Legal Medicine.

• is a branch of medicine that deals with application of medical knowledge for the purpose of
law and administration of justice.

Forensic Medicine.
• It is a medicine applied in the solution of various problems in courts and legal proceedings.

Medical Jurisprudence.
• is that part of the law which is concerned with regulations governing the professional practice
of the Doctor of Medicine. The sights, duties and obligations of the medical practitioner to his
patient.

Difference Between Forensic Medicine and Medical Jurisprudence

Forensic Medicine Medical Jurisprudence

Origin: • Originate from the • Emanates from the acts

development of medical of congress, executive
science orders, usages
Nature: • Branch of Medicine • Branch of Law
Characteristics: • Deals with the medical • Deals with the policies,
knowledge that applied to rules and regulations,
law and administration of ethics that are applied to
justice the practice of medicine
Principle to follow • Coordination • Subordination

Technical Definitions
1. Law
• is a Rule of Conduct, just and obligatory laid by legitimate powers for common observance
and benefit.

2. Forensic
• It devotes anything belonging to the court of law or used in court of legal proceedings or
something fitted for legal or public argumentation.

3. Jurisprudence
• is a pratica1 science which investigates the nature, origin, development and functions of
law.

4. Principle of Stare Decisis

• A principle that when the court has once laid down a principle of law 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

5. Criminalistics
• application of medical and other basic sciences in crime detection and investigation.
• It includes collection, identification and preservation of evidence.
 History of Legal Medicine
1858
• First medical textbook printed including pertinent instruction related to medico-legal practice
and included in pre curriculum of College of Medicine University of Santo Tomas.
1895
• Medico-legal laboratory was established in the city of Manila.
1908
• Legal Medicine was thought in all medical schools in the Philippines.
1919
• The Department of Legal’ Medicine and ethics of the University of the Philippines was created
under Dr. Sixto delos Angeles as the chief.
1945
• After the liberation of Manila, Criminal Investigation Laboratory Division was created with Dr.
Mariano Lara a chief Medico-legal officer.
Paulus Zacchias
• Father of legal medicine as well as father of psychiatry.
Bologna, Italy
• First medical –legal autopsy was done.
1302
• Bartolomeo De Varignana- conducted the first medico-legal autopsy in Italy
1602-Fortunato Fedele
• an Italian physician who published the first book in forensic medicine

Persons Authorized to Perform Autopsies

1. Medico-legal officers of law enforcement agencies like the NBI and PNP.
2. Medical staff of accredited hospitals
3. Health officers in remote or rural areas.
Other Names of Autopsy:
1. Post –mortem examination
2. Necropsy particularly as to the non-human body to prove the fact in issue.
3. Autopsy
Objectives of Autopsy
1. To find out the time of death
2. To find out the cause of death
3. To find out the manner of death whether accidental, suicidal, homicidal.
4. To established the identity of the body
5. To new born infants to determine the live birth or viability
 Medical Evidence
Evidence
• is a means, sanctioned by rules of court, of ascertaining in the judicial proceedings the truth
respecting the matter of fact. (Rules of court, Rule 128 section 1)
Medical evidence
• if the means employed to prove a fact is medical in nature
Medical Ethics
• Deals with the moral principles which should guide members of the medical profession in their
dealings with each other, their patients, and the state.

Type of Medical Evidence:

1. Real, autoptic or object evidence
❖ It is an evidence that made known or addressed to the senses of the court. Example. Human
Skeletal remains may be allowed inside the court room to show presence of Ante Mortem
fractures.

2. Testimonial Evidence
❖ form of evidence taken orally or in writing the answers to questions propounded by the counsel
and presiding officer of the court. A medical witness can only testify on matters derived by his
own perception.

RIGHT OF THE PATIENT TO CONFIDENTIALITY AND PRIVACY

Nothing that the Px told you can be repeated to any other person. You keep that in confidence.
You cannot even tell the parents if the Px is of legal age; neither to his friends nor your fellow doctors.
That is why when a doctor sued asking for access to information in connection with a research, the
court did not allow him. Blanket Authority? The court said yes, you may use the information but you
cannot reveal the identity of the Px. That is why in CPC's, you would notice that only the initials and the
sex, but never the name are used because that would be a violation of the Px's right.

RIGHTS OF PHYSICIANS
❖ Right to choose patients
❖ Right to limit his medical practice
❖ Right to avail of hospital services
❖ Right to determine the appropriate management procedure
❖ Right of way in a call for emergency
❖ Right of exemption of instruments from execution
❖ Right to hold certain public or private offices
❖ Right to perform certain services
❖ Right of membership in medical societies of
❖ Right to compensation
RIGHTS OF PATIENTS
❖ Right to give consent
❖ Right to religious belief
❖ Right of privacy
❖ Right of disclosure of information
❖ Right of confidential information
❖ Right to choose his physician
❖ Right to treatment
❖ Right to refuse necessary treatment

MEDICO-LEGAL DIVISION
Functions

1. Perform autopsy to determine the cause, manner, mechanism and time of death.
2. Perform examination of human skeletal remains to determine the sex, age, race, and body built
in order to establish the identity and to determine the cause of death.
3. Conduct exhumation of human remains.
4. Perform physical examination on victims of physical injuries.
5. Perform genital and extra-genital examinations on victims of sexual abuse.
6. Perform physical examination on suspects prior to detention or release.
7. Perform forensic odontology examinations.
8. Perform hispathological examination.
9. Perform serological and microbiological examination.
10. To conduct DNA Analysis and paternity determination.
11. Psychiatric evaluation.

Capabilities
1. AUTOPSY - to determine the cause, mechanism and manner of death.
2. EXHAUMATION - to determine/verify the exact cause of death.

THE MEDICAL WITNESS AND THE COURT

❖ Physician as an ordinary witness
❖ Privileged communication between the physician and patient
❖ Dying declaration
❖ Probative value of standard medical textbooks
❖ Physician as an expert witness
❖ Attendance of a medical witness in court
❖ Preparation for trial
❖ Order of trial
❖ Stages in the examination of a medical witness
❖ Advices to a medical courtroom witness

Hearsay information's
• Are as a rule not admissible in court. Hearsay evidences are not knowledge of the witness but
from mere repetition of what he has heard. A witness can testify only to those facts which he
knows of his own knowledge.
• Exception to the non-admissibility of hearsay evidence is Dying Declaration. Physicians are
frequent recipients of the dying declarations in clinic and hospitals.
Dying Declaration
• is a testimony that would normally barred as a hearsay but may nonetheless be admitted as
evidence in certain kinds of cases because it constituted the last words of a person

Nemo Morituros Praesumitur Mentiri

• a dying person is not Presumed to lie

To be admissible the following factors should be considered:

1. That the declarant was conscious about his impending death.
2. That the declarant was in full possession of his mental faculties.
3. That the declarant must be with regards to his impending death.
Note: A dying declaration cannot be used in civil action and is not admissible if the patient
recovers.

Medical legal officer

• ( Medical Examiner) a physician who determine the cause of injury / death/ disease by
examining the patient/ cadaver and testify in court to aid in the administration of justice.

3. Experimental evidence
• a medical witness may be permitted to conduct experiment on laboratory animals to prove his
allegations on certain position he had previously stated in full view of the court.

4. Documentary Evidence
• a written evidence presented to the court by the expert witness about the subject matter in
dispute.
• medical Documentary Evidence may be in the form of:
• Physical exam report, autopsy report, exhumation report, death cert. birth cert.

5. Physical Evidence
• These are articles and materials which are necessary in crime investigation and detection,
this will aid in establishing the identities of the criminal and the circumstances surrounding
the commission of the crime.

The following are types of physical evidence necessary for the conviction of the perpetrators.
A. Corpus Delicti Evidence
• It means the body of the crime or actual commission of the crime charged. Examples.
• Body of the victim of murder, blood stained knife.

B. Associate evidence
• These are evidences which links the suspect to the commission of the crime. Examples.
• Weapons used, finger and foot prints, wearing apparent.
 C. Training Evidence
• These are physical evidence which may help in locating the whereabouts of the
perpetrators of the crime. Examples.
• Ship manifest, airlines manifest

Differences between male and female pelvis:

MALE PELVIS:
❖ heavier in construction
❖ pubic arch-narrow and less round
❖ diameter of true pelvis is less
❖ greater sciatic notch is narrow
❖ body of the pubis is narrow
❖ obturator foremen is egg shape
❖ sacrum is short and wide

FEMALE PELVIS:
❖ lighter in construction
❖ pubic arch-wider and round
❖ diameter of true pelvis is greater
❖ greater sciatic notch is wider
❖ body of pubis is wider
❖ obturator foramen-triangular in shape
❖ sacrum is short and wide

Skull (Cranium and Mandible)

Male Skulls
❖ Generally larger than female
❖ Larger brow ridges, with sloping, less-rounded forehead
❖ Greater definition of muscle attachment areas on the back of the head
❖ Larger projections behind the ears (mastoid processes)
❖ Square chin with a more vertical (acute) angle of the jaw
Female Skulls
❖ Smoother bone surface where muscles attach
❖ Less pronounced brow ridges, with more vertical forehead
❖ Sharp upper margins of the eye orbits
❖ Smaller projections behind the ears (mastoid processes)
❖ Chin more pointed, with a larger obtuse angle of the jaw.

DEATHS FROM ASPHYXIA

ASPHYXIA
• is a condition wherein there is interference in the process of respiration resulting to impairment
of normal exchange of respiratory gases. Whereby the supply of oxygen to the blood and
tissues has been reduced below the normal level.
 Stages of Asphyxia Death
1. Dyspneic Stage
• due to lack of oxygen and retention of carbon dioxide, breathing becomes rapid and
deep. Blood pressure is elevated the pulse rate increased.

2. Convulsive Stage
• retention of carbon dioxide stimulates the central nervous system. Cyanosis becomes
more marked. Eyes become starring and pupils dilated.

3. Apneic Stage
• there is paralysis of the respiratory center. The breathing becomes shallow, slow and
gasping. The victim dies of heart failure.

Classifications of Asphyxia
I. Asphyxia by Hanging
• Is a form of violent death wherein the body is suspended by a ligature encircled around
the neck. Pressure by the ligature is present in front or in the side of the neck causing
the air passages to constrict and compression of the carotid arteries reduces the blood
supply to the brain causing cerebral anoxia.
Evidence to Support Homicidal Hanging
1. Signs of struggle in the clothing and surrounding.
2. Presence of bodily injuries on the victim.
3. Presence of defense wounds on the body of the victim.

Evidence to Support Suicidal Hanging

1. No signs of struggle.
2. History of previous ineffective suicidal attempt.
3. Presence of suicidal notes.
4. History of reverses in life, loss of loved ones, failure in jobs and love

II. Asphyxia by Strangulation

• is produced by compression of his neck by trying to ligature around the neck and the
two ends pulled in the opposite direction in such a manner to tighten the ligature.

Causes of Death in Ligature Strangulation

1. Asphyxia due to occlusion of trachea.
2. Cerebral anoxia due to compression of cerebral arteries.
3. Inhibition of his respiratory center due to pressure on vagus and sympathetic nerves.

Manual Strangulation or Throttling

• It is a form of strangulation whereby the hands are used in applying pressure to the beck
and obstructing the air passages causing asphyxia death. It is homicidal and the assailant
is either in front, at the side or back of the victim while applying pressure over the neck,
one or both hands may be used.
 Special Forms of Strangulation
1. Palmar Strangulation
▪ wherein palms of the hand are used in applying pressure over the neck while the
assailant is eithers in front or at the back of the victim.

2. Garroting
▪ wherein a metal collar or strap is placed around the neck and tighten to
compress the neck.

3. Mugging
▪ wherein the assailant stands at the back of the victim and forearm is applied in
front of the neck.

4. Compression of the Neck with a Stick Rod or Pipe

▪ wherein a piece of pipe, rod or stick is used in applying pressure over the neck
and the assailant is either in front or at the back of the victim.

III. Asphyxia by Suffocation

• Is exclusion of air from the lungs by closure of air openings or obstruction of air
passages from the external openings.

1. Smothering
• caused by closing of the external respiratory orifices (mouth and nostrils) either by the
use of hands, cloth, pillow or linen.
2. Over laying
• most common accidental smothering in children suffocated either from beddings or
pillows.

3. Gagging
• application of materials usually handkerchief, linen other clothing material through the
mouth and nostrils.

4. Plastic bag suffocation

• Used of plastic bag common among children.

5. Choking
• form of suffocation brought about by the impaction of the foreign body, food or blood
clots in the respiratory passages.
a. VOMITUS- too much alcohol in take
b. Bleeding pulmonary tuberculosis
c. Dentures
d. Bolus of food
Asphyxia by Drowning or Submersion in Water
• The air passages are submerged in water thereby preventing the force blow of air into
the lungs. It is not necessary for the whole body to the submerged in water.
 SEX CRIME AND DEVIATIONS:
1. Sex
• is an inborn instinct of man, any person out of sex desire is abnormal.

2. Sexual crime
• a sexual act about sex.

3. Sexual Harassment
• is asexual act committed by a person by uttering obscene languages which irritates the
victim as well as the unconventional sexual acts which are not in conformity with the
moral standard in a society.

4. Sexual Assault
• is a genderless crime which involves unconventional sexual acts of violence and
aggression committed on genital, oral or anal orifices of another person.

5. Virginity
• is a condition of a woman who has not experienced sexual intercourse and whose
genital organ has not been altered by sexual intercourse.

6. Defloration
• rupture or laceration of the hymen as a result of sexual intercourse.

Kinds of Virginity:
1. Moral Virginity
• is a state wherein the female is not yet physically and sexually matured, and has not
experienced Sexual intercourse. The sex organs and secondary sex characteristics are
not fully developed. This applies to children below the age of puberty.

2. Physical Virginity
• a condition of a female wherein she is conscious about sexual life, the sex organs and
secondary sex characteristics are fully developed but had not experience sexual
intercourse.

3. True physical Virginity

• the woman is usually matured, had not experienced sexual intercourse and whose
hymen is still intact with distinct regular edges and the opening is small barely admits
the tip of the smallest finger.

4. False Physical Virginity

• is a condition of a woman who had not experienced sexual intercourse. The hymen is
unrupted, elastic and distensible and admits 1 or 2 examining fingers with least
resistance.
5. Demi-Virginity
• is a condition of a woman who allows any form of sexual acts but refrain from rupturing
the hymen.

6. Virgo Intacta
• is a condition of a woman who had several sexual intercourses but had not born a child.

Parts of the Female Anatomy which may be Considered in the Determination of Virginity
Breast
• are two masses of fleshy tissues at the region of the chest with its nipple at the center
and surrounded by brown or pinkish areolae.

Vaginal Canal
• it is a muscular membranous canal used as a female copulatory organ and covered by
hymen externally among virgin.

Labia Majora and Labia Minora

• are two longitudinal folds of tissues which formed the lateral boundaries of the pudendal
cleft which the urethra and vagina open.

Fourchette and Parinium

• the fourchette is the V-shaped structure formed by the anion of the labia majora posturing
and below the vaginal orifice. This may become rounded by several sexual intercourse or
distended by the passage if the fetus during delivery.
Hymen
• this is a thin fold of mucous membrane surrounding by the vaginal orifice. It ruptures
during sexual intercourse, instrumentation or self-manipulation. This is not a good basis
of virginity. A woman may have a ruptured hymen yet she is virgin. A woman might resort
to musturbation yet she is a virgin.