liable (People v. Lucena, 69 Phil. 350).

2. As a Mitigating Circumstance:

Art. 13, Revised Penal Code — Mitigating circumstances — The following are mitigating circumstances:

8. That the offender is deaf and dumb, blind or otherwise suffering from physical defect which thus restricts his means of action, defense, or communication with his fellow beings.

9. Such illness of the offender as would diminish the exercise of the will-power of the offender without however depriving him of consciousness of his acts.

10. And, finally, any other circumstance of a similar nature and analogous to those above mentioned.

The fact that the accused is suffering from a mild behavioral disorder as a consequence of an illness she had in early life is regarded as mitigating circumstance under Art. 13, Par. 8 or in Par. 9 of the Revised Penal Code (People v. Amit. 82 Phil. 820).

One who was suffering from acute neurosis which made him ill-tempered and easily angered was entitled to the mitigating circumstance because illness diminished his exercise of will power (People u. Carpenter C.A. G.R. 4168 Apr. 22, 1940).

Phase In The Criminal Act Where The Evidence Of Insanity Of The Accused Must Be Established:

The evidence of insanity must be referred to at the time preceding the act under prosecution or to the very moment of its execution. In order to ascertain a person's mental condition at the time of the act, it is permissible to receive evidence of the condition of his mind during a reasonable period both before or after that time. To prove insanity, circumstantial evidence, if clear and convincing, will suffice (People v. Bonoan, 64 Phil. 93).


Rules Utilized By Courts to Determine Whether The Mental Con-dition Of An Accused Exempts Him From His Criminal Liability:

Art. 12 (1) of the Revised Penal Code provides that "an imbecile or an insane person, unless the latter has acted during lucid interval" is exempt from criminal liability.

In the medical viewpoint a person is insane when he is suffering from mental derangement or confusion or a condition which prevents a person from orienting himself. It is a prolonged departure of the individual from his natural mental state arising from bodily disease.

The legal definition of insanity by which the court is guided is more of an intellectual and moral concept rather than medical. It is a defect of the mind which renders a person incapable of entertaining a criminal intent. The law further presumes every person to be sane and to possess a sufficient degree of reason to be responsible for his act unless the contrary can be proven.

The following rules have been adopted by courts to determine whether an accused is suffering from insanity to exempt him from criminal liability : 1. Earlier Test for Insanity:

a. "Wild Beast Rule":

A person is exempted from criminal liability if he is totally deprived of his understanding and memory and knows no more than an infant, a brute, or a wild beast of what he is doing.

The rule has been applied in England (Arnold case, 1724) and in the United States (State v. Pike, 49 N.H. 399), but was not universally accepted because:

a. Its application is limited to violent crimes against a person; and

b. It is quite hard to measure the aggressive behavior of a wild beast.

b. Delusion Rule: A person is not responsible for his act if he is suffering from

delusion although he knows that his act is wrong.

This rule was applied to the James Hadfield case wherein the accused attempted to kill King George III of England while entering the Drury Lane Theater. Hadfield was found to be suffering from a delusion although he knew at the time that he was actually firing a gun at the King.

A person with delusion may be insane but his suffering from delusion may not necessarily affect his judgement in a particular act. If a person who is suffering from delusion commits an illegal act which has no relation to the particular delusion from

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which he is suffering he must be considered responsible for such an act as if he were sane.

2. Later Tests for Insanity: a. McNaghten's Rule (1843):

A defense on the ground of insanity can be established if it can be proven that at the time of committing the act: (1) The accused was laboring under such defect of reason or

from a disease of the mind as not to know the nature and quality of the act he was doing, or

(2) If he did know, he did not know that what he was doing was wrong.

Under the rule, before an accused can be exempted from criminal liability, it must be proven first.

(a) That the accused was suffering from the disease of the mind.

It is the psychiatrist who must determine the presence of the disease of the mind, although what constitutes the disease is not entirely clear.

An accused was held to be suffering from the disease of the mind when he attacked a person during a temporary loss of consciousness caused by congestion of the brain due to arteriosclerosis (Bratty v. Atty. Gen. of Northern Ireland, 1963).

A person who is suffering from malignant malaria when she killed her husband was held not criminally liable because of insanity due to disease of the mind (People v. Lacena, 69 Phil. 330).

(b ) It must be proven that the accused did not know the nature and quality of the act he was doing. A person who, on account of mental disease, did not know the nature and quality of his act does not have criminal intent (mens rea).

(c) If the accused knew the nature and quality of the act, then it must be proven that he did not know that what he was doing was wrong. "Wrong", insofar as McNaghten's Rule is concerned, means contrary to law. The knowledge that the act was in violation of criminal law has been held to be sufficient to justify holding the accused reponsible.

The accused's delusion that the killing in question has been directed by God was not sufficient to excuse


him in view of the showing that he knew it was against the law (McElroy v. State, 146 Tenn. 422).

One who commits bigamy under the delusion that the act has been directed by a vision from God was held to be responsible when he admitted he knew at the time that the act was punishable by law of the State (People v. Schmidt, 216 N. Y. 324).

Criticisms to the McNaghtensRule:

(1) The rule is too rigid and strict that it unjustly subjects the insane to punishment.

(2) It is based solely on cognitive factor and ignores emotion and will.

(3) The test is unintelligible to psychiatrists because it requires a moral judgment by the physician; a judgment outside of his professional training, experience and competence.

In the United State 36 states adopt the rule.

b. Irresistible Impulse Rule:

A person is considered insane when mental disease has

rendered him incapable of restraining himself, although he

understands what he is doing and knows it is wrong.

Criticisms to the Irresistible Impulse Rule:

(1) On account of its laxity it opens the door for the escape of many persons who are sane and should be prosecuted as criminals.

(2) There is difficulty in differentiating irresistible impulse from impulse which can be actually resisted.

(3) It fails to differentiate between real insanity and mere impulsive condition.

c. Durham Rule: The accused is not criminally responsible if his act was the

product of mental disease or mental defect.

The determination of criminal responsibility is based on the answer to two questions: (1) Is the defendant suffering from a mental disease or defect?

(2) If so, was his crime a product of the mental disease or defect?

Criticisms to the Durham Rule: (1) There seems to be uncertainties in the definition of "mental

disease or defect". Does it include personality disorders, character defect, sociopathic disorder which are clinically true mental diseases?

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(2) There is ambiguity of the term "product". When is an act the "product" of the diseased mind or deranged mental condition within the scope of the rule?

(3) The application of the rule will create a fear that all criminals would be regarded by psychiatrist as mentally ill, and hence, no one will be subjected to criminal prosecution or conviction.

d. Currens Rule:

In order to make the accused not responsible for his act it must be proven that at the time of committing the prohibited act the defendant, as a result of mental disease or defect, lacked substantial capacity to conform his conduct to the requirements of the law which he has allegedly violated. Criticisms to the Currens Rule:

Like the Durham Rule, a large number of the prison population will be considered not guiltv by reason of insanity.

e. American Law Institute Rule:

In 1955, The American Law Institute with the support of the American Bar Association, formulated the following rule of criminal responsibility:

(1) A person is not responsible for his criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks essential capacity to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law;

(2) TVie term "mental disease or defect" does not include an abnormality manifested only by repeated criminal or otherwise anti-social conduct.

Criticisms to the American Law Institute Rule:

(1) Some authorities, even psychiatrists, objected to the inclusion of item (b) of the rule. It has been pointed out that such exclusionary division discriminates between the poor and the well-to-do offenders. The poor defendants cannot avail themselves of a more rigid and more searching inquiry into their mental state but merely superficial, one done by government physicians.

(2) It does not give the court a simple, helpful guide in their effort to decide whether the accused was insane at the time of his act.

(3) The phrase "or to conform his conduct to the requirement of the law" permits the defendant to find refuge in what is equivalent to the "irresistible impulse" test.


There is a need of insanity defense in a civilized society to show that insane people who do not have criminal intent while performing a criminal act are not penalized.

Recent court decisions are moving to a broader definition of mental illness. Some rules now even define mental disease and mental defect to include addiction, alcoholism and conceivably even the slightest abberation of the mind. The expansive meaning of insanity cannot always be tolerated by law. Law and psychiatry have been in collision in the recent past.

No matter how mentally ill a person is, he may still probably be responsible to some degree. Psychiatrists should offer medical diagnosis and interpretation of signs of mental illness but not give legal judgment.

The assassination attempt by Hinkley to President Ronald Reagan of the United States wherein the court considered Hinkley to be insane has caused the development of a strong public opinion of re-examination or restructuring of our law on defense of insanity. There is now a strong public opinion not to consider insanity as an exempting circumstance to criminal liability. The following proposition are suggested for future action:

(1) An accused may be pronounced to be mentally ill. He can be treated in a mental hospital until recovery. After recovery he may then be transferred to prison to serve cut the remaining term.

(2) The accused may be pronounced guilty with diminished responsibility. His mental condition may be considered only as a mitigating circumstance to his criminal liability. Or he may be convicted if found insane for a lesser offense because of emotional disturbance.

II. MENTAL DEFICIENCY

Mental deficiency (mental subnormality, mental retardation) is the below-normal intellectual functioning which originates from the arrest or incomplete development of the mind during the development period below the age of 18 which may be induced by various factors associated with the impairment of learning, social adjustment or maturation.

Classical Classification: 1 Idiot - Usually congenital and due to defective development of

the mental faculties. An idiot is wanting in memory, will power and emotion. He cannot express himself by language, is quiet,

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timid and easily irritated. He cannot guard himself against common physical dangers. The deficiency is usually associated with physical abnormalities like microcephaly and mongolism. Mentality never exceeds that of a normal child over 2 years old. The I.Q. is between 0 — 20.

2. Imbecile — Although the mental defect is not as severe as that of idiots, he cannot manage his own affairs. He may be able to speak but with poor command of the language. He can easily be aroused to passion and may show purposeful behavior. He may be trained to do simple work under supervision. The mental age may be compared to a normal child from 2 to 7 years old and the I.Q. is 20 - 40.

3. Feeble-minded — Person whose mental defect, although not amounting to imbecility, is pronounced such that he requires care, supervision, and control for his protection and for the protection of others. He is incapable of receiving proper benefit from instructions in ordinary school. He lacks initiative and ability for any work or responsibility. He has a mentality similar to that of a normal child between 7 to 12 years old and an I. Q. of 40-70.

Moron — A feeble-minded person of considerably higher intelligence as that of an imbecile but his intellectual faculties and judgment are not as well developed as in a normal individual. He can carry routine duties in civilized society as long as the demands made upon his mental capacity is not too discretionary. He is amenable to the customs of the community and may not present so much of a social problem.

4. Moral Defective — In addition to the mental defect, there are strong vicious and criminal propensities, so that the person requires care, supervision and control for the protection of others. He is devoid of moral sense and often shows intellectual deficiency, though he may be mentally alert. He is careless; pleasure loving; and a devil-may-care sort of young man or woman who adheres to the principles of "live today for tomorrow we die", "live fast and die young" and "it is only happiness that counts". (A Sypnosis of Forensic Medicine & Toxicology by C. Thomas, 2nd ed., p. 125).

Because of the stigma that may likely be attached to the child if the classical classification (idiot, imbecile, feeble-minded) is used, new classifications have been adopted by some countries. Mental retardation is classified as follows: 1. Profound — I .Q. is under 20, and capable at most to limited

self-help. There is most likely a need for hospitalization or some type of environment in which care is available throughout his life-time.


2. Severe — I .Q. is between 20 and 35 and capable of habit training as a child. As an adult he is likely in need of a controlled environment.

3. Moderate — I .Q. is 36 to 51 and can develop academic skill equal to about the second grade level. As an adult he will most probably need a sheltered environment.

4. Mild — I.Q. is 52 — 67 and constitutes the greatest group of mentally retarded. He can develop academic skill to about the sixth grade level. As an adult he can develop social and vocational skills. Whether he is to be institutionalized or not depends more on his social skill and on the range of alternatives available to him than on his intellectual functioning.

Although it is not a part of the original standard classification, a fifth degree known as borderline retardation with an I.Q. of 68 — 83 may be added.

In England, under the Mental Health Act 1959, Part I, No. 4, mental deficiency is simply classified as:

1. Severe Abnormality — A state of arrested or incomplete development of mind which includes abnormality of intelligence and is of such a nature or degree that the patient is incapable of living an independent life or of guarding himself against serious exploitation, or will be incapable when of an age to do.

2. Subnormality — A state of arrested or incomplete development of mind (not amounting to severe abnormality) which includes subnormality of intelligence and is of a nature or degree v/hich requires or is susceptible to medical treatment or other special care or training of the patient.

Methods of Estimating Mental Capacity:

1. Intelligence Tests: At the age of 18 the human mind is presumed to have attained

its full development. Knowledge acquired after such age comes from experience, memory and study.

Intelligence testing may be used to (a) diagnose the degree of mental retardation, (b) study the ways in which the individual's intellectual ability is threatened by personality problems, and (c) as a means to understand personality dimensions.

There are many different tests used by psychometrists and it is sufficient to mention some of them. a. Performance Tests (Don't Require the Use of Language):

(1) Good Enough Draw-a-person Test — A subject is asked to draw a person and a number of corresponding points are

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given to different parts of the body and clothings. The total number of points is then converted into a quantitative measure of intelligence. The test can provide evidence for personality functioning and conflicts as well as intelligence estimate.

(2) Raven Progressive Matrices Test: — A series of designs in which a part is removed from each member of the series, and the individual is presented with six alternative parts from which to choose the part which is missing in the original design. This test is useful in measuring the person's ability to reason by analogy, for comparison and to indicate the logical method of thinking.

b. Verbal Test — This depends essentially on words and numbers.

c. Mixed (Verbal and Non-verbal) Test: (1) Binet Test — The individual is given credits in months for

task completed successfully, and the individual's total score is the sum of the months of credit received for items passed. The total credit in months (mental age) in conjunction with the individual's chronological age is converted into an intelligence quotient ( I . Q . ) . The test is valuable for children under 10 years old.

Example: If a person at the age of 20 was able to answer all the questions up to the age of 12, 2 in 8, 1 in 9 and 1 in 10 and each of the answers is equivalent to 2 months, then the person has an intelligence or mental age of 12 years and 8 months.

(2) Wechsler Tests — (Wechsler Intelligence Scale for Children — Revised, WISC-R, and Wechsler Adult Intelligence Scale, W A I S ) : This consists of 12 subtests (six verbal and six non-verbal). The verbal test may consist of information, general comprehension, similarities and vocabulary. The performance test includes a variety of scales, like pictures, arrangements, block design, etc. The row for each subtest is converted to an equivalent weight score permitting comparison with other subtests. When the different weighed scores are added together, the clinician can obtain three different intelligence quotients: verbal, performance and full scale.

2. Intelligence Quotient (I.Q.):

Several test types are prepared corresponding to every age in months and these are answered by the person examined. The age of the person examined is determined in terms of months. The number of months corresponding to the test type answered

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divided by the age of the person in months is the intelligence quotient (I .Q.) -

Example: A child at the age of 8 years and 4 months was able to answer the test for 7 years and 6 months. 8 years and 4 months is equivalent to 100 months, while 7 years and 6 months is equivalent to 90 months. 90 divided by 100 equals 90 as I.Q.

/. Q. Classification

Above 140 "Near" genius or genius 1 2 0 - 140 Very superior intelligence 1 1 0 - 120 Superior intelligence

90 - 110 Normal or average intelligence 80 - 90 Dullness, rarely classified as feeble-minded 7 0 - 80 Borderline deficiency, sometimes classified

as dullness, often as feeble-minded Below 70 Definitely feeble-minded

Principal Drawbacks to Different Intelligence Tests:

1. The tests seem to give undue weight to memory.

2. The tests do not take into consideration the vision or hearing of the subject.

3. The tests overlooked the fact that some persons are inattentive or nervous.

4. Cooperation of the person tested is absolutely necessary.

Mental Deficiency and Criminal Responsibility:

Imbecility, according to Article 12, par. 1 of the Revised Penal Code, is an exempting circumstance to criminal liability. Inferential-ly the condition of idiocy is also an exempting circumstance inasmuch as it is of a much more deficient degree as compared to imbecility.

Feeble-mindedness is a mitigating circumstance provided in Article 13 par. 8, 9 or even 10 of the Revised Penal Code.

Art. 13, Revised Penal Code — Mitigating Circumstances — The following are mitigating circumstances:

8. That the offender is deaf and dumb, blind or otherwise suffering from some physical defect which thus restricts his means of action, defense, or communication with his fellow beings.

9. Such illness of the offender as would diminish the exercise of will-power of the offender without however depriving him of consciousness of his acts.

10. And, finally, any other circumstance of a similar nature and analogous to those above mentioned.

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The fact that the accused is feeble-minded warrants the findings in his favor of the mitigating circumstance provided for in either par. 8 or 9 of Art. 13 of the Revised Penal Code, namely, that the accused is "suffering from some physical defect which thus restricts his means of action, defense or communication with his fellow beings" or "such illness as would diminish the exercise of his willpower" (People v. Formigones, 48 O.G. 1772).

How the Court Becomes Aware of the Mental Condition of a Person:

1. Any party in a proceeding may present evidences to show the mental condition of a person. He who alleges something must prove the same by presentation of evidence in support of his allegation.

In a criminal proceeding wherein the defense of insanity is invoked, the party must present proofs that the accused is insane and does not know the nature and quality of his act. In the probate of a will, the petitioner must present evidence to show that the testator is of a sound and disposing mind at the time of execution of a will.

2. Upon motion of one of the parties, the court may issue an order to submit a person to a physical and mental examination.

Rule 28, Rules of Court:

Physical and mental examination of person:

Sec. 1. When examination may be ordered — In an action in which the mental or physical condition of a party is in controversy, the court in which the action is pending may in its discretion order him to submit to a physical and mental examination by a physician.

Sec. 2. Order for Examination — The order for examination may be made only on motion for good cause shown and upon notice to the party to be examined and to all other parties, and shall specify the time, place, manner, conditions and scope of the examination and the person or persons by whom it is to be made. Sec. 3. Report of findings — If requested by the person examined, the party causing the examination to be made shall deliver to him a copy of a detailed written report of the examining physician setting out his findings and conclusions. After such request and delivery the party causing the examination to be made shall be entitled upon request to receive from the party examined a like report of any examination, previously or thereafter made, of the same mental and physical condition. If the party examined refuses to deliver such report the court on motion and notice may


make an order requiring delivery on such terms as are just, and if a physician fails or refuses to make such a report the court may exclude his testimony if offered at the trial.

Ways of Hospitalizing an Insane Person:

1. Judicial Method:

a. Upon petition by the Director of Health. b. The court upon knowledge that the imbecile or insane com

mitted a felony.

2. Extra-judicial method:

a. Voluntary. b. Involuntary.

1. Judicial Methods:

a. Rule 101, Rules of Court:

Proceedings for hospitalization of insane persons:

Section 1. Venue. Petition for commitment — A petition for the commitment of a person to a hospital or other place for the insane may be filed with the Court of First Instance (Regional Trial Court) of the province where the person alleged to be insane is found. The petition shall be filed by the Director of Health in all cases where, in his opinion, such commitment is for the public welfare, or for the welfare of said person who, in his judgement, is insane, and such person or the one having charge of him is opposed to his being taken to a hospital or other place for the insane.

Section 2. Order for hearing — If the petition filed is sufficient in form and substance, the court, by an order reciting the purpose of the petition, shall fix a date for the hearing thereof, and copy of such order shall be served on the person alleged to be insane, and to the one having charge of him, or on such of his relatives residing in the province or city as the judge may deem proper. The court shall furthermore order the sheriff to produce the alleged insane person, if possible, on the date of the hearing.

Section 3. Hearing and judgment — Upon satisfactory proof, in open court on the date fixed in the order, that the commitment applied for is for public welfare or for the welfare of the insane person, and that his relatives are unable for any reason to take proper custody and care of him, the court shall order his commitment to such hospital or other place for the insane as may be recommended by the Director of Health. The court shall make proper provisions for the custody of property or

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money belonging to the insane until a guardian be properly appointed.

Section 4. Discharge of insane — When, in the opinion of the Director of Health, the person ordered to be committed to a hospital or other place for the insane is temporarily or permanently cured, or may be released without danger he may file the proper petition with the Court of First Instance (Regional Trial Court) which ordered the commitment.

Section 5. Assistance of fiscal in the proceeding — It shall be the duty of the provincial fiscal or in the City of Manila the fiscal of the city, to prepare the petition for the Director of Health, and represent him in court in all proceedings arising under the provisions of this rule.

2. The court may order confinement of insane or imbecile upon knowledge that he has committed^ felony: Art. 12, Par. 2, Revised Penal Code:

When the imbecile or an insane person has committed an act which the law defines as a felony (delito), the court shall order his confinement, in one of the hospitals or asylums established for persons thus afflicted, which he shall not be permitted to leave without first obtaining permission of the same court.

2. Extrajudicial Methods:

a. Voluntary:

The insane person himself or with the assistance of the relatives or guardian during the lucid intervals or during such time that he is still normal may request his confinement in a hospital or asylum. This is common among persons who are afflicted with the disease and are aware of the advantage of hospitalization.

b. Involuntary:

The immediate relatives, the peace officer or other persons who are concerned with the welfare of the society may force the insane to be confined in a hospital. Such coersive confinement may be in accordance with the valid exercise of police power of the state or by virtue of ordinance.

Police power is the power inherent in a government to enact laws within constitutional limitations, to promote order, safety, health, morals, and the general welfare of society. Sec. 2238, Revised Administrative Code — General power of council to enact ordinances and make regulations: —"The municipal council shall enact such ordinance and make such


regulations, not repugnant to law, as may be necessary to carry into effect and discharge the powers and duties conferred upon it by law and such as shall seem necessary and proper to provide for the health and safety, promote the prosperity, improve the morals, peace, good order, comfort and convenience of the municipality and the inhabitants thereof, and for the protection of property therein".

III. MALINGERING

Malingering is the feigning or simulation of a disease or injury characterized by ostentation, exaggeration and inconsistency.

Causes of Malingering:

1. To Avoid Military or Naval Training:

A person may feign disease or injury because he is required by law to undergo military or naval training. Under the National Defense Act (Commonwealth Act No. 1) all male citizens of the Philippines who have reached 20 years of age must undergo military training under penalty of law for failure to do so. All male college students enrolled must have at least two years of military training as a requisite for graduation. For some reason or cause, a person may malinger disease or injury so that he will not be subjected to such a requirement.

2. To Avoid Court Summons:

A person may have received a summon from a court requiring him to appear on a specified date, time and place but refuses to appear because he is a defendant in the case wherein he wants to delay the proceeding, or he is afraid to be subjected to the ordeal of direct and cross examination. He may simulate that he is suffering from a disease or injury which incapacitate him to attend the trial.

3. As a Defense to a Criminal Prosecution:

Impotency may be utilized by the defendant in the prosecution of the crime of rape. An accused while on trial may allege that it is not possible for him to commit the crime of rape because he is impotent.

4. To Increase Civil Liability: A plaintiff in a civil action for the recovery of damages and for

the injury sustained may exaggerate the physical disability so that he may receive bigger award from the court.

5. To Promulgate Sympathy: A beggar may exaggerate incapacity or simulate disease or injury

so that the public may be more sympathetic towards him and give him more alms.

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Types of Malingering: 1. "Feigned or Fictitious" Malingering:

Malingering is built up out of pure imagination and does not have the slight basis of fact. The disease or injury which a person allegedly is suffering from does not exist at all.

Example: A person may simulate that he is totally blind while in fact both eyes are normal.

2. "Factitious" Malingering:

This is a form of malingering whereby something really exists as a fact but is converted to a more serious disability or injury, or to an exaggeration of the real complaint. Here the person is really suffering from an injury or disease but he may exaggerate or amplify the seriousness of the complaint or nature of the injury or disease.

Example: A person might have received a small superficial scratch but complained of severe and unbearable pain and incapacity to move.

Points which Make a Physician Suspect that a Person is Malingering:

1. Presence of a Cause for the Subject to Malinger:

A person may feign disease or injury because he wants to avoid something, like military training, court trial or other obligations which he does not like, or he wants to get something, like sympathy or greater civil damages.

2. Inconsistency Between the Injuries or Disease Suffered from and the Symptoms or Disability Manifested:

In factitious malingering the subject may show certain manifestations which, in the ordinary course of life, are inconsistent or not proportionate to the actual physical disability present.

3. Symptoms Not Supported with Organic Lesion:

A woman may allege that she has been abused by force and that she bied profusely, but on physical examination a few hours after the alleged assault, no sign of physical injury was noticed on her private organ.

4. Abrupt Onset of Symptoms:

If a person feigns insanity or some other diseases, he may manifest abrupt symptoms which are incompatible with the normal course of disease.

5. Refusal to be Subjected to Painful or Annoying Treatment:

A person may feign that he is suffering from sprain or fracture of his upper or lower extremities. The physician may suggest the


placing of the injured portion under plaster cast and the patient may refuse because it may put him to some inconvenience.

A person may complain of some disturbance in the gastrointestinal tract but when prescribed magnesium sulfate, he refused to take it.

Whenever a physician is requested to examine a patient to determine whether he is malingering or not, he must utilize all of his senses, have a keen observation and apply methods of detection appropriate for the occasion.

Ways to Determine Malingering:

There is no specific test for a specific form of malingering. The test applicable depends upon the demand of the occasion considering the attitude of the subject and the nature of the malingering. The tests may be:

1. General Procedure — The method is applicable to all forms of malingering:

a. Observation of the subject during his unguarded moments:

A person cannot always be conscious that somebody is observing him. He may for some moments unconsciously show his normal condition and not exhibit the disability feigned.

b. Complete history and physical examination:

The history that may be narrated by the subject may not be compatible with the result of the physical examination and the manifesting symptoms are common among malingerers.

c. Application of general anesthesia.

d. Application of sudden unexpected minimal amount of electrical stimulus.

2. Specific Procedure:

a. Feigning Blindness: (1) Place a convex 12D lens before the "good" eye and a weak

concave lens (say 0.25D) before the "blind" eye and ask the patient to read Snellen's test types from a distance of 6 meters. If he succeeds in reading it is a definite proof that he is malingering, since it is impossible to read the type through such convex lens.

(2) Place a lighted candle at a distance of 6 meters from the patient, and a prism with base upwards or downwards, before the good eye. If the patient can see two flames it means that good vision is present on both eyes.

(3) Take a firearm and with the patient focusing his eyes towards the revolver, fire three or four shots in the air.

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Then all of a sudden aim the firearm towards him. If the patient is blind there will be no instinctive act of dodging.

b. Feigning Deafness:

(1) This is a method to determine whether only one of the ears is allegedly deaf. Place a loud tickling watch in the supposed sound ear and ask if he is able to hear the tickling. If he answers in the affirmative, gradually withdraw the watch and ask him when he can no longer hear the tick.

Place the watch on the "deaf" ear and ask him if he hears the tick. He will certainly give a negative answer.

Now let him close both eyes and you place something metallic (which will make him believe it to be a watch) against the back of the deaf ear, at the same time hold the watch behind (but not touching) the sound ear and ask him if he is able to hear the tick.

If he says no, then he is malingering.

(2) Close the sound ear with cotton. Make a loud noise on the "deaf" ear. Notice the expression of the face.

c. Feigning Insanity:

There is no specific test or procedure to determine feigning insanity. A keen observation of the behavior coupled with the history and physical findings probably are the most reliable.

IV. OTHER CONDITIONS MANIFESTING OR SIMULATING DISTURBANCE OF MENTALITY

1. Somnambulism:

This is an abnormal mental condition whereby a person is performing an act while in the state of natural sleep. A somnambulist might be concentrated in a particular train of idea or obsessed by certain thoughts which baffled his mind that he tried to execute it while in the state of sleep. He may commit the crime of murder, infanticide, or parricide while under the influence of the fit. A somnambulist has no recollection of the events occurring during the fit and in several courts of different countries somnambulists are exempted from criminal liability.

In a case cited by Modi, Marggie Alexander was charged of having killed her child with a razor while in the state of sleep. The jury gave a verdict of guilt but insane because the somnambulist did not know what she was doing nor was capable of appreciating the nature and quality of the act.

In the Philippines, in the case of People v. Gimena (55 Phil-604) the defendant attacked his wife with a bolo. The defense


was that he was in the state of somnambulism when he attacked his wife. The court held that the offense charged was committed by the accused while in the state of somnambulism. Somnambulism is recognized by the court as an exempting circumstance as a manifestation of insanity. Here the defendant was placed under observation for sometime but it was not shown that he was suffering from somnambulism.

2. Semisomnolence or Somnolencia:

A person is in a semisomnolence state when he is half asleep or in a condition between sleep and waking. A person may be suddenly aroused and may unconsciously commit a criminal act, like murder, infanticide or parricide, or some other crimes, while his mind is at the state of confusion.

Criminal acts committed in this state do not show manifestations to justify insanity. There is no jurisprudence in the Philippines deciding squarely whether it will exempt a person from criminal liability.

3. Hypnotism or Mesmerism:

A person is made unconscious by the suggestive influence of the hypnotist. He may commit a criminal act while under the influence of hypnotism which he may not be capable of doing while under a normal state.

A person cannot be hypnotized against his will, and if a person volunteers to be hypnotized he must anticipate all the consequences of his acts while under the hypnotic spell.

Hypnotism as a defense to a criminal act is not accepted with favor in the court. A person cannot take advantage of his own misconduct.

However, under the Civil Code (Art. 1328) contracts agreed to during hypnotic spells are voidable. The Civil Code seems to acknowledge the absence of the normal state of mind of a person under the influence of hypnotism.

4. Delirium: Delirium is a state of confusion of the mind. It is characterized

by incoherent speech, hallucination, illusions, delusions, restlessness, and apparently purposeless motions. A person may, when under the state of delirium, commit a crime.

It may be advanced that a person committing a felonious act while in a delirious state may be exempted from criminal liability although there is no jurisprudence in the issue yet.

Chapter XXXII

DRUG DEPENDENCE

1. Biosocial Factors Responsible for the Emergence of Drug Problems:

a. It is less than three hours flight westward from the Philippines to the Golden Triangle, the primary source of opium supply for legitimate and illegitimate use. From this source narcotics have been transported all over the world and in some instances the Philippine ports are used for transshipment. There are several instances where opium has been discovered and confiscated in the airports allegedly en route to a foreign port.

b. The Philippines is endowed by nature with a humid, warm tropical weather most conducive to luxuriant propagation and growth of marijuana plant. This accounts for vast tracks of land in the mountain region of the north yielding vigorous plants and bountiful harvest.

c. A demographic study of our population revealed that a greater part of our population is getting younger and younger. A great number of our citizenry belongs to the age group most susceptible to marijuana.

d. The Philippines is a mirror image of America. There are reports that in some states of the Union one out of four children is drug dependent. This prevailing situation in the United States is seemingly brought to our shores.

e. Men are by nature pleasure loving or hedonistic. The feeling of euphoria, well-being, day-dreaming, hallucination, vigor, illusion, develops whenever a person is under the influence of drug. Whenever a man intends to do something, he always measures the amount of pleasure and pain that accompanies it.

f. The profit motive of the pushers, planters, and retailers is another factor. In any human activity, profit and risk go hand in hand. More risk — more profit principles dominate human action in periods of economic difficulties.

g. The gradual disappearance of the olden nuclear nature of the the Philippine family and the emergence of a permissive society

. have contributed to the rise in drug problems. (1) The western system of less control of parents over children

has gradually become a fashion of time.

654

DRUG DEPENDENCE 655

(2) The world's clamor to respect human rights has reverberated in all corners of the world.

(3) The constitutional provision that "no person shall be deprived of his right, liberty or property without due process of law" has been extended in its application to include almost everything.

h. As we enter another decade, we begin to feel the impact of the discoveries, explorations, and researches done in the past. Scientists have discovered new drugs for the purpose of alleviating human diseases or symptoms of diseases. Pain, a scourge of mankind, is now a thing of the past. Exploration of the deeper structure of man, organ transplantation, and control of human behavior are now of common occurrence. Botanists, pharmacologists, and pharmacognosists have delved deeper into structures, contents, manner and site of action of the potent, contents of the members of the plant kingdom. New drugs have been synthesized, and have produced beneficial, as well as deleterious effects on mankind.

D A N G E R O U S D R U G ACT

The provisions of the Revised Penal Code on crimes relative to opium and other prohibited drugs (Art. 190 — 194) have been repealed by Republic Act No . 6425 as amended, otherwise known as Dangerous Drug Act of 1972.

During the past decades opium and other allied drugs have been considered to be the only drugs found to be harmful to mankind and society so that they are the ones subjected to social control. But, in the recent past, new drugs have been discovered to be naturally existing while others have been synthesized which are equally or even more harmful than opiates. It is therefore imperative to enact new laws to include and intensify control on all drugs deleterious to human beings and to society as a whole. In response to the social demand, the Dangerous Drug Act of 1972 was passed by the defunct Congress of the Philippines.

A dangerous drug is a drug whose use is attended by risk and therefore unsafe, perilous and hazardous to people and/or to a society. A drug is any substance, vegetable, mineral or animal in origin, used in the composition or preparation of medicine or any substance used as medicine.

The Dangerous Drug Act has classified drugs which are subject to control into prohibited drugs and regulated drugs. It did not define what is a prohibited or what is a regulated drug. It merely enume-

656 LEGAL MEDICINE

rates the drugs which are included in the category of prohibited and those considered regulated drugs for the purpose of graduating penalties. Violation of different acts relative to prohibited drugs has higher penalties as compared with the same acts committed in violation of the regulated drugs. The classification is not based on their pharmacologic effects but on societal reaction in the control on specific acts of specific drugs. If society has a strong adverse attitude against any drug, then it will be included in the enumeration of prohibited drugs. The following drugs or group of drugs are considered dangerous and are governed, by the Dangerous Drug Act.

1. Prohibited Drugs:

a. Opium and its active components and derivatives, such as heroin and morphine;

b. Coca leaf and its derivatives, principally cocaine;

c. Alpha and beta cocaine, hallucinogenic drugs, such as mescaline, lysergic acid diethylamide ( L S D ) and other substances producing similar effects;

d. Indian hemp and its derivatives; e. All preparations made from any of the foregoing; and

f. Other drugs, whether natural or synthetic, with the physiological effects of a narcotic drug (Sec. 2.2, No . 1, R.A. 6425).

2. Regulated Drugs:

a. Self-inducing sedatives, such as secobarbital, phenobarbital, pentobarbital, barbital, amobarbital and any other drug which contains salt or a derivative of a salt of barbituric acid;

b. Any salt, isomer or salt of an isomer, of amphetamine, such as benzedrine, or any drug which produces a physiological action similar to amphetamine; and

c. Hypnotic drugs, such as methaqualone or any other compound producing similar physiological effects (Sec. 2. No. (2), R. A. 6425).

Any drug or group of drugs included in the classification may cause a user to be drug dependent. Drug dependence means a state of psychic or physical dependence, or both, on a dangerous drug, arising in a person following administration or use of that drug on a periodic or continuous basis (Sec. 2(g), R .A. 6425). Drug dependence may either be a condition of drug addiction or drug habituation. 1. Drug addiction is a state of periodic or chronic intoxication pro

duced by the repeated consumption of a drug, whether synthetic or natural, and found to be detrimental to the individual and to the society ( W H O ) .

DRUG DEPENDENCE 657

Characteristics of Drug Addiction:

a. An overpowering desire or need (compulsive) to continue taking the drug or to obtain it by any means;

b. A tendency to increase the dose;

c. A psychological and physical dependence on the effects of the drug; and

d. A detrimental effect to the society and to the individual.

2. Drug habituation is the desire to have continuous use of the drug but with the capacity to refrain physically from using it.

Characteristics of Drug Habituation:

a. The desire to use the drug is not compulsive but merely psychical;

b. There is little or no tendency to increase the dose;

c. The dependence is not physical but merely psychical; and

d. The detrimental effect, if any, is primarily on the individual.

PROHIBITED ACTS A N D RESPECTIVE P E N A L T I E S U N D E R THE D A N G E R O U S D R U G S A C T :

1. Prohibited Drugs

Section Prohibited Act

3 Importation of prohibited drugs.

4 Sale, administration, delivery, distribution and transportation of prohibited drugs.

5 Maintenance of a den, dive or resort for prohibited drugs.

6 Employees and visitors of a prohibited drug's den.

Penalty

14 yrs. & 1 day to life imprisonment and a fine of 14,000 to 30,000 pesos.

12 yrs. & 1 day to 20 years imprisonment and a fine of 12,000 to 20,000 pesos. If the victim died, life imprisonment to death & a fine of 20,000 to 30,000 pesos.

12 yrs. & 1 day to 20 yrs. imprisonment and a fine of 12,000 to 20,000 pesos.

2 yrs. & 1 day to 6 yrs. imprisonment and a fine of 2,000 to 6,000 pesos.

658 LEGAL MEDICINE

7 — Manufacture of prohibited drugs.

Possession or use of prohibited drug.

Cultivation of plants which are sources of prohibited drugs.

10 Failure to record prescriptions, sales, purchases, acquisitions and/or deliveries of prohibited drugs.

11 Unlawful prescription of prohibited drugs.

12 Unnecessary prescription of prohibited drugs.

13 Possession of opium, pipe and other paraphernalia for prohibited drugs.

2. Regulated Drugs

14

15

Importation of regulated drugs.

Sale, administration, dispensing, delivery, transportation of regulated drugs.

Life imprisonment to death and a fine of 20,000 to 30,000 pesos. 6 yrs. & 1 day to 12 yrs. imprisonment and a fine of 6,000 to 12,000 pesos. 14 yrs. & 1 day to life imprisonment, revocation of license, and a fine of 14,000 to 30,000 pesos.

1 yr. & 1 day to 6 yrs. imprisonment, revocation of license, and a fine 1,000 to 6,000 pesos.

8 yrs. & 1 day to 12 yrs. imprisonment, revocation of license, and a fine of 8,000 to 12,000 pesos.

4 yrs. & 1 day to 12 yrs. imprisonment, revocation of license, and a fine of 4,000 to 12,000 pesos.

6 mos. & 1 day to 4 yrs. imprisonment and a fine of 600 to 4:000 pesos.

yrs. & 1 day to 12 imprisonment and

fine of 6,000 to 12,000 pesos. 6 yrs. & 1 day to 12 yrs. imprisonment, revocation of iicense, and a fine of 6,000 to 12,000 pesos.

6 yrs a

DRUG DEPENDENCE 659

16 Possession or use of reg- 6 mos. & 1 day to 4 ulated drugs. yrs. imprisonment and

a fine of 600 to 4,000 pesos.

17 Failure to record prescrip- 6 mos & 1 day to 4 tion, sales, purchases, ac- yrs. imprisonment and quisitions, and/or deliveries a fine of 600 to 4,000 of regulated drugs. pesos.

18 Unlawful prescription of 4 yrs. & 1 day to 6 regulated drugs. yrs. imprisonment, re

vocation of license, and a fine of 4,000 to 8,000 pesos.

19 Unnecessary prescription of 6 mos. & 1 day to 4 regulated drugs. yrs. imprisonment, re

vocation of license, and a fine of 600 to 4,000 pesos.

Pharmacologic Classification of Dangerous Drugs:

1. Hypnotics. 2. Sedatives and Tranquilizers. 3. Hallucinogens and Psychomimetics. 4. Stimulants. 5. Deliriants and Intoxicants.

OPIATES AND THEIR DERIVATIVES:

Opium is obtained from the milky exudate of the incised unripe seed capsules of the poppy plant, Papaver Somaiferum. The milky juice is dried in the air and forms a brownish gummy mass which contains 25% opium by weight.

1. Classification of Opium Alkaloids:

Those that are naturally existing in the poppy plant: a. Morphine — Name derived from Morpheus, the God of Dream. b. Codeine c. Thebaine d. Papaverine e. Nescapine

Those derived by chemical manipulation of the naturally occurring alkaloid: a. Heroin (diamorphine, diacetylmorphine).

H Y P N O T I C D R U G S

660 LEGAL MEDICINE

b. Dihydromorphinone (Hydromorphine, Dilaudid). c. Methyl dihydromorphinone (Metaphon). d. Apomorphine.

Synthetic: a. Methadone Dolophine. b. Pethidine (Meperidine, Demerol).

Heroin and dehydromorphinone are approximately five times as potent as morphine. Heroin is poorly absorbed after oral dosage and is usually given parenterally. Synthetic compounds are effective by mouth and methadone has more prolonged effect than pethidine.

Chronic administration of the majority of opium and its derivatives causes tolerance and an increasing dose is necessary to produce effect. Dependence is physical and psychical and one is likely to develop into a chronic user and withdrawal of the drug may precipitate the symptoms of the withdrawal syndrome.

2. Derivatives of Opium Commonly Used:

a. Morphine (sulfate, hydrochloride, acetate or tartrate) — Average dose 1/6 to 1/4 gr. given by mouth or by subcutaneous injection.

b. Heroin — Therapeutic dose is 1/2 to 1/6 gr. and may be given in the same way as morphine. It may be sniffed with or without cocaine.

c. Dionine — Therapeutic dose 1/10 to 1/2 gr. d. Dihydromorphinone (Dilaudid) — Therapeutic dose 1/20 gr.

Taken like morphine or as suppositories. e. Metaphon — Effective dose is by mouth 1/20 gr. f. Pantopon — A propriety medicine containing all the alkaloids

of opium and may be taken by mouth or by injection. g. Codeine — Therapeutic dose is 1/2 gr. and may be taken by

mouth. h. Synthetic preparations.

(1) Demerol — Therapeutic dose is 50 — 100 mg. and resembles morphine and atropine in action.

(2) Methadone — Given by mouth or hypodermically. The therapeutic dose is 5 mg.

3. Signs and Symptoms of Opium Administration:

Stage of Excitement: a. There is an increase in mental activity, restlessness or even

hallucination. b. There is flushing of the face and increased action of the heart.

This state is of short duration and in big dosages it may be absent.

DRUG DEPENDENCE 661

Stage of Stupor:

a. The person suddenly becomes quiet. b. There may be headache, giddiness, lethargic condition and

uncontrollable desire to sleep. c. When asleep, he can be aroused by external stimuli. d. Pupils are contracted, face and lips are cyanosed. e. There is itching sensation all over the skin. f. Pulse and respiration are still normal.

Stage of Narcosis:

a. The patient passed into a deep coma. b. He cannot be aroused by external stimuli. c. Muscles are relaxed and reflexes are lost. d. Skin secretion is completely suspended although the skin feels

cold and clammy. e. The face is pale, the lips are livid and there may be a drop of

the lower jaw. f. The pupils are contracted to almost a pinpoint and they're

insensible to light. g. Conjunctivae are injected. h. The pulse is slow, small and compressible. i. Respiration is slow, labored and stertorous.

If dosage is lethal and no prompt and proper treatment is given, the following symptoms of the toxicity may be observed: j. Lividity of the face increases and pulse becomes slower, irreg

ular and imperceptible, k. Respiration becomes slower, feeble and later Cheyne-Stokes

and the patient may die of asphyxia. 1. The heart may beat for a while but later stop,

m. Convulsion may occur with the pupils dilated immediately after death.

4. Consequences of Continuous Use of the Drug: a. Development of tolerance to the drug. The drug is taken in

large quantity without producing any effect or without fatal consequence.

b. Physical and moral deterioration. c. Untruthfulness, dishonesty and mental deterioration. d. When under the influence of the drug, he is calm and com

posed, but becomes restless and irritable when deprived of the drug.

e. May develop constipation and intercurrent infection, like tuberculosis.

f. Those who try to inject themselves develop scars and abscesses in the skin.

662 LEGAL MEDICINE

g. Some manifest suicidal tendencies or maniacal symptoms.

5. Early Presumptive Signs that a Person is Taking any Addictive or Habit Forming Drugs:

At Home: a. Unaccountable change in habit and mode. b. Loss of appetite and weight. c. Sudden development of clandestine friendship especially with

elder boys. d. Personality change for which the parents can find no rational

explanation. e. Unexpected discovery of the tablet, capsule or peculiar smelling

cigarette in the home. f. Unexpected neglect of personal appearance and hygiene.

At School:

a. Sudden loss of interest and performance in studies and sports. b. General evasiveness, truancy and problems over discipline. c. Unconscious depression and cheerfulness at work or play over

a period should lead to suspicion.

At Work:

a. Late time-keeping. b. Frequent change of occupation. c. Problem with employer. d. Failure to settle down.

6. Evidences of Opium Addiction: a. Presence of symptoms as mentioned. b. History of partaking of drugs. c. Addict is skinny or asthenic — He prefers to buy drug than

food. d. "Main liner" — Multiple pigmented punctured marks along the

course of the superficial veins. e. "Skin popper" — Scars of previous subcutaneous abscesses

also along the course of the superficial veins. f. Fresh needle puncture marks with underlying hemorrhage can

be demonstrated in recent intravenous injection. g. Constriction of the pupil of the eyes. h. Weakness and paleness due to malnutrition. i. Blood examination reveals presence of the drug, j . Presence of the drug in the urine. k. Presence of paraphernalia for the administration of the drug.

(1) "Cooker" — a bottle toy or spoon. (2) Syringe — usually an eye dropper. (3) Tourniquet — usually belt, shoelace or stocking.

DRUG DEPENDENCE 663

(4) "Spike" - a needle.

1. Withdrawal syndrome develops when deprived of the drug.

7. Withdrawal Syndrome:

If an addict is suddenly deprived of opiate, the following symptoms may be observed: Objective Signs:

a. 8 to 16 hours after withdrawal — nervousness, restlessness and anxiety.

b. 14 hours later — frequent yawning, sweating, running of nose and lacrimination.

c. 24 hours later — symptoms increase, pupils are dilated, goose-flesh develops and shivering attack.

d. 36 hours — severe twisting of muscles, painful cramps of legs and abdomen, vomiting and diarrhea.

e. 3 — 4 days — blood sugar rises; patient becomes sleepy on the 3rd day.

Subjective Symptoms:

a. Pain. b. Hallucination. c. General body weakness. d. Suicidal impulse. e. Depression. f. Criminal propensities. g. Colic.

8. Elimination of Opium:

a. Through the stomach and intestine irrespective of whether the drug is administered by mouth or by injection.

b. A great portion of the drug is oxidized in the liver. c. A small portion is eliminated through the urine.

9. Post-mortem Findings in Opium Poisoning: Nothing characteristic but signs of asphyxia are most pro

minent: a. Face and fingernails are livid. b. Froth comes out of both nostrils and mouth. c. Dark fluid blood is found in the heart and big blood vessels. d. Trachea is congested and filled with froth. e. Lungs are engorged, edematous and exudes frothy fluid. f. Stomach may contain brownish lump of opium mixed with

brownish viscid fluid, if opium was ingested. g. Odor of opium may be present in the stomach content. h. There is brain congestion.

664 LEGAL MEDICINE

i. Pupils are pinpoint-size. j. Multiple scars and abscesses along the course of the superficial

veins in the arms and forearms are observed, k. Chemical examination of the blood shows the presence of the

drug.

SEDATIVES

BARBITURATES:

Barbituric acid or malonyl carbamide was the product of the synthesis of malonic acid and urea allegedly on St. Barbara day. Small dose has sedative effects while bigger dose may induce sound sleep.

1. Common Preparations and their Slang Equivalents:

Short-acting preparation:

a. Secobarbital (Seconal) — "red devil". b. Pentobarbital (Nembutal) — "yellow jackets", "nemmies".

Intermediate acting preparation:

a. Amobarbital (Amytal) — "blue heavens", "blue dragon".

Long-acting preparations:

a. Phenobarbital (Luminal) — "purple heart", "barbs".

Combination:

a. Secobarbital — amobarbital (Tuinal) — "tooies", "christmas trees", "rainbow".

Barbiturates in general — "goofballs", "footpills".

2. Use of Barbiturates:

Medicinal: a. Prescribed in the treatment of high blood pressure, insomnia

and epilepsy. b. Used in the diagnosis and treatment of mental illness. c. Given to relax patient before and during surgery.

Non-medicinal: a. To escape personal problems — usually insecurity, failure or

frustration. b. A substitute for heroin when the supply of their preferred

drugs runs short to intensify the effect of heroin. c. To quiet oneself down (Amphetamine abusers). d. Some patients have increased their prescribed dosage to the

state of dependence.

DRUG DEPENDENCE 665

3. Signs and Symptoms:

In ordinary dose:

a. Sedation without analgesia. b. Decrease in mental acuity. c. General sluggishness and slowed speech and comprehension. d. Emotional liability. e. Poor memory and faulty judgment.

f. Exaggeration of basic personal traits.

In toxic dose: a. Ataxia and diplopia. b. Positive Romberg sign. c. Respiratory depression. d. Perceptual time distortion. e. Suicidal tendencies. f. Dysarthria (slurred speech). g. Toxic psychosis. h. Coma or death.

Continuous administration will cause a marked degree of physical dependence and tolerance to all the barbiturates, and when suddenly withdrawn, Withdrawal Symptoms may be experienced, which include:

a. Anxiety. b. Involuntary twitching of the muscles. c. Tremor of the hands and fingers. d. Progressive weakness. e. Dizziness. f. Distortion of visual perception. g. Nausea and vomiting. h. Insomnia and loss of weight. i. Precipitated drop of blood pressure on standing, j. Convulsion of the grand mal type.

METHAQUALONE:

Methaqualone is a sedative drug in a smaller dose and a hypnotic in a bigger dose. The effect is similar to barbiturates and action is within 30 minutes after administration; the effect is for 6 to 10 hours. It has no analgesic effect but can potentiate the analgesic effect of other drugs like codeine. The hypnotic dose is 150 — 500 mg. and the fatal dose is probably 5 grams.

The symptoms of poisoning are nausea, gastric irritation, vomiting muscle twitching, hypertonia, cardiac arrhythmia, tachycardia and respiratory depression.

666 LEGAL MEDICINE

Most fatal poisoning results from the ingestion of drug in combination with other drugs. It is possible that the combination made on the drug is more toxic than methaqualone alone due to potentiation.

Excretion of the drug is relatively slow so it is inevitable that the drug will accumulate during multiple dosing.

Post-mortem findings are not specific and similar to barbiturate poisoning.

Mandrax, a proprietary medicine commonly used by adolescent drug dependents and contains 250 mg. of methaqualone with 25 mg. of diphenhydramine, an anti-histaminic drug. The combination has a powerful hypnotic effect and it is alleged to produce its effect by selective action of the thalamico-cortical part of the ascending reticular-activating system by reducing the inflow of sensory impulse to an otherwise unaffected cortex. This results into a state of indistinguishable form of normal sleep. The drug can also produce anti-histaminic effect.

Psychological rather than physical dependence tends to occur after several dosage. Dependents sometimes complain about an effect called "Stonewalling1'. This means that several mandrax tablets taken may cause insensitivity and drowsiness to such an extent that the individual may walk into a wall or barrier or crash a motor vehicle into a wall, an embankment or other obstacle.

The effect of mandrax is potentiated by alcohol. The drug is contra-indicated in epilepsy, eclampsia and marked hepatic dysfunction. Mandrax has been implicated as a cause of peripheral neuropathy.

H A L L U C I N O G E N S O R PSYCHOMIMETIC D R U G S

1. Classification:

a. Natural

Source

Amanita muscaria — Mushroom Banisteria caapi — vine Cannabis sativa — Hemp Catnip — plant Datura — plant Epena — tree bark Iboga — plant root Kaba — Piper M. plant Nutmeg — tree seeds

Active principle

Unknown Harmine Cannabinols Unknown Scopolamine Unknown Ibogaine Unknown Myristicine

DRUG DEPENDENCE 667

Ololiuqui — Morning glory Peganum harmala — plant Peyote — cactus Piptadenia peregrina Psilocybe — Mushroom Virola — Nutmeg family

Harmine Mescaline Bufotenin Psilocybin Elemicin

Lysergic acid

b. Synthetic

Name

DET

Chemical Name

Diethytrytamine pipidylbenzilate Pipidylbenzilate Dimethyl tryptamine N (1) N dipropyltryptamine N (CH3) 3 piperidylbenzilate HCL D Lysergic Acid Diamide 3, 4 Methylenedioxyamphetamine 5 methoxymethlenedioxyamphetamine Phencyclidine p-chlorophenylalanine 2, 5 dimethoxy 4 methylamphetamine 3, 4, 5, trimethoxyamphetamine

D I T R A N D M T DPT LBJ LSD M D A M M D A PCP PCPA STP-DOM T M A

MARIJUANA.

Marijuana is a Mexican term meaning "pleasurable feeling". Marijuana is a mixed preparation of the flowering tops, leaves, seeds and stem of the hemp plant, Cannabis sativa. The plant may grow from 3 to 10 feet high, but may grow as tall as 16 feet. The highest quality of marijuana is derived from choice hemp grown in hot, and humid places and from the mixture containing mostly of resin covered tops and upper leaves. The flowering tops of both male and female plants produce a sticky resin which contains Tetrahydrocannabinol or THC, the major pharmacological active ingredient. The potency of the mixture depends on the resin content and this is determined mainly by the plant strain and also by the factors involved in cultivation, harvesting and preparation of the crop.

There are many species of cannabis and other plants reported to contain THC. On a study, it's been reported that 117 of 350 plants of cannabis contains 0% of THC. Another study showed that the THC content ranges from 0.04% to 6.1%.

Questions: 1. Does our local marijuana plant contain THC? 2. If so, how much does it averagely contain? 3. What will be the effect on the toxic contents if grown in high

mountain or in the lowland?

668 LEGAL MEDICINE

4. Which portion of the plant has relatively more THC content? 5. Which type of plant is more toxic, the mature? or the immature

plant?

Other Names for Marijuana:

Pot, grass, Indian hemp, "damu", weed, bhang, ganja, chards, dagga, kif hash, hashish, tea, reefers, cigarette, stick, joint, smoke, straw, live, ped, Acapulco gold, bush, butter flower, muggles, griffe, Indian hay, loco weed, MJ, Mary Jane, love weed, Mary Warner, Mehasky, Sativa, reach.

Classification of Marijuana:

According to the U.S. Army Chemical Laboratory in Japan, Marijuana may be classified as:

1. "Vietnam Green" — Coming from southeast Asia and found to be twice as potent as those varieties grown in the United States.

2. "Acapulco Gold" — Grown in southern Mexico and may contain as much as 2 to 4% THC.

3. "Panama Red" — Grown in the canal zone and is reputedly the strongest of all.

Special Preparations of Marijuana:

1. Hashish or Charas— A preparation obtained by separating the pure resin from the tops, leaves and stem of the plant. It is dark green or brown and is smoked with tobacco in pipe. It is the most potent of all cannabis preparations.

2. Bhang — The dried leaves and fruit shoots are used as an infusion in the form of beverage. It is the least potent of all preparations.

3. Ganja — This consists of dried flowering tops of female plant with rusty green color and characteristic odor. It is mixed with tobacco and smoked in pipe.

4. Majun — Infusion of dried leaves and tops mixed with flour, milk, butter and sugar. Sometimes dhatura seeds are added to increase potency.

5. Reefers — Dried leaves and stem are sliced and made into cigarettes and smoked.

In addition to being an extractable active principle from cannabis resin, tetrahydrocannabinol can be synthesized. It can be ingested or smoked, but smoking provides rapid induction of the drug effects. Ingestion delays the onset of action from 45 to 60 minutes.

Synthetic tetrahydrocannabinol is more effective when smoked than when ingested. The reason probably is that the synthetic THC undergo heat-isomeration to a more potent compound with the combustion or smoking.

DRUG DEPENDENCE 669

Natural tetrahydrocannabinnol ingestion makes the power effect long lasting and there is more hang-over than when smoked. There is a strong possibility that certain toxic constituents of natural cannabis resin which entered the body when eaten are destroyed by heat combustion.

Factors Influencing the Effects of Marijuana:

1. Dosage of the drug and modes of administration: 2. Potency of the preparation. 3. Period of use (short or long term). 4. Expectations and mood of the user. 5. Environmental or social setting. 6. Personality and psychology of the user.

Effects of Marijuana:

1. Subjective Effects (after a number of inhalation): a. A feeling of lightness of the extremities, followed by "rushes"

of warmth and well-being that eventually lead to a sense of relaxation and mild euphoria.

b. A distortion of sense of time, distance, vision and hearing.

(1) A minute seems like an hour. (2) Eyes tend to focus on one object to the exclusion of others. (3) Certain sounds become striking in character and music

takes on a new dimension.

c. Whetted appetite. Food and drink taste especially good. d. A tendency to be confused about the past, present and future. e. Impaired short-term memory. There is a deterioration in the

capacity to carry out task requiring multiple mental steps to reach specific goals.

f. Tendency to be easily distracted. g. The suggestibility and release of inhibition. h. Increased sense of sociability and hilarity.

These effects are at peak, shortly after smoking and fade away after a few hours, leaving a desire to sleep.

2. Objective Effects: a. Moderate increase in resting pulse rate. b. Reddening of the eyes due to dilatation of the conjunctival

blood vessels. c. Difficulty of speech and of remembering the logical trend of

what was being said. d. Neurological and EEG examinations show slight increase in

cortical functions.

670 LEGAL MEDICINE

e. Tremor and muscular incoordination. f. In high dosage it may cause:

(1) Frank hallucination, delusion and paranoid feeling. (2) Confused and disorganized thinking. (3) Toxic psychosis.

3. Other Undesirable Effects:

a. Bronchitis and asthma may occur in susceptible individuals and may be treated symptomatically.

b. Nausea and vomiting occasionally develop when a novice smokes too much but disappear as the effect of the drug wears off.

c. Panic reaction occurs when the individual becomes frightened about the effects of the drug and starts to doubt that the changes are irreversible. It is more common among novice users and more frequently observe in areas where people believe that smoking marijuana causes deviant behavior, but rare where it is accepted as a recreational intoxicant.

d. Amotivational Syndrome — This is characterized by a progressive change from conforming, achievement-oriented behavior to a state of relaxed drifting. As a result, the person affected seems unwilling to follow routines, endures frustrations or carry out long-ranged plans. In extreme cases, greater introversion is exhibited with the subject becoming totally involved with the present, while disregarding the future goal. He tends toward child-like magical thinking and reports greater creativity but less objective productivity. The condition is reversible and if smoking is discontinued the user returns to his pre-drug level of functioning.

e. Acute toxic psychosis — A temporary malfunction or less in reality, this is self-limited and usually no drug is necessary. The patient must only be protected from injury for the duration of his disorientation.

Marijuana is not addictive. Physical dependence and dose tolerance do not develop with its use and withdrawal symptoms are not seen when usage is discontinued. Psychic dependence may occur among marijuana users.

Marijuana is a non-lethal drug to human subject. A high degree of safety has also been demonstrated in animal experiments. A dose of 150 mg. per kilo body weight in mice and huge dose have been given to dogs without causing death. There has been no reported case of fatal marijuana overdosage in man. (Historical Aspect of

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Cannabis Sativa in Western Medicine by T.H. Mikuriya. The New Physician, 1656).

The fact that many heroin addicts have smoked marijuana does not establish a casual relationship between marijuana smokers and opium addiction. The "stepping stone theory" is considered invalid and that the progression to stronger drugs that occurs is a result of personality and environmental factors and not dependent on the pharmacological properties of marijuana (Acute and Chronic Toxicity of Marijuana by D.E. Smith, U. of California Press, 1969).

Marijuana does not cause aggressive criminal behavior. The pacifying effect of marijuana makes the individual non-aggressive rather than cause violent crime (Marijuana Problem by W.R. Mc-Glothis, AmJ of Psychiatry, 125, 370, 1958).

There is no evidence that marijuana leads to sexual debauchery. Marijuana is not an aphrodisiac. There were reports of greater sexual enjoyment while high and the possible explanation is the increase sensory awareness and the distortion of time which would seem to prolong the duration of orgasm (Cannabis by W.H. Mc-Glothin, The Marijuana Paper, Indianapolis, 411, 1966).

However, recent findings revealed that cannabis may act on hormone regulators and produces impotence and temporary sterility. Heavy marijuana smokers have lowered sperm counts and impotence. Hormones such as leuteihizing hormone, anti-diuretic hormone, growth hormone, and prolactin are also affected by marijuana (Marijuana by Gabriel G. Nahas, JAMA Vol. 233, No. 1, Jul. 1975).

Marijuana also affects the body's cellular processes which include reduction of the number of T-lymphocytes with the resultant interference in the immune process. There is also increase in the number of cells with broken chromosomes (JAMA, Vol. 232,No. 9 June 2, 1975, p. 923). Metabolism:

Marijuana has three major components: THC, cannabidiol and cannabinol. All of them have pharmacologic activity. Variance in the amount of the active constituents has some bearing in the difference in pharmacologic activities.

The metabolism of cannabinoid takes place in the liver and possibly on other site, like the lung. The cannabinoids are rapidly hydrolyzed into some form of 11-hydroxy compounds. A small amount is found in the blood and there is a major metabolites in the feces.

There is a rapid elimination of THC from the blood during the first 40 minutes, then a much slower elimination in the next 24 hours.

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LYSERGIC ACID D I E T H Y L A M I D E (LSD-25;D) — Lysergic acid diethylamide tartrate.)

The drug was first synthesized by Dr. Albert Hoffman and Dr. Arthur Stell while working in a Swiss pharmaceutical firm. LSD is synthesized from the alkaloids or ergot (Claviceps purpurea), a fungus that parasitizes rye and other grains in Europe and America and diethylamide portion of ergotamine ergonevine, the active oxytocic and vasoconstrictor drugs. The synthesis was found to have strange and potent central effects.

It may be medicinally used in the treatment of alcoholism and opium addiction and is the drug of choice to induce tranquility and reduces the need for analgesic in cases of terminal cancer.

LSD is colorless, tasteless, odorless, usually in liquid form and taken orally.

1. Symptoms:

a. Physiological — Dilatation of the pupils, over-activity of reflexes, increase of muscle tension, lack of coordination, visual disturbance, laughter.

b. Somatic — Dizziness, weakness, tremor, nausea, drowsiness, parasthesia (sensation of pricking, tingling or creeping of the skin) and blurred vision.

c. Perceptual — Alteration of shapes and color; music appreciation with abnormal intensity; focusing difficulty; sharpening of the hearing sense, recurrent voice accompanied by brilliant hallucinatory color sensation (synesthesia or seeing sound, hearing color, etc.).

d. Psychic — Mood alteration, tension, distortion of time sense, difficulty in thought expression, depersonalization, dreamlike feeling and visual hallucination. Delusion of omnipotence is common such that a user thinks he can fly from a high building. A number of deaths occur in this manner.

2. Dose and Tolerance:

It is more than 100 times more potent than psilocybin and 4,000 times more potent than mescaline in producing psychological effect.' LSD is a very potent drug. A dose of 15 microgram can produce psychological effects. The normal dose is from 100 to 250 microgram.

LSD has the capacity to develop rapid tolerance. In a few days of repeated use, a formerly effective dose will no longer cause a response but physical and psychological dependence does not develop.

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3. Untoward Effects:

a. Acute panic reaction ("Bad trip", "freak-out") as a frequent complication may lead to suicide attempts.

b. LSD removes the usual intrinsic restraints causing uncontrollable violence or aggression.

c. It causes chromosomal breaks and/or chromosomal rearrangements which may persist as long as 15 months. This may cause malformation of the children to be born.

Thalidomide is another allied drug which produces a broadly defined syndrome of limb, cranial nerve, heart, eye, ear and reproductive system defects of varying degree of severity. The fetus is susceptible to thalidomide only for 14 days; that is between the 36th to the 50th day following the last menstrual period.

Absence of ears and paralysis of the cranial nerves is usually caused by thalidomide intake on the 35th to 36th day after the last menstruation. The arms are affected 3 to 5 days later. The legs are usually affected before the 43rd day. The 40th to 50th day marked the end of the sensitive period. Thalidomide given on these last days does no more than producing hypoplastic thumbs with three joints or anorectal stenosis.

d. Damage on the white blood cells may cause leukemia.

4. Treatment:

Phenothiazines and barbiturates, singly or in combination, have sometimes been found effective in treating an acute intoxicated state. The regular LSD user knows this well and may keep a supply of chlorpromazine on hand.

OTHER H A L L U C I N O G E N S A N D PSYCHOMIMETIC DRUGS: DMT, DET and DPT are tryptamine derivatives which produce a

syndrome similar to that of LSD but differ in the following ways:

1. The onset is more rapid, increasing the likelihood of a panic reaction;

2. The duration of action is only 1 to 2 hours; and 3. The autonomic effects consisting of pupil dilatation and elevation

of blood pressure are more marked than in LSD.

STP and DOAf induce an LSD-like reaction lasting for 72 hours or longer. Because of their long effect they are less popular than LSD.

AfDA or "love pill" induce a relatively mild LSD-like reaction lasting 6 to 10 hours. The amphetamine-like effect it produces tends to persist longer than the psychomimetic effect. This causes

674 LEGAL MEDICINE

euphoria instead of psychic depression as the "coming down" effect.

MORNING GLORY (Ololiuqui, "HeavenlyBlue", "Pearly Gates" — The seeds contain compounds similar to LSD. Symptoms include drowsiness, perceptual distortion, confusion, liability of effect, hallucination, giddiness and euphoria may alternate with intense anxiety. The common side effect in oral ingestion includes nausea, vomiting and diarrhea.

CACTUS-PEYOTE (Active principle-Mescaline) — The protuberance atop the plant are cut off and dried in the sun to form peyote or mescal buttons which contain the active drug, mescaline. They are made into cakes, tablets or powder and used by Indians in Northern Mexico in ceremonies.

Mescaline produces effects similar to LSD but less potent. Although it may produce vivid hallucination, psychotic reactions are far less common as compared with LSD.

MUSHROOM-PSILOCYBIN - This is available in powder and liquid form and extracted from mushroom (psilocybe) which grows in Mexico. The effect is similar to mescaline.

DATURA — An anti-cholinergic agent and a constituent of "Asth-mador", an over the counter preparation for asthma. High dose induces disorientation, confusion, hallucination and eventually coma. Other signs of mydriasis, tachycardia, decreased salivary action, urinary retention and warm, flushed skin are also observed.

NUTMEG (Myristica) — It is the powdered seed kernel of the East, Indian Tree, Myristica fragrans, which contains a hallucinogenic substance thought to be myristicin. When ingested it produces euphoria, hallucination and acute psychotic reaction. The side effects are similar to that of atropine, but nutmeg produces early pupillary constriction.

S T I M U L A N T S

AMPHETAMINES:

Amphetamine was first synthesized in 1927 as a substitute for epinephrine which was isolated from the adrenal gland and from ephedrine obtained from the Chinese herb ephedra vulgaris.

The Most Common Preparations of Amphetamine in the Market are:

1. Dextreamphetamine (Dexedrine) also called "co-pilot", "dexies", or "orange".

2. Amphetamine (Benzedrine) also called "bennies", "splash", "peaches".

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3. Methamphetamine (Methedrine: Desexyn) also called "meth" "speed", "crystal", "crank", "white cross tablets".

4. Dextroamphetamine plus amphetamine (Dipetamine; Bipheta-mine) also called "footballs".

Amphetamine acts on the cerebral cortex causing alertness, excessive self-confidence and feeling of well-being. Drowsiness and sleep are prevented. Mood elevation and fantasy thinking are common effects and sexual excitation has been described.

Medicinally, amphetamines are used (1) to curb the appetite in overweight persons, (2) to relieve mild depression such as accompanying grief, senility, menopause and convalescence, and (3) to keep patient awake in narcolepsy, a disorder characterized by brief attacks of deep sleep.

Reasons Why Some Persons Abuse the Use of Amphetamine:

1. For thrill.' 2. As a substitute when other narcotic supplies are temporarily cut

off. 3. To give a feeling of increased strength and endurance. 4. To reduce fatigue during athletic performance. 5. To ward a sleep among students cramming for the examination. 6. To effect a prolonged high when used in combination with other

drugs, like alcohol, heroin or barbiturates. 7. As a body reducer by reducing appetite.

Types of Amphetamine Abusers:

1. Adaptive abusers —Those who take amphetamine to bolster their functioning within conventional, interpersonal and social activities.

2. Excapist abuser — Those who abuse amphetamine to avoid such interpersonal and social activities. This type of abuser has a cycle having two phases of approximately equal duration.

a. "Up" or active phase — The subject is given the drug, usually methamphetamine, at two to four hours interval for four to five days. During the time he remains awake.

b. "Down" or reactive phase — After being awake and continuously active four or five days, the abuser then collapses from exhaustion, remaining in a semi-comatose state and sleeping intermittently for the next four or five days.

Danger of Amphetamine Misuse: 1. Overactivity leading to social consequence (car accident) or aggres

sive behavior; stealing and murder may have been associated with excessive amphetamine taking.

2. Production of a psychotic illness of the schizophrenic type.

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3. Shock and collapse following amphetamine usage and excessive physical exertion.

4. May lead to habituation. 5. Risk of suicide during the withdrawal phase.

Withdrawal Symptoms:

Initially there is a sensation of chilliness, uneasiness and yawning. This symptom will be followed by rhinorrhea, lacrimation and mydriasis. Respiration will become labored and short with a feeling of anorexia. Later the person will fall asleep and if awakened the symptoms will become pronounced with tachycardia, fever and hypertension. Pain and cramp of the legs and abdomen will be observed. Perspiration, vomiting, diarrhea and tremor will be observed.

Psychological dependence develops among chronic abusers only and may lead to social, economic and emotional deterioration.

Possible complications that may develop in the course of continuous and excessive use of amphetamine:

1. Development of a syndrome resembling heat stroke with coagulopathy and renal failure.

2. Necrotizing angilitis, 3. Fatal collapse associated with marked fatigue and nervous tension. 4. Widespread hemorrhage, especially in the endocardium and

myocardium and rapid development of myocardial fiber necrosis. 5. Psychosis and other permanent brain damages. 6. Frequent accidents in highway driving.

Excretion:

50% of amphetamine is destroyed in the liver by dissemination and the rest in the kidneys at a slower rate. The drug use to appear in the urine 3 hours after administration.

The presence of amphetamine is detected in body fluid by (1) gas chromatography with hydrogen flame detector or by (2) thin layer chromatography.

COCAINE: Cocaine is an alkaloid from the leaves of the coca shrub cul

tivated extensively in Bolivia and Peru. It is also grown in Java, Taiwan and Sri Lanka. The leaves are harvested from the plant not less than 10 months old. The matured leaves are plucked, dried and packed in bales.

Cocaine may be taken by injection, by chewing or by sniffing of crystals through the nostrils. The coca leaf is chewed by many

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Indians of the Andes for its stimulating effects and also for depressing appetite. Repeated sniffing of cocaine crystals into the nasal passage may cause gradual erosion and perforation of the nasal membrane.

Cocaine stimulates the sympathetic system causing increased pulse rate, dilatation of the pupils and perspiration. It is a euphoriant and speedily relieves fatigue. Cocaine is said to cause sexual excitement and the drug therefore is popular among the undersexed or sexual perverts.

Tolerance to the drug is slow and dependence tends to be psychological rather than physical.

If cocaine is taken for a period of time, especially in excessive dosage, it may cause pallor, poor appetite, salivation, loss of weight, and damage to the nasal membrane and cartilage in sniffers. Cutaneous scars of old injection sites may be evident and habitual cocaine eaters develop black teeth and tongue.

Magnan's Symptom or the feeling as if grains of sand are lying under the skin or small insects (cocaine bugs) are creeping on the skin is the most characteristic symptom.

It has been reported that cocaine leads to erotic tension in women. Death may be due to epilepsy or respiratory failure.

The drug when withdrawn from the user may cause withdrawal symptoms in the form of insomnia, reactive depression, and paranoid attitudes which may lead to paranoid psychosis.

Users of cocaine recently combine it with heroin called "mixing the gravy" to counteract lethargy and social isolation effect of heroin.

Medically the use of cocaine has markedly declined and its major use is only as anesthesia of the nose and throat. On account of the disadvantages observed in the use, the synthetic procaine becomes the wildly used substitute under the trade name of novocain.

Prostitutes inject a solution of cocaine into the vagina. This gives the individual a sense of local constriction and exhilarating systemic feeling. In men cocaine is applied locally to the glans penis to increase the duration of the sexual act. It may cause sexual perversion especially in homosexuality or in libidinous outrages.

In fatal dose, death is due to cardiac or respiratory failure.

Cocaine "body packer" Syndrorpe refers to the ingestion of multiple small packages of cocaine for the purpose of transporting the contraband. The drug is placed in a durable, non-digestible container, taken by mouth to be recovered at the place of destination in the fecal discharge. Aside from human beings, the pack-

678 LEGAL MEDICINE

ages are fed to camels or ducks. In the case of ducks they are slaughtered to retrieve the drug. Rupture of the container while in the alimentary tract with consequent cocaine poisoning has been reported in literature.

DRUG DEATH:

Drug related death may be classified into three categories: 1. Primary drug fatalities — those which death is due to the toxic

or adverse effect of the chemical agent, with or without the contributory influence of pre-existing, unrelated natural disease.

2. Secondary drug fatalities — those arising from medical complications of drug abuse, such as viral hepatitis and bacterial endocarditis.

3. Drug-associated fatalities — those caused by homicidal, accidental and suicidal violence stemming directly or indirectly from activities related to the obtaining and use of illicit drugs.

The qualitative and quantitative determination of the dangerous drug in the human body or the pathologic changes in organs cannot be utilized as the basis of the cause of death. There are other factors to be considered which may be responsible for the death:

1. The decedent may be usually susceptible to the deleterious effect of the drug;

2. The combination of the drugs taken can interact in an additive fashion;

3. Some pre-existing natural disease may have contributed to the death;

4. The rapid absorption of large quantity of the drug can kill prior to complete absorption of all the substance from the gastro-intestinal tract;

5. Normal metabolic degradation of the chemical can reduce its blood concentration during the prolonged survival interval in which respiratory complications and hypoxic encephalopathy maintain coma and act as the immediate cause of death.

(Modern Legal Medicine, Psychiatry and Forensic Science by Curran, et. at., p. 1129).

Identification of Some Dangerous Drugs:

1. Gross and Microscopic: Inasmuch as marijuana is smoked as leaf fragments, its iden

tification may be used on the botanical features, grossly and microscopically by trained experts. A complete leaf may be identified by the characteristic irregular shape. Microscopically, identification depends largely on observation of short hair on the

DRUG DEPENDENCE 679

upper side of the leaf known as cystolith and the presence of longer nonglandular hair on the opposite side.

2. Micro-crystalline Test: A drop of chemical reagent is added to a small quantity of the

drug on a microscopic slide. After a short time, a chemical reaction ensues producing a crystalline precipitate. It is the size and shape of the crystal under the microscopic examination that is characteristic of the drug.

3. Color Test:

a. Opium and its derivative together with amphetamine: (1) Marquis test — (2% formaldehyde in sulfuric acid) — Turns

purple in the presence of heroin and morphine as well as most opium derivatives. The test will also produce an orange-brown color when mixed with amphetamine and methamphetamine.

b. Barbiturates: (1) Dillie Koppanyi test — (1% cobalt acetate in methanol is

first added to the suspected material followed by 5% iso-prophylamine in methanol). A violet-blue color is produced. This is a valuable screening test for barbiturates.

(2) Zwikkers test — Add approximately 0.5 ml. of 0.5% aqueous solution of copper sulfate to a small amount of sample. Mix gently and add an equal volume of a 5% solution of pyridine in chloroform. Shake first the layers, separate and observe the color of the chloroform layer.

If the sample contains the free acid or sodium salt of a barbiturate, the chloroform layer will be purple. If the sample contains the free acid or sodium salt of a thio-barbiturate, the chloroform layer will be bright green.

Addition of one drop of glacial acetic acid to the chloroform, water system will: (a) Destroy the purple color of the chloroform layer and

change it to a very weak blue if the sample contains the free acid or sodium salt of a barbiturate:

( b ) Reduce the color of the chloroform layer to a faint green if the sample contains the free acid or sodium salt of a thiobarbiturate. On further addition of the acid the color will change to a light yellow green.

c. Marijuana: Duquenois-Levine test — Solution A is a mixture of 2%

vanillin and 1% acetaldehyde in ethyl alcohol; solution B is concentrated hydrochloric acid; and solutions A,B and C are added respectively to the suspected material. A positive result is shown by purple color in the chloroform layer.

680 LEGAL MEDICINE

d. LSD: Van Urk test (1% p-dimethylaminobenzaldehyde and 10%

concentrated hydrochloric acid in ethyl alcohol). This reagent turns blue-purple in the presence of LSD. However, owing to the extremely small quantities of LSD in illicit preparations, this test is difficult to conduct under field conditions.

e. Cocaine: Cobalt Thiocynate test — (2% cobalt thiocyanate in water).

This reagent produces a blue flaky precipitate in the presence of cocaine. The test is not reliable as many other drugs and diluents respond in the same manner.

4. Chromatography: a. Thin layer chromatography. b. Gas chromatography.

In both methods the drug is separated from the diluent while providing for its identification.

5. Spectrometry: Selective absorption of light by drugs in the UV (Ultra-violet)

and IR (Infra-red) regions of the electromagnetic spectrum. UV spectrum is not conclusive for the positive identification of drug because other drugs may very well produce an indistinguishable spectrum, but may be useful to establish the probable identity of the drug.

IR spectrophotometry can specifically identify substances, but the substance to be identified must be in pure form. A combination of preliminary screening by UV followed by verification through infra-red spectrophotometry is the most ideal approach to drug identification.

D E L I R I A N T S

Drugs which cause delirium, intoxication and other mental and psychic disturbances when the toxic vapors and fumes are inhaled are not covered by the Dangerous Drug Act of 1972 as amended, hence Presidential Decree No . 1619 was promulgated on July 23, 1979.

Drugs included in P.D. 1619:

Volatile substances including any liquid, solid or mixed substance having the property of releasing toxic vapors or fumes containing one or more of the following chemical compounds:

Methanol Stryene Ethanol Napthalone Isopropanol N-pentane

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Ethyl acetate N-propyl acetate N-butyl acetate Acetone Methyl ethyl ketone Methyl butyl ketone Benzene Tolouene Xylene

N-hexane N-heptane Methylene Chloride Trichloroethylene Tetrachloroethylene Nitrous oxide Dichlorodiflouremethane Isoamyl nitrate Chloroform

or other chemical substance which when sniffed, smelled, inhaled, or introduced into the physiological system of the body produces or induces a condition of intoxication, inebriation, excitement, stupefaction, dulling of the brain or nervous system, depression, giddiness, paralysis, or irrational behavior or in any manner changing, disturbing or distorting the auditory, visual and mental processes (Sec. 1).

Acts which are Punishable:

1. The use or possession of volatile substances for the purpose of inhalation to induce or produce intoxication or any of the conditions described in Sec. 1 (Sec. 2).

2. The sale, administration, delivery, or giving away to another on any term whatsoever, or distribution, dispatch, transaction or transportation or acting as a broker in any such transaction, any substance or mixture or substances containing one or more of the chemical compounds mentioned in Sec. 1 (Sec. 4).

3. Maintenance of a den, dive or resort where any substance or mixture of substances containing one or more chemical compounds mentioned in Sec. 1 (Sec. 5).

4. The sale or offer to sell volatile substances to minors without requiring the written consent of their parents or guardians as a condition for such sale or offer to sell, provided that when the minor is 18 years or over and is duly licensed to drive a motor vehicle, such written consent shall not be necessary when the volatile substance sold or offered for sale is gasoline or any other motive fuel for vehicles.

5. The sale of, or offer to sell, to minors of liquors or beverages containing an alcoholic content of thirty percentum or above (60% proof or above) (Sec. 6).

For public information the Dangerous Drug Board is obliged to publish the list of dangerous drugs and any subsequent changes in

"The Board shall give notice to the general public of the reclassification, addition to or removal from the list of any drug by publish-

the list.

682 LEGAL MEDICINE

ing such notice in any newspaper of general circulation once a week for two consecutive weeks (Sec. 40, Dangerous Drugs Act of 1972 as amended — Reclassification, addition or removal of any drug from the list of Dangerous Drugs.)

Effects of such Reclassification, Addition or Removal:

1. In the case of prohibited drug reclassified as regulated, the penalties for violation of this Act involving the latter shall, in case of conviction, be imposed in all pending criminal prosecutions.

2. In the case of regulated drug reclassified as prohibited, the penalties for violation of this Act involving regulated drugs shall, in case of conviction, be imposed in all pending criminal prosecutions.

Present State of the Drug Problem in the Philippines:

1. Marijuana is now planted in almost every province of the country. a. The profit aspect is comparatively great. b. Local and foreign demand are probably more. c. The Philippine climate is most conducive to favorable growth.

2. There is an increasing number of our youth who are prospective users.

3. Pushers motivated by profit although unquantifiable are seemingly increasing in number.

4. Property offense can be directly correlated with drug dependence. "High" with the drug means high in crime. The effects of the drugs responsible are: a. Toxic psychotic effect. b. Release of inhibition. c. Confusion of thought and disorganization of ideas. d. Suggestibility.

5. There is an increase in vehicular accidents with the driver under the influence of drug due to: a. Distortion of time, distance, vision and hearing. b. Aggressiveness. c. Lack of inhibition. d. Deterioration of the capacity to carry out task requiring multi

ple steps to reach a specific goal. e. Mental confusion and psychosis. f. Desire to sleep during the later part.

6. Suicide is more common among drug users. This may be attributed to: a. Frank hallucination, delusion or paranoid feeling. b. Confused or disorganized thinking. c. Panic syndrome — feeling of worthlessness. d. Suggestibility and release of inhibition.

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7. Mental affection, like psychosis among drug users is on the rise. 8. Truancy and drop-out in schools among users are rampant. 9. The socio-economic condition of the family is affected.

10. The socio-economic progress of our country has been markedly prejudiced.

Ways of Controlling or Combating the Drug Problem:

1. By preventing users to further use the drug. a. Counseling. b. Treatment and rehabilitation. c. Destruction of the source of the drug. d. Instilling into the mind the philosophy that "It is better late

than never".

2. By preventing non-users from starting a life of drug dependence. a. Medical means:-

(1) Research on the causes, epidemiology, symptomatology, prevention and cure. Drug dependence is a social malady and like any human disease can only be minimized, if not eradicated, by means of a scientific approach.

(2) Formation and implementation of medical hypothesis: (1) Attentuation (2) Fortification

b. Concerted social action: (1) Instilling the maxim that "drug dependence does not pay." (2) Preventive education:

(a) Group counselling ( b ) Individual case study

3. In case of addition of a new drug to the list of dangerous drugs, no criminal liability involving the same under this Act shall arise until the lapse of fifteen (15) days from the last publication of such notice; and

4. In case of removal of a drug from the list of dangerous drugs, all pending criminal prosecution involving such a drug under the Act shall forthwith be dismissed (Sec. 40(4) D D A of 1972).

PRESCRIPTION O F D A N G E R O U S D R U G S

Prescription Forms: For the purpose of this Act, all prescriptions issued by physicians,

dentists, veterinarians or practitioners shall be made out on forms exclusively issued by and obtained from the Board. Such forms shall be made of a special kind of paper and shall be distributed in such quantities and contain such information and other data as the Board may, by rules and regulations, require. Such forms shall not be issued

684 LEGAL MEDICINE

by the Board or any of its employees except to licensed physicians, dentists, veterinarians and practitioners in such quantities as the Board may authorize (Sec. 25 (b ) , par. 2, D D A of 1972 as amended). However in emergency cases, the required prescription form may not be used:

In such emergency cases, however, as the Board may specify in the public interests, prescriptions need not be accomplished on such forms (Sec. 25 ( b ) , 2nd par., Dangerous Drug Act of 1972 as amended).

The following specific conditions fall within the category of emergency wherein the required form may not be used:

1. Where the prescription has to be used on a patient whose need for dangerous drugs is immediate and urgent and has been brought by the effects, or during the course of natural or other calamities, such as typhoons, earthquakes, conflagrations, etc., of such a magnitude as to preclude prompt access to the official prescription forms of dangerous drugs.

2. Where the need for prescribing the dangerous drugs has arisen as a result of a serious accident necessitating the administration of the drugs at the scene or in the vicinity of the accident and the required prescription forms are not readily available.

3. Where the need for the dangerous drug is urgent and its ready availability may, in the opinion of the prescribing physician, spell the difference between life and death of the patient, and for unavoidable and justifiable reasons the prescribed prescription form is not within access (Board Regulation No. 4, Series of 1973).

Obligations Imposed on Physician when Prescription Was Not Made on the Required Form:

1. The prescribing physician shall certify at the back of the ordinary prescription form utilized, as to the nature, time and place of the emergency conditions and the name and address of the patient, and shall see to it that his (physician's) full name and address is indicated in printed form beneath his signature. (Sec. 2, Board Regulation No. 4, 8. 1978).

2. The prescribing physician shall, within three (3) days after issuing such prescription, inform the Board of the same in writing (Sec. 25 ( b ) D D A of 1979 as amended and Board Regulation No. 4, series of 1973).

DRUG DEPENDENCE 685

Loss of Prescription Forms for Dangerous Drugs (DDR Form No.

Sec 1. It shall be the duty of every physician, dentist, veterinarian or other practitwner to whom prescription form (DDB FomTES for the dangerous drugs have been issued, to report any to* thereof to the Dangerous Drugs Board within twenty-four (24) hours from the discovery of such loss, indicating the circumstances surrounding the loss. Upon, receipt of said report, the Board shall cause the publication of the loss in a newspaper of general circulation.

Sec. 2. Every loss of prescription forms for dangerous drugs shall be referred for investigation to any police or investigative agency as the Board shall determine. Whenever necessary the police or investigative agency may take possession of the prescription forms remaining in the possession of the physician, veterinarian, dentist or other practitioner. Should the findings of the police or investigative agency show negligence on the part of the physician, veterinarian, dentist or practitioner, the loss shall be reimbursed to the Board by the. negligent physician, veterinarian, dentist or practitioner, and he may be barred from further purchasing prescription forms (Board Regulation No. 10, s. 1973).

How to Make the Prescription:

A physician, dentist, veterinarian or practitioner authorized to prescribed any dangerous drug shall issue the prescription therefor in one original and two duplicate copies. The original after the prescription has been filled, shall be retained by the pharmacist for a period of one year from the date of sale or delivery of such drug. One copy shall be retained by the buyer or by the person to whom the drug is delivered until such drug is consumed, while the second copy shall be retained by the person issuing the prescription (Sec. 25 (b ) , Dangerous Drug Act of 1972 as amended).

Duty of the Drugstore Owner in Filling Prescription:

Whenever a prescription for dangerous drugs is filled by a drugstore, it shall be the duty of the drugstore owner to use the words "USED IN F U L L " to be stamped in bold prints diagonally across the original copy of said prescription in case the full quantity of the drug therein stated is sold, and the words "USED FOR O N L Y " in case the quantity of the drug therein stated is not fully

m c<i&e m i m •> l 4 7 n v / T h e blank space must sold (Board Regulation No. 11, s. 197d) U n e d a n * y indicate the number of tablets, capsules, etc. actually sold).

Every pharmacist dealing in dangerous drugs shall keep a? original record of sales, purchases, acquisitions and deliveries of dangerous drugs indicating therein:

686 LEGAL MEDICINE

1. Name and address of the pharmacist; 2. The name, address and license of the manufacturer, importer or

wholesaler from whom dangerous drugs have been purchased; 3. Quantity and name of the dangerous drugs so purchased or ac

quired; 4. The date of acquisition or purchase; 5. The name, address and class A residence certificate of the buyer; 6. The serial number of the prescription and the name of the doctor,

dentist, veterinarian, or practitioner issuing the same; 7. The quantity and name of the dangerous drugs so sold or delivered; 8. The date of sale or delivery.

A certified true copy of such record covering a period of three calendar months, duly signed by the pharmacist or the owner of the drug store or pharmacy, shall be forwarded to the city or municipal health officer within fifteen days following the last day of every quarter of each year (Sec. 25 (a) , 2nd par., Dangerous Drug Act of 1972 as amended).

Chapter XXXIII

ALCOHOLISM

Ethyl alcohol ( C 2 H 5 O H , Ethanol, grain alcohol) i> a colorless transparent, volatile liquid with aromatic odor and with boiling point at 78°C. Like any other types of alcohol, it is formed out of the fermentation of various carbohydrates in grains, fruits or flowers, and from other materials subjected to and isolated by distillation.

Ethyl alcohol is commonly used as solvents, antiseptic and beverage. When ingested, it does not require digestion before absorption. Although the word "alcohol" refers to a large group of chemical compounds in possession of hydroxyl radical ( O H ) , whenever alcohol is used as part of a beverage, it refers to ethyl alcohol.

Alcoholic beverages are primarily a mixture of water and ethyl alcohol with small amount of other substances which impart the characteristic odors and tastes. These substances are called "congeners" since they are simultaneously produced during the fermentation process. The congeners consist of organic acids and esters or even other types of alcohol. It is the congener content that imparts the so called "odor of alcohol" among drinkers.

A drunkard is a person who habitually takes or uses any intoxicating alcoholic liquor and while under the influence of such, or in consequence of the effect thereof, is either dangerous to himself and to others, or is a cause of harm or serious annoyance to his family or his affair, or ordinary proper conduct.

A habitual drunkard is one who excessively uses intoxicating drink. Habit should be actual and confirmed, but it is not necessary that it be continuous or of daily occurrence. It lessens individual resistance to evil thought and undermines will power, making its victim a potential evil doer. (People v. Amenamon, 37 O.G. No. 114, p. 2324).

Classification of Commercially Available Alcoholic Beverages: 1. Wine — A product of natural alcoholic fermentation with wide

variety of sugary materials including fruit juices and contains not less than 7% but not more than 17% of alcohol by volume. In fermented beverages the alcohol content is expressed in volume percent.

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688 LEGAL MEDICINE

a. Red Wine — The wine contains the extracted pigments from the skin, stem and seed of the fermented fruit juice. The color ranges from pale straw to pale pink.

b. White Wine — The product of fermentation of fruit juices only after removal of the skin and stem. They are not really colorless but impart a pale straw or green to gold or amber color.

c. Dry Wine — Wine wherein practically all the sugar contents are fermented into alcohol.

d. Sweet Wine — Wine which contains not less than 1 gram of sugar per 100 milliliter.

e. Still Wine — Wine in which fermentation has been completed before bottling so that it contains only such properties of carbon dioxide produced in the fermentation which can be dissolved in the liquid in equilibrium with air under conditions of manipulation.

f. Sparkling Wine — Wine that is bottled before fermentation has ceased so that it contains CO 2 gas in solution at greater than atmospheric pressure. The wine may also be impregnated with C O 2 b y allowing it t o undergo fermentation i n closed tanks and bottling under pressure or by simply carbonating the bottled wine under pressure.

g. Fortified Wine — Wine whose alcoholic contents are derived partly from fermentation and partly from the addition of distilled spirit. This includes cherries, port and vermouth.

h. Chinese Medicinal Wine — Wine which is a mixture of refined alcohol and Chinese herbs and contains not less than 2 0 % alcohol.

i. "Ztosi" — Composed of fermented juice of sugar with the characteristic brown color, bitter taste and aroma imparted by dried leaves, bark, twigs and flowers of a tree called "samak" (Macaranga Tanarius).

j. "Lambanog" — Native wine produced by distillation of fermented coconut sap ("tuba") and bottled at not less than 80% proof.

2. Distilled Liquor — Distilled liquors are alcoholic beverages produced from distillate of wines, distilled from grains or starch solution or distillate from aromatic substances. In distilled beverages the alcohol contents are expressed in proofs. "Proof" is approximately twice the percentage of alcohol by volume.

The sole purpose of the distillation process is to increase the concentration of alcohol in the finished product. This is neces-

ALCOHOLISM 689

sary because fermentation ceases when the alcohol concentration is approximately 12% to 14% by volume.

a. Whiskey — An alcoholic distillate from mass of cereal grains or cereal grain products saccharified by the action of yeast distilled at less than 74.7°C and aged at least three years and may contain a flavoring of caramel.

b. Gin — The distilled product obtained from the original distillation of mash or by redistillation of distilled spirits with or over juniper berries and may contain other aromatic botanical substances or sugar.

c. Rum — A distilled alcoholic beverage prepared by fermentation, distillation and aging of sugar cane products, e.g. sugar cane juice, molasses. It is a yellow-brown liquor of fine bouquet and sweet, smooth alcoholic taste. It may contain caramel and may be flavored with fruit or other flavoring from other botanical substances.

d. Alcoholic Cordials and Liquors — These are distillates obtained by mixing or redistillating neutral spirits, usually brandy, with or over fruits, flowers, leaves, seeds or other botanical substances or their juices or with extracts derived from infusion, percolation or maceration of such botanical substances and to which sugar or dextrose or both have been added in an amount not less than 2.5% of the finished product and contain not less than 23% of absolute alcohol by volume. These may also contain natural or artificial coloring material.

e. Vodka — Distilled liquor from grain spirit, filtered through activated carbon (charcoal) so as to render the product without distinctive character, aroma or taste.

3. Malt Liquors — Alcoholic beverages brewed from malt or from a mixture of malt and malt substitute, like rye, and may contain other cereal grains and starchy saccharine matters. A characteristic bitter flavor is imparted by the addition of hops. The amount of alcohol need not be stated in the label.

a. Ale — a malt liquor brewed in such a manner as to possess the aroma, taste and character commonly attributed to ale and shall contain not less than 3.2% absolute alcohol. In its fermentation, top yeasts are utilized instead of bottom yeasts the latter being utilized in beer.

b. Beer — The product of alcoholic fermentation of a mash in potable water of malted barley, hop and/or hop preparation with or without the addition of starchy and saccharine material and

690 LEGAL MEDICINE

shall contain not less than 2% and not more than 10% by volume of alcohol.

c. Stout — A malt liquor brewed in such a manner as to possess the aroma, taste and character commonly attributed to stout and, to a marked degree, the flavor of hops.

d. Porter — Malt liquor brewed in the manner used in brewing of stout but having in comparison with stout a less marked flavor of hops.

An alcoholic beverage shall possess the characteristic attributed to the type of drink that is stated in the definition and standard of identification. The preparation must be free from any ingredient injurious to health, free from sediment of any kind, and shall be manufactured in premises built and maintained under hygienic condition.

Causes of Drinking Alcoholic Beverages:

1. Curiosity — Children prefer to experience the pleasant and unpleasant effects rather than being told.

2. It is being served as a symbol of friendship and sociability. Social gathering with alcoholic beverages served becomes lively. Drinking is a part of our culture.

3. As an escape from unpleasant realities, it suppresses inner tension, deadens the pain of failure, frustration and anxieties.

4. Alcohol is a part of religious ceremonies.

5. As a stimulant to combat shyness, inferiorities and to suppress strong inhibition.

6. It is a source of heat and energy. One gram of alcohol may yield 7 calories, by the process of oxidation. One ounce of 100 proof whiskey may yield 100 calories.

Provisions of Law Regarding Alcoholism:

1. Intoxication is an alternative circumstance to criminal liability:

Art. 15, Revised Penal Code — Their concept:

Alternative circumstances are those which must be taken into consideration as aggravating or mitigating according to the nature and effects of the crime and the other conditions attending its commission. They are the relationship, intoxication, and the degree of instruction and education of the offender.

The intoxication of the offender shall be taken into consideration as a mitigating circumstance when the offender has committed a felony in a state of intoxication, if the same is not

ALCOHOLISM 691

habitual or subsequent to the plan to commit said felony; but when the intoxication is habitual or intentional it shall be considered as an aggravating circumstance.

1. Mitigating: a. If intoxication is not habitual; or b. If intoxication is not subsequent to the plan to commit the

felony.

2. Aggravating: a. If intoxication is habitual; or b. If intoxication is subsequent to the plan to commit the

felony.

2. Public scandal committed by a person while drunk is punishable:

To be drunk is not punishable, but if alarm and scandal happens in a public place while at the state of intoxication, it is punishable.

Art. 155, Revised Penal Code — Alarms and scandals — The penalty of arresto menor or fine not exceeding 200 pesos may be imposed upon:

4. Any person who while intoxicated or otherwise, shall cause any disturbance or scandal in public places.

3. Contracts agreed to in a state of drunkenness are voidable-Art. 1328, Civil Code:

Contracts entered into during a lucid interval are valid. Contracts agreed to in a state of drunkenness or during a hypnotic spell are voidable.

4. The law penalizing manufacture of liquor without license is valid:

If a person administers beverages to another which is injurious to the latter without intent to kill, he is punished for his wrongful act.

Art. 264, Revised Penal Code: Administering injurious substances or beverages:

The penalties established in the next preceding article (arresto mayor in its maximum period to prision correccional in its minimum period) shall be applicable in the respective cases to any person who, without intent to kill, shall inflict upon another any serious physical injury, by knowingly administering to him any injurious substances or beverages or by taking advantage of his weakness of mind and credulity.

5. The state may prevent some people from drinking highly spirited wine:

The state may promulgate laws which may prevent people of lower degree of civilization from drinking scientifically manu-

692 LEGAL MEDICINE

factored, highly spirited liquor. The reason is to promote peace and order.

The accused was prosecuted and convicted for violation of Act 1639, which prohibits any native of the Philippine Islands, who is a member of the non-Christian tribes to buy, receive, have in possession, or drink any intoxicating liquor other than the native wine or liquor which the tribe has been accustomed to take. The accused attacks the legality of the law on the ground that it denies him of the equal protection of tr e law. HELD: Act 1639 is valid. The use of "non-Christian tribes" is not based upon accident or birth or parentage but upon the degree of civilization. The members of the non-Christian tribes have a low degree of civilization. The purpose of the prohibition is to insure peace and order in and among the people. It has been experienced in the past that people of a lower degree of civilization taking scientifically distilled wine with a high percentage of alcohol resulted to lawlessness and crimes thereby hampering the effort of the government to raise the standard of life and civilization (People v. Cayat, 68 Phil. 12).

Absorption and Distribution of Alcohol:

Inasmuch as alcohol when ingested does not require digestion, it is immediately absorbed in the walls of the stomach and duodenum. The maximum period of absorption occurs thirty to sixty minutes after the initial intake.

The rate of absorption of alcohol in the stomach and intestine depends upon the following :

1. Concentration and total quantity of alcohol taken. The higher the percentage of alcohol taken, the greater is the volume of alcohol per unit of time. The greater the volume of alcohol consumed will likewise enhance the absorption.

2. Nature of the food in the stomach and intestine. Fatty food makes absorption slower as compared with sugar and other carbohydrates and proteins.

3. Volume of gastric content — The presence of sufficient amount of food and water in the stomach may delay the rate of absorption.

4. Diseased condition of the stomach and intestine. Achlorhydria, gastric atony and chronic gastritis cause slower absorption, however subtotal gastrectomy or a gastroenterostomy may cause abnormally early intoxication because of its early evacuation of food to the duodenum where absorption is more rapid.

5. Length of time the gastric content is held in the stomach prior to the opening of the pylorus and permeability of the stomach or

ALCOHOLISM 693

intestinal wall. Warm drinks dilate gastric capillaries to cause more absorption.

6. The optimum concentration of alcohol in beverages between 10 to 20% is the most rapidly absorbed.

After absorption, alcohol is distributed throughout the body in proportion to the water contents. Parts of the body with more water content (blood, urine, brain, liver, kidney) have the highest concentration while those with low water contents (fat, bone) have the lowest concentration.

Pharmacologic Effects of Alcohol:

Ethyl alcohol depresses the central nervous system in descending order from the cerebral cortex to the medulla oblongata. It causes depression or temporary functional paralysis of the ganglionic cells. The more specialized the cells are, as in the cerebral cortex, the more sensitive they are to alcohol. A moderate dose will cause disturbance in the intellect and fine muscular movement, but bigger doses will involve depression of the ganglion cells of the lower brain centers in the basal ganglia and brain stem causing the person to be stuporous and even comatose.

Effects on the Special Senses:

1. Vision — With increasing amount of alcohol intake the acuity is progressively diminished to the point where vision to obscure to a degree comparable to wearing dark sunglasses at night. There is diminution of the peripheral vision similar to that of a person viewing an object by means of a binocular (tunnel vision), the amount of blood alcohol is somewhere between 100 to 200 mg., ocular coordinator is impaired and diplopia develops.

2. Hearing — The increasing amount of alcohol intake diminishes the ability of the individual to perceive and appreciate varying intensities of sound. This is the very reason why in a drinking party at the start of the drinking the conversation is in a low tone, but as the alcohol level in the blood increases the group tends to talk louder. This also accounts for the tendency of drivers not to perceive the sound of horns and train whistles when intoxicated and to become more prone to vehicular accidents.

3. Touch — The sense of touch is diminished with the increased amount of alcohol intake. The blunting of touch sensation is responsible for frequent cigarette burns on the hand of chronic alcoholics.

4. Taste — There is a decrease in the sense of taste. When a person is drunk, all food taste good.

694 LEGAL MEDICINE

5. Smell — The perception of smell is depressed by alcohol. Malodorous substances may be undetected by those under the influence of alcohol.

"Proprioception" or the so-called "sixth sense" is also impaired.

Blunting of judgment is one of the first mental functions affected by alcohol. This leads to automobile accidents, poor business decisions, gambling losses, fights and injuries.

The faculty of attention deteriorates rapidly and this is the principal reason why individuals even with low level of alcohol end up as traffic victims.

Motor skills are also impaired progressively with increasing amount of blood alcohol. Reaction time is prolonged.

Ability to hear is blunted and recall memory is often markedly disturbed.

Moral standard is blunted and lowered, and there is a tendency to distort reality.

It increases the desire for sex but markedly impairs the performance; a prolonged intercourse without ejaculation is often the result (Legal Medicine Annual 1969, pp. 241-268).

Other Effects:

1. Dilatation of the blood vessels of the cutaneous surface. 2. Increase in the pulse rate. 3. Weaker cardiac systole which tend to cause cardiac dilatation. 4. Locally, it has direct irritation effect on the mucous membrane

of the stomach and intestine. 5. Slight depression of the liver functions as indicated by the de

crease in hepatic oxygen consumption and decrease in glycogen storage.

6. Fall of the blood pressure.

Clinical Signs and Symptoms in Relation to Blood Alcohol Level: Blood Alcohol Clinical Signs and Symptoms

10 mg % Pleasant clearing of the head. 20 mg %, Physical feeling of well-being. 50 mg % The individual feels on top of the world and has

the wisdom of Solomon and the talkativeness of Senator Claghorn. Increased self-confidence; decreased inhibitions; diminution of attention, judgment, and control.

100 mg % The individual is intoxicated and "under the influence". Experts in the field believe that no

ALCOHOLISM 695

innocent person would be convicted of being "under the influence" if he had a blood alcohol level of 100. Some mental confusion, incompetency; drowsiness; emotional instability; decreased inhibitions; loss of critical judgment; impairment of memory and comprehension.

150 mg % At this level all individuals are intoxicated, and deterioration in performance of acts of skill or judgment are present.

150-300 mg % Somewhere between these figures all individuals lose some degree of muscular coordination, including the ability to walk properly and coordinate other body movements. Disorientation; mental confusion; dizziness; sensory disturbances; deceased sense of pain; slurred speech; exaggerated emotional (state of grief, anger and fear).

300 mg % At this level most individuals become stuporous, incoordinated, and may even lose sphincter control. Apathy; general inertia; decreased response to stimuli; impaired consciousness; sleep or stupor.

400 mg % This is the anesthetic level. Alcohol is not a good anesthetic because there is a narrow margin between the anesthetic and the death level. Death from alcohol per se may occur at any level above 400 mg%. Complete unconsciousness; coma; depressed or abolished reflexes; embarrassment of circulation and respiration; incontinence of urine and feces.

(From Legal Medicine Annual 1969, p. 254).

Symptomatic Changes Following Ingestion of Alcoholic Beverages:

Although human reaction varies from person to person, the clinical signs and symptoms following ingestion of alcohol may be divided into three stages, namely: 1. Stage of Excitement — This develops a few minutes after the

initial dose of alcoholic drink has been absorbed and has reached the central nervous system. It is characterized by a feeling of well-being and slight excitation. The actions, speech and emotion are less strained. Self-confidence develops, as well as blunting of self-criticism, self-consciousness and self-control.

696 LEGAL MEDICINE

It is the manifestation during this state that makes the people entertain the erroneous belief that alcohol is a stimulant rather than a depressant. Alcohol does not stimulate the brain centers but rather "inhibits the inhibition" causing it to act freely without constraints.

2. Stage of Incoordination or Confusion — As the effects of alcohol become more pronounced, the nervous control of the body gradually diminishes. There is blunting of all perceptive mechanism. Muscular coordination is lost. The irritating effects of alcohol, like nausea and vomiting, confusion, cardiac and respiratory symptoms appear.

3. Stage of Narcosis or Coma — The person passes into a deep sleep and may only respond to strong stimuli. Pupils are dilated, breathing is slow and stertorous, pupils are dilated and reflexes, abolished. Death may ensue from paralysis of the cardiac or respiratory center.

Degree of Intoxication:

1. Slight Inebriation — There is flushing of the face, with exaggerated mood, but a person is able to control his behavior. He shows no signs of mental impairment, incoordination of movement and difficulty of speech.

2. Moderate Inebriation — Person is talkative, argumentative and over-confident. There is slight impairment of mental faculties, difficulty of articulation, and loss of coordination to finer movements. The face is flushed with eyeballs congested. He is reckless and shows motor incoordination. He may be certified as being "under the influence of alcohol".

3. Drunk — The mind is confused, behavior is irregular and movement is uncontrolled. The speech is thick and incoordinated. Behavior is uncontrollable.

4. Very Drunk, "Dead drunk" — The mind is confused and disoriented. There is difficulty in speech and marked motor incoordination and often walking is impossible.

5. Coma — The subject is stuporous or comatose. Sometimes it is difficult to differentiate this condition with others having coma.

Diagnostic Points of Drunkenness:

1. Alcoholic smell of the breath or of the vomitus. 2. Dry furred tongue or with excessive salivation. 3. Irregular behavior. 4. Congestion of the conjunctivae. 5. Hesitancy or thickness of speech with impaired articulation.

ALCOHOLISM 697

6. Tremor or error of coordination and orientation. 7. Examination of the blood and the urine shows the presence of

alcohol.

8. History of having taken alcoholic beverages.

Physical Tests to Determine Drunkenness:

1. Romberg's test — Let the subject stand straight with heels together and with closed eyes for at least one minute. If he is not drunk, he will not sway to the front or to the sides, but if he is drunk the body will not be stable in the absence of any existing disease.

2. Let the subject stand straight with one foot ahead of the other so that the toes of one foot touch the heel of the other. This will remove the brace to prevent side sway. If drunk, there is more likelihood that the subject will sway sidewise and fall. The test is repeated after the subject is free from the effect of alcohol and make a comparison of stability.

3. Let the subject sit comfortably in a desk and get samples of his handwriting. Compare these writings, with those taken when he is free from the effects of alcohol.

4. Let the subject bend down and pick up a small object from the floor. If he stumbles, then his nervous system is not stable and that he may be drunk.

5. Let the subject walk straight forward to a comer of a room and rapidly turn around without stopping. Tell him to walk back. You will notice that the subject may have uncertainty of steps, side steps, or he staggers while making the turn and in walking.

Conditions Simulating Alcoholic .Intoxication:

1. Severe head injuries. 2. Metabolic disorders — e.g. hypoglycemia, diabetes precoma,

uremia, hyperthyroidism.

3. Neurological conditions associated with dysarthria, ataxia, tremor, drowsiness — e.g., disseminated sclerosis, intracranial tumors, Parkinson's disease, epilepsy, acute aural vertigo.

4. The effect of a drug is unlikely to be confused with the effect of alcohol unless the drug has been taken for the first time and has produced an unexpected reaction, or unless it has been in an unusually large dose. (Some drugs whose effects simulate alcoholic intoxication are: insulin; the barbiturates; most of the antihistamine group of drugs; morphine; the new analgesics which tend to cause giddiness; certain drugs used in the treatment of asthma — e.g. remedies containing atropine; drugs used in the treatment of involuntary movement — e.g. hyoscine.)

698 LEGAL MEDICINE

5. Certain pre-existing psychological disorder — e.g. hypomania, general paresis.

6. Prodromata of cerebral vascular emergencies, which may show themselves as confusional states, amnesia, or aphasia. The history may enable the doctor to settle any doubt.

7. High fever.

8. Exposure to carbon monoxide in sufficient concentration to give significant anoxemia.

(Taylor's Principles and Practice of Medicine Jurisprudence by K. Simpson, 12th ed.. Vol. 2, p. 392).

On account of a number of conditions simulating the condition of intoxication, a physician must exercise due care and diligence in the history taking, physical examination and in the observation of the signs and symptoms coupled with appropriate and available laboratory examination before the diagnosis of drunkenness is entertained.

A patient became nauseated while driving his car and got out to vomit. A passing policeman arrested him for drunkenness. He went into a spasm in the cell and the defendant physician was called and saw the patient twice for five minutes each time. He adviced the policeman that the man was drunk. The patient died a few hours.

An autopsy revealed that there was no alcohol in his blood and that he had coronary occlusion. The court found that a cause of action in the widow's complain properly pointed out that cursory examination fell below the reasonable standard of due care (Johnson v. Borland, 26 NW 2d 755, Mich. 1947).

Relation of the Blood Alcohol Level to the Degree of Intoxication:

1. Persons with blood alcohol below 0.05% are not considered intoxicated.

2. The majority of persons (80-90%) with blood alcohol levels between 0.1% and 0.15% will have their faculties so impaired as to render them unfit to drive motor cars with reasonable safety.

3. The majority of young people who are not habitual drinkers will be intoxicated to the extent of staggering when the blood level is about 0.15%.

4. The majority of all persons (80-90%) including habitual drinkers will be intoxicated to the extent of staggering when the blood alcohol level is approximately 0.2%.

5. The majority of persons will be in a coma when the blood alcohol level is approximately 0.5%

ALCOHOLISM 699

The American Medical Association and the National Safety Council of the United States recommended the following presumptive limits of intoxication:

1. Persons who have 0.05% alcohol or less in their blood are presumed to be uninfluenced by an alcohol.

2. Persons who have 0.05% to 0.10% alcohol in the blood are considered to possibly be under the influence of alcohol.

3. Blood alcohol level of 0.10% to 0.15% or more gives rise to the presumption that the person is drunk.

The percentages of alcohol in the blood and in the urine are, on the average, parallel so that the determination of alcohol level in the urine will indicate the amount of alcohol in the blood.

Amount of alcoholic beverage consumption to reach the level of 0.15% or higher:

As a general rule, it is not the quantity of alcohol consumed that determines the degree of intoxication, although there is an existing relationship, but rather the amount that actually gets into the blood stream. It may require many times more alcohol to raise the blood level in an individual to a given point than is required for another individual. Likewise, it may take more alcohol to raise the blood alcohol in the same individual to a given point on different occasions.

It has been found that the blood alcohol level of 0.15% or higher is considered definitely intoxicating, and to have such concentration in the blood will depend on the alcoholic beverage taken.

The following are among the alcoholic beverages consumed necessary to bring its level to 0.15% in the blood:

1. Whiskey (distilled spirit) — It requires the consumption of 8 oz.of whiskey to bring a blood level of 0.15%. The body eliminates about 1 oz. of whiskey per hour. Thus, if a person were to drink over a period of three hours, he would have consumed 11 oz. of whiskey to reach and maintain a blood level of 0.15%.

2. Wine (fermented spirit) — Wine with 20% alcohol requires 16 oz. to cause intoxication. The body eliminates 2 oz. per hour for every hour spent in the consumption of the wine in order to reach the level of 0.15%.

3. Beer (malt liquor) — With beer containing 3.7% by weight of alcohol, the amount required is 80 oz. plus 10 oz. for every hour spent in the consumption.

The above consideration is dependent on the proof of the case of distilled spirit or the percent by volume in wine and beer, of a certain specific beverage manufacturer, actually contained in the bottle.

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Conversely, the amount of alcohol consumed may be determined from the blood alcohol concentration by applying the Widmarks formula, as follows:

Ounces of Blood alcohol „. . . * , u i body weight x 0.68 x concentration Fluid ounces of alcohol =

0.8

For a quick and easy consolidation of the formula the following may be used: 13.6 x weight in pounds x concentration of blood alcohol = minimum fluid ounces of pure alcohol (200 proof) to achieve the blood concentration. Double this and one has the fluid ounces equivalent to 100-proof whiskey. (Modern Legal Medicine, Psychiatry and Forensic Science by Curran, McGarry and Petty, p. 316).

Factors Responsible for the Tolerance and Susceptibility to Alcohol:

1. Tolerance to Alcohol: Two or more persons of the same age, sex, weight and environ

mental up-bringing may react differently to alcohol. One may be tolerant while others may be sensitive.

Tolerance of a person to alcohol may be a result of two different factors namely:

a. Consumption Tolerance — A person who has developed tolerance may have lesser percentage of blood alcohol as compared with another person who is not used to it when given the same quantity at the same time. The reason is that those habituated eliminate faster as compared with non-habitual drinkers.

b. Constitutional Tolerance — If a person habitually drinks alcoholic beverages there develops a certain degree of adaptation by the body, thereby increasing the body threshold to it. Later, greater quantity and percentage will be tolerated and will lead to the diminution of its effects.

2. Susceptibility to Alcohol: The following factors render a subject unduly susceptible to the

effects of alcohol: a. Exposure to extreme cold; or fatigue. b. Pre-existing post-concussional state. c. Chronic cerebral vascular state — e.g. hypertension, advanced

cerebral arteriosclerosis. d. Cerebral depression caused by drugs, like barbiturates. e. Neurological disorders, like disseminated sclerosis, intracranial

tumor. f. Psychological disorders.

ALCOHOLISM 701

How Alcohol Influences the Production of Trauma:

Alcohol enhances the production of trauma in the following ways: 1. Alcohol increases the irritability and decreases the sense of res

ponsibility of a person which, in effect, may cause him to become involved in quarrels or accidents.

2. If a person is under the influence of alcohol, the anesthetic effect of alcohol may obscure pain and other symptoms of injury so that serious trauma may be overlooked.

3. Alcohol, being a depressant, renders the individual susceptible to the effects of traumatic shock or hemorrhage.

(Legal Medicine, Pathology and Toxicology by Gonzales, Vance, Helpern and Umberger, 2nd ed., p. 183).

How Alcohol Diminishes the Driving Skill:

The basic of the maxim that "Don't drive when drunk and don't drink when driving" is that alcohol deteriorates the driving skill in the following ways:

1. It increases the reaction time. The driver becomes sluggish in his reaction in an impending danger.

2. It creates a false feeling of confidence. 3. It impairs concentration, dulls judgment and degrades muscular

coordination. 4. It decreases visual and auditory acuity. (Pathology of Homicide by Adelson, p. 910).

Fate of Alcohol in the Body: After absorption of alcohol in the alimentary tract, it reaches the

liver by way of the portal circulation. It is then eliminated from the body through two mechanisms, namely:

1. Oxidation — Approximately 90% of the blood alcohol is metabolized by the enzyme Alcohol Dihydrogenase ( A D H ) and the coenzyme Nicotinamide-adenine Dinucleotide ( N A D ) into aldehyde and acetate and finally converted into carbon dioxide and water. A major portion of the process occurs in the liver although it may occur in other parts of the body inasmuch as A D H is also present in the kidney and retina from birth. This is the basis of enzymatic method of alcohol determination on body fluid.

2. Excretion — The remaining portion of the blood alcohol (approximately less than 10%) remains as such excreted through the urine, lungs, saliva and perspiration.

During the early period of the drinking, blood alcohol concentration is more than that of urine alcohol concentration. When the blood alcohol level is stabilized, the blood level is

702 LEGAL MEDICINE

almost the same as that of the urine alcohol level. However, at the period after termination of the drinking, the urine alcohol level is higher than the blood alcohol level.

The elimination of alcohol through the alveolar sacs follows the physical phenomena of diffusion. The amount of alcohol in the breath is proportional to the concentration of alcohol in the blood.

The rate of elimination of alcohol varies in different individuals. As a general rule, a person of average weight (150 lbs.) eliminates approximately 10 cc. of alcohol per hour.

Causes of Death in Alcoholics:

1. Acute Alcoholic Intoxication: a. Paralysis of the medullary center — Alcohol depresses the

nervous system by affecting the cerebral cortex, basal ganglia, cerebellum, and finally the brain stem and medulla.

b. Cardiac myopathy — The heart muscles may suffer direct damage from the high concentration of blood alcohol.

c. Ingestion of alcohol and synergistic drugs, like barbiturates and tranquilizers may cause fatality. Potentiation of alcohol by psychotrophic drugs has been reported to have caused death.

A blood level of 0.45% or greater is generally accepted as a fatal level, although death has occurred at a level below 0.35%.

2. Hidden Trauma:

Alcoholics are prone to be victims of traffic accidents or other traumatic injuries. Acute intoxication produces considerable analgesia and may deceptively conceal physical injuries. They may suffer from subdural hematoma, brain concussion or abdominal injuries which may be considered symptoms of drunkenness.

3. Unexpected Aspiration of Food ("Cafe Coronary"): Aspiration of food into the respiratory passage may cause

severe asphyxia. The sudden death in this case is characterized by the rapid onset of shortness of breath, choking on mealtime or vomiting and the presence of food particles on the respiratory system on post-mortem examination.

4. Poisoning by Congener or Contaminants in Alcoholic Beverages: Alcoholic beverages may accidentally contain toxic substances

which may cause injury or death of the drinker. There is a wide variety of impurities that may be found but the following contaminants in bootleg liquors are quite common: a. Methyl Alcohol (CH3OH, Methanol, Wood Alcohol) - The

mechanism of methanol poisoning is its conversion to formaldehyde and formic acid which consequently causes acidosis.

ALCOHOLISM 703

In the eye, it may cause blindness. The symptoms start as photophobia, followed by blurred vision to permanent blindness. This is due to the action of the poison on the ganglionic cells of the retina with subsequent atrophy of the optic nerve. If blindness is not total, there is considerable contraction of the field of vision and an impairment of the color sense.

b. Isopropyl Alcohol (Rubbing Alcohol) — The compound is converted in the body to acetone and excreted as such. Acetone is excreted through the lungs and produces hemorrhagic tracheobronchitis, bronchopneumonia and hemorrhagic pulmonary edema. It also causes lower nephron nephrosis, hemoglobinuria, fatty changes in the liver, respiratory paralysis and death.

c. Ethylene glycol and/or Diethylene glycol — Either or both are present in industrial antifreeze mixture but may become contaminant to the alcoholic beverages.

Ethylene glycol is marked central nervous system depressant and is oxidized in the body to toxic oxalic acid. The oxalic acid crystals plug the excretory tubules of the kidneys causing marked functional impairment and nephrosis. In the brain it may cause chemical meningitis and meningoencephalitis.

Diethylene glycol is also a central nervous depressant and causes centrolobular hydropic degeneration and necrosis of the liver as well as bilateral cortical necrosis.

5. Diseases Associated with/or as a Complication of Alcoholism:

The most frequent effect of continuous consumption of alcohol is that the development of fatty liver may ultimately become a condition of cirrhosis. A cirrhotic liver may cause rupture of the esophageal varices.

Alcoholism may also cause hemorrhagic pancreatitis, bronchopneumonia and development of other infectious diseases.

An alcoholic who is suddenly withdrawn from alcohol may suffer a state of excitement with hallucination known as delirium tremens. It is characterized by an attack of acute insanity with sleeplessness, marked tremors, excitement, fear and sometimes with strong suicidal tendencies.

An alcoholic may develop Korsakow's psychosis. It is a syndrome characterized by hallucination, disorientation and multiple neuritis, and the loss of memory for recent events. Cortical atrophy is the main alteration grossly observed in fatal cases.

Alcoholic Polyneuritis may also develop as a complication of alcoholism. There is a combined degeneration of the nerve fibers and myelin sheaths.

704 LEGAL MEDICINE

Post-mortem Findings in Death Due to Alcoholism:

Gross post-mortem findings are not characteristic. Most often the pathological findings were associated with or have developed a complication of alcoholism that had been observed. However, the following are some of the most common findings:

1. Presence of "alcoholic odor" of the stomach contents. The odor emitted is not due to alcohol but most often to that of the congener.

2. Congestion of the mucosa of the stomach. 3. Congestion of brain and its meninges. 4. Heart may be dilated and flabby and lungs congested and frothy,

otherwise normal. 5. Blood, alveolar air and urine examinations reveal the presence of

alcohol.

Pathological Drunkenness:

A condition wherein a small amount of alcohol intake may be sufficient to make a person drunk on account of an existing pathological condition of the body. Brain concussion, sun-stroke, epilepsy and other conditions may predispose a person to the effects of alcohol.

Punch Drunkenness:

This is not a condition of drunkenness. It may be observed among professional boxers who may have developed a peculiar physical and mental condition on account of repeated trauma on the head. The individual begins to have lack of concentration. He may change the subject-matter of a conversation abruptly and may ask the same question for several times. He has a bad memory of recent events. He is not too sociable, garrulous and boastful but rather timid and shy. His articulation may be glazed and slurring. Romberg's sign may be positive and locomotion may be ataxic and unsteady. Involuntary movement of a boxic nature may be present. He simulates continuously a person who is drunk.

Laboratory Examination in Alcoholism:

For the qualitative and quantitative determination of alcohol, blood, urine and respired air may be used from a living subject. Blood preferably extracted from the heart, and urine taken directly from the urinary bladder may be used to determine the presence of alcohol in the dead.

The legal issue confronting physicians in the taking of specimens of blood, urine and breath has been resolved in the decision of the

ALCOHOLISM 705

U.S. Supreme Court in the case of Schmerber v. California (34 U.S. 757, 16 L. Ed. 908) where it was held that:

1. There was no violation of the defendant's constitutional privilege against self-incrimination because the privilege applies only to testimonial compulsion and does not apply to the taking of physical evidence from an accused.

2. The taking of a blood specimen by a physician in a simple medically acceptable manner of a hospital environment was not brutal and offensive.

It did not constitute a violation of the due process clause of the constitution.

3. The taking of a blood specimen under such circumstances, despite the fact that the accused had objected and protested because his lawyer had advised him not to submit to any chemical test, did not deprive him of his constitutional right to counsel. The fact that his counsel had erroneously advised him that he could assert his privilege against self-incrimination with respect to a chemical test did not give him any greater rights to which he was entitled.

4. While the taking of breath or bodily fluid specimens from an accused for the purpose of analysis to determine blood alcohol concentration does come within the scope of the constitutional protection against unreasonable searches, the accused had been lawfully arrested before the blood specimen has been withdrawn. Under these circumstances the withdrawal was reasonable as an incident to a lawful arrest.

Withdrawal of Blood from a Dead Body Cannot be a Ground for Civil Damage:

A man was killed in an automobile accident. Because there was a reasonable cause to believe that he had been driving while intoxicated, the policeman in charge of the investigation asked the embalmer to draw a blood sample prior to the embalming of the body. The embalmer complied with the request. There was a very high alcohol level in the blood. The test result was admitted in evidence in suits brought by others injured in the accident against the driver's estate and they were awarded very substantial damages. The widow sued the embalmer for mental anquish for his disturbance of her husband's body. The court dismissed her complaint, holding that removal of blood did not disfigure the corpse, thus, she had no cause to a legal action (Hazelwood v. Stokes 483 SW 2d 576, Ky 1972).

706 LEGAL MEDICINE

1. Analysis of Blood: Analysis of the blood is probably the most widely accepted

way to determine the concentration of alcohol in the body. It is a direct method of estimation although the subject may refuse blood extraction for such analysis.

Alcohol should not be used to sterilize the skin before withdrawal for it might possibly give a false high reading. The blood sample must be drawn by a physician, nurse or other competent technician under sterile condition. On account of the great number to be tested, especially those traffic violators, it makes the blood analysis quite impractical.

2. Analysis of the Breath: The concentration of alcohol in the blood can be determined

indirectly by making a quantitative determination of alcohol in the respired air. The basis of the analysis is that there is a constant ratio between the concentration of alcohol in the blood stream and in the alveolar air.

3. Analysis of the Urine:

Urine as a specimen for alcohol determination has not gained widespread use because of variability in the different periods of alcohol intake.

4. Analysis of Body Tissue:

This method is applicable in death cases. Examination of the brain for its alcohol content is a reliable diagnostic procedure. Other bloody organs like the liver, spleen, kidney may also be examined for alcohol contents.

5. Analysis of Saliva, Perspiration and Spinal Fluid: Although it may be done, examination of these fluids is seldom

done.

Objectives of Alcohol Examination:

1. For Screening — This is done to determine whether alcohol is present in the sample. The sample may be blood, urine, saliva, vitreous humor, stomach content or respired air (alveolar air). The instrument and the procedures must be simple for an ordinary layman or a police officer to perform the job. The apparatus must be portable so that the result will be available in the shortest possible time. The apparatus may be placed in a mobile laboratory for the purpose of screening drivers of motor vehicles.

Percentage of blood alcohol = Gms. of Alcohol in breath x 2

Gms. of Carbon dioxide x 100

ALCOHOLISM 707

Insofar as breath alcohol determination is concerned, the following are the available instruments.

Device & Manufacturer

Alcolyzer (Intoximeters, Inc.)

Bect-ton-D ickenson (Becton-Dickenson)

Kitigawa Drunk-O-Tester

(Komo Chemical Industrial Company) Sober-Meters SM-1, SM-6 SM-9 and SM-9A (Luckey Laboratories) Alco-Halt

(Mine Safety Appliance Co.)

Method of Detection

Chromate salt in acid


Chromic Acid


Catalytic combustion

Indicator Response

Color Change Orange-yellow

to green Color change Orange-yellow to

green Color change Orange-yellow to

blue-gray

Color change Orange-yellow to

green

Lights-pass or fail

Bat III (Century Systems, Inc.)

Catalytic combustion Pointer-warn fail

or

A .L .E .R.T . , Model Taguchi Mos Conduc-J3A (Alcohol Counter tor Measures, Inc.)

Fuel cell

Lights-Pass, warn or fail

Lights-Pass, warn or fail

Alco-Sensor (Intoximeters, Inc.)

Alco-Sensor II Fuel cell (Tntoximeters, Inc.)

(Forensic Science Handbook by Richard Saferstein, p. 626).

Digital readout

2. For Evidentiary Purpose — If in the screening process the sample had a positive result, the next procedure to be applied is the determination of the quantity of alcohol. The report is to be submitted in connection with such examination to be used as an evidence as to the presence and actual amount of alcohol in the submitted specimen. The procedure requires the use of precision instrument and should be performed in a regular chemical laboratory.

708 LEGAL MEDICINE

Withdrawal of Blood for Alcohol Determination Not Giving Evidence Against the Defendant:

Withdrawal of blood from a person suspiciously drunk to determine the alcohol concentration in the blood is not self-incriminatory. The act is purely mechanical and it does not utilize the mental faculties of the subject.

The defendant having been convicted of causing a death by driving an automobile while under the influence of intoxicating liquor, appealed to the Supreme Court of Colorado.

The defendant contented on appeal that he was required to give evidence against himself by the admission of the result of a test of blood to determine the alcoholic content. H E L D : The original intent of the constitutional provision was to prevent the defendant being forced to give testimonial evidence against himself and did not contemplate the exclusion of evidence of physical facts relating to the defendant. The defendant is not deprived of any of his constitutional right by the admission of the testimony here in question. He is not compelled to testify against himself (Block v. People, 240 p. (2d) Colo. 1951).

Chemical Test for Intoxication Admissible in Evidence:

Any chemical test for alcohol to determine whether a person is under the influence of alcohol is admissible as evidence in court. The tendency of our modern court is to accept scientific methods in crime detection provided that it has gone beyond the experimental stage and has already been perfected.

The defendant was charged with the offense of driving his automobile when drunk and was found guilty by a jury in the trial court. He appealed to the criminal court of appeals of Oklahoma.

The defendant contented that the drunkometer and urine analysis tests for the determination whether the defendant was under the influence of intoxicating liquor have not gained such scientific standing for infallibility as to justify admission of the expert testimony on it. H E L D : The court is of the opinion that we should favor the adoption of scientific methods for crime detection, where the demonstrated accuracy and reliability has become established and recognized. Justice is truth in action, and any instrumentality that aid justice in the ascertainment of truth should be embraced without delay. We believed that chemical tests of such body fluids as blood, urine, breath, spinal fluid gained that scientific recognition for infallibility as to be admissible in evidence.

ALCOHOLISM 709

Methods Used in Alcohol Detection:

At present there are many kinds of apparatus perfected and laboratory procedures adopted in alcohol detection, but these different methods are actually based on any of the following principles: 1. Chemical Method — The sample is distilled and later allowed to

react with a known quantity of oxides, usually chromate, and it determines the amount of chromate which has not reacted to alcohol. By computation the amount of alcohol in the sample can be determined.

This is the principle involved in the use of breath alcohol determination with the use of Alco-tester (500), Breath analyzer (900A, 1000) and Alcometer (AE-D1) .

2. Enzymatic Method — A known quantity of purified alcohol dehydrogenase and its coenzyme nicotamide adenine nucleotide ( N A D ) is allowed to react to the sample. Alcohol is oxidized to aldehyde the coenzyme nicotinamide adenine dinucleotide ( N A D ) , and this can be measured colorimetrically or spectophotometrically.

The dipstick method or quick quantification of ethanol in the body fluid is based on this principle:

"A quarter-inch cellulose pad at one end of the strip is impregnated with a buffered solution containing yeast alcohol dehydrogenase ( A D H ) , nicotinamide — adenine dinucleotide, pyrazole iodonitrotetrazolium chloride ( I N T ) and deaphorase. When the strip is dipped into saliva, urine or serum that contains ethanol, it turns various shades of pink instantly because of a reaction between, on the one hand, the N A D H that is produced and, on the other, diaphorase and INT. on the other. The amount of ethanol present can be quantitated by comparison with a color chart.

By this method, ethanol concentrations in body fluids can be measured in only 60 seconds, a considerable savings in the time over methods that require the delivery of a sample to a laboratory plus testing time. In an emergency situation in which the patient cannot be tested by breath analysis, this is an obvious advantage (JAMA, Vol. 250, No. 13, Oct. 7, 1983).

3. Gas Chromatographic Method — The specimen may be first purified or injected directly to the apparatus.

4. Infrared Absorption Method — Alcohol is present as a vapor in breath. It absorbs specific wave lengths of infrared. An intoxi-lyzer measures alcohol by detecting the decrease in the intensity of infrared energy as it passes through the cell.

710 LEGAL MEDICINE

Effect of Delayed Examination or Putrefaction of Sample:

To have an accurate determination as to the quantity of alcohol in a specimen, immediate examination must be done. Fermentation of the alcohol present may take place and transforms it to acetaldehyde and ultimately to carbon dioxide and water. The sugar and other forms of carbohydrates and protein in the sample may also go

through the action of enzymes, bacteria and fungi acting singly or in a combination that may be transformed into alcohol. The alcohol to be oxidized to form carbon dioxide and water is comparatively very much less than the amount of carbohydrates and protein material to be transformed into alcohol. Consequently, the longer the time interval between extraction and examination, the more it increases the alcohol contents of the sample. This condition is also true when extraction of body fluid is done a long time after death.

"It, nevertheless, is worthwhile to do an alcohol analysis in such putrid sample despite the fact that it will not give a true picture of the state of intoxication of the deceased at the time of death. Alcohol concentration in excess of 0.20% would indicate alcohol consumption prior to death, while levels below 0.20% may be ascribed to possible putrefactive alcohol production" (Medico-Legal Investigation of Death by Spitz and Fisher, p. 482).

Societal Reaction to the Problem of Alcoholism:

1. Promulgation of laws and regulations:

a. Manufacturing of liquor only to a certain percentage of alcohol in beverages.

b. Restricting the time and place of drinking and the availability of liquor to a particular age, sex and other socio-economic group.

c. Subjecting drivers at random to an alcohol screening test, and if found positive, it is to be followed by a quantitative determination of blood alcohol. If blood alcohol exceeds the maximum tolerable limit prescribed, the driver can be arrested.

2. Various indoctrination methods may be employed to encourage moderation or abstinence, like education in schools and churches.

3. An institutional-organization approach, introduces substitute form of tension relief into the social structure. Subsequent removal of the cause of tension and diverting attention to something else can also be looked into.

4. A variety of therapeutic approaches are taken under the concept that an alcoholic is a patient:

ALCOHOLISM 711

a. Therapy combines medicine with psychiatry, psychology, social case work and alcoholic anonymous.

b. Pastoral counseling are given in churches. c. Half-way houses are built to bridge the gap between the penal

institution and the community.

Chapter XXXIV

MEDICO-LEGAL ASPECT OF POISONING

Definition of Poison:

A poison is anything other than physical agencies which is capable of destroying life, either by chemical action on the tissues of the living body, or by physiological action by absorption into the living system.

Legally, a poison is a substance which, if applied or administered internally, has been applied or administered with the intention to kill or to do harm.

The intent in the administration is the essential element in law. The quantity does not affect culpability, nor is the law concerned with the quantity in which the substance acts.

(From: A Synopsis of Forensic Medicine & Toxicology by E. W. Caryl Thomas, 2nd ed., p. 142).

In cases of suspected poisoning, it is not advisable to confine the toxicological analysis to the stomach and its contents because:

1. The gastrointestinal tract is only one of the means of entry of poison into the body. It is possible for poisonous substances to gain entry by inhalation, by absorption through the skin, by intravenous, intramuscular and subcutaneous injection, or by introduction into the vagina or rectum. Analysis of the gastric content would not eliminate poisoning as a factor when poison gains entrance into the body via other route.

2. Even if the poison was taken orally, after a significant period of time (4 to 6 hours) has elapsed from ingestion to death, the poison might have passed out of the stomach and could no longer be present in identifiable amount.

3. If analysis of the gastric contents disclosed presence of possible toxic substance, it is possible that the said poison could have been introduced post-mortem to conceal the real cause of death.

4. Except in cases of poisoning by strong corrosive agent, there must be a demonstration of absorption of the poisonous agent. This can be shown by the presence of the toxic materials in other organs or parts of the body.

712

MEDICO-LEGAL ASPECT OF POISONING 713

Site of Action of Poison: 1. Local Action:

The poison may act on the skin or on the mucous membrane or on any part of the body where it is applied. Example: Sulfuric acid.

2. Remote Action:

The poison may act remotely in any of the following ways:

a. By the production of shock.

Example: Poisoning by strong acid.

b. By absorption into the blood and being carried to the organs they affect.

Example: Morphine is absorbed by the blood and carried to the brain and depresses it.

c. By transmission through the nerves of local parts affected going to the nerve centers and then reflected to the organs on which they act.

Site of Remote Actions of the Different Poisons are: a. On the Brain:

Narcotics, alcohols, cerebral stimulants like caffeine.

b. On the Cord:

Strychnine.

c. On the Peripheral Nerves:

Conium, curare.

d. On the Alimentary Tract*. Corrosives.

e. On the Kidneys: Cantharides.

f. On the Salivary Glands: Mercury.

g. On the Liver: Phosphorus.

h. On the Mucous Membrane: Arsenic

i. On the Heart: Digitalis,

j. On the Blood Vessels: Ergot, nitrites,

k. On the Blood Cells:

Snake venom.

714 LEGAL MEDICINE

3. Both Local and Remote:

The poison may act at the site of application and in some distant place.

Example: Carbolic acid is an irritant to the alimentary tract and also toxic when absorbed.

Condition of the cadaver when the organs or other tissues are removed which makes the examination difficult or the result meaningless:

1. Embalming: — A dead body must be autopsied and organs and other tissues saved for toxicological analysis before embalming because:

a. Fixation of tissues by formaldehyde makes them more resistant to the action of organic solvents used for the extraction of nonvolatile organic substances, such as most drugs, leading to low recovery of these substances.

b. It is extremely difficult, if not impossible, to detect and identify most volatile poisons. Cyanide, for example, reacts chemically with formaldehyde so that it is no longer identifiable in an embalmed body.

c. Many embalming fluids contain methyl alcohol or ethyl alcohol or both so that analysis of these substances is rendered meaningless.

2. Putrefaction:

a. Most volatile compounds are lost as a result of putrefaction.

b. Putrefaction of normal tissue components may produce substances which yield chemical reactions similar to those obtained from toxic compounds.

c. Some substances, like alcohol and cyanide, may be produced in the process of putrefaction of normal components.

d. Many substances which might be present in the tissue may undergo chemical changes and may no longer respond to the identifying test made for them.

Minimum Amount of Autopsy Specimens for Toxicological Examination: 1. Brain — One hemisphere 2. Liver — 500 gms. 3. Kidney — One whole kidney 4. Stomach content — 50 gms. 5. Spleen — Whole spleen 6. Urine — All avilable up to 100 cc. 7. Blood — 100 cc. 8. Bile — AH available


Recommended Organs to be Saved for Suspicious Poisoning

Poison to be Tested Organs to be Submitted

1. Arsenic (Acute poisoning) Liver, kidney, stomach contents 2. Arsenic (Chronic poisoning) Liver, urine, hair 3. Alcohol Blood, liver, kidney, urine, brain 4. Cyanide or H C N Stomach and liver 5. Carbon monoxide Blood placed in a sealed container 6. Alkali Stomach and contents, esophagus 7. Morphine and other Stomach and contents, liver, urine

alkaloids 8. Barbiturates Brain, liver, kidney, urine 9. Phosphorus Stomach, liver, kidney

10. Lead Kidney, liver, bone 11. Phenol Liver, kidney, stomach 12. Pesticide (insecticide) Stomach and contents, liver, blood 13. Antibiotic Liver, blood 14. Kerosene, gasoline Brain, liver, lungs, blood

Circumstances Affecting Action of Poison:

1. Method of Administration:

Poisons may enter the body in the following ways:

a. Orally:

Except irritants and corrosives, poisons must be digested or absorbed in the gastric or intestinal mucosa before producing effect.

b. Hypodermically:

Poison reaches the blood stream without passing the digestive organs. This method is only available for such substances that are soluble in the lymph and tissue juices.

c. Intramuscularly:

Absorption is faster than in the hypodermic method.

d. Endodermically:

The poison may be rubbed into and absorbed through the skin.

e. By Rectum, Vagina or Bladder:

Absorption through the rectum is about twice as much as absorption through the mouth.

f. By the Lungs:

Poison through this route may be made of a substance which can be transformed to gaseous state.

716 LEGAL MEDICINE

2. Idiosyncrasy:

Some persons possess sensitivity to certain foods or drugs. The most common drugs are potassium iodide, arsenical preparations, aspirin and the sulfas. As to foods, the most common are fish, shrimps, eggs and oysters.

3. Age:

There are substances which are considered poison for babies but wholesome for adults, while the opposite is true for other substances.

There are substances which children can take more than the proportionate dose in adults, like mercury and belladonna. In case of some other drugs, children may be so sensitive that they cannot take the proportionate dose for their age, like opium preparations.

4. Habit:

The body may acquire tolerance to some drugs. Habit diminishes the effect of certain poisons. Tobacco, alcohol, opium, barbiturates, arsenic are good examples of this.

5. Dose:

The effect of drugs and poisons in the body is usually proportional to the dose taken.

Example: Alcohol, when taken in small dose, stimulates body reflexes and tone, while large amount depressed the whole body.

Fatal Dose:

This is the smallest dose known to cause death: not the smallest amount which will certainly cause death.

Guide in Detennining the Single Dose of Drugs Suitable for Children:

Clark's Rule:

Divide the weight of the child in pounds by the average weight of the adult (150 lbs.) and take the fraction of the adult dose.

Example: The weight of the child is 50 lbs. then 50/150 equals 1/3. So the child can take 1/3 of the adult dose.

Young's Rule:

Divide the age of the child by the age of the child plus 12, and the resulting fraction is the portion of the adult dose which may be used.

Example: If the child is 6 years old, then 6/6+12 equals 6/18 or 1/3 of the adult dose.


Cowling's Rule:

Divide the age of the child on his next birthday by twenty-four and the fraction of the adult dose is to be used.

Example: If the child is 8 years old, then 8/24 equals 1/3 of the adult dose.

Gabius stated a series of fractions of the adult dose which may be used for different ages:

For a child one year or less 1/12 2 years 1/8 3 years 1/6 4 years 1/4 7 years 1/3 14 years 1/2 20 years 2/3 Above 20 years For adult dose

6. Stare of the Stomach and Kidneys:

Since the stomach is the first organ where the ingested food stays for a time, so it must be the first organ to be affected by the action of poison. If the organ is diseased or abnormal, it has less resistance to the effect of poison. A healthy person is usually more resistant to the action of the ingested poison in insoluble form.

SIGNS AND SYMPTOMS THAT MAY LEAD ONE TO SUSPECT POISONING:

1. The complaints and symptoms appear suddenly like an acute abdomen, apoplexy, heart failure or cholera.

2. The symptoms appear when the individual is at the state of health.

3. The symptoms usually appear after a meal or after taking some food or medicine. The onset of the symptoms is influenced by the modifying factors mentioned, but it appears within an hour in most cases.

4. When several persons partake the food or drug at the same time, the approximate occurrence of the symptoms is at the same time.

5. The course of the symptoms may either be getting severe or having steady improvement.

6. The detection of the poison can be done on any of the following: a. food taken c. vomitus b. container <i. excretions

Failure to detect poison does not show that the substance is absent because:

718 LEGAL MEDICINE

a. The poison might have already been eliminated.

b. The material examined may not contain the poison.

c. The procedure applied is not delicate enough to detect small quantity of the drug.

d. The poison might have already been transformed to another state in the body before detection.

In order to confirm the suspicion that it is a case of poisoning, the

following must be done:

1. Obtain information from:

a. The victim himself. b. Member or members of the family. c. Police or other peace officers.

2. Obtain sample of the vomitus, urine and other bodily discharges for analysis.

3. Observe the patient as to other developments of the symptoms and progress of the condition.

4. Request a fellow physician to assist and observe the patient if necessary.

Signs

Coma

Collapse

Delirium

Paralysis

D I F F E R E N T I A L D I A G N O S I S O F P O I S O N I N G

Poison Disease

Opium, Chloral, Alcohol Apoplexy, Brain injury, Uremia, Diabetes, Epilepsy, Fever.

Corrosives, Arsenic, An- D i p h t h e r i a , Cholera , timony,. Aconite, To- Fever, bacco, Antipyrine.

Belladonna, Hyoscya- Pneumonia, Phthisis, Fe-mus, Cannabis, Alcohol, ver, Acute mania, Me-

Convulsion

Cyanosis

Camphor. ningitis.

Conium, Aconite, Gelse- Injury of cord or brain, mium, Eserine, Arsenic, Apoplexy, Hysteria. Lead.

Nux vomica, Arsenic, Tetany, Hysteria, Epilepsy.

Vulvar heart diseases.

Antimony. Analine, Antifibrin

Enlarged pupil Atropine, Hyoscyamus, Paralysis of the 3rd nerve, Aconite, Alcohol, Co- Paralysis of sympathetic, nium, Chloroform.

Dry skin Belladonna,Hyoscyamus Fever, Pneumonia.


Moist skin Opium, Aconite, Antimony, Tobacco, Alcohol.

Acute rheumatism.

Colic

Cramp

Purgation

Vomiting

Irritants, Digitalis, Col-chicum.

Corrosives and irritants

Lead, Copper, Arsenic

Lead, Arsenic, Anti-

Gastric ulcer, Acute gastritis, etc.

Dysentery, Cholera, Typhoid Fever, Tuberculosis.

Volvulus, Obstruction.

Cholera, Diarrhea.

mony. (From: A Synopsis of Forensic Medicine & Toxicology by E. W. Caryl Thomas, 2nd ed., p. 147).

T R E A T M E N T O F P A T I E N T S U F F E R I N G F R O M A C U T E POISONING:

1. Evacuation of the Stomach:

This may be done by:

a. Stomach Tube:

A long rubber tube is introduced to the mouth and allowed to reach the stomach. Fluid must first be introduced into the stomach to prevent the tube to come in close contact with its wall. Fluid is withdrawn and introduced until traces of the poison are removed. The procedure is contra-indicated in poisoning by corrosives on account of the danger of tear or laceration of the stomach wall.

b. Administration of Emetics:

(1) Zinc Sulfate — 30 grs. (2) Ipecacuanha — 20-30 grs. in two six drachms of wine. (3) Mustard and Water — One tablespoon in one tumbler of

water. (4) Salt and Water. (6) Apomorphine — 1/10 gr. hypodermically.

2. Neutralization of the Poison that Remains in the Stomach:

a. Neutralization by Direct Chemical Reaction:

Examples: (1) Acids neutralize alkalies. (2) Alkalies neutralize acids.

b. Neutralization by Physiochemical Reaction:

Examples: (1) Silver nitrate is precipitated by common salt. (2) Iodine reacts with starch.

720 LEGAL MEDICINE

c. Physical Reaction:

This is the formation of a non-soluble compound thereby preventing absorption.

Examples: (1) Tannic acid precipitates Strychnine. (2) Egg albumen precipitates mercuric chloride.

When the exact nature of the poison is unknown, a mixture composing of the following substances may be used:

Powdered charcoal 2 parts Magnesia 1 part Tannic acid 1 part

The following formula is advanced by Murrel to be used in cases of poisoning of any kind, although it may be incomplete:

Saturated solution of sulphate of iron 100 parts Calcined magnesia 88 parts Animal Charcoal 40 parts Water 100 parts

The above formula is indicated in case of arsenic, zinc salts, digitalis, acids of ordinary types, mercury salts, morphine and strychnine poisoning; but this is of no use for alkalies, phosphorus, tin salts, or hydrocyanic acid poisonings.

3. Application of Physiological Antidotes:

a. Strychnine may be used to stimulate respiration.

b. Depression of the heart by aconite may be counter-acted by digitalis.

c. Blood vessels may be constricted by ergot, suprarenal extracts, digitalis and dilated by amyl nitrate and sodium nitrite.

d. Morphine, bromides or barbiturates may be given for poisoning by stimulants.

4. Keep the patient alive by general measures, while his organs of elimination are getting rid of the poison. Treat any urgent and dangerous symptoms.

5. Eliminating the Poison:

The elimination of the poison is aided by purgatives, sudori-fics, and diuretics.

Sweating may be encouraged by hot bath, warm packing, and injection with apomorphine.

Symptomatic Treatments:

Pain may be relieved by the injection of morphine.

Absorption from the stomach may be hindered by adrenalin and the use of demulcent like oil, starch, egg-albumen and water.


In some cases, it is advisable to administer glucose either by mouth or intravenously to restore the depleted glycogen.

Diffusive stimulants, artificial respiration, inhalation of oxygen and carbon dioxide, and application of heat on the skin surfaces may be adopted.

M E D I C A L E V I D E N C E S I N CASE O F P O I S O N I N G

In the trial of a case of poisoning, the defense counsel will prove:

1. That the death of the victim was not due to poisoning but to some natural cause.

2. That the victim did not suffer from poisoning of the particular poison mentioned in the complaint or information.

3. That there was no intent on the part of the defendant to poison the victim.

For the purpose of clarification and in the best interest of justice, the medical witness must answer the following questions:

1. What is the actual cause of the death?

2. Why is death attributable to poisoning rather than to disease?

3. What is the maximum fatal dose of the poison alleged to have caused the death?

4. If the symptoms which appeared do not resemble the typical symptoms of poisoning by the alleged poison, what explanation can he give?

5. Was the dose taken by the victim necessarily fatal?

In order that the physician may be able to answer the above questions, he must know and report on the following points:

1. History and Symptoms During Life:

a. History of any previous suicidal attempts. b. History of his mental condition. c. History of business, marital and social failures. d. Presence of persons having grudge against him. e. Possible source of the poison. f. Time of actual administration of the poison. g. Nature and actual time of occurrence of the symptoms. h. Order of occurrence of the symptoms. i. If the victim died, note the exact time of death and the period

of time from ingestion to death. j . Inquire about the presence of vomitus, urine, and other bodily

discharges for analysis, k. Date, time and place where the victim was last seen alive.

2. Post-mortem Examination:

722 LEGAL MEDICINE

a. External Post-mortem Examination:

(1) Note the attitude of the body and dress, especially for stains.

(2) External signs of physical violence. (3) The expression of the face. Some poison, with convulsion

as the symptom, may be inferred from the expression of the face.

(4) Approximation of the time of death.

b. Internal Post-mortem Examination:

(1) The bodily openings must be noted for any peculiar smell characteristic of some poisons.

Examples: Carbolic acid, hydrocyanic acid, phosphorus, chloroform, etc.

(2) The tongue, mouth and esophagus must be examined for inflammation, erosions and stainings.

(3) The larynx, trachea and bronchi must be opened to see the effect of volatile irritants.

(4) Examination of the stomach:

(a) The color of the stomach wall may sometimes indicate poisoning by certain drugs.

Examples:

— Mercury usually produces a slate-color stain.

— Arsenic may produce white particles adherent to possible yellow sulfides.

— Strong sulfuric acid and concentrated oxalic acid may produce blackened or charred wall.

— Hydrochloric and carbolic acids produce white wall. However, the color changes may be due to food, bile or post-mortem changes.

( b ) Ulceration:

Strong corrosive may produce ulceration of the wall. This must be differentiated with simple ulcer and cancerous growth.

(c) Actual perforation:

This may be found in poisoning by strong mineral acids, especially sulfuric acid. It must also be differentiated from perforation brought about by disease of the wall.

(d) Softening:

Usually found in poisoning by strong alkaline irritants. It must be differentiated from post-mortem digestion of the stomach wall.


(5) Examination of the stomach contents:

(a) Quanity. (b ) Nature of food. (c) Color. (d) State of digestion. (e) Presence of matters not commonly considered as food. ( f ) Odor.

(g) Reaction.

(6) Examination of the duodenum and its contents.

(7) Condition of the rest of the small intestine.

(8) Examination of the large intestine and its contents.

(9) Examination of other visceral organs.

(10) Examination of the bladder and the vagina, in the case of a female, for poison that might have been introduced into the body through these channels.

(11) Saving of organs for chemical analysis.

For the purpose of chemical analysis of the visceral organs, the Forensic Chemistry Division of the National Bureau of Investigation Department of Justice have recommended the following organs to be saved by the physician for the quantitative and qualitative determination of poisons and offer poisonous substances as enumerated below:

Poison to be Tested

Arsenic (Acute poisoning). . . Arsenic (Chronic poisoning) .

Mercury Phenol Alcohol Cyanide or HCN Phosphorus Carbon monoxide Veronal, luminal, amytal . . . Strychnine

Morphine Other alkaloids Lead (chronic) Mineral acids Oxalic acid Alkalies

Organs Required

Liver, kidneys, stomach contents. Hair, urine, liver.

Liver, kidneys, stomach, intestines. Liver, kidneys, stomach. Blood, liver, kidneys, urine, brain. Stomach and liver. Stomach, liver, kidneys. Blood (placed in sealed container). Urine, brain, liver, kidneys. Stomach, stomach contents, liver, kidneys, urine. Stomach and contents, liver, urine. Same as morphine. Bone, kidneys, liver. Stomach and contents, esophagus. Same as morphine. Stomach and contents, esophagus.

724 LEGAL MEDICINE

Suggested Autopsy Specimens and Quantities To be Submitted for Toxicologic Examination

Specimen

Bile

Blood

Brain

Fat

Hair

Fingernail clip-p i n gs o r whole nails

Intest inal contents

Kidney

Liver

Lung

Muscle

Spinal fluid

Spleen

Stomach contents

Urine

Vitreous humor

Minimum Amounts

All available

20 to 30 ml.

100 gm.

100 gm.

About 0.5 gm.

As much as possible

30 gm.

100 gm.

100 gm.

1 lobe

100 gm.

All available

25 gm.

All available

All available

From both eyes (about 5 ml.)

Indications

Valuable in narcotic cases. For all types of determina

tions.

For fat-soluble drugs.

For insecticides and other fat-soluble drugs (thiopental).

Chronic (not acute) arsenic

poisoning.

Chronic arsenic poisoning.

In instances in which poison presumably was taken orally.

For all types of poisoning, especially heavy metals and narcotics.

For all types of poisoning, especially heavy metals and alkaloids.

For inhaled poisons and basic drugs.

In instances in which internal organs are badly putrefied.

All types of poisoning when blood is not available.

Carbon monoxide determination when blood is not available.

In instances in which poison presumably was taken orally. Valuable in nearly all types

of poisonings.

Most drugs and alcohol.


•Italicized specimens are considered to be the most significant for toxicological examination.

(From: Clinics in Laboratory Medicine, Vol. 3, No. 2 by DiMaio ed., 1983, p. 368).

3. Chemical Analysis:

This portion of criminal investigation is beyond the scope of a physician's duty. The expert analyst or a toxicologist is much more in the position to perform the work.

The expert chemist, analyst or toxicologist must be able to answer the following questions:

a. When, where and from whom did you receive the article which you have analyzed?

b. In what state were they received? c. When did you analyze it, and where? d. Did you analyze it alone, or were you assisted? e. What test did you employ?

C L A S S I F I C A T I O N O F POISONS

Poisons may be classified in different ways. Some authors classify poisons based on the manner of action and effect on the body, while chemists usually classify them from the purely chemical standpoint.

The following are the classifications of poisons based on the manner of action and effect in the body:

A Corrosives:

1. Strong Acids:

a. Sulfuric Acid d. Carbolic Acid b. Nitric Acid e. Oxalic Acid c. Hydrochloric Acid

2. Caustic Alkalies:

a. Potassium Hydroxide b. Sodium Hydroxide c. Ammonia

3. Compounds:

a. Zinc Chloride b. Antimony Trichloride

B. Irritants: 1. Non-metals 2. Salts of Metals 3. Vegetable Irritants:

a. Castor oil c. Belladonna b. Digitalis d. Croton Oil, etc.

726 LEGAL MEDICINE

4. Animal Irritants: a. Cantharides

5. Food Irritants

C. Narcotics:

1. Somniferous Group:

a. Opium c. Synthetic Hypnotics

b. Chloral

2. Deliriant:

a. Belladonna c. Stamonium b. Hyoscyamus d. Cocaine

D. Depressants:

1. Neural Depressant: Paralysis of the spinal cord.

a. Aconite

b. Conium

2. Cerebral Depressants: Inhibiting the brain functions.

a. Hydrogen Cyanide c. Laurel Water

b. Oil of Bitter Almond

3. Cardiac Depressants:

a. Digitalis c. Camphor b. Strophanthus

E. Poisons which are Exito-Motor in Action:

1. Strychnine 2. Brucine 3. Thebaine

F. Poisonous and Irrespirable Gases:

1. Poisonous Gases:

a. Carbon Dioxide d. Arseniureted Hydrogen b. Carbon Monoxide e. Carbon Disulfide

c. Hydrogen Sulfide

2. Irrespirable Gases:

a. Chlorine c. Hydrogen Cyanide b. Benzene

G. Contact Poisons:

1. Vegetable Irritants 2. Animal Irritants 3. Chemical Irritants

H. Vulnerants:

1. Nails 3. Dust 2. Broken Glasses


The Forensic Chemistry Division of the National Bureau of Investigation, Department of Justice made the following classification based on the Chemical Standpoint:

A. Gaseous Poisons (Poisons Present in the Gaseous State):

Carbon dioxide; Carbon monoxide; Hydrocarbons; Hydrogen sulfide; Sulfur dioxide; the Oxides of nitrogen (Nitrous oxide, Nitric acid and Nitrogen dioxide); war gases.

B. Inorganic Poisons:

1. Corrosives (Poisons characterized principally by an intense and destructive action — a few organic corrosives are included in this group for the sake of completeness):

a. Acid; Mineral and Organic:

Sulfuric acid; Hydrochloric acid; Nitric acid; Oxalic acid; Acetic acid.

b. Alkaline Corrosives:

Potassium hydroxide; Sodium hydroxide; Calcium oxide; Ammonium hydroxide.

c. Halogens:

Chlorine; Bromine; Iodine; Fluorine.

d. Corrosive Metallic Salts:

Silver; Zinc.

e. Organic Corrosives:

Phenol; Pyrogallol; Formaldehyde.

2. Metallic Poisons and Salts: (These chemicals are protoplasmic irritants, but their chief action is the deleterious effect produced after absorption into the system.)

a. Heavy Metals:

Phosphorus; Antimony; Arsenic; Bismuth; Mercury; Lead; Radioactive substances; Thallium; Gold; Osmium; Platinum; Nickel; Chromium; Tin; Vanadium.

b. Inorganic Salts: Alum; Alkaline earths; Magnesium sulfate; Lithium salts; Potassium salts; Boric acid and borax; Tellurium; Sodium silicate.

C. Organic Poisons:

1. Volatile Poisons (Volatile liquids or easily sublimated solids many of which are irritants; their chief action occurs after absorption):

a. Alepathic Compounds:

Methyl alcohol; Ethyl alcohol; Fuel oil; Amyl alcohol;

728 LEGAL MEDICINE

Tertiary or Dimethyl carbinol; acetaldehyde; Paraldehyde; Methyl chloride; Methyl bromide; Tribromoethanol; Ethyl chloride; Ethyl bromide; Ether; Chloroform; Bromofonn; Chloral hydrate; Carbon tetrachloride; Tetrachlorethane; Amyl nitrite; Nitroglycerin; Carbon bisulfide; Hydrocyanic acid and the cyanides; Paraffin hydrocarbons.

b. Atomic Compounds:

Benzene series; Essential oils.

2. Alkaloidal Poisons: (These substances are toxic principles of plants which have a characteristic action on some parts of the central nervous system; they are a well-defined group).

a. Volatile Alkaloidal Poisons: Nicotine and tobacco; Conine and poison hemlock.

b. Non-volatile Alkaloids:

Opium and morphine; Aconitum and aconitine; Atropine and related alkaloids; Epicac and emetine; Cocaine and allied alkaloids; Nux vomica and its alkaloids strychnine and Brucine; Physostigmine; Alkaloids of the veratrum species; Gelsenium and its alkaloids; Colchicum and Colchicine; Ergot and its alkaloids; Cinchona and quinine; Pilocarpus Jaborandi and pilocarpine; Caffeine; Curare.

3. Non-alkaloidal Poisons (A conglomerate collection of other organic toxic substances, non-volatile and non-alkaloidal):

a. Hypnotics:

Alepathic series; Aromatic series.

b. Aromatic Compounds: Naphthol; Salicylic acid; Picric acid; Dinitrophenol;

Trinitrotoluene; Acetanilid; Antipyrine; Atophan; and the Cinchopen group.

c. Glucosides: Digitalis, Strophanthus; Oleander; Hellebore; Gossypium;

Locust; Scilla; Cannabis indica.

d. Organic Purgatives: Purgative oils; anthracene group; Jalap; purgatives.

e. Essential Oils: Aspidium; Abortifacients; Oil of chenopodium; Apiol;

Affion; Turpentine.

f. Picrotoxin Group: Picrotoxin; Water of hemlock.

g. Miscellaneous Group: Taxus; Sparteine; Abrus; Laburum; Larkspur; Health

family; Santonin; Cantharides.


D. Miscellaneous Poisons: (Associated with botulism; food poisoning; mushroom poisoning; snake venom poisoning).

1. Food Poisoning: Toxic substances in the food; Abnormal hypersensitivity to

normal constituents of food.

2. Poisonous Plants.

3. Poisonous Animals and Their Poisons:

Arachnids; Centipedes; Insects; Caterpillars; Vertebrates.

4. Biological Products.

5. Ground Glass.

F O O D P O I S O N I N G

Food poisoning is a state of ill-health resulting from food which has some abnormal or noxious content.

Food May Cause Disease in the Following Ways:

1. Lack or excess.

2. Unbalance proportion of proper constituents.

3. Absence of certain constituents, including vitamins and specific proteins.

4. Idiosyncracy. The most common reaction occurs in the gastrointestinal tract in the form of nausea and vomiting. The sensitivity may be manifested in the form of rashes.

5. Presence of abnormal constituents:

a. Products of putrefactive bacteria. b. Specific bacteria. c. Parasites. d. Molds. e. Vegetable substances as ergot in rye or solanin in potatoes. f. Chemicals.

6. Food inherently poisonous as fungi, horse raddish, water hemlock.

Bacterial Food Poisoning:

1. Food Poisoning of Non-specific Bacterial Origin:

This is sometimes called ptomaine poisoning and is probably caused by the degradation products of the protein molecules occurring in the decomposition of food when they have reached an advanced stage.

2. Specific Bacterial Food Poisoning:

This is brought about by infection with the salmonella group of microorganisms.

730 LEGAL MEDICINE

Symptoms: a. Vomiting and diarrhea. b. Abdominal pain. c. Prostration. d. Collapse with cold sweating. e. Rigor with pain at the back and limbs. f. Headaches and dizziness.

Post-mortem Examination:

a. Congestion of mucous membrane of the stomach and intestine. b. Petechial hemorrhages of the visceral organs. c. Cloudy swelling of the kidneys. d. Congestion of the liver and spleen. e. Isolation of the specific organism.

Bacteriology:

The members of the salmonella group which may cause food poisoning are:

a. B. Enteritidis e. B. Suipestifer b. B. Paratyphosus A f. B. Psittacosis c. B. Paratyphosus B g. B. Abortus equi d. B. Aertryke

Botulism:

This is a specific infection in which symptoms arises from the ingestion of a very potent exotoxin of anerobic Clostridium botu-linum. Poisoning is usually due to ingestion of food stored and prepared in unsatisfactory conditions and eaten without cooking.

L A W S O N POISONS A N D O T H E R P O I S O N O U S SUBSTANCES IN THE PHILIPPINES

Provisions Relative to Dispensing of Violent Poisons: Sec. 755, Revised Administrative Code:

Every person who dispenses, sells, or delivers any of the following violent poisons, to wit, arsenic, arsenical solutions, phosphorus, corrosive sublimate, cyanide of potassium or other cyanide, atropine, cocaine, morphine, strychnine, or any of their salts, and all other poisonous vegetable alkaloids or any of their salts, hydrocyanic acid, or prussic acid, oil of bitter almonds containing hydrocyanic or prussic acid, oil of mirbane (nitro-benzene), opium and its preparations, except paregoric and such others as contain less than four hundred and fifty milligrams of opium per one hundred cubic centimeters (two grains to the ounce), shall make or cause to be made in a book kept for the purpose of recording the sale of such


poisons an entry stating the date of each sale and the name and address of the purchaser, the name and quantity of the poison sold, and the purpose for which it was claimed to be purchased, before delivering it to the purchaser. He shall not deliver any such poison to any person without satisfying himself that such person is aware of its poisonous character, and that the poison is to be used for a legitimate purpose, and he shall affix to every box, bottle, or other package containing any dangerous or poisonous drug, a label of red paper upon which shall be printed in large black letters the word "poison" and a vignette representing a skull and bones, before delivering it to any person. Books kept for the purpose of recording the sale of poisons shall be open at all times to the inspection of the Board of Pharmaceutical Examiners, and of health officers or officers of the law, and every such book shall be preserved for at least five years after the last entry in it has been made.

Provisions Relative to Dispensing of Less Violent Poisons:


Every person who dispenses, sells or delivers any aconite, belladonna, cantharides, colchicum, conium, cotton root, digitalis, ergot, hellebore, henbane, phytolaca, strophanthus, oil of tansy, veratrum viride, or their pharmaceutical preparations, carbolic acid (Phenol), chloral hydrate, chloroform, creosote, croton oil, mineral acids, oxalic acid, paris green, salts of lead, salts of zinc, tartar emetic, white hellebore, or any drug, chemical, or preparation which according to standard works of medicine or materia medica is liable to be destructive to human adult life in quantities of four grams (sixty grains) or less, without the prescription of a physician, shall label the receptacles containing them as is above provided for violent poisons, but shall not be required to register the same.

Nothing in this section shall be construed as applying to the dispensing of medicines, drugs, or poisons on physicians' prescriptions, but no prescription the prescribe dose of which contains a dangerous quantity of poison shall be filled without first consulting the prescribing physician and verifying the prescription.

Receptacle for Poisonous Drugs: Sec. 757, Revised Administrative Code:

The poisonous drugs specified in the two next preceding sections shall be kept in a cabinet to be provided in every pharmacy carrying such drugs in stock for the retail trade; and the same shall be kept securely locked when not in use.

732 LEGAL MEDICINE

POST-MORTEM FINDINGS IN SOME CHEMICAL POISONING

A. Sulfuric Acid:

1. External Appearance:

a. Putrefaction is frequently delayed.

b. There are cutaneous stains in areas where the corrosive liquid has been spilled. The stains are frequently found in the angles of the mouth and running in a linear fashion from the posterior part of the lips to the chin.

c. The outer layers of the skin are destroyed and the derma is parchmentized, while the deepest layer is reddish-brown in color.

d. The lips may be blackened.

e. The tongue and mucous membrane of the mouth may be softened, corroded and white in color.

2. Internal Appearance:

a. Internal findings are usually confined to the changes due to the local action of sulfuric acid.

b. Cardio-Vascular System:

(1) The aorta may be found with the outer wall blackened and corroded.

(2) The blood in the vessels may be coagulated and hardened. This produces black arborescent cast in the smaller vessels and in their branches and larger cylindrical casts in the vessels of greater caliber.

c. Respiratory System:

(1) The epiglottis may be blackened and shrunkened.

(2) The mucous membrane of the larynx and trachea may be swollen and congested.

(3) Death may be due to asphyxia when acid has been inspired.

(4) The diaphragm may be perforated after the escape of the acid into the peritoneal cavity.

(5) The surface of the lungs and pleura is then tough, leathery and stained brown.

d. Digestive System:

(1) Mucous membrane of the pharynx is gray and may be softened. Patches of brownish color are scattered in the pharynx due to the effusion of dark-colored blood.


(2) The stomach, if not perforated, shows an injected surface and the contents are coffee-ground color.

(3) The mucous membrane of the stomach is brown or black with some thin or perforated areas. If perforated, the edges of the perforation are black and irregular.

(4) The intestine has a dark-brown content. The pylorus may be hardened and constricted. Mucous membrane of the duodenum is usually congested and swollen.

B. Hydrochloric Acid:


a. External staining is absent. b. The angle of the mouth may be whitish, opaque and may be

inflamed.


a. Blood is darkened but not as a rule coagulated by the action of acids.

b. Edema of the glottis.

c. Larynx and trachea are congested and the mucous membrane is converted into whitish-gray opaque layer which can be rubbed off.

d. There may be congestion and edema of the lungs.

e. Mucous membrane of the mouth and pharynx is opaque and grayish-white.

f. Esophagus is dilated with the mucous membrane reddened and inflamed.

g. The liver is pale and fatty.

C. Nitric Acid:

The lesions produced by nitric acid are similar to hydrochloric acid except that the cutaneous stains are distinctly yellow.

D. Caustic Alkalis (Potassium Hydroxide, Sodium Hydroxide):


a. Dirty yellow color stains at the angle of the mouth and on the chin.

b. Swelling of the tissues in contact with the alkali.

c. Surface of the tongue, mouth and lips becomes slightly reddened or dark and eroded.

d. The membrane may be detached exposing the submucous layer which may be chocolate in color or sometimes black.

734 LEGAL MEDICINE


The only changes are those due to the local action of the alkali.

a. Pharynx is lined by softened and hyperemic mucous membrane.

b. Edema may be considerable especially at the opening of the larynx.

c. Esophagus is corroded in its upper part.

d. Peritoneal surface is pale and blood vessels are filled with dark fluid blood.

e. Stomach contents are viscid, turbid fluid.

f. The mucous membrane of the stomach at the region of the cardiac end is brownish-red in color, uneven and hardened.

g. The wall of the stomach is edematous and with a soapy feel.

h. The entire length of the intestine is congested.

i. Larynx and trachea are inflamed and congested.

j . Bronchial tree is congested and contains viscid mucous.

E. Ammonia (Ammonium Hydroxide):


Lips, mouth, pharynx and larynx are inflamed with patchy erosion of the mucous membrane.


The only characteristic changes are those in the respiratory and digestive systems:

a. Digestive System:

(1) The tongue is swelling with the mucous membrane softened and peeled off.

(2) The mucous membrane of the esophagus and the lower portion may be detached and it is intensely inflamed.

(3) The mucous membrane of the stomach may be with dark-colored blood, thinned, or perhaps destroyed at the point of contact with the chemical. Perforation may be present. The whole membrane is edematous and congested, and may show petechial hemorrhages. There may be a strong odor of ammonia.

(4) The duodenum and jejenum may contain blood but are usually unaffected.

b. Respiratory System:

(1) The epiglottis may be very swollen and eroded. There is a considerable edema of the vocal cords.


(2) The laryngeal and tracheal mucosa are swollen.

(3) Trachea and bronchi are lined with a fibrinous membrane which can be easily stripped off leaving a raw surface.

(4) The lungs may be congested and edematous.

(5) Broncho-pneumonia may be present in those cases which survived for a time.

Death may be due to suffocation brought about by the gas or edema of the glottis or pulmonary changes, if the victim does not die immediately.

F. Phenol and its Derivatives (Lysol, Cresol, Carbolic Acid):


a. Brownish and shrunken stains at the angles of the mouth, chin and cheeks.

b. Characteristic odor of phenol is perceptible.


a. The blood is dark and fluid.

b. The lungs are congested and sometimes edematous. If the victim lived for sometime, broncho-pneumonia may be found.

c. There may be edema of the glottis and of the vocal cord.

d. Digestive System:

(1) The tongue is swollen with white fur and the mucous membrane is hardened.

(2) The esophagus is contracted and the mucous membrane is thrown into ridges. It is grayish-white in color and the longitudinal fissures running between the ridges are hyperemic.

(3) The stomach may contain blood-stained mucous with a characteristic smell. The mucosa may be thrown into longitudinal ridges. The muscular and subserous coats are edematous and with small hemorrhagic patches. The peritoneal surface is congested.

(4) The upper portion of the intestine may show similar, changes as that of the stomach.

e. The liver is large, pale, and fatty in those cases which have survived for a length of time.

f. The kidneys are congested and swollen.

g. The urinary bladder contains greenish smoky urine.

h. The meninges and brain are usually congested.

736 LEGAL MEDICINE

G. Acute Arsenic Poisoning:


a. The whole body may have a shrunken appearance.

b. The cutaneous surfaces, especially the hands and feet are cyanotic.

c. Putrefaction of the body is quite delayed.


a. Cardio-Vascular System:

(1) Heart contains coagulated blood. (2) Ecchymosis is frequently observed underneath the peri

cardium.

b. Respiratory System:

(1) The lungs are congested and sometimes edematous.

(2) Subpleural hemorrhages may be present.

c. Digestive System:

(1) Changes in the mouth, pharynx and esophagus are rare.

(2) The mucous membrane of the stomach is swollen and spongy with tenacious mucous adhering. The mucous membrane may be thrown into rugae, often with a dark red color. There may be petechial hemorrhages distributed all over. Crystals of arsenic may be present.

(3) If death is delayed there may be inflammatory changes in the duodenum. The solitary and Peyer's patches are swollen.

d. The liver may show cloudy swelling. If death did not occur within 24 hours, the organ may be enlarged and pale.

e. There may be cloudy swelling of the cortex of the kidneys with numerous small hemorrhages.

H. Chronic Arsenic Poisoning:


a. Bo'dy is emaciated. b. Hair is scarce. c. There is pigmentation of the skin with eczematous eruptions. d. There is a yellowish-brown color of the skin. e. Localized thickening of the epidermis is present.


a. Car dio-Vascular System:

(1) Diffused fatty degeneration of the myocardium. (2) Musculature is flabby, pale and friable. (3) Blood vessels are thick and dark in color.


b. Respiratory System: (1) There may be ulceration of the nasal septum. (2) Bronchitis may be present.


(1) Tongue may be coated. (2) Mucous membrane of the stomach is inflamed with

ulcerative patches. The whole surface is covered with tenacious mucous with blood or blood streaks.

(3) Mucous membrane of the duodenum and upper part of the jejenum, ascending colon and rectum are inflamed.

(4) Peyer's patches are swollen and minute ulcerative areas are common.

d. The liver is enlarged and shows advanced fatty changes.

e. The kidneys are enlarged. On section, the cortex is swollen and pale.

L Mercury (Perchloride and Nitrate Salts):


If the salts (perchloride or nitrate) of mercury has been taken by mouth, it produces corrosion of the epithelium and swelling of the lips.


a. Digestive System:

(1) The mucous membrane of the mouth is softened, whitish and sodden-looking.

(2) The esophageal mucosa is corroded, softened and inflamed in patches.

(3) The muscular coat of the stomach is contracted and the mucous membrane is thrown into folds. The surface is converted into a grayish-white layer. The mucous membrane is reddened and with dark ecchymosis. There are areas of necrosis with white color and those that are found at the cardiac and pyloric end are easily detached.

(4) The small intestine shows severe inflammation. It takes the form of diphtheritic enteritis and this is most prominent at the cecum.

(5) The whole of the large intestine shows severe inflammation. The mucous membrane is thickened and' the contraction of the muscles made it thrown into folds. The summit of the folds is converted into a grayish-white necrotic layer. The rest of the mucosa is deep red, swollen and soft.

738 LEGAL MEDICINE

b. Renal System:

Both kidneys are enlarged. Section shows that the cortex is pale, yellowish, and swollen. The capsule strips easily and leaves a smooth pale surface. Hemorrhagic spots may be seen in the cortex and on the outer surface.

If the victim survived for a time, he will later succumb to renal insufficiency. The pale cortex is streaked with yellow due to fatty changes in the section, owing to the deposit of calcium carbonate and phosphate.

c. When poisoning is due to mercurials administered by injection or absorbed through the skin or mucous membrane, the changes in the stomach are slight although intense congestion may be found.

J. Lead (Chronic poisoning):


a. Emaciation. b. Skin shows icterus. c. Parotid glands are sometimes enlarged. d. Wasting of the muscles of the shoulder, arm and forearm. e. Gouty tophi and arthritis or simple effusion of fluid may be

found in joints.


a. Blood is thin and watery. b. Cardio-Vascular System:

(1) Fibrosis of the myocardium. (2) Interior of both auricles and ventricles is whitish and

opaque in appearance. (3) There may be some degree of atheroma of the aorta and

large blood vessels.


(1) Teeth are discolored and brown. (2) Gums may show bluish line in their edges near the lower

canines and incisors. The gums may be ulcerated and softened.

(3) Stomach shows chronic gastric catarrh. (4) Intestine is inflamed, contracted and thickened. (5) Patches of pigmentation may be present in the mucous

membrane of the large intestine.

d. Renal System:

Kidneys resemble that of arteriosclerosis. They are smaller than their normal size. The surface is granular, the granules


are yellow separated by reddish depressions. The capsule is opaque, thickened and possibly adherent. The cortex is somewhat reduced in size. There is an increase in the pelvic fat.

e. Nervous System:

(1) The meninges of the brain are thickened. (2) The pia-arachnoid is opaque and shows hemorrhagic

spots. (3) Convolutions of the brain are atrophied. (4) Section of the brain shows that the gray matter of the

cortex is narrowed. (5) The blood vessels at the base of the brain show some

thickening and are sometimes rigid.

f. Hematopoietic Organs:

(1) The spleen may be somewhat atrophied and fibrotic. (2) The bone marrow in the shaft of long bones is red owing

to hyperplasia.

K. Phosphorus (Rat-poison, fireworks, match stick):

1. Cardio-Vascular System:

a. Heart is flabby and the musculature is pale, friable and fatty.

b. The blood is dark and fluid.

2. Respiratory System:

a. Blood-stained fluid may be effused into the pleural cavity. b. The lungs are congested. c. There may be a subpleural hemorrhages.

3. Digestive System:

a. The stomach may show swollen grayish-white mucosa. b. The intestine may also show the same changes as that of the

stomach.

4. The liver may be enlarged, soft and doughy. The lobules may be easily seen. There is necrosis of the liver cells and intense fatty changes.

5. There may be small hemorrhages in the omentum.

6. Renal System:

a. The kidneys are enlarged and soft. b. The cortex is swollen, thickened and pale yellowish-gray in

color. c. Hemorrhagic! areas are present.

7. Meninges and brain are congested.

8. The skeletal system may show fatty changes, being pale and brownish.

740 LEGAL MEDICINE

L. Hydrocyanic Acid (Potassium and sodium cyanide):


a. Rigor mortis sets in early and persists longer than usual. b. Skin is bright pink in color. c. Cyanosis of the skin may be present due to asphyxia. d. Hypostasis is distinctly lighter in color than normal. e. Face is pale. f. Eyes are prominent and pupils are dilated. g. Mouth and nostrils may show froth.


a. Characteristic odor is emitted on opening of the abdomen. b. Blood is bright red in color and coagulated. c. Cardio-vascular System:

(1) Right side of the heart is distended with blood. (2) Left ventricle is contracted and empty. (3) Venous system is engorged with blood. (4) Pericardium may show petechial hemorrhages.

d. Respiratory System:

(1) Larynx and trachea contain blood-tinged froth. (2) Lungs are congested and edematous. (3) Odor of bitter almond is perceptible. (4) Subpleural petechial hemorrhages.

e. Digestive System:

(1) Mucous membrane of the pharynx, esophagus and stomach is apparently normal, but may be congested.

(2) Subserous ecchymosis is present. (3) If potassium cyanide is taken, the stomach may be

wrinkled, reddish-brown in color and the blood vessels in the wall are distended.

f. Congestion with edema of the brain.

g. Other organs do not show any gross changes.

A P P E N D I X

BASIC PRINCIPLES OF PHILIPPINE CRIMINAL L A W

CRIMINAL OR PENAL L A W DEFINED: Criminal or Penal Law is defined as that branch or division of law

which defines crimes, treats of their nature and provides for their punishment.

The Philippine criminal law is embodied in the R E V I S E D P E N A L CODE and in the penal provision of other statutes.

The Revised Penal Code took effect on January 1, 1932. (Art . 1) It consists principally of three parts, namely:

(a ) Principles affecting criminal liability (Arts. 1-20)

(b) Provisions on penalties including criminal and civil liability (Arts. 21-113)

(e) Felonies defined under different title (Art. 114-367).

Characteristics of Penal Laws:

(1) It must be general: The penai law must apply to all person within a territory, ir

respective of sex, race, nationality, and other personal circumstances; with certain exceptions.

(2) It must be territorial: As a general rule, penal laws are enforcible within the terri

torial jurisdiction of a state. It is inherent upon a state to promulgate such laws which it thinks best for its self-preservation.

(3) It is prospective: No person can be penalized for a crime which is not punishable

at the time of commission.

APPLICATION OF THE PROVISIONS OF THE REVISED PENAL CODE:

Except as provided in the treaties and laws of preferential application, the provisions of this Code shall be enforced not only within the Philippine Archipelago, including its atmosphere, its interior waters and maritime zone, but also outside its jurisdiction against those who:

1. Should commit an offense while on a Philippine ship or airship.

2. Should forge or counterfeit any coin or currency note of the Philippine Islands or obligations and securities issued by the Government of the Philippine Islands.

3. Should be liable for acts connected with the introduction into this Islands of the obligations and securities mentioned in the preceding number.

4. While being public officers or employees, should commit an offense in the exercise of their functions; or

743

744 LEGAL MEDICINE

5. Should commit any of the crimes against national security and law of nations, defined in Title One of Book Two of this Code. (Art. 2).

Exceptions to the Rule that the Penal Laws are Strictly Territorial:

I. Provisions of treaties and Laws of -preferential application: The Philippines accepted the principles of international law as a

part of the law of the land. The generally accepted principles of International Law must prevail over the existing municipal laws in case of conflict between the two laws.

1. Provision of Treaty: The Philippine-United States Base Agreement:

a. The Philippine consents that the United States shall have the right to exercise jurisdiction over the following offenses: (1) Any offense committed by any person within any base ex

cept: (a) Where the offender and the offended parties are citizens

of the Philippines, and

(b) The offense is against the security of the Philippines.

(2) Any offense committed outside the bases by any member of the armed forces of the United States in which the offended party is also a member of the armed forces of the United States.

(3) Any offense committed outside the base by member of the armed forces of the United States against the security of the United States.

b. The Philippines shall have the right to exercise jurisdiction over all other offenses committed outside the bases by any member of the armed forces of the United States.

2. Operation of International Law (Exterritoriality): The right of exterritoriality is the right to be exempted from

local jurisdiction granted to citizen or subjects of another state by operation of International Law.

Exterritoriality embraced the following immunities and privileges of diplomats and members of the suite: a. Exemption from criminal and civil jurisdiction. b. Immunity of domicile and diplomatic premises from local juris

diction (franchise de l'hotel). The diplomatic envoy and his residence is considered to be an

extension of the territory and person of the country wherein he is a citizen of.

II . Statutory Exceptions:

Article 2 of the Revised Penal Code mentioned specific instances wherein the provision may also be applied.

1. Should commit an offense while on a Philippine ship or airship. This is based on the theory that the vessel or airship of local

registry is an extension of the territory of the Philippines.

APPENDIX 745

If the offense is committed within the Philippine maritime zone on board foreign ships, the following are the theories as to jurisdiction: a. French Rule — If the crime is committed on board a foreign

vessel in Philippine water, it should not be prosecuted in our local court, except when the offense affects the peace, security and safety of the Philippines. This theory emphasizes nationality.

b. English Rule — If a crime is committed on board a foreign vessel in Philippine water, the case is triable in our local court, except when it merely affects internal discipline and management of the vessel.

2. Should forge or counterfeit any coin or currency not of the Philippine Islands or obligations and securities issued by the government of the Philippine Islands.

S. Should be liable for acts connected with the introduction into this Islands of the obligations and securities mentioned in the preceding number.

4. While being public officers or employees, should commit an offense in the exercise of their function; or

5. Should commit any of the crimes against national security and laws of national.

The reason for this is to safeguard the State from acts of treason and espionage based upon the inherent right of a state to self-defense.

DEFINITION OF FELOND2S:

Acts and omissions punishable by law are felonies (delitos). Felonies are committed not only by means of deceit (dolo) but also

by means of fault (culpa). There is deceit when the act is performed with deliberate intent; and

there is fault when the wrongful act results from imprudence, negligence, lack of foresight, or lack of skill. (Art. 3).

Elements of a Felony:

1. There must be an act or omission: By act is meant the positive action on the part of a person

doing a thing which he must not lawfully do, while omission is failure of a person to do a thing which he is legally obliged to do.

2. Such act or omission must be done voluntarily: There must be free and voluntary act or omission on the part

of the person committing the felony. If the act or omission is done due to the compulsion of an irresistible force or due to an impulse of an uncontrollable fear or an equal or greater injury, then the person is exempted from criminal liability.

3. Such act or omission must be punishable by law at the time of the commission:

No felony shall be punishable by any penalty not prescribed by law prior to its commission. (Art. 21). Penal laws shall have

• a retroactive effect in so far as they favor the person guilty of a felony, who is not habitual criminal, although at the time of the

746 LEGAL MEDICINE

publication of such laws a final sentence has been pronounced and the convict is serving; the same.

CRIMINAL INTENT: As a general |rule, intent is necessary in a felony, for an act does not

make a person a criminal unless he possesses a criminal mind.

Requisites of Criminal Intent:

1. There must be freedom of the person committing the felony:

There is no freedom to act in the following instances:

a. Any person who acts under the compulsion of an irresistible force. (No. 5, Art. 12).

b. Any person who acts under the impulse of an uncontrollable fear or an equal or greater injury. (No. 4, Art. 12).

2. There must be intelligence on the part of the person committing the felony:

In the following instances a person is exempted from criminal liability because of the lack of intelligence:

a. An imbecile or an insane, unless the latter has acted during a lucid interval. (No. 1, Art. 12).

b. Persons under nine years of age. c. A person over nine years of age and under fifteen, unless

he has acted with discernment (No. 3, Art. 12).

For crimes defined under the Revised Penal Code, criminal intent is necessary, however in other statutory crimes, the intent is immaterial, provided that the prohibited act is committed.

CRIMINAL LIABILITY:

Criminal liability shall be incurred:

1. By any person committing a felony (delito) although the wrongful act done be different from that which he intended.

2. By any person performing an act which would be an offense against persons or property, were it not for the inherent impossibility of its accomplishment or on account of the employment of inadequate or ineffectual means. (Art. 4) .

This includes the impossible crimes. Although the wrongful act was made with evil intent, it does not produce the desired injury on account of either of the following:

1* Inherent impossibility of accomplishing it.

2. Employment of inadequate or ineffectual means.

There is inherent impossibility of accomplishing the felony, when the very nature of the act, it is impossible to consummate it.

Example:—Stabbing a person with intent to kill who has been long long dead.

Employment of inadequate or ineffectual means implies that the offended performs an act which is not capable of producing the desired effect.

APPENDIX 747

Example: — When a person tries to kill another by putting arsenic in the drinking water when in fact it is table salt.

The provision only refers to acts which would have been an offense against persons or property. It does not refer to other crimes described in the Revised Penal Code.

The penalty imposed in the commission of the impossible crimes depends upon the social danger and the degree of criminality of the offender and shall impose upon him the penalty of arresto mayor or a fine ranging from 200 to 500 pesos (Art . 59).

I. By any person committing a felony (delito) although the wrongful act done be different from that which he intended:

A person is responsible for all the natural and logical consequences of his felonious act even if the wrongful act done is different from that which he intended to commit.

The following requisites must concur before a person can be held responsible for the felony if the wrongful act done is different from that one intended:

1. That a felony was committed.

2. That the wrongful act done to the aggrieved party is a direct and natural consequence of the crime committed by the offender.

Exceptions:

1. When the injury suffered by the offended party is due to some causes or accident foreign to the facts constituting the felony.

Example: — If the offender inflicted slight physical injuries to the offended, and later the offended died of heart failure. The offender cannot be liable for homicide or murder but only for slight physical injuries.

2. When the injury suffered by the offended party is due to his inexcusable negligence or deliberate misconduct.

Example: — If the offended party received slight physical injuries from the offender and later the offended party deliberately contaminated the wounds which later become serious, the offender is only liable for slight physical injuries.

3. When the injury suffered by the offended party is due to the lack of skill, lack of foresight, or gross carelessness or negligence of a third person. Example: — If the offender inflicted less serious physical in

juries to the offended and due to the gross negligence of the attending physician, the offended died, the offender is only liable for less serious physical injuries.

I I . By any person performing an act which would be an offense against persons or property, where it not for the inherent impossibility of its accomplishment or on account of the employment of inadequate or ineffectual means (Par. 2, Art. 4) .

STAGES OF EXECUTION OF A CRIME:

Consummated, as well as those which are frustrated and attempted, are punishable.

748 LEGAL MEDICINE

A felony is consummated when all the elements necessary for its execution and accomplishment are present; and it is frustrated when the offender performs all the acts of execution which would produce a felony as a consequence but which, nevertheless, do not produce it by reason of causes independent of the will of the perpetrator.

There is an attempt when the offender commences the commission of a felony directly by overacts, and does not perform all the acts of execution which should produce the felony by reason of some causes or accident other than his own spontaneous desistance. (Art. 6).

1. Attempted crime:

In attempted felony, the offender never goes beyond the subjective phase of the crime. The following are the requisites:

a. The offender commences directly or by overt acts the execution of the crime.

b. The external acts must have direct connection with the crime. Overt act means the act which followed by another act will commit the felony.

c. The offender fails to perform all the acts of execution by reason or cause other than his spontaneous desistance.

In attempted felony, the offender fails to perform all the acts of execution of the crime due to external interventions or causes. If the offender desisted later because of fear or remorse, there would be no attempted felony and such act is not punishable by law. The reason of the law for exempting him from any criminal liability is to reward him for having been at the verge of a crime, heed to the call of his conscience and return to the path of righteousness. (Guevarra)

Example: The offender with intent to kill tried to aim his gun against another person, but fortunately the gun was grabbed by another.

2. Frustrated Crime: There is frustrated felony when the offender has performed all

the acts of execution which will produce the felony, but it did not produce the crime because of some causes independent of the will of the offender. The subjective phase of the crime is complete but fails to realize the objective phase for reason independent of the will of the offender.

The subjective phase of the crime begins from the moment the offender thought of committing the felony or from the commencement of the overt acts to the last act of the offender to produce the desired effect. The objective phase starts beyond the last act of the offender up to the time the desired effect has been produced.

Requisites: a. The offender has done all the acts of execution which would

produce the felony. b. The desired effect was not produced by reason or causes

independent of the will of the offender.

APPENDIX 749

If the desired felony was not produced because of the voluntary will of the perpetrator, then there is no frustrated crime.

Example: The offender with intent to kill stabbed a person in the abdomen and because of the timely intervention by a surgeon, the offended did not die.

3. Consummated Crime: There is consummated crime when the offender has done all

of the acts of execution necessary for a felony and the desired result as a direct and natural consequence of which was produced. The crime is complete in its subjective and objective phase.

Example: An offender stabbed treacherously another person with intent to kill and as a result of which the victim died. The offender may be charged for consummated murder.

PERSONS CRIMINALLY LIABLE:

1. Principals: The following are considered principals:

a. Those who take a direct part in the execution of the act (Principal by direct participation);

b. Those who directly force or induce others to commit it (Principal by inducement);

c. Those who cooperate in the commission of the offense by another act without which it would not have been accomplished (Principal by cooperation). (Art. 17)

2. Accomplices:

Accomplices are those persons who, not having included in Article 17 (Principals), cooperate in the execution of the offense by previous or simultaneous acts. (Art. 18).

The presence of an accomplice although necessary is not indispensable. The accomplice in order to be criminally liable must have a common criminal purpose with the principal. The accomplice must have the intention to help morally or materially in the commission of the crime.

3. Accessories:

Accessories are those who, having knowledge of the commission of the crime, and without having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners:

a. By profiting themselves or assisting the offenders to profit by the effect of the crime.

b. By concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery.

c. By harboring, concealing, or assisting in the escape of the principal of the crime, provided the accessory acts with abuse of his public functions or whenever the author of the crime is guilty of treason, parricide, murder, or an attempt to take

750 LEGAL MEDICINE

the life of the Chief Executive, or is known to be habitually guilty of some other crimes. (Art. 19).

The penalty prescribed by law for the commission of a felony shall be imposed upon the principals in the commission of the felony.

Whenever the law prescribes a penalty for a felony in general terms, it shall be understood as applicable to the consummated felony. (Art . 46).

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY:

I. Justifying Circumstances:

A person who acted by virtue of a justifying circumstance does not commit a crime in the eye of the law. In as much as no crime is committed then it follows that there is no criminal. The person is exempted from criminal and civil liability.

The following do not incur any criminal liability:

1. Anyone who acts in defense of his person or rights, provided that the following circumstances concur:

First. Unlawful aggression;

Second. Reasonable necessity of the means employed to prevent or repel it;

Third. Lack of sufficient provocation on the part of the person defending himself.

2. Anyone who acts in defense of the person or rights of his spouse, ascendants, descendants, or legitimate, natural or adopted brothers or sisters, or of his relatives by affinity in the same degrees, and those by consanguinity within the fourth civil degree, provided that the first and second requisites prescribed in the next preceding circumstance are present, and the further requisite, in case the provocation was given by the person attacked, that the one making defense had no part therein.

3. Anyone who acts in defense of the person or right of a stranger, provided that the first and second requisites mentioned in the first circumstance of this article are present and that the person defending be not induced by revenge, resentment, or other civil motive.

4. Any person who, in order to avoid an evil or injury, does an act which causes damage to another, provided that the following requisites are present:

First. That the evil sought to be avoided actually exists; Second. That the injury feared be greater than that done to

avoid it;

Third.- That there be no other practical and less harmful means of preventing it.

5. Any person who acts in the fulfillment of a duty or in the lawful exercise of a right or office.

6. Any person who acts in obedience to an order issued by a superior for some lawful purposes. (Art . 11).

APPENDIX 751

II. Exempting Circumstances:

In exempting circumstances, there is a crime committed but there is no criminal on account of the absence of free will and voluntariness to act. The offender although exempted from the criminal liability may be civilly liable for his felonious act.

Circumstances which exempt from Criminal Liability:

1. An imbecile or an insane person, unless the latter has acted during , a lucid interval.

When the imbecile or an insane person has committed an act which the law defines as a felony (delito), the court shall order his confinement in one of the hospitals or asylums established for persons thus afflicted, where he shall not be permitted to leave without first obtaining the permission of the* same court.

2. A person under nine years of age.

3. A person over nine years of age and under fifteen unless he has acted with discernment, in which case, such minor shall be proceeded against in accordance with the provision of article 80 of this Code.

When such minor is adjudged to be criminally irresponsible, the court, in conformity with the provisions of this and the preceding paragraph, shall commit him to the care and custody of his family who shall be charged with his surveillance and education; otherwise, he shall be committed to the care of some institution or person mentioned in said article 80.

4. Any person who, while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it.

5. Any person who acts under the compulsion of an irresistible force.

6. Any person who acts under the impulse of an uncontrollable fear of an equal or greater injury.

7. Any person who fails to perform an act required by law, when prevented by some lawful or insuperable cause. (Art. 12).

III. Mitigating Circumstances:

These are circumstances which lessen the penalty. The penalty may be the minimum within a degree provided there are no aggravating circumstances to off-set them or the penalty will be lowered one or two degrees from that one prescribed by law.

Kinds of Mitigating Circumstances:

1. Privileged mitigating circumstances: This kind of mitigating circumstances cannot be off-set by ag

gravating circumstances. It lowers the penalty one or two degrees. 2. Ordinary mitigating circumstances:

This can be off-set by the aggravating circumstances and lower only the penalty to the minimum period within a degree. (Padilla).

752 LEGAL MEDICINE

Circumstances which Mitigate Criminal Liability:

1. Those mentioned in the preceding chapter, when all the requisites necessary to justify the act or to exempt from criminal liability in the respective cases are not attendant.

2. That the offender is under eighteen years of age or over seventy years. In the case of the minor, he shall be proceeded against in accordance with the provisions of Art. 80.

3. That the offender had no intention to commit so grave a wrong as that committed.

4. That sufficient provocation or threat on the part of the offended party immediately preceded the act.

5. That the act was committed in the immediate vindication of a grave offense to the one committing the felony (delito), his spouse, ascendants, descendants, legitimate, natural or adopted brothers or sisters, or relatives by affinity within the same degrees.

6. That of having acted upon an impulse so powerful as naturally to have produced passion or obfuscation.

7. That the offender had voluntarily surrendered himself to a person in authority or his agents, or that he had voluntarily confessed his guilt before the court prior to the presentation of the evidence for the prosecution.

8. That the offender is deaf and dumb, blind or otherwise suffering some physical defect which thus restricts his means of action, defense, or communication with his fellow beings.

9. Such illness of the offender as would diminish the exercise of the will-power of the offender without however depriving him of consciousness of his acts.

10. And, finally, any other circumstance of a similar nature and analogous to those above mentioned. (Art. 13).

IV. Aggravating Circumstances:

Aggravating circumstances increase the penalty or qualify a crime to a graver one. The basis is the moral perversion of the offender is dangerous to the state and justify longer confinement.

Kinds of Aggravating Circumstances:

1. Generic — Those aggravating circumstances that may be applied to all crimes. Example: recidivism, night time.

2. Specific — Those that may only be applied to a particular crime. Example: Cruelty can only be applied to crime against person.

3. Qualifying — These are aggravating circumstances that change the nature of the crime. Example: Treachery qualifies homicide to murder.

4. Inherent — Those that are considered to be a party of the crime itself. Example: Breaking of the wall in robbery. (Padilla).

Circumstances Which Aggravate Criminal Liability: 1. That advantage be taken by the offender of his public position. 2. That the crime be committed in contempt of or with insult to the

public authorities.

APPENDIX 753

3. That the act he committed with insult or in disregard of the respect due the offended party on account of his rank, age, or Bex or that it be committed in the dwelling of the offended party, if the latter has not given provocation.

4. That the act be committed with abuse of confidence or obvious ungratefulness.

5. That the crime be committed in the palace of the Chief Executive, or in his presence, or where public authorities are engaged in the discharge of their duties, or in place dedicated to religious worship.

6. That the crime be committed in the night time or in an uninhabited place, or by a band, whenever such circumstances may facilitate the commission of the offense.

7. That the crime be committed on the occasion of a conflagration, shipwreck, earthquake, epidemic, or other calamity or misfortune.

8. That the crime be committed with the aid of armed men or persons who insure or afford impunity.

9. That the accused is a recidivist. A recidivist is one who, at the time of his trial for one crime,

shall have been previously convicted final judgment of another crime embraced in the same title of this Code.

10. That the offender has been previously punished for an offense to which the law attaches an equal or greater penalty or for two or more crimes to which it attaches a lighter penalty.

11. That the crime be committed in consideration of a price, reward, or promise.

12. That the crime be committed by means of inundation, fire, poison, explosion, stranding of a vessel or intentional damage, thereto, derailment of a locomotive, or by the use of any other artifice involving great waste and ruin.

13. That the act be committed with evident premeditation.

14. That craft, fraud, or disguise be employed.

15. That advantage be taken of superior strength, or means be employed to weaken the defense.

16. That the act be committed with treachery (alevosia). There is treachery when the offender commits any of the crimes against the person, employing means, methods, or form in the execution thereof which tend directly and specially to insure its execution, without risk to himself arising from the defense which the offended party might make.

17. That means be employed or circumstances brought about which add ignominy to the natural effects of the act.

18. That the crime be committed after an unlawful entry. There is an unlawful entry when the entrance is effected by

a way not intended for the purpose. 19. That as a means to the commission of a crime a wall, roof, floor,

door, or window be broken.

20. That the crime be committed with the aid of persons under fifteen years of age or by means of motor vehicles, airships, or other similar means.

754 LEGAL MEDICINE

21. That the wrong done in the commission of the crime be deliberately augmented by causing other wrong not necessary for its commission (Art. 14, Revised Penal Code).

V. Alternative Circumstances:

Alternative circumstances are those which must be taken into consideration as aggravating or mitigating according to the nature and effects of the crime and the other conditions attending its commission. They are the relationship, intoxication and the degree of instruction and education of the offender.

The alternative circumstance of relationship shall be taken into consideration when the offended party is the spouse, ascendant, descendant, legitimate, natural, or adopted brother or sister, or relative by affinity in the same degrees of the offender.

The intoxication of the offender shall be taken into consideration as a mitigating circumstance when the offender has committed a felony in the state of intoxication, if the same is not habitual or subsequent to the plan to commit said felony; but when the intoxication is habitual or intentional it shall be considered as an aggravating circumstance. (Art. 15).

PENALTIES:

No felony shall be punishable by any penalty not prescribed by law prior to its commission (Art. 21). Penal laws shall have a retroactive effect in so far as they favor the person guilty of a felony, who is not a habitual criminal, as this term is defined in rule 5 of article 62 of this code, although at the time of the publication of such laws of final sentence has been pronounced and the convict is serving the same. (Art. 22). For purposes of this article, a person shall be deemed to be habitual delinquent, if within a period of ten years from the date of his release or last conviction of the crimes of serious or less serious physical injuries, robo, hurto, estafa, or falsification, he is found guilty of any of said crimes a third time or offender. (Rule 5, Art. 62).

Theories Justifying Penalties:

1. As a preventive measure of the State: The state is obliged to punish the criminals to prevent or sup

press the danger to the State and to the public arising from the criminal acts of the offender.

2. As a measure of self-defense: The State has the right to punish the wrong-doer to protect

society from the threat and wrong inflicted by the criminal.

3. To reform the criminal: It is the prime duty of the State to correct or reform the

criminals. 4. For exemplarity:

The wrong-doer is punished to be made as an example to discourage others committing crimes.

APPENDIX 755

5. To do justice: The criminals are punished by the State as a n act of retributive

justice, a vindication of absolute right and moral law violated by the criminal.

Classification of Penalties:

I . Principal Penalties:

1. Capital punishment: death

2. Afflictive penalties: Reclusion perpetua Reclusion temporal Perpetual or temporary absolute disqualification Perpetual or temporary special disqualification Prision mayor

3. Correctional penalties: Prision correccional Arresto mayor Suspension Destierro

4. Light penalties: Arresto menor Public censure

5. Penalties common to the three preceding classes: Fine, and Bond to keep the peace.

II . Accessory Penalties: 1. Perpetual or temporary absolute disqualification 2. Perpetual or temporary special disqualification 3. Suspension from public office, the right to vote and to be voted

for, the profession or calling. 4. Civil interdiction 5. Indemnification 6. Forfeiture or confiscation of instruments and proceeds of the of

fense 7. Payment of costs. (Art. 25)

Duration of Penalties:

1. Reclusion perpetua: Any person sentenced to any of the perpetual penalties shall be

pardoned after undergoing the penalty for thirty years, unless such person by reason of his conduct or some other serious cause shall be considered by the Chief Executive as unworthy of pardon. (Art. 27)

2. Reclusion temporal: The penalty of reclusion temporal shall be from twelve years

and one day to twenty years. (Art. 27)

756 LEGAL MEDICINE

3. Prision mayor and temporary disqualification: The duration of the penalties of prision mayor and temporary

disqualification shall be from six years and one day to twelve yean except when the penalty of disqualification imposed as an accessory penalty, in which case its duration shall be that of the principal penalty. (Art. 27>

4. Prision correccional, suspension and destierro: The duration of the penalties of prision correccional, suspension

and destierro shall be from six months and one day to six years, except when suspension is imposed as an accessory penalty; in which case, its duration shall be that of the principal penalty. (Art. 27)

5. Arresto Mayor: The duration of the penalty of arresto mayor Bhall be from one

month and one day to six months. (Art. 27)

6. Arresto Menor: The duration of the penalty of arresto menor shall be from one

day to thirty days. (Art. 27)

7. Bond to keep the peace: The bond to keep the peace shall be required to cover such period

of time as the court may determine. (Art. 27)

Effects of the Penalties:

1. Perpetual or temporary absolute disqualification: a. The deprivation of the public offices and employments which

the offender may have held, even if conferred by popular election. , b. The deprivation of the right to vote in any election for any

popular elective office or to be elected to such office. c. The disqualification for the offices or public employment and

for the exercise of any of the rights mentioned. In case of temporary disqualification, such disqualification as

is comprised in paragraphs 2 and 3 of this article shall last during the term of the sentence.

d. The loss of all rights to retirement pay or other pension for any office formerly held. (Art. 30)

2. Perpetual or temporary special disqualification: a. The deprivation of the office, employment, profession or calling

affected. b. The disqualification for holding similar offices or employments

either perpetually or during the term of the sentence, according to the extent of such disqualification. (Art. 31)

3. Suspension from any public office, profession or calling, or right of suffrage:

The suspension from public office, profession or calling, and the exercise of suffrage shall disqualify the offender from holding Buch office or exercising such profession or calling or right of suffrage during the term of the sentence.

The person suspended from holding public office shall not hold another having similar functions during the period of his suspension. (Art. 33)

APPENDIX 757

4. Civil Interdiction: Civil interdiction shall deprive the offender during; the time of

his sentence of {he rights of parental authority, or guardianship, either as to the person or property of any ward, of marital authority, of the right to manage his property and of the right to dispose of such property by any act or any conveyance inter vivos. (Art 34)

5. Bond to keep the peace: It shall be the duty of any person sentenced to give bond to

keep the peace, to present two sufficient sureties who shall undertake that such person will not commit the offense sought to be prevented, and that in case such offense be committed they will pay the amount determined by the court in its judgment, or otherwise to deposit such amount in the office of the clerk of the court, to guarantee said undertaking.

The court shall determine, according to its discretion, the period of duration of the bond.

Should the person sentenced fail to give the bond as required he shall be detained for a period which shall in no case exceed six months, if he shall have been prosecuted for a grave or less grave felony, and shall not exceed thirty days for a light felony. (Art. 35)

6. Destierro: Any person sentenced to destierro shall not be permitted to enter

the place or places designated in the sentence, nor within the radius therein specified, which shall not be more than 250 and less than 25 kilometers from the place designated. (Art 87)

EFFECT OF PARDON: A pardon shall not work the restoration of the right to hold public

office, or the right of suffrage, unless such rights be expressly restored by the terms of the pardon.

A pardon shall in no case exempt the culprit from the payment of the civil indemnity imposed upon him by the sentence. (Art. 36)

DIVISION OF THE DEGREE OF PENALTY INTO PERIODS: Each degree of penalty is further subdivided into three periods, namely:

maximum, medium, and minimum periods, except the indivisible penalties, like death. As to what period within a degree shall be imposed upon a convict depends upon the mitigating and aggravating circumstances present which must offset one another.

DEFINITION OF COMPLEX CRIME:

When a single act constitutes two or more grave felonies, or when an offense is a necessary means for committing the other, the penalty for the most serious crime shall be imposed, and the same to be applied in its maximum period (Art. 48)

CONSPIRACY AND PROPOSAL TO COMMIT FELONY: Conspiracy and proposal to commit felony are punishable only in

cases in which the law specially provides a penalty therefor.

758 LEGAL MEDICINE

A consipracy exists when two or more person come to an agreement concerning the commission of a felony and decide to commit it

There is proposal when the person who has decided to commit a felony proposes its execution to some other person or persons. (Art. 8)

EXTINCTIONS OF CRIMINAL LIABILITY:

I . Total Extinction: 1. By the death of the convict, as to the personal penalties; and as to

pecuniary penalties, liability therefore is extinguished only when death of the offender occurs before final judgment.

2- By service of the sentence. 3. By amnesty, which completely extinguishes the penalty and all its

effects. 4. By absolute pardon. 6. By prescription of the crime. 6. By prescription of the offense. 7. By the marriage of the offended woman, as provided in article 344

of this Code. (Art. 89)

II . Partial Extinction: 1. By conditional pardon. 2. By commutation of the sentence. 3. For good conduct' allowances which the culprit may earn while he is

serving his sentence. (Art. 94) 4. Special time allowance for loyalty (Art. 98) 5. Preventive imprisonment.

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760 LEGAL MEDICINE

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762 LEGAL MEDICINE

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Walter, A. Earl, CEREBRAL DEATH, 2nd ed., 1981, Urban & Schwarzenberg, Baltimore & Munich.

Walls, H. J., FORENSIC SCIENCE, 1968, sweet & Maxwell Ltd., London.

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Wells, Kenneth M., & Paul B. Weston, ELEMENTS OF CRIMINAL INVESTIGATION, 1971, Prentice-Hall, Inc., New Jersey.

Wing, Kenneth R., THE LAW & THE PUBLIC'S HEALTH, 1976, The C.V. Mosby Co., St. Louis.

I N D E X

- A -

Abduction, 520 Abortion, 557

causes, 558 clinical types, 557 complications, 565 medical evidences, 567

methods of, 562 penal provisions, 558 practiced by physicians, 560

pros and cons, 572 Abrasion, 260 Abrasion collar, 351 Abuse against chastity, 527 Accessories, 749 Accomplices, 749

Acetone-haemin or Wagenhaar test, 100

Acid phosphatase test, 511

Active aggressive offender, 33

Adipocere formation, 149

Adopted children, 596 Adultery, 521

Age determination, 90

Aircraft injuries and fatalities, 423 Alcohol, 687

absorption, 692

concentration in blood, 694 effects, 693 fate of alcohol in the human body, 701 susceptibility, 700 symptoms, 695 tolerance, 700

Alcoholic beverages, classified 687 Alcoholism, 687

causes, 690 chemical test for intoxication, 708 societal reaction, 710

Algolagnia, 533 Algor mortis, 120 American Law Institute rule, 640 Ammonia poisoning, 734

Ammunition, 336 Amnesia, 630 Amphitanunes, 674 Anamnesis, 634 Anemic Anoxic death, 426 Anilingus, 533 Anoxic death, 426 Anthropometry, 52 Apathy, 632 Apparent death, 116 Arresto mayor, 756 Arresto menor, 756 Arsenic poisoning, 736 Artificial msemination, 601

classification, 601

precaution, 602

status of the child, 603 Asphyxia, 426

classification, 427

death from, 199

mechanism of death, 429 phases, 427

Asphyxiant gas, 457 Associative evidence, 16 Athletic sports, 469 Atmospheric pressure injuries, 421 Atomic bomb explosion, 327

effects to human body, 328 place of, 328

Attempted crime, 748 Autolytic changes after death, 136 Automatism, 212 Automotive crash, 459

factors responsible, 459 purpose of autopsy, 467

Autopsies, 163 hospital autopsies, 163 kinds of, 165 medico-legal autopsies, 164 mistakes, 178 persons authorized to perform, 165 preliminary stages, 170

767

768 LEGAL MEDICINE

procedures, 168 when required, 165

Autosexual, 532 Avulsion, 275

- B -

Ballistic coefficient, 348 Ballistic examination, 383 Barbiturates, 664 Barotrauma, 421 Barrel riflings, 344 Benzidine test, 98 Berberio's test, 510 Bestosexual, 532 Bibliotics, 66 Biological test of Farnum, 512 Birth, 575

causes of still-birth, 576 importance of the study, 575

Black powder, 337 Blistering gas, 457 Blood grouping, 102 Blood identification, 95

biological examination, 100 chemical examination, 98 legal importance of the study, 95 micro-chemical examination, 99 microscopic examination, 99 physical examination, 97 preliminary or gross examination, 97 problems in the examination, 96 spectroscopic examination, 100

Blood poison gas, 458 Botulism, 730 Boxing, 470

Brain death, 112

Braxton-Hick's sign, 544 Breast, classified 487

Breath analysis for alcohol, 706 Bullet, 338

classification, 339 efficiency, 348 embolism, 368 kinetic energy, 347 migration, 368 movement, 349

recovery box, 385 special bullets, 340

Burial requirements, 220 Burking, 450 Burns, 400

age of, 405 ante-mortem, 405 cause of death, 404 chemical burns, 410 differential diagnosis, 407 electrical burns, 412, 418

- C -

Cadaveric lividity, 131 Cadaveric rigidity, 126 Cadaveric spasm, 128 Cafe' coronary, 442 Cannibalism, 534 Carbolic acid poisoning, 735 Carbon dioxide, 452 Carbon monoxide, 451, 458 Cardio-respiratory death, 112 Carnal knowledge, 500 Cartridge, 336 Cauliflower ear, 472 Caustic alkali poisoning, 733 Cephalic index, 82 Cerebral hemorrhage, 306 Champignon d'ocume, 446 Chemical burns, 410 Chemical explosion, 322 Child abuse, 478

causes, 479

classification of abuser, 480 other battered victims, 484 presumptive proof, 481 social reaction, 481

Chlorine gas, 457

Choking, 442 Choking gas, 457 Civil law, 4 Circumstances affecting criminal

liability, 750 aggravating, 752 alternative, 754 exempting, 751

INDEX 769

justifying, 750 mitigating, 751

Circumstantial evidence, 19 Clark's rule, 716 Cobalt thiocynate test, 680 Cocaine, 676

Cocaine "body packer" syndrome, 677 Codicil, 626

Cognition, disorder in 629 Cold, local and systemic effect 394

Cold stiffening, 128 Coma, death from 201 Comparison microscope, 385 Complex crime, 757

Compression, asphyxia by 450

Compression, brain 309

Concubinage, 522 Concussion, brain 309

Concussion, cerebral 259, 309 Condensed reactant explosion, 323

Confession, 36 Consented abduction, 521

Conspiracy, 757

Constitutional tolerance, 700 Consummated crime, 749 Consumption tolerance, 700 Content of thought, disorder 630 Contraceptive methods, 616 Contre-coup injury, 243, 301 Contusion, 255 Contuso-abradded collar, 351 Coprolagnia, 535 Coprolalia, 536 Corpus delicti, 37 Corpus delicti evidence, 16 Corruption of minors, 527 Coup injury, 243, 300 Cowling's rule, 717 Crash asphyxia, 450 Cremation, 228 Crib death, 184 Crime scene investigation, 159 Crime scene methods of search, 161 Crime stages of execution, 747 Criminals, persons criminally liable 749 Criminal intent, 746

requisites, 746 Criminal law, 5, 743

application, 743

characteristics, 743 Criminal liability, 746 Criminal offenders, types 33 Crural index, 83 Culpa, 745 Cunnilingus, 533 Currenslaw, 640

- D -

Dactylography, 56

Dactyloscopy, 56

Dangerous drug, 655

legal classification, 656

pharmacological classification, 659 prescription, 683

Dead body disposal, 218

donation of dead body, 230

executor's right of custody, 219 methods of disposal, 220 requirements, 221 right of possession, 218

scientific purpose and use, 228 Dead on arrival (DOA), 185 Death, 111

autopsy, 163

basis in death determination, 112 body changes following death, 126 causes of death, 182 degree of certainty, 183 duration of, 151 immediate cause, 182 importance of determination, 111 judicial death, 203 kinds of death, 116 mechanism, 182 medico-legal classification, 185 medico-legal investigation, 156 natural cause, 183 pathological classification, 198 penal classification, 191 presumptions, 154 proximate cause, 182

770 LEGAL MEDICINE

special death, 203 under exceptional circumstances, 198 violent cause, 183

Death penalty, other methods 207 Death struggle of muscle, 126 Deception detection, 21

hypnotism, 31 intoxication with alcohol, 30 lie detector, 22 narcoanalysis, 30 observation, 31 truth serum, 29 word association test. 28

Decompression, 422 Defense wound, 244 Defloration, 490 Deformity, legal meaning 250 Deliriants, 680 Delirium, 653 Delivery, 552

signs of, 553 Delusion, 630

types, 630 rule, 637

Dementia, 629 Demi-virginity, 486 Dental identification, 61 Deposition, 15 Depression, 632 Diaphanous test, 119 Diffused reactant explosion, 323 Dillie Koppanyi test, 679 Direct evidence, 19 Distilled liquor, 688

Doctor Hankin's method, 512 Dolo, 745 Donation of organs, 230 Donjuanism, 536 Drowning, 442

cause of death, 443 phases of, 443

post-mortem findings, 445 Drug addiction, 656 Drug defendence, 654, 656 Drug habituation, 656 Drunkard, 687

Dupertuis and Hadden's formulae, 77 Dupuytren's classification, 401 Duquenois-levine test, 679 Duration of interment, 85 Durham rule, 639 Dying declaration, 14 Dyspareunia, 533 Dysthanasia, 208

- E -

Ecbolics, 564 Edema aquosum, 446 Electrical burns, 412

nature, 418 Electrical explosion, 322 Electrical shock, 417 Electricity, 417 Electrocution, death by 204 Embalming, 220 Emmenagogues, 563 Emotion, disorder 632 Emotional offender, 34 Emphysema aquosum, 446 Euthanasia, 207

criminal liability, 209

types, 208 who may perform, 209

Evidence, 11 admissibility, 12 kinds, 19 preservation, 16 weight and sufficiency, 19

Exaltation, 632 Exhibitionism, 536 Exhumation, 233 Explosion, 322

classification, 322 collection of evidence, 326 explosion site identification, 326 types of chemical explosion, 323

Eye changes following death, 124

- F -

Facies, 46 Factitious malingering, 650 Fatal dose, 716

INDEX 771

Feeble-minded, 642 Felonies, 745

elements, 745 Fetishism, 534 Fiber identification, 105 Fictitious malingering, 650 Fingerprints, 56

kinds of impression, 57 floaters, 58

types, 59 Firearm, 332

caliber, 346 classification of small firearms, 334

parts, 343 Firearm action, mechanism 346 Firearm cartridge, 336 Fire investigation, 408 Fireman's cramp, 396 Florence test, 510 Fodere's test, 578 Food poisoning, 729 Foot and hand impression, 46 Forcible abduction, 520 Forensic, 3 Fourchette, 488, 491 Fracture, skull 302 Fracture a la signature, 302 Friction mark, 260 Frostbite, immersion foot 394 Frottage, 535 Funeral, 225

limitations, 226 requirements, 225

- G -

Gagging, 441 Gait, 44 Gait pattern, 44 Ganguli's method, 512 Garroting, 440

Gas, heated and compressed 349 Gas chamber, death by 207 Gerontophilia, 533 Gettler's test, 447 Gonadal agenesis, 538 Graphology, 66

Grave scandal, 529 Gravindex slide test, 546 Guaiacum test, 98 Gunpowder, 337

identification, 378 residue determination, 378

Gun smoke, 350 Gunshot, 369

accidental, 370

destructive effects, 352

effects on clothings, 367

factors affecting entrance, 367

from revolver or automatic, 373

homicidal, 370

suicidal, 369

Gunshot wound, 353

bigger than caliber, 358

contact fire, 354

determination of trajectory, 360

entrance, 353

evidence of entry, 359

exit, 361

far range, 358

loose or near contact fire, 357

medium range, 357

short range, 357

smaller than caliber, 359

Gutter fracture, 303

- H -

Hair identification, 107 Hallucination, 629 Hallucinogens, 666 Handgun, 334

automatic pistol, 335 revolver, 335

Handwriting, 65 factors which determine, 67 forgery, 73 movements, 66

Hanging, asphyxia by 428 cause of death, 431 death by, 206 ligature, 430 post-mortem finding, 433 treatment, 432

772 LEGAL MEDICINE

Harvard report of 1968, 113 Heat collapse, 397 Heat cramps, 396 Heat exhaustion, 397 Heat hyperpyrexia, 397 Heat, local and systemic effect 396 Heat rupture, 407

differential diagnosis, 407 Heat stiffening, 128, 407 Heatstroke, 397 Heat syncope, 397 Hegar's sign, 543 Height index, 82 Helicopter injuries, 424 Hematoma, 258 Hemin crystals test, 100 Hemochromogen crystal test, 99 Hemorrhage, 278 Hess or Haase's rule, 92 High order explosion, 323 Histotoxic anoxic death, 427 Homicide, 196 Homosexuals, 530 Hospitalization of insane, 647 Humphrey's table, 78 Hymen, classified 488, 492

laceration, 492 Hypnotic drugs, 659 Hypnotism, 653 Hypnosis, 31 Hypobarism, 422 Hydrochloric acid poisoning, 733 Hydrogen cyanide, 454, 458 Hydrogen sulfide, 453, 458 Hyperbarism, 421 Hydrostatic test, 578

fallacies, 578 procedures, 578

I -

Icard'stest, 118 Identification, 41

importance, 41

methods, 42

rules in personal identification, 41

Idiot, 641 Illusion, 629 Imbecile, 642 Immersion foot, 394 Impossible crime, 746 Impotency, 620

causes, 621 Impression mark, 260 Impulsion, 633 Incendiarism, 535 Incest, 533 Incestuous seduction, 515 Incised wound, 263 Indecent exposure, 536 Infanticide, 194, 583

how committed, 585 motives for committing, 584 post-mortem findings, 586 types of evidence, 584

Infantosexual, 531 Inhibition, death by 184 Injurious substances, administration 250 Injury, complications 283 Inquest officer, 156 Insanity, 625

Insanity and criminal responsibility, 635 Instantaneous physiologic death, 184 Instantaneous rigor of muscles, 128 Intelligence test, 643 Intentional abortion, 558 Intermembral index, 83 Interrogation, 32

techniques, 35 Intersexuality, 538 Intoxication, cause of death 702

conditions simulating, 697 degree, 696

test, 697 Intoxication with alcohol, 30 Intracranial hemorrhage, 303 Investigation, crime scene 160

composition, 160

equipments, 160 importance, 160

methods, 161 techniques, 35

INDEX 773

Investigator's attitude & conduct, 33 In vitro fertilization, 606

basis of legality, 608 possible situations, 607 procedure of, 606 problems of surrogate mother, 610 status of the child, 612

Irrational offender, 34 Irresistible impulse rule, 639 Irrespirable gas, asphyxia by 451 Ischium-pubis index, 83

- J -

Jacquemin-Chadwick's sign, 542 Judicial death, 203

methods, 204 Jurisprudence, 4

- K -

Kansas statute on death, 113 Kastle-Meyer's test, 98 Kidney punch, 472 Klenefetter syndrome, 538

- L -

Lacerated wound, 272 Laceration, brain 307 Lacrimator, 456 Langer's line, 276 Lascivious acts, 518 Law, 3

Lead poisoning, 738 Legal medicine, 1

history, 7 nature of study, 1 scope, 1

Legal separation, 618 grounds for, 618

Legitimate children, 588 presumption, 588

Legitimation, 595 Length of survival, child 581 Less serious physical injuries, 251 Leucomalachite green test, 98

Lewisite, 457 Lie detector, 22

errors, 26 inadmissibility, 25 phases, 23

Light factor in identification, 55 Lightning, 414

classes of burns, 415

diagnostic point, 415

effect in the body, 415 Line of cleavage, 276 Live-birth, 576

proof of, 577 signs of maturity, 581

Livor mortis, 131 Locus rninoris resistencia, 243 Low order explosion, 323 Luminaria tent, 562 Lung irritant gas, 457 Lysergic acid diethylamide, (LSD) 672 Lysol poisoning, 735

- M -

MacDonald's sign, 543 Maceration, 150 Magnan's symptom, 677 Magnus test, 118 Malingering, 649

causes, 649

types, 650 Malt liquor, 689 Maltreated child, 478 Mandrax, 666 Mania, 631 Mannikinism, 535 Manouvrier's formulae, 78 Manual strangulation, 439

manner of death, 439 methods, 439 post-mortem findings, 439

Marbolization, 137 Marginal abrasion, 351 Marijuana, 667

classification, 668 effects, 669

774 LEGAL MEDICINE

special preparation, 668 Marital dissatisfaction, 615 Marriage, 613

incestuous, 614 non-consummation, 616 requirements, 613

Marquis test, 679 Masochism, 534 Mayor's sign, 545 McNaghten's rule, 638 Mechanical explosion, 322 Medical evidence, 11

autoptic, 12 documentary, 15 experimental, 15 physical, 16 testimonial, 13

Medical jurist, 2 Medicine, 3

Medico-legal autopsy, 164

cases to be autopsied, 167 peculiarities, 167

persons authorized, 165 precautions, 169

procedures, 168 purpose, 164

religious objections, 180 stages, 170

Medico-legal v. hospital autopsies, 166 Medico-legal investigation of death, 156 Medico-legal masquerade, 183 Medullary index, 108 Memory, disorder 629 Mental deficiency, 641

classification, 641

criminal responsibility, 645 method of estimating mental

capacity, 643 Mesmerism, 653 Mercury poisoning, 737 Metal fouling, 356 Metallization, 419 Methaqualone, 665, 656 Methods of search, 161 Micro-crystalline test, 679 Miner's cramp, 396

Missile, 338 Mixoscopia, 536 Molecular or cellular death, 116 Moral defective, 642 Moron, 642 Motorcycle crash, 468 Mugging, 440 Mummification, 148 Munro-merritt, ageing subdural

hematoma 305 Murder, 195 Muscle changes following death, 126 Musculoskeletal injuries, 258 Musketry, death by 206 Mustard gas, 457 Mutilation, 246 Mysophilia, 535

- N -

Narcissism, 535 Narcoanalysis, 30 Narcosynthesis, 30 Nasal index, 82 Natural child, 595 Necrophilia, 533 Negative autopsy, 179 Neglected child, 478 Negligent autopsy, 180 Negligent death, 192 Nerve gas, 458 Nitric acid poisoning, 733 Non-emotional offender, 34 Nuclear explosion, 322

- O -

Observation, 31 Obsession, 631 Occupational marks, 47 Opium, 659

derivatives, 660 symptoms, 660

Opium addiction, evidence 662 post-mortem findings, 663

Orbital index, 82 Organs, average measurement 176

INDEX 775

medical evidence, 721 site of action, 713 treatment, 719

Poroscopy, 56, 60 Portrait parle, 53 Possession, concept of 218 Post-mortem caloricity, 121 Post-mortem contact flattening, 124 Post-mortem lividity, 131 Post-mortem rigidity, 126 Post-mortem suggilation, 131 Powder grains, 350 Powder burns, 350 Precipitin test, 100 Pregnancy, 539

importance of determination, 539 positive signs, 545 presumptive signs, 541

Pregnancy slide test, 545

Presumption of death, 154

Preternatural combustibility, 410

Primer, 337

Prision correccional, 756

Prision mayor, 756

Prisoners, maltreatment 38

Prohibited drugs, 656

Projectile, 338

Propellant, 337

Prostitute, 523

methods of control, 526 type, 524

Prostitution house, 525 Pseudocyesis, 549 Psychological stress evaluator (PSE), 28 Psychomimetic drugs, 666

Pugilistic encephalopathy, 475 Punch drunkenness, 475, 704 Punctured wound, 271 Puramen reaction, 510 Putrefaction, 136

changes in, 140 effect of pressure gases of, 137 modification to, 148

Pygmalionism, 535

donations, 230 Orthothanasia, 208 Ospresiophilia, 534 Overlaying, 441

- P -

Palmar strangulation, 440 Paralyzant gas, 458 Pardon, effect 757 Parricide, 194 Partialism, 535

Passive inadequate offender, 34 Paternity, proof 599 Pathological drunkenness, 704 Patterned wound, 245 Pearson's formulae, 76 Pedestrian-vehicle collision, 464 Pedophilia, 531 Pelvic index, 82 Penalties, 754

classification, 755

effects, 756 Personal identification, 42

ordinary methods, 42

scientific methods, 55 Petechiae, 255 Phenolphthalein test, 98 Phenol poisoning, 735 Philadelphia protocol, 114 Phobia, 632 Phosgene, 457 Phosphorus poisoning, 739 Physical injuries, 246

administration of injurious substances, 250

examination of wounded body, 288 less serious, 251 mutilation, 246 serious, 248 slight, 253 under exceptional circumstances, 198

Plastic bag suffocation, 441 Pluralism, 536 Poison, 712

classification, 725 laws, 730

776 LEGAL MEDICINE

- Q -

Qualified seduction, 515

- R -

Race determination, 82 Radiation, 328

factors responsible for the effects of, 329

rays emitted by radioactive substances, 328

other sources, 330 Rape. 500

elements of the crime, 500 evidence, 501, 505

Rational offender, 34 Reclusion perpetua, 755 Reclusion temporal, 755 Regulated drug, 656 Remedial law, 5 Rigor mortis, 126 Rule of nine 278 Russian roulette, 370

- S -

Sadism, 534 Sado-masochism, 533 Saponification, 149 Satyriasis, 533 Scald, 398 Scar, 51

Schombein's test, 98 Schourup's formula, 122 Scratch, 260

Scientific identification, 55

age, 90

blood, 95

dental, 61 fingerprint, 56 handwriting, 65

hair and fibers, 107

skeleton, 75

sex, 86 Sea disposal, 227 Sedatives, 664 Seduction, 515

Self-inflicted wound, 245 Self-mutilation, ways 245 Seminal fluid and spermatozoa, 509 Semisomnolence, 653 Serious physical injuries, 248 Severe abnormality, 643 Sex crimes, criminological

consideration 498 Sex determination, 86

evidence of, 88 Sexual abnormalities, 528, 530 Sexual act, death due to 496 Sexual orgasm, 496

Sexual physiological consideration, 495 Sexual reversal, 537 Shored gunshot, 361 Shotgun, range of fire 377 Shotgun wound, 374 Signature forgery, 73

Skeletal age determination, 83

Skeleton identification, 75

Sketching, 17

Slash injury, 263

Slight physical injuries, 253 Slug, 338

Smokeless powdei, 338 Smothering, 441 Snake venom, 280 Sodomy, 535

Somatic or clinical death, 116 Somnambulism, 652 Sound and disposing mind, 626 Souvenir bullet, 368 Special death, 203 Spermatozoa, 509

microscopic examination, 512 Spontaneous combustibility, 410 Spurious children, 597 Stab wound, 267 Stagnant anoxic death, 426 Stare decisis, principle 4 Starvation. 213

causes, 214

causes of death, 215 survival, 214 symptoms, 215

INDEX 777

State of suspended animation, 116 Static test, 578 Stature, 48 Statutory rape, 503 Sterility, 622

causes of, 623 Sterilization, methods 623 Sternutator gas, 458 Still-birth, 576

causes, 576 Stimulants, 674 Stoker's cramp, 396 Strain, 259

Strangulation, asphyxia by 436 cause of death, 437 post-mortem findings, 438 treatment, 437

Subarachnoidal hemorrhage, 306 Subdural hemorrhage, 304 Subluxation, 259 Submersion, asphyxia by 442 Subnormality, 643 Succession, 626

Sudden infant death syndrome, 184

Sudden unexplained nocturnal death, 185 Suffocation, asphyxia by 441 Suicide, 193, 211

evidence, 212 methods employed, 212 psychological classification, 211

Suicide automotive crash, 463 Sulfur dioxide, 455 Sulfuric acid poisoning, 732 Superfecundation, 549 Superfoetation, 549 Survivorship, presumption of 155 Suspect, 33 Suture obliteration, 85 Syncope, death from 199

- T -

Tache noir de la sclerotique, 125 Takayama test, 99 Tandem bullet, 368 Tardieu spot, 433

Tattoo marks, 49 Tattooing, gunpowder 350 Tear gas, 456 Thalidomide, 673 Thermal burns, 400 Thermal injuries, 394 Thermic fever, 397 Throttling, 439 Tokyo declaration, 38 Topinard and Rollet formula, 78 Tracing evidence, 16 Transexualism, 537 Transvestism, 537 Trench foot, 394 Trend of thought, disorder 631 Trigger, 343

classification, 343 Trigger pressure, 344 Troilism, 536 Truth serum, 29 Tumultuous affray, 197, 254 Turner's syndrome, 538 Typewriter identification, 74

- U -

Unintentional abortion, 559 Unnatural sexual offenses, 528 Uranism, 535 Urolagnia, 534

- V -

Vaginal canal, 487, 491 Vampirism, 535 Van deen's test, 98 Vehicular crash evidence, 466 Vehicular run over injury, 465 Vehicular turn-turtle impact, 462 Vesicant, 457 Violent death, 190 Virginity, 485

determination of, 486 kinds of, 485

Virgo intacta, 486 Vital reaction, 241

778 LEGAL MEDICINE

Volition or conation, disorder 633 Voyeurism, 536

- W -

War gases, 455 White slave trade, 527 Wild beast rule, 637 Will, 626 Wine, 687 Winslow's test, 120 Witness, 33

ordinary, 13 expert, 14

Word association test, 28 Wound, 240

ante- or post-mortem, 290

cause of, 282 classification, 242

deep wound, 243

effect of medical and surgical

intervention, 295

extrinsic evidence, 297

fatal effect, 282

gaping,of, 274

healing of, 285

investigation of, 288 legal classification, 246 length of survival, 293 medical classification, 254 penetrating wound, 243 perforating wound, 243 physics of, 240 possible instrument used, 294 power to perform volitional act, 296 regional injuries, 298 severity, 278 superficial wound, 243 which cause death, 294 which was inflicted first, 295

Wrestling, 476

- X -

- Y -

Young'srule, 716

- Z -

Zoophilia, 531

Zwikker's test, 679

LEGAL MEDICINE

PEDRO P. SOUS, M.D., Ll.B., D. Crim. Professorial lecturer in Legal Medicine and Medical Jurisprudence, University of the Philippines, Far Eastern University, University of the East, Fatima College of Medicine. Medico-Legal Consultant, Makati Medical Center, Manila Medical Center, U.E.-R.M. Memorial Hospital, Manila Central University Hospital. Retired Deputy Director For Technical Services, National Bureau of Investigation.

PRINIEU BY

R. P. GARCIA Publishing Co., 903 Quezon Avenue, Quezon City

Copyright 1987

By

PEDRO P. SOUS

All rights reserved

P R E F A C E

The professions of Medicine and Law, together with Theology are considered the most ancient and most learned of professions as they have commanded respect since the dawn of history. Both Medicine and Law are dedicated to the service of humanity; Medicine, which its goal is to preserve lives and maintain the health of the people while Law has as its goal to promote peace and order and give justice to one whom justice is due. Both professions are involved in the pursuance of truth. A medical practitioner is trained to diagnose the true ailment the patient is suffering so as to institute the appropriate treatment, while a lawyer is concerned with the true nature of the law and the basis for its promulgation in consonance with the demands of society. Practitioners of both professions have to respect the right of their clients or patients. In so far as the information gathered by the physician from his patient is concerned, it must be held in confidence by the former. In the same manner the lawyer cannot disclose information which he gathered from his client.

However, there are appreciable divergencies between Law and Medicine, the main purpose of Law is to maintain peace and order, respect human rights and promote equality, while that of Medicine is to save the lives and preserve the health of the people. In the doctor-patient relationship, the physician has the right to diagnose and treat patients with limited interference from outside influences, while in the lawyer-client relationship, external interference is inevitable. In defending a client-complainant, the lawyer is confronted by the defendant, cross-party complainant or a third party defendant. In the area of investigation or research; in Medicine, substantial correlation between a scientific fact and a specific social factor is considered sufficient, while in Law, there must be preponderance or absolute correlation between a crime and its effects.

There is an aphorism which states that "people follow Medicine and Law follows people". The stride of Law has a slower pace than that of Medicine. Because of the advancement of Medicine, crimes which would have been consumated in the past, can now become frustrated. In criminal acts which would formerly have resulted in deaths, the victims may, with the application of modern medical management procedures, be able to live. Physical injuries can now be classified of the lesser serious type on account of modern medicines

iii

iv LEGAL MEDICINE like antibiotics and other potent bactericidal drugs. Injuries which have produced permanent deformity as a consequence, no longer do so because of plastic surgery. The moment of death which was considered an uncertain future event can now be predetermined if a patient is hooked to a mechanical life-saving apparatus.

It is essential that the professions of Medicine and Law complement each other to be able to serve the best interest of the people. A connecting link must be built to bring them closer. This indeed is the primordial objective of Legal Medicine. Legal Medicine is the proper venue or forum which will both harmonize and serve the purposes of the two disciplines. There is an increasing need for scientific medical facts in the field of Law and the administration of justice. Substantive and procedural laws must also be made to conform with established medical facts.

It has never been the intention of the author to include all aspects of Medicine which has to do with the legal issues. The subject of Legal Medicine is quite pervasive and encompassing that a comprehensive treatment is not possible considering the time allocated to the subject in the undergraduate courses. What are included herein are some of its basic principles. Details of specific subject matters may be studied in textbooks of the different specialties if Medicine.

TABLE OF CONTENTS

CHAPTER Page INTRODUCTION

I. GENERAL CONSIDERATION 1

Scope and Nature of Legal Medicine 1 History 7

V Medical Evidence 11 Methods of Preservation 17 Weight and Sufficiency of Evidence 19

II. DECEPTION DETECTION 21 Polygraph 22 Word Association Test 28 Psychologic Stress Evaluator 28 Truth Serum 29 Narcoanalysis or Narcosynthesis 30 Intoxication with Alcohol 30 Observation 31 Scientific Interrogation 33 Admissibility of Evidence through Interrogation 34 Confession 36 Tokyo Declaration 38

Identification of Persons 42 Anthropometry 52 Portrait Parle S3 Extrinsic Factors in Identification 54 Light Factor in Identification 55 'Fingerprinting 56 Dental Identification 61 Handwriting 65 Identification of Skeleton 75 Determination of Sex 86 Determination of Age 90 Identification of Blood and Blood Stains 95 Identification of Hair and Fibers 105

IDENTIFICATION HI. MEDICO-LEGAL ASPECTS OF IDENTIFICATION 41

v

TABLE OF CONTENTS

111 Types of Death 112 Kinds of Death 116 Signs of Death 117

^Changes in the Body following Death 126 Changes in the Muscles 126 Changes in the Blood 130 Autolytic or Autodigestive 136 Putrefaction 136 Special Modification to Putrefaction 148 Duration of Death 151 Presumption of Death 154 Presumption of Survivorship 155

V. INVESTIGATION OF DEATH 156 Inquest Officer 156 Crime Scene Investigation 160 Autopsies 163

VI. CAUSES OF DEATH 182 Immediate or Primary Cause of Death 182 Proximate or Secondary Cause of Death 182 Mechanism of Death 182 Manner of Death 183 Instantaneous Physiologic Death 184 Medico-legal Classification of Death 185 Penal Classification of Death 191 Pathological Classification of Death 198

Methods of Disposal of Dead Body 220 Embalming 220 Burial or Inhumation 220 Disposal into the Sea 227 Cremation 228 Use of Dead Body for Scientific Purposes 228 Donation of Parts of the Human Body 230

Exhumation 233

VII. SPECIAL DEATHS 203 Judicial Death 203 Euthanasia 207 Death by Starvation 213

VID. DISPOSAL OF DEAD BODIES 218

TABLE OF CONTENTS

PHYSICAL INJURIES LX^MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

Physical Injuries brought about by Physical Violence 240 ^Classification of Wounds 242 . Legal Classification of Physical Injuries 246

< Mutilation 246 Serious Physical Injuries 248 Administering Injurious Substances or Beverages 2S0 Less Serious Physical Injuries 251 Slight Physical Injuries or Maltreatment 253

^Medical Classification of Wounds 254 Factors Affecting the Severity of Wounds 278 Fatality of Wound 282 Complication of Wound 283 Healing of Wounds 285

x. INVESTIGATION OF WOUNDS Outline of Investigation of Physical Injuries 288 Determination Whether the Wounds were Inflicted

During Life or After Death 290 Length of Survival of the Victim 293 Possible Instruments Used by Assailant 294 Which Injuries Sustained Caused Death 294 Which of the Wounds was Inflicted First 295 Effect of Medical and Surgical Intervention 295 Volition Power of the Victim 296 Relative Position of the Victim & Assailant 297 Extrinsic Evidences in Wounds 297

XI. PHYSICAL INJURIES IN DIFFERENT PARTS OF THE BODY

Head and Neck Injuries 299 Injuries in the Chest 314 Abdominal Injuries 317 Pelvic Injuries 320 Extremities 321

DEA TH OR PHYSICAL INJURIES XII. DEATH OR PHYSICAL INJURIES CAUSED

BY EXPLOSION Mechanical Explosion 322 Electrical Explosion 322 Chemical Explosion 322 Identification of the Site of Explosion

and Collection of Evidences 326

viii TABLE OF CONTENTS

Atomic Bomb Explosion 327 Other Sources of Radiation 330

XIII. GUNSHOT AND SHRAPNELS 332 Classification of Small Firearms 334 Cartridges or Ammunition 336

"'Firearm 343 Other Parts of Firearm 343

Mechanism of Firearm Action 346 Things Coming Out of the Gun Muzzle after the Fire 347

Bullet Kinetic Energy 347 Bullet Efficiency 348 Bullet Coefficient 348 Flame 349 Heated, Compressed and Expanded Gas 349

Factors Responsible for the Injurious Effects of Missile 351 /Gunshot Wound of Entrance 353 Êxit (Outshoot) Wound 361

Effects of Clothings in Gunshot 367 Special Consideration on Bullets 368

/Gunshot Wound - Suicidal, Homicidal or Accidental 369 Determination How Long a Firearm Has Been Fired 372 Determining Whether the Firearm is an Automatic

Pistol or a Revolver 373 Shotgun Wounds 374

" Determination of the Presence of Gunpowder and Primer Components 378

Firearm Identification 382 Gunshot Wounds in Different Parts of the Body 389

XTV. THERMAL INJURIES OR DEATHS 394 Death or Injury from Cold 394

Local Effect 394 Systemic Effect 395

Death or Injury from Heat 396 General or Systemic Effect 396 Local Effects of Heat 398

XV. DEATH OR PHYSICAL INJURIES BY LIGHTNING

rhor Physical Injury by lightning 414 Elements of lightning that Produce Injury 414 Points to be Considered in Making Diagnosis 415 th or Physical Injury from Electricity 417 Factors which Influence the Effect of Electrical Shock 417

Mechanism of Death 418

AND ELECTRICITY 414

TABLE OF CONTENTS ix

XVI.

XVII.

XVIII.

XIX.

XX.

XXI.

DEATH OR PHYSICAL INJURIES DUE TO CHANGE OF ATMOSPHERIC PRESSURE (BAROTRAUMA) 4 2 1

Effect of Increase of Atmospheric Pressure 421 Effect of Decrease of Atmospheric Pressure 421 Aircraft Injuries and Fatalities 423 Helicopter Injury 424

DEATH BY ASPHYXIA 426 ^Pypes of Asphyxial Death 426

Asphyxia by Hanging 428 Asphyxia by Strangulation 436 Asphyxia by Suffocation 441 Asphyxia by Submersion or Drowning 442 Asphyxia by Breathing Irrespirable Gases 451 War Gases 455

DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE CRASH OR ACCIDENT 459

Automotive Crash 459 Pedestrian-Vehicle Collision 464 Motorcycle Crash 468


Some Aspects of Sports Development 469 Boxing 470 Wrestling 476

CHILD ABUSE OR NEGLECTED CHILD 478 Duties of Parents 478 Rights of Parents 479 Classification of Child Abuser 480 Social Reaction to Child Abuse and Neglect 481 Other Battered Victims 484

Rape 500 Examination for Seminal Fluid and Spermatozoa 509 Other Crimes Against Chastity 515

.Seduction 515 A6ts of Lasciviousness 518

X TABLE OF CONTENTS

Adduction 520 Adultery and Concubinage 521 Prostitution 523 Abuse Against Chastity 527

Unnatural Sexual Offenses and Sexual Abnormalities 528

PREGNANCY AND DELIVER Y XXII. PREGNANCY 539

Legal Importance of the Study 539 Medical Evidences of Pregnancy 541

Signs and Symptoms of Pregnancy 541 Laboratory Tests 545 Signs of Pregnancy in the Dead 547 Duration of Pregnancy 548 Proofs of Previous Pregnancy 549

XXIII. DELIVERY 552 Methods of Delivery 552 Signs of Recent Delivery 553 Signs of Remote Delivery in the Living 555 Post-mortem Finding in a Woman who Died Recently After Delivery 555

^ ABORTION, BIRTH AND INFANTICIDE

XXIV. ABORTION 557 /Clinical Types 557

Causes of Abortion 558 ^ Kinds of Abortion 561

How Abortion is Induced or Procured 562 Medical Evidences 567 Therapeutic Abortion 569 Religious Consideration 574

XXV. BIRTH 575 Legal Importance of the Study 575 Still-Birth 576 Live-Birth 576

Proofs of Live-Birth 577 Hydrostatic Test 578 Signs of Maturity of the Child 581

XXVI. INFANTICIDE 583 Motives for Committing Infanticide 584 Criminological Characteristics 584 Type of Evidences in Infanticide 584 Post-Mortem Findings 586

TABLE OF CONTENTS xi

PATERNITY AND FILIATION XXVH. CONVENTIONAL METHOD OF PROCREATION 587

Kinds of Children 587 Legitimate Children 588 Illegitimate Children 597

Evidences of Paternity and Filiation 599 Medical Evidences 599 Non-Medical Evidences 600

XXVIII. NON-CONVENTIONAL METHOD OF PROCREATION 601 Artificial Insemination 601 In Vitro Fertilization 606

Other Non-Conventional Methods of Procreation 612

MARITAL RELATION XXLX. MARITAL UNION AND DISSOLUTION 613

Requisites of a Valid Marriage 613 Marital Relation 614 Annulment of Marriage 617 Legal Separation 618

XXX. IMPOTENCY AND STERILITY 620

Impotency 620 Legal Classification 620 Causes of Impotency 621

Sterility 622 Causes of Sterility 622 Methods of Sterilization 623

DISTURBANCE OF MENTALITY XXXI. INSANITY AND MENTAL DEFICIENCY 625

Legal Importance 625 Some Manifestations of Mental Disorders 629 Insanity and Criminal Responsibility 635 Mental Deficiency 641

Classical Classification 641 Methods of Estimating Mental Capacity 643 Ways of Hospitalizing an Insane Person 647

Malingering 649 Causes of Malingering 649 Types of Malingerer 650 Ways of Determining Malingering 651

Other Conditions Manifestating or Simulating Disturbance of Mentality 652

xii

XXXIII.

XXXTV.

TABLE OF CONTENTS

TOXICOLOGY POISONING 712

Definition 712 Site of Action of Poisons 713 Signs and Symptoms That May Lead One to Suspect Poisoning 717

Differential Diagnosis of Poisoning 718 Treatment of Patient Suffering from Acute Poisoning 719 Medical Evidences 721 Classification of Poisons 725 Food Poisoning 729 Laws on Poisons and Other Poisonous Substances in the Philippines 730

Post-mortem Findings in Some Chemical Poisoning 732

DRUG DEPENDENCE AND DANGEROUS DRUG ACT 654 Biosocial Factors Responsible for the Emergence of Drug Problems 654

Dangerous Drug Act 655 Prohibited 656 Regulated 656

Hypnotic Drugs 659 Sedatives 664 Hallucinogens or Psychomimetic Drugs 666 Stimulants 674 Deliriants 680 Prescription of Dangerous Drugs 683

ALCOHOLISM 687 Classification of Commercially Available Alcoholic Beverages 687

Absorption and Distribution of Alcohol 692 Effects of Alcohol 693 Degree of Intoxication 696 Physical Tests to Determine Drunkenness 697 Factors Responsible for the Tolerance and Susceptibility to Alcohol 700

Causes of Death in Alcoholics 702 Chemical Test for Intoxication Admissible in Evidence 708

Methods Used in Alcohol 708 Societal Reaction to the Problem of Alcoholism 710

XXXII.

TABLE OF CONTENTS xiii

APPENDIX - Basic Principles of Philippine Criminal Law 743

REFERENCES 759

INDEX 767

Documents

Legal Medicine_OCR by Pedro Sous