HI-YIELD NOTES IN LEGAL MEDICINE [from Legal Med & Med Juris Summary] “marbled” reticule of branching veins.

Clostridium welchii Microorganism that plays a dominant role in decomposition

Important definitions in Legal Medicine & Medical Jurisprudence 70 ◦ to 100 ◦ F Optimum temperature for specific decomposition
Legal medicine Branch of medicine w/c deals w/ application of medical knowledge to 6 inches The flame does not usually go beyond this in case of firing [< 3 inches
purposes of law & justice in pistol and revolvers]
Forensic medicine Use of medical science to elucidate legal problems Inquest Officer A state official charged with the duty of inquiring into certain matters.
Medical jurisprudence Branch of law w/c deals w/ organization & regulation of medical CSI Place where the essential ingredients of the crime took place.
profession. Knowledge of law in relation to practice of medicine Autopsy Comprehensive study of a dead body, in addition to external exam
Medical jurist or A physician who specializes in science of legal medicine Post-mortem exam External exam without incision being made.
medicolegal expert Negative autopsies If after all efforts including gross and microscopic studies and
Jurisprudence Science w/c investigate nature, origin, development & function of law. toxicological analysis fail to reveal a cause of death.
Principle of stare When court has once laid an interpretation of law as applied to certain Negligent autopsy No cause of death is found due to imprudence, negligence, lack of
decisis facts, it will adhere to & apply to all future cases where facts are skill, lack of foresight
substantially the same. Dead on arrival [DOA] Means actually dead or dying provided the physician had not been
. “Ignorantia legis Prevent use as defense in violation [ignorance of law excuses no one] given ample opportunity to arrive a working dx as to cause of death
nominem excusat “ Undetermined If the physician cannot determine the cause of death
Medical evidence Means sanctioned by rules of court of ascertaining in a judicial Cerebral apoplexy Sudden loss of consciousness followed by paralysis or death due to
proceeding the truth respecting a matter of fact wherein scientific Hemorrhage from thrombosis or embolism in the cerebral vessels.
knowledge is necessary. Concept of possession The right of custody over a dead body.. The right of custody does not
BERTILLON SYSTEM Aka Alphonse Bertillon, w/c utilizes anthropometrical measurement mean ownership of the dead body.
of the human body for identification. Euthanasia Willful, deliberate & painless acceleration of death of a person
Portait Parle (spoken picture) picturesque description of a person Violent death Deaths due to injuries inflicted by body by some form of outside force
Transvestism Sexual deviation by desire to assume attire & be accepted as member Infanticide Killing of a child less than 3 days old
of the opposite sex Parricide Killing of ones relative
Deposition Written record of evidence given orally & transcribed in writing in form
Mutilation Intentional act of lopping/cutting off any part or parts of the living body
of questions by interrogator
MAYHEM Is the unlawful and violent deprival of another of the use of a part of
Dying declaration Made under consciousness of an impending death. the body so as to render him less able in fighting, either to defend
Grounds for admissibility: necessity, trustworthiness himself or to annoy his adversary.
Documentary evidence May be: formal written report [necropsy report], written opinions, death Hematoma Is the extravasation or effusion of blood in a newly formed cavity
certificate, or a dying declaraion underneath the skin
Direct evidence Proves the fact in dispute w/o any interference or presumption, CEREBRAL THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED
corresponds to actual point of issue CONCUSSION BY MORE OR LESS COMPLETE SUSPENSION OF ITS
Circumstantial Proof of facts taken either singly or collectively, the existence of fact /COMMOTIO FUNCTIONS AS A RESULT OF INJURY TO THE HEAD WHICH
evidence may be inferred as necessary CEREBRI LEADS TO SOME COMMOTION OF THE CEREBRAL SUBSTANCE.
Expert evidence Opinion of witness regarding question of science, art of trade, when
he is skilled, therein may be in evidence Sprain A subcutaneous separation or tearing of muscles, tendons, ligaments
Physical evidence All those material things subjected to 5 basic senses Metallization Specific feature of electrical injury wherein the metal of the conductor
Proof beyond Defendant is entitled to an acquittal, unless his guilt is shown beyond is volatilized & particles of the metal are driven into the epidermis
reasonable doubt reasonable doubt Forensic ballistic Study of firearm identification from ammunition fired thru them
Confession Expressed acknowledgement by accused in a criminal of the truth of Ballistics Science of the motion of projectile
his guilt as to the crime charge Patricide Murder of ones father
Extrajudicial Confession by the accused made outside the court prior to the trial of Fratricide Murders or kills his own brother or sister
confession the case
Heat cramps/Miner’s Involuntary spasmodic painful contraction of muscles essentially due
Admission Statement of fact of the accused in a criminal case of the truth of his Camp/Firema to dehydration & excessive loss of chloride in swating. Tx: Fluids with
guilt as to crime charge or some essentials thereof ns chlorides
Quasi delict A fault or negligence; if there is no preexisting contractual relation Camp/Stroker’
between the parties s camp
Corpus delicti Objects or substances w/c may be part of body of a crime. The body Heat exhaustion Aka heat collapse/syncopal fever/heat syndrome/heat prostration, due
evidence of the victim, drugs recovered from the victim or fingerprints, etc. to HF primarily caused by muscular excretion & warm clothing. Tx:
Judicial confession Confession of an accused in court removal from the heated area
Law of multiplicity of Is true in the case of identification. The greater the number of Heat stroke Aka sunstroke, hyperpyrexia, comatous form, thermic fever, due to HF
evidence similarities, the greater is the probability for correct conclusion caused primarily by rise in temperature or heat excessiveness.
Ultimen mariens Usually auricle of heart contracts after somatic death for a longer Hyperbarism Due to Increase of atmospheric pressure. Normal atmospheric
period of time than ventricle & the auricle is the last to stop pressure at sea level is 760 millimeters of Hg.
Algor mortis Cooling of the body [rapid at 1st 2 hrs of death] Decompression Decrease of atmospheric pressure
Rigor mortis Starts at 3-6 hrs, ends at 12 hrs, a dead person freezing after death 1. Hypobarism – at high altitudes the atmospheric pressure is
Livor mortis/hypostasis Starts a 1 ½ to 2 hrs, purplish discoloration of the body & organs lower and more gas will be liberated by the body fluid.
Postmortem caloricity Rise of temperature of the body after death due to rapid and early 2. Anoxia – Hypoxia felt at 8000-15,000 feet level. Aircrafts
putrefactive changes. Usually seen in the first 2 hrs. [Cholera, greater than 34,000 feet be provided with O2.
liver abscess, tetanus, RF,Strynine poisoning, peritonitis] “virgo intacta” Women who had isolated sexual intercourses or even habitually
Post-mortem / Death struggle of muscles, whole body becomes rigid due to provided she have not born a child.
cadaveric rigidity contraction of muscles. Develops 3-6 hrs after death & may Defloration Laceration/rupture of hymen due to sexual intercourse
last from 24-36 hrs [rigor mortis]. Carnal knowledge Ac of man having sexual bodily connection w/ women.
Cadaveric spasm or Instantaneous rigidity of muscles w/c occurs at the moment of death Seduction Act of man enticing women to have unlawful intercourse, w/ means of
Instantaneous rigor due to extreme nervous tension, exhaustion, & injury to persuation, solicitation or bribes or other means w/ applying force.
nervous system or to the chest. Ex. Presence of gun highly Qualified seduction Seduction of virgin 12-18 y.o, committed by any person in public
grasped by hand of the shooting victim authority, priest, servant, guardian, teacher, or any one who in any
Postmortem or Aka postmortem suggilation or postmortem hypostasis or liver mortis, capacity shall be entrusted w/ education or custody of the women.
cadaveric lividity stoppage of heart action & less tone of blood vessel cause Incestuous seduction Seduction committed on sister or descendant. Victim may not be 1
blood to be under influence of gravity or when blood virgin 12-18 y.o
accumulates in the dependent part of the body Simple seduction Seduction of a woman who is single or widow of good reputation, 12-
Putrefaction of the Breaking down of complex proteins into simpler components 18 y.o committed by means of decoit carnal knowledge
body associated w/ evolution of foul smelling gasses and accompanied by Acts of lasciviousness Conducts w/c tend to excite lust or produce valaptous / lewd emotion.
the change of color of the body Lewd design Intent of abductor to have sexual intercourse w/ the woman abducted
Tache noir de After death a spot may be found in the sclera w/c may be oval, round Abduction Carrying away of a woman by an abductor w/ lewd design
sclerotique or triangular w base towards the cornea.
Forcible abduction Abduction of any women against her will & w/ lewd designs
Marbolization Prominence of the superficial veins with reddish discoloration which
Consented abduction Abduction of a 12-18 y.o, carried out w/ her consent w/ lewd designs.
develops on both flanks of the abdomen, neck, and shoulder, look like

1
White slave trade Any person who in any manner or under any pretext, shall engage in Sacrilegious children Children born of parents who have been ordained in sacris.
business or shall profit by prostitution or shall enlist services of Menceres Children conceived by prostitutes.
women for purpose of prostitution. Impotency Physical incapacity of either sex to allow the other sexual gratification
Adultery Committed by married woman who shall have sexual carnal Relative impotence Type of impotence not a ground for annulment of marriage
knowledge of her, knowing her to be married, even if marriage be Sterility Loss of power of procreation & is absolutely independent of whether
subsequently declared void. or not impotence is present.
Concoubinage Any husband who shall keep a mistress in conjugal dwelling, or shall Police power Power inherent in a government to enact laws win constitutional
have sexual intercourse under scandalous circumstances w/ a woman limitations, to promote order, safety, health, morals & welfare
not his wife or cohabit w/ her in any other place. Discernment Mental capacity to distinguish right from wrong
Buggery Form of sexual perversion wherein a person obtains sexual Illusion False interpretation of external sensory stimuli
gratification w/ animals or by means of anus of human beings. Hallucination False perception occurring w/o any stimuli
Sodomy When sexual gratification as attained by having sexual intercourse Delusion Faulty association of ideas w/c result to false belief or judgment
thru anus of other human beings Delusion of grandeur One consider himself in possession of great power, wealth or wisdom
Bestiality When gratification is by means of sexual relation w/ animals Idiot [a 2 y.o child] A mental defect in w/c one is unable to guard himself against danger
Pederastia A form of buggery in w/c he passive role is played by a boy Imbecile [2-7 y.o child] Incapable of managing themselves or their affairs, or their children
Paedophilia A person has a sexual or erotic love of children. An adult engages Feeble-mindedness Requires care, supervision & control in their protection or for others
sexual contact w/child of either sex Remote injury A fall in the feet or buttocks w/c results in basal fracture is known as
Tribadism/Lesbianism Wherein a woman has sexual intercourse w/ another woman what type of injury
Fetishism A peculiar sexual perversion found in male only. Part of female Feeble-mindedness Means an intelligent quotient of 75
clothing or part ofs of female body as sole power to arouse feeling or Moral defective Mentally defective coupled w/ strong viscious or criminal propensities
produce orgasm
Drunkard Person who habitually uses any intoxicating alcoholic liquor.
Transvertism Perversion among males who find sexual pleasure in wearing female
Habitual drunkard one who excessively uses intoxicating drink
apparel. Also in females who desire to dress in male attire.
Delirium tremens Sudden withdrawal from alcohol may suffer a state of excitement w/
Algolagnia Abnormal & distorted activity of sexual impulse towards opposite sex
hallucination
w/ pain as source of sexual stimulus.
Korsakow’s psychosis Syndrome characterized by hallucination, disorientation, multiple
Sadism or active Form of sexual perversion in w/c infliction of pain on another is
neuritis, loss of memory of recent events.
algolania necessary 7 sometimes the sole factor in sexual enjoyment. If victim
Punch drunkenness Observed in boxers who develop a physical and mental condition due
dies, it is called as necrosadism or lust murder.
to repeated trauma.
Masochism or passive Reverse of the above that is enjoyment is attained only when pain or
Criminal/penal law Branch of law w/c defines crimes, treat of their nature & punishes
algolania humiliation has been received from the opposite sex.
Felonies Acts or omissions punishable by law
Fellatio or Irrumation Female agent receiving penis of a men into her mouth & by friction w/
lips & tongue coupled w/ act of sucking initiate orgasm. “emphysema Lungs are distended like balloons overlapping the heart, w/ rib
aquosum” markings on the surface & protruded out of the chest
Cunnulingus Peculiar form of sexual deviation by licking or sucking the external
female genitalia. “edema aquosum” Due to entrance of water into air sacs w/c makes lung doughy
Frottage Characterized by compulsive desire of a person to rub against some champignon d’ ocume Whitish foam w/c accumulates in mouth & nostrils
part of the body to another of the opposite sex. “tete de negri” Dark bloated condition of the face occurring during early stage of body
Partialism Person has special affinity to certain part of female anatomy decomposition or the bronze color of head & neck of dead one
Troilism Aka “ménage a trios”, in w/c 3 persons participate in sexual orgy Throttling or manual Form of asphyxial death whereby the constricting force applied in the
strangulation neck comes from the hand
Pluralism In w/c group of people participate in sexual orgy
Smothering Asphyxial death caused by closing of external respiratory orifices
Voyeurism Characterized by compulsion to peep for a purpose of seeing persons
undress or engage in sexual relations. Overlaying MC accidental smothering in children, child is suffocated either from
pressure of bedding & pillows or from pressure of unconscious or
Mixoscopia Sexual pleasure is attained by watching couple in the act of sex
drunk mother.
Coprolalia Characterized by need to use obscene language to obtain excitement
Gagging The application of materials usually handkerchief, linen or clothing to
Urolagnia Wherein sexual gratification is associated w/ interest in the act of
prevent air to have access thru mouth or nostrils. Its homicidal.
defecation of feces.
Garroting A ligature meal collar or bowstring is placed around neck
Don juanism Sexual promiscuity & made seduction of any woman as a career
Mugging Form of strangulation w/ the assailant standing at the back & the
Necrophilia Erotic desire or actual sexual intercourse w/ a corpse
forearm is applied in front of the back
Satyriasis Excessive sexual desire or intercourse in men
Tardieu’s spots Found beneath conjunctivae, face, neck, chest & lungs, punctiform
Nymphomania Excessive sexual desire or intercourse in women “hanging” hemorrhages of the pleurae
Anilingus A person derives sexual excitement by licking anus of another person ‘Locus Minoris Physical injury found in some areas offering the least resistance to the
Narcissism A person has extreme admiration & love of one’s self Resistencia” force applied
Pygmalionism A person has sexual desire w/ statues Act The [+] action on a person doing a thing w/c he must not lawfully do
Abortion Willful killing of fetus in uterus or violent expulsion of fetus → death Omission Failure of a person to do a thing w/c he is legally obliged to do.
Spontaneous abortion Aka natural abortion, ccurs w/o any form of inducement of intervention Contact An agreement creating obligation in w/c there must be competent
Induced abortion Occurs w/ inducement or intervention parties, subject matter, mutual agreement & terms not ascertainable
Therapeutic abortion Purposely done to preserve the mother’s life Consent Manifested by meeting the offer & acceptance upon the thing
Criminal abortion Done w/o therapeutic indication but w/ criminal intent Blanket Type of consent not contemplated under Philippine law
Emmenagogues Substance w/c increases menstrual flow Simple/contractual fee Specified in expressed contract agreement before the tx or mgt
Echolics Substances w/c when taken causes death or expulsion of product of Contingent fee Depends upon success or failure of tx or mgt instituted. Ex. Mr .X
conception by stimulation of uterine muscles. promised to pay Dr. T 1M if he is cured of his CA.
Puramen reaction Based on presence of spermine in prostatic fluid. Very reliable & Retainer’s fee Fee made periodically for certain space of time.
characteristic of seminal fluid. Dichotomous fee or Wherein a doctor may require the service of a 3 rd person who may act
Paternity Civil status of the father w/ respect to child begotten by him. fee-spliting as an agent in soliciting px and the agent share in the medical fee. Ex.
Filiation Civil status of the child in relation to its mother or father. The receptionist in the hospital lobby receives a fee from Dr. T for
Legitimate children Those who were born on lawful wedlock or w/in 300 days after the referring cases to latter.
[proper] dissolution of marriage. Straight fee or “pakyaw For the amount of fee rendered to the doctor as professional fee, he
Legitimate child One who is born in lawful wedlock or w/in competent time afterwards system” shall be responsible for payment of the hospital bill, labs & etc.
Presumption of Children born after 180 days following marriage, & before 300 days Quantum meruit Principle applied when medical fee is not specified
legitimacy following is dissolution/separation of the spouses. PRC To w/c forum can administrative complaint be filled against doctors
Natural children Those born outside lawful wedlock of parents who at time of Administrative liability Reprimand is a sanction imposed against doctors when guilty of this
[proper] conception of the former where not disqualified by impediment to 2 years If MD license is suspended, he can apply for reinstatement after
marry each other. Medical malpractice Failure of doctor to perform his duty w/c devolves upon him in his
Spurious children Illegitimate children who are not natural professional relationship w/ px resulting to his/her injury.
Adulterous children Children conceived in an act of adultery Gross negligence An entire disregard for & indifference to safety & welfare of others
Incestuous children Born by parents who are legally incapable of contracting valid Forseability test Fundamental basis of the law of negligence
marriage because of their blood relationship as marriage btw brother Ignorance Want or absence of knowledge or lack of information or ability
& sisters, father & daughter Incompetence Lack of adequate ability, lack of fitness to discharge the required duty

2
Immoral conduct Any conduct or behavior that is disgraceful, unbecoming, or unethical the wrongful at is due to imprudence, negligence, lack of foresight, or
Associative evidence Physical evidence w/c link a suspect to a crime. Ex. Weapons, etc. lack of skill of the physician.
Tracing evidence Physical evidences w/c my assist investigator in locating suspect. Reckless imprudence Consists on voluntary, but w/o malice, doing & failing to do an act from
Cow’s gait A swaying movement due to knock knee w/c material damage results by reason of inexcusable lack of
Paretic gait Steps are short, feet are dragged & legs are held more widely apart precaution on part of the person performing or failing to perform such
Spastic gait Legs are held together & move in stiff manner, toes are dragged act, taking into consideration his employment or occupation, degree of
Festinating gait Involuntary movement in short accelerating steps intelligence, physical condition & other circumstances regarding
Frog gait A hopping gait resulting from infantile paralysis persons, time & place.
Waddling gait Exaggerated alternation of lateral trunk movement similar to uck Simple imprudence Consists in lack of precaution displayed in those cases in w/c the
movement damage impending to be caused is not immediate nor the danger
clearly manifest.
Breech of legal duty of Failure to do something to px w/c a prudent & reasonable man must
physician or dereliction be doing something w/c standard or practice dictates must be done. Defamation A public and malicious imputation of a crime
Violation of a positive When a physician deliberately induces abortion on a pregnant woman Civil malpractice Every person who, contrary to law, willfully & negligently causes
law w/o therapeutic indication damage to another shall indemnify the latter for the same. To recover
damages for injury sustained by the plaintiff.
Breach of contract When a physician made contract w/ the px stating absolute cure for
specific no. of days of tx & such term cure was not fulfilled. Contract of Torts Legal wrong committed by person / property independent of contract.
warranty, not void, violated, legally recognizable Living will Refers to written instruction given by px to relatives & attending MD
Tort Legal wrongdoing independent of contract: negligence > injury for them to cremate his body
Simulation of birth Is the substitution of 1 child for another w/ intent or by negligence In quasi-delicts The contributory negligence of plaintiff shall reduce the damages that
he may recover.
Illegal detention Crime committed by any privilege individuals who shall detain another,
or in any manner, deprive him of his liberty or freedom for at least “volanti non-fit injuris” To w/c a persons assents is not regarded in law as injury
more than 5 days Vicarious liability of Liability for the act of another act of his partner, act of another
Exemplary damages Monetary compensations over & above actual damages awarded as physician physician not his partner, acts for his assistance
punishment or deterrence Right for consortium Right of society, companionship, sexual relationship & service
Reckless imprudence 1 who fails to do an act resulting in personal injury or death of others, Right to privacy Right of px to be left alone & free from unwarranted publicity
there being inexcusable lack of diligence & care or intentional lack of Right of disclosure Righ of px to know his condition & prognosis of such condition. Ex.
care or precaution During OR, the suture needle was lost in the abdomen & was not
Simple imprudence It is ordinary lack of care & care & diligence resulting to personal recovered, the physician did not inform px. He violated pxs right of
injury or death of others Right of confidential Physician is not allowed too divulge pxs information to a 3 rd party
Slander/oral Any verbal or oral statement or utterances made in public against a information 1. statutory privilege communication – nt in a civil case
defamation person w/c tends to destroy or blacken the character of the person, 2. confidential information – sacred trust
public & malicious imputation of a crime [defamation] NOTE: not applicable in criminal cases PD 169
Libel Defamation committed by means of means of writing or any form of Expressed consent When procedure was stated to px before he gives consent
literary communication Implied consent Given w/o expressed words but from conduct of px
Slander Oral form of defamation General or Blanket Consent given by px whereby doctor is given the full authority
Perjury / False It is the willful telling a lie made under oath orally or written consent
testimony Limited or conditional Consent to certain medical procedure but may impose certain
Forgery The making or alternating of a writing or document or instrument w/ consent conditions. Must be observed to prevent breech of legal duty.
the intent to defraud or deceive another or to prejudice his right 30 days A petition for reconsideration for hearing shall be filed within
Friction/pressure Type of abrasion observed in hanging or strangulation 2 years Certificate of registration of a doctor can be reinstated after
Euthanasia If a poison is administered by a nurse to a px w/ knowledge & content Non-liability or Ex. The hospital or any member of its staff shall not be held liable
of the latter & his relatives exculpatory clause in civilly or criminally to whatever be the consequence of the procedure
3 years Permission to permission to disinter remains of a person who died of consent consented to.
non-communicable disease may before granted after Disclosure of info of px Relationship of doctor & px is fiduciary.
72 hrs Burial of embalmed body should be done within “ghost surgery” Consent given by px to surgeon to perform operations & the actual
12 hrs Unless permit is granted otherwise, within how many hours should a operation is done by another doctor
body who died of a dangerous communicable disease be buried Privileged Doctor is obliged to disclose all info to his px, but not to others
At any time If a dead body is subject matter of a criminal investigation, it may be communication
exhumed Patient’s right of Right of px to be left alone & free from publicity
Within 24 hrs How soon after drowning does the body float privacy
Serious physical injury Any person who shall wound, beat, or assault another so as to render Statutory privileged Information gathered by physician from his px w/c can not be
him less able to defend himself, this act is called. communication disclosed by doctor in the court
Subdural hemorrhage MC cause of cerebral compression in skull fracture is due to Ethical or professional Doctor cannot divulge info he obtained from his px to other persons,
hemorrhage from a small blood vessels w/c cross subdural space to privileged otherwise he will be liable for breech of contract trust
subarachnoid areas communication
Bullet momentum The most important determinant of wounding capacity of bullet Independent A px entering a hospital does not enter into contract w/ hospital but w/
Shockwave There is more “shocking or knockdown power” of the bullet due to contractor theory the physician who traits him
what physical phenomenon Implied waiver theory A charitable px accepts the service of a private chariable hospital
Tangential approach of The production of a furrow in cranium called gutter fracture is caused Contract of service Doctrine of respondent superior is applicable
a bullet by Actual or Compensation w/ the loss sustained in consequence of the
0.45 pistol Diameter of GSW POE is 1 cm x 1 cm, the probable firearm used is compensatory defendant’s act.
Gutter fracture Fracture produced by tangential or glancing approach of bullet damages
Primer Functions for transformation of mechanical energy by the hit of the Nominal damages Wherein no substantial loss or injury to be compensated
firing pin on percussion cap to chemical energy. It usually made of Exemplary or Damages on an increase scale that will compensate him for his
lead, barium & antimony corrective damages property loss
6 inches When ammunition was from a gun, live flames came out of the muzzle Special damages Includes hospital & medical damages, loss of income & etc.
of the gun in the form of a cone w/ vertex of w/c is at region of muzzle. General damage Include pain and suffering, disability & inconvenience
The farthest distance it can go beyond the muzzle is: Hearsay evidence That is not proceeding from personal knowledge of the witness, but
Eyes & testicles Organs most vulnerable to microwave radiation because they are the for mere repetition of what he has heard others say.
most radiosensitive organs Expert witness One who have had special skill to deduce correct inferences from
Proximate cause W/c in natural & continues sequence, unbroken by an efficient hypothetical, stated facts or scientific facts & technical knowledge
intervening cause, produces injury & w/o w/c result would not have Expert evidence May state his opinion of, deduction, conclusion or inference to what
occurred. he perceived. He is skilled on the art, science, or trade he is testifying
Administrative The complaint for malpractice is filled in the board of Medial Ordinary witness All persons who use their senses & make their own perception, he
malpractice examiners. may not be skilled on the line he is testifying
Criminal malpractice When the act or omission done by physician is punishable by law. The Medical ethics Branch of moral science w/c treats duties & obligations of a physician
acts or omissions complained of must be done w/ deliberate intent or to his px & to the profession, and to public

3
Summons Written notification that serves as a warning to him to appear in court surgery where in fact it is only a minor operation
Subpoena Requires the doctor to testify on some material issue in court. Failure Violative prescription When MD prescribed a drug w/o writing down the generic name or
testificandum to comply shall be deemed contempt of the court to w/c it was issued. when a prescription contains the phrase “no substitution allowed
Subpoena duces Requires the doctor to produce some documents in court Licensee He has no contractual relation w/ hospital but is permitted expressly or
tecum impliedly to come w/in the premises of hospital. Ex. Visitor of px
Indirect contempt A doctor who deliberately refuse to obey a subpoena w/o any Invitee One who is essential to operation of a hospital or for whom the
justifiable reason is guilty of it hospital has a purpose ex. AP, private nurse, blood donors, students
Consummated felony When all the elements necessary for its execution & accomplishments Trespasser One who enters the property w/o being granted the privilege to do so
are present. Rodeo circuiting A surgeon who makes a series of operations in a place & leaves the
Frustrated crime Occurs when offender has performed all acts of execution w/c will practice post-operation care to another physician whom he trusts is called
produce felony but it did not produce the crime because of some Negligence Px leaves hospital against medical advice, or COD resulting from lak
causes independent of the will of the offender. The subjective phase of skill, foresight and reckless imprudence
of the crime is complete but fails to realize the objective phase for Independent Common defense of hospital as regards to consultant’s liability to
reason independent of the will of offender. contractor private pxs
Attempted crime The offender never goes beyond the subjective phase of the crime. Substantive law Law enforced by the state
Impossible crime Means that violence was applied not knowing that the person is dead Murder Terminally ill px given an overdose of sedatives w/o his knowledge. Or
Complaint A formal allegation or charge against a party filled by a private person if a 3 day old intentionally killed w/ cruelty & during a calamity
to Court or officer as for a wrong done or crime committed Pelvis More informative for regarding the sex of the owner of the skeleton
Information A formal accusation by public prosecutor or information is a Anytime When body is thesubject matter of criminal investigation is exhumed
proceeding in nature of a prosecution for some offense against Diffusion Any change for position of cadaver will not change the lividity location
government prosecuted really or normally by public
Drug dependence State of psychic or physical dependence or both on a dangerous drug Judicial death Examples are musketry, electrocution & hanging
Pusher Any person who sells, administers, delivers, or gives away drugs Photography Most practical, useful & reliable means of preserving evidence
8-12 yrs Penalty for lawful prescription of prohibited drugs No change in color of Principle used in Magnum test for determining somatic death
Sledgehammer blow When somebody is hit by a lightning, sever tearing or displacement of fingers
effect body parts may be produced secondary to what the effect of lightning 5 years Permission to disenter remains of person who died of dangerous
Narcotic drug Any drug w/c produces insensibility, stupor, melancholy or dullness communicable disease may be granted after a period of
Manual/throttling Form of asphyxial death where the constricting force is the hand. Freedom of origin Faith healing is allowed as a norm of tx in our country based on the
Smothering: Asphyxial death caused by closing the external respiratory orifices. constitutional guarantee on
Overlaying Most common in children: pressure of pillows Immorality An unmarried MD was discovered having sex w/ an unmarried nurse
Gagging Application of materials to prevent air to have access to mouth & nose < 50 km MD must appear in response to subpoena if his place is far from court
Choking Form of suffocation by impaction of F.B. in the respiratory passage. Slight physical injury Type of injury need not to be reported to police under PD 169
Compression/traumatic Form of asphyxia where the free exchange of air in the lungs is Plastic Indentations left on soft or pliable material belongs to what type of
crush asphyxia prevented by the immobility of the chest and abdomen due to external fingerprints
pressure or crush injury. Hanging Tardiieu spots are associated
Subdural hematoma MC form of brain injury in vehicular accidents
15% A drunk person has at least % of alcohol in his blood Important signs & tests to remember
5 hours If rectal temperature of a corpse is 89.4 ◦F, then the cadaver has been Jacquemin-Chadwicks Pale violet discoloration of interior wall of vagina below urethral
dead for: sign meatus
Grave threat A person who mistreats another or violates his rights w/o causing Hegar’s sign Gravid uterus shows extreme softening of the cervix
actual physical injury MacDonald’s sign w/ the softening of isthmus, fundus of uterus is anteflexed, so
30 days Decomposition will reduce the entire body to a skeleton in there is easy approximation of fundus & the cervix
30 days Serious physical injuries will heal in this number of days Goodel’s sign Cervix of the uterus feels as hard as tip of the nose, [-] pregnancy
100 yards / 25 yards One is able to identify a friend in broadway daylight Mayor’s sign Rhythmical contraction & relaxation of uterus felt by the hands
16-17 or 10-13 yards Be able to identify individual in a clearest moonlight or starlight Macewen’s sign Comatous stage wherein pupils in drunken pxs are contracted, but
48 hrs A dead person should be buried within may dilate w/ slow return to their constricted state by stimulation
3 or 5 yrs Permission to disinter remains of a person who died of communicable Hydrostatic / Fodere’s / To determine if respiration took place on newborn child before
disease is granted static test death. Entire lungs is removed & is immersed in water en bloc
> 7 yrs Disputable presumption of death is one unheard from a period of Stomach-bowel / floating/ Ligate cardiac end of stomach & lower end of intestine & placed it
< 18 y.o A person is considered infant to a suit if Breslau’s test in water. If it floats, breathing has taken place.
Damage to introitus Most important factor in establishing rape in a woman Wredin’s test When the middle gelatinous ear of a child disappears after birth
Scarring effect A wound may be indirectly fatal if Binet-Simon test Intelligence test corresponding to every month up to 2 y.o & a
Suggilation Accumulation of blood in most dependent part of the body graduated time interval thereafter of 2-6 mos.
Hippocratic facies Sunken eyes, pinched nose & hollow temple Romberg’s test Standing straight w/ eyes closed, heels together for 1 minute
20-30 mins /1 hr Cessation of heart action in judicial hanging, in decapitation Nalline test A N-allyl-normorphine & is a specific antidote for morphine
< 3 ½ minutes Cessation of respiration poisoning [at 5-10 mg IV – withdrawal Sx may appear]
2-5 mins Death in drowning Gottler’s / Getter’s test Determines chloride content of blood in R and L ventricles
4-5 days When color of contusion changes to green Walker’s test [2-napthalamine-4-8 disulfonic acid] test for the presence of
10 d Survival w/o food & water, survival w/ water is 50-60 days gunpowder in clothing’s especially colored ones
Latent print A suspect w/ L fingerprint on a door after killing his victim. This type Schombein’s test Done to identify blood where guiacum & H2O2 are used
Visible fingerprint A person affixes his R fingerprint on the door after killing the victim Kestle-Meyer’s test Done to identify blood using phenolphthalein
Real impression A person affixes his R thumb mark on his residence certificate Takaya’s test Done to identify blood w/c yields brown crystals as [+] result
Flat EEG Demonstrates a brain dead Teichmann’s test The best of microchemical tests for blood identification
7 years A penalty of arresto mayor + fine shall be imposed upon anyone who Wagenhear’s test Acetone-haemin crystals are formed as [+] result
shall abandon a child under his custody. The child should be how old? Winlow’s test Detects cessation of respiration by putting H2O2 or Hg on chest
Ignorant child abuser The most tragic type of child abuser. Lung’s test Test for gunpowder stains by use of paraffin
2 hrs Mobility of sperm cells w/in vagina is invariably absent by the end of Walker’s test Test for presence of gunpowder on clothing
60 Million Number of spermatozoa per cm of semen Florence test Test for presence of seminal fluid in clothing
Pulmonary embolism Death 14 days following criminal abortion is usually due to Berberio’s test Test for spermatic fluid, specific for it
Sacrilegious children Children of a priest & nun Acid phosphatase test Test is conclusive for presence of semen
Manceres of children Children of a prostitute are Precipitin test Aka biologic test of Farnum, it determines whether semen is of
Arresto mayor If a young widow remarries before he legal restriction is lifted, the human or not.
penalty is Kunkel’s test Test for carbon monoxide in blood. Done by adding 3% tanic acid
Heart The site of remote action of arsenic poisoning Florence test Test produced by action of iodine on choline; not specific for
Neurosurgery Specialty having the highest risk of professional liability litigations spermatic fluid, [+] result is merely presumptive evidence of
Misrepresentation MD issued a medical certificate testifying that his px underwent major spermatic fluid.
Fodere’s test Aka hydrostatic test/static test, determines whether respiration

4
 took place on a newborn child before death. “borrowed servant The master must be responsible for the wrongful act of his
Wredin test Changes in middle ear. Middle ear of a child before birth is filled w/ doctrine” servant. Ordinarily, resident doctors, nurses & other staff are
gelatinous, embryonic CT w/c disappears after birth of the chid. employees or servants of the hospital. Ex. X suffered fractured rib
Breslau’s test Test for livebirth of a newborn child consisting of floating of due to pressing of her abdomen by a nurse during delivery, a med
stomach in water. tech has mislabeled bottles of blood resulting to wrong BT
Paraffin test or dermal Aka, Diphenylamine test, Lung’s test, Gonzales’ test A test on skin Doctrine of ostensible These are employees & at the same time independent contractors
nitrate test surface to determine presence of gunpowder agents who occupy a peculiar status in administrative set-up in a hospital.
Walker’s test ( C-acid Glossy photographic paper fixed in hyposolution for 20 min to Ex. Misdiagnosis of tissue biopsy by pathologist, or
test, H-acid test) remove the silver salts and washed for 45 min. and dries. anesthesiologists giving anesthesia at a wrong site
Harrison and Gilroy test Cotton swab moistened with 0.1 molar HCl to gather the primer Doctrine of hold-over Principle under w/c a public officer is permitted to continue in
component. possession of an office & to continue to exercise the functions of
Ascheim—Zandek test Test of pregnancy by use of mice the office even after the end or termination of his lawful term until
Hogben / Xenopus test Test of pregnancy by use of frog their successor shall have been appointed.
Magnus test Application of ligature around the base of the finger [bloodless Doctrine of superior Means that the physician px relationship, the physician has
area at site of application, dead man – no change] knowledge superior knowledge over the px, hence px usually follows him.
Icards test Injection of flourescein SQ, [greenish yellow discoloration in the Doctrine of Res Ipsa The thing speaks for itself. Rebuttable presumption that the
whole skin dead man only in the area of injection Loquitor or Doctrine of dependent was negligent. Testimony of an expert witness is not
Diaphanous test Fingers are spread wide through a strong light- Red common knowledge needed because the injury is a proof of a negligent act. Ex: in
surgery when incision is closed & foreign body is left
Winslow’s test No movement in the image formed by reflecting artificial light on
unintentionally & allowed to remain in pxs body. Ex. Px was aware
water in a saucer & placed in chest if respiration is taking place.
that MD was drunk yet he allowed the doctor to inject him.
Hemin-crystal test Slide+stain+H2O+NaCl. Consider the best of microchemical test
Doctrine of contributory The act or omission of ordinary care on the complaining party, w/c
Romberg’s test standing straight w/ eyes closed, heels together for 1 minute
negligence or Doctrine of concurring w/ the dependent’s negligence is the proximate cause
Diaphanous test Viewing the finger webs thru a bright light o determine if a person common fault of injury. Ex. Px coughs w/o telling the doctor & during
is dead or alive.
esophagoscopy, px dies due to puncture of esophagus, then the
doctor is not held liable, failure to seek medical assistance if Sx
Important rules and RA’s to remember persists, HAMA, failure to follow tx, or failure to give MD the
McNaghten rule Determine whether accused is laboring under such defect of reason accurate history.
from disease of the mind as not to know & appreciate the nature & Doctrine of continuing The doctor after a prolonged tx of px produces no improvement
quality of the act he was doing, or circumstance in w/c it was done. negligence when in fact normally it would. Ex. Non-response to tx
Curren’s rule A person is not responsible for his criminal conduct if it is proven that Doctrine of last clear Aka doctrine of discovered peril, it is withstanding negligence if
the time of committing the prohibited ac of defendant as a result of chance or doctrine of dependant could have avoided the injury after knowing the peril.
mental defect, lack substantial capacity to conform his conduct to the supervening negligence Ex. Failure to apply tourniquet to a px causing his death, or that
requirements of the law w/c he has allegedly violated. MD fails to examine px who subsequently dies of asphyxia on a
Durham rule Accused is no criminally responsible if his act was the product of child suffering from diphtheria
mental disease Doctrine of the Anyone who voluntarily assumes the risk of injury from a known
Hess’s rule or a) Fetus of less than 25 cm long- get square root of length in cm, assumption of risk danger is disbarred from recovery. Ex. HIV px takes experimental
Haase’s rule result in months drug despite unknown side effects, infection developed from foot
b) > 25 cm- divide the length of the fetus by 5 and the result is the age operation of a DM patient
in month. Fellow servant doctrine If an employee was injured on account of negligence of his fellow
Odd & even rule in If the number of entrance and exit wound is even so presumption that employee, the employer can not be held liable
GSW no bullet is lodged in the body. Verified by x-ray Doctrine of forseability or The doctor can not be held liable for negligence if the injury
Henry’s Law At constant temperature, the amount of gas dissolved in a liquid is doctrine of force majeure sustained by the px is on account of unforeseen conditions. Ex.
directly proportional to the pressure” Railings on pediatric pxs, or injury due to fall of a delirious px from
bed because of lack of any means to restrain him
Schourup’s Determines the time of death of any cadaver whose CSF is examined
formula for LA, NPN, and amino acids Doctrine of proximate There is direct physical connection btw the wrongful act of MD &
cause the injury is suffered by px.
RA no. 5921 Violation of pharmacy law, w/c prohibits selling of drug samples
Doctrine of efficient May mitigate the damage to be rewarded
RA no. 8344 Penalizing doctors & hospitals who refuse tx of emergency cases
independent intervening
RA no. 6615 Mandates that all government & private hospitals & clinics duly
cause
licensed to operate is required to render immediate emergency
Doctrine of calculated risk Means that when an accepted method of medical treatment
medical assistance & to provide facilities & medicine
involves hazards/risks w/c may produce injurious results
RA no. 2625 Dangerous drugs act of 1972 as amended
regardless of the care by physician, the doctor is not held liable.
RA no. 6425 No prescription form once issued may be refilled.
Doctrine of assumption of Means that a person who assents & injured, is not regarded in law
RA no. 6111 Philippine medical care act, a national program to provide adequate risk [volenti non-fit injuria] to be injured. That is px voluntarily assumes the risk.
medical service to he people, a joint endeavor of the government.
Rescue doctrine Provides that a physician who went to rescue a victim of an
RA 4226 Hospital licensure act accident was injured, the original wrongdoer must be held liable.
RA 7877 Sexual harassment law Trust fund doctrine A theory w/c protects government hospitals established to perform
PD 603 Aka child & youth welfare code, makes mandatory for doctors to governmental function, w/c is to preserve & maintain people, from
report suspected cases of child abuse any liability & therefore government officials cannot be sued.
PD 169 Failure of doctor to report any person who is treated of serious Doctrine of avoidance of Means that the injured party is obliged to minimize as much as
physical injuries to nearest PNP consequence possible the damage suffered by him & is required to take steps as
Article 259, RPC Abortion an ordinary prudent person would have reasonably adopted for his
Article 365, RPC Criminal negligence & imprudence own good
Articles 353, 359 Defamation Principle of respect for Basis for “informed consent”. It expects from doctor the respect for
Art. 3753, 1553 Liabilities in issuance of birth & death certificates autonomy right of px not to receive tx that the doctor recommends
Principle of non- Doctor must not act in a way that entails harm or injury. He will not
Important doctrines to remember maleficience intentionally create needless harm or injury to px.
Doctrine of unjustified No one must enrich himself at the expense of another. That is “ Principle of beneficence Doctor must act in ways that promotes pxs welfare.
enrichment service rendered, service paid”. Principle of justice Giving to each what is due. Fair distribution of goods in the society
Doctrine of parens Means that the state has the right to assume guardianship when
partelan child is neglected by parents to have the child treated medically
Doctrine of respondent A master is liable for wrongful acts of his servant, while such
Important facts in Legal Medicine [from review notes on SOLIS]
superior or Doctrine of servant or agent is acting w/in the legitimate scope of authority.
vicarious liability Includes: ostensible agent, borrowed servant & captain of the ship
Ordinary physician vs. medicolegal officer
doctrine. Ex hospital owner may be liable for mistakes of
Difference Ordinary physician Medicolegal officer
residents, but the hospital is not liable to an injured px caused by
its employee if it can be established that the employee was under View on injury/disease Treatment Cause
he supervision of the attending physician P.E, examine a px Diagnose Testify / justice

5
Minor injuries Ignored Records all esp. crime 3. Conclusive evidence = ovary in females

Persons authorized to perform autopsies: Bones used to determine sex of the skeleton
1. Health Officers 1. pelvis 4. humerus
2. Medical officer of law enforcement agencies. 2. femur 5. sternum
3. Members of the medical staff of accredited hospitals. 3. skull

Autopsies shall be performed in the following cases. IDENTIFICATION OF BLOOD AND BLOOD STAINS
1. Required by special laws Physical examination
2. Order of competent court, mayor, fiscal a) Solubility test
3. Written request of police officers b) Heat test
4. SolGen, fiscal disinter to determine cause of death. c) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL, Sodium peroxide , distilled water
5. written request of nearest kin to ascertain cause of death > Bluish-white in a dark room
Chemical examination:
a) Saline extract of the blood + ammonia – brownish > alkaline hematin
Types of medical evidence : b) Benzidine test – blue color in white filter paper
Autoptic or Real evidence Made known to the senses c) Guaiacum test ( Van Deen’s Dyas or Schombein’s test) – blue
Testimonial evidence Oral under oath d) Phenolpthalein test ( Kastle-Meyer test) – pink
Experimental evidence Medical witness may be required to prove fact e) Leucomalachite Green test
Documentary evidence Written evidence presented by physician
Microscopic examination- saline extract of stain
Age of Scar: Micro-chemical tests:
A. Recently formed: Slightly elevated, reddish/bluish, tender to touch 1. Hemochromogen crystal or Takayama test:
B. Few week-2 months: Inflammatory redness, soft, sensitive 2. Teichmann’s blood crystals or Hemin crystal test = Sodium chloride – dark brown
C. 2 – 6 months: brownish, free from contraction, soft rhombic prisms of chloride, hematin formed, best of the micro-chemical test.
D. > 6 months: white, glistening, contracted, tough 3. Acetone-haemin or Wagenhaar test
NOTE: Scar formation is delayed by: sepsis, age, depth of wound, mobility
Spectrospcopic examination - blood pigments have the power to absorb light of certain length
Light as a factor in identification: and produce the characteristic absorption bands on the spectrum.
1. Clearest moonlight = Less than 16-17 yards; Starlight = Less than10-13 yards = Fresh blood – oxyhgb, Hgb, reduced hematin
2. Broad daylight = Not farther than 100 yards not seen before = olders stains – methemoglobin, alkaline hematin
Almost strangers =recognized at 25 yards
3. Flash of firearm = 2 inches letters can be read w/ aid of the flash of 22 caliber at distance of 2 ft. Biologic examinations
4. Flash of lightning – sufficient light to identify 1. Precipitin test – blood is human or not
5. Artificial light – relative to the intensity of light 2. Blood grouping

Scientific methods of identification

1. Fingerprinting – most valuable method, not changeable [4h month formed in
Differential characteristics of blood
fetus] Arterial blood Venous blood Menstrual blood Child’s blood
= DACTYLOGRAPHY: art and study of recording fingerprints as means of id. Bright, scarlet color Dark red color Does not clot Thin & soft
= DACTYLOSCOPY: art of id by comparison of fingerprints Leaves blood Does not spill far [+] vaginal epithelial RBC nucleated &
= POROSCOPY: study of pores found on the pappillary friction ridges of skin vessels w/ pressure from wound cell; dorderlein’ bacilli more than adult
2. Dental identification High O2 content Low O2 content Acidic reaction Greater fragility
3. handwriting
= BIBLIOTIC: Science of handwriting analysis
= GRAPHOLOGY: study of handwriting for the purpose of determining the writers
Inheritance pattern of ABO blood group
personality, character and aptitude. Group of parents Group of children Exclusion cases
4. Identification of skeleton OXO O A, B, AB
5. Determination of Sex, Age O X A, A X A O, A B, AB
6. Identification of blood, blood stains Q X B, B X B O, B A, AB
7. Identification of hair, fibers AX B O, A, B , AB -
O, AB A, B O, AB
Difference between Male pelvis Female pelvis A X AB, B X AB, AB X AB A, B, AB O
Construction Heavier Lighter
Wall More pronounced Less IDENTIFICATION OF HAIR AND FIBERS
Height Greater Lesser
Pubic arch Narrow and less round Wider and rounder HAIR HUMAN ANIMAL
Diameter of true pelvis Less Greater Medulla
Curve of iliac crest Reaches higher level Lower Air network in fine grains large or small sacks
Greater sciatic notch Narrow Wide Cells Invisible w/out tx in H2O Easily visible
Fuzz w/out medulla Fuzz w/ medulla
Body of pubis Narrow Wide
Cortex Looks like a thick muff Fairy thin hollow cylinder
Ileopectineal line Sharp Rounded
Pigments in the form of fine grains irregular grains
Obturator foramen Egg-shaped Triangular Cuticle Thin scales thick scale
Sacrum Short & narrow Long & wide
Kinds of death:
CRANIUM MALE FEMALE 1. Somatic or clinical death – persistence of vital functions
1) Shaft less curve more curve 2. Molecular or cellular death – 3 to six hours after cessation of life
2) Mastoid process larger smaller 3. Apparent death or State of suspended animation – transient loss of consciousness
3) cranium placed rest on mastoid process occipital& maxillary bone in hysteria, uremia, electric shock
4) Styloid process shorter longer/slender
5).Forehead higher, more oblique less high, more vertical NOTE: A fall in temp of 15-20 degrees Fahrenheit is considered as a certain sign of death
6) Superciliary ridges less sharp, more rounded sharper
7) Zygomatic arches more prominent less prominent Factors delaying the rate of cooling of body: Factors accelerating cooling:
8) Lower jaw larger & wider narrower and lighter Acute pyrexial disease Leaness of the body
9) Face larger in proportion to cranium Sudden death in good health Extreme age
Obesity of person Long-standing illness
Evidences of sex: Death from asphyxia Chronic pyrexial disease with wasting
1. Presumptive evidence = General features, hair in some parts Death of the middle age
2. Highly probabale = vagina, large breast

6
Methods of estimating how long a person has been dead from the cooling of the body: Color of lividity may indicate the cause of death.
1. If body temp. is normal at the time of death: a) asphyxia – lividity is dark
= the average rate of fall of the temp. during the first 2 ½ hours is ½ of the b) CO poisoning – pink
difference of the body temperature and that of the air. c) Hemorrhage – less marked
= the body attains the temp. of the surrounding air from 12 to 15 hours after d) Hydrocyanic acid – bright red
death in tropical countries. e) Phosphorus – dark brown
2. Chemical Method ( Schourup’s formula for the determination of the time of death of any cadaver f) Potassium chlorate – coffee brown
whose CSF is examined for the concentrations of L.A., NPN, A.A.
= L.A> 15 mg to 200 mg/100cc rapid in 1st 5 hours. CONTUSSION (BRUISE) POST-MORTEM
= NPN inc. from 15 to 40 mg/100 cc in 1st 15 hours HYPOSTASIS
= A.A. inc. from 1 mg to 12 mg% 1st 15 hours. 1. Small bruises below epidermis in true skin in the epidermis or cutis
Larger ones below this
CHANGES IN AND ABOUT THE EYE 2. Cuticle Abraded by the same violence Unabraded that produce bruise.
a) Loss of corneal reflex – seen I n live pts: G.A., uremia, narcotic poisoning 3. Bruise Appears at the seat or surrounding Always dependent
b) Clouding of cornea may or may not be dependent
c) Flaccidity of the eyeball 4. Elevated, inflammatory condition not elevated blood in b.v.
d) Pupil in the position of rest.
e) TACHE NOIR DE LA SCLEROTIQUE – spot found in the sclera after death. CONTUSSION (BRUISE) POST-MORTEM
HYPOSTASIS
Three Stages after Death: 5. Incision shows blood outside the b.v. Blood inside the vessels
a) Stage of primary flaccidity (POST-MORTEM IRRITABILITY) = most certain test of difference
= muscle relax, may contract, dilated pupil, sphincters are relaxed 6. Color variegated Uniform color
= presence of molecular life
= warm place: 1 hour and 51 minutes POST-MORTEM LIVIDITY OF SIMPLE
= chemical reaction of muscle is alkaline ORGANS CONGESTION
b) Stage of post-mortem rigidity (CADAVERIC RIGIDITY, DEATH STRUGGLE OF Post-mortem staining in organs Irregular, most dependent parts Uniform, all organs
MUSCLES OR RIGOR MORTIS) Mucous membrane Dull,lusterless Not in congestion
= whole body is rigid due to contraction of the muscles Inflammatory exudate Not seen Not seen
= starts at muscle of neck, lower jaw
= Reaction is acidic due to inc. of lactic acid Liquefaction of the soft tissues
= develops 3 to 6 hours after death in temperate, earlier in warm Putrefy rapidly: Eyeball, lining of trachea, larynx , brain, stomach, intestine, liver, spleen
= last from 2 to 3 days in temperate warm: 24-48H cold weather, 18-36H summer Putrefy late: Highly muscular organs and tissues, Esophagus, diaphragm, heart, lung,
c) Stage of Secondary flaccidity or Commencement of putrefaction (DECAY OF kidneys, U.B., uterus, P.G.
MUSCLES)
= muscle are flaccid, not respond to stimuli, reaction is alkaline CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES IN TEMPERATE
= due to dissolution of muscle proteins REGIONS
1-3 DAYS AFTER DEATH - greenish discoloration over iliac fossa, soft eyeballs
Conditions simulating RIGOR MORTIS: 3-5 DAYS - frothy blood from mouth, nostrils
1. Heat stiffening - > 75 degrees coagulates muscle proteins resulting to rigidity. 8-10 DAYS - abdominal distention, nails firm
= “Pugilistic attitude” flexed upper and lower limb 14-20 DAYS - blisters all over the body, maggots
= hands clenched, flexor stronger than extensors, burned to death 2-5 MONTHS - skull exposed, orbits empty
2. Cold stiffening = due to solidification of fats when exposed to cold temp.
3. Cadaveric spasm or Instantaneous Rigor CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES IN TROPICAL REGION
= instantaneous rigidity due to extreme nervous tension, exhaustion, injury to the nervous 12 HOURS - Rigor mortis all over, hypostasis, greenish-discoloration caecum
system. 24 HOURS - Rigor mortis absent all over, abdominal distention
= weapon in hand, weeds 48 H - Ova of flies, trunk bloated, face discolored
72 H - Whole body grossly swollen, hairs and nails loose
RIGOR MORTIS CADAVERIC SPASM 1 WEEK- Soft viscera putrefied
1. Time of appearance 3-6H after death immediately after death 2 WEEKS - Soft tissues largely gone
2. Muscles involved all muscles certain group 1 MONTH - Body skeletonized
3. Occurrence Natural phenomena May or may not appear
4. Medico-legal signif. Approximates time of death Determine nature of death BEEN SUBMERGED IN WATER
FIRST 4 OR 5 DAYS - Cold water little change, in rigor mortis
RIGOR MORTIS MUSCLE CONTRACTION FROM 5 – 7 DAYS - Skin on hands, feet is bleached, face faded white
1. Contracted muscle Losses transparency More or less transparent 1–2 WEEKS - Face swollen and red, skin of hands and feet wrinkled
2. Elasticity Loss elasticity Very elastic 4 WEEKS - Skin wrinkled, nail intact
3. Litmus reaction Acidic Neutral or slightly alkaline 6 – 8 WEEKS - Abdomen distended, skin of hands/ feet come off with nails
4. Contraction Absolute flaccidity Possess inherent contraction
Factors influencing the floating of the body in water:
CHANGES IN THE BLOOD 1. age – fully developed, well nourished - rapid
a) Coagulation of blood = blood may remains fluid inside the blood vessels 6-8H after death. 2. sex – females floats sooner
3. conditions of the body – obese float quicker
ANTE-MORTEM CLOT POST-MORTEM CLOT 4. season of the year – moist hot air – putrefaction – floats due to gas
1. Consistency Firm Soft 5. water- shallow and stagnant water of creeks, higher specific gravity, sea water floats
2. Surface of blood vessels Raw after clots are removed smooth, health after sooner than fresh water, higher specific gravity
3. Clots Homogenous can’t be stripped Can be stripped off in layers 6. External influence – heavy-wearing apparel - slower
Clots w/ uniform color clots w/ distinct layer & color
 Only teeth, bones and hair remain for an indefinite time.
b) Post-mortem Lividity or Cadaveric Lividity , or Post-mortem Suggilation or Post-mortem  A flat bone disintegrates faster than round bones.
Hypostasis or Livor Mortis
= Stoppage of heart action and loss of tone of b.v. accumulates in dependent areas except in
bony areas. SPECIAL MODIFICATION OF
= capillaries coalesce > purplish in color called Post-mortem lividity.
= Hasten by death due to cholera, uremia, and Typhus fever PUTREFACTION
= appears 3 – 6 H after death and fully developed 12 H after death. Mummification is the dehydration of the whole body which results in the shivering
& preservation of the body
Kinds of Post-mortem Cadaveric Lividity Saponification or A condition where the fatty tissues of the body are transformed to
1. Hypostatic lividity – early stage Adipocere fromation soft brownish-white substance known as ADIPOCERE at SQ level.
2. Diffusion lividity - late stage, no change in location of lividity Maceration Softening of the tissues when in fluid medium in the absence of
putrefactive mircro-org, seen in death in utero. Reddish or

7
 greenish color, skin peeling off and arms flaccid and frail. Violent death Deaths due to injuries inflicted by body by some forms of outside force
Accidental Due to misadventure or accident. Ex. Patient died of ATS injection after
HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH death proper skin test.
1. Presence of rigor mortis: 2-3 hours after death; 12 H fully developed; 18-36 H disappears Negligent Felonies may be committed when the wrongful act is due to reckless
concomitant with putrefaction death imprudence, negligence, lack of skill or foresight. Ex. Surgeon left a pack –
2. Presence of Post-mortem lividity: 3-6 H after death appears as small petechia-like red spots Homicide through reckless imprudence
3. Onset of decomposition: 24-48 H after death manifested watery; foul smelling froth, mouth, and Infanticide Killing of a child less than 3 days old
nostrils Suicidal death Destruction of one’s self. Not punished, unfortunate being
4. Stage of decomposition Parricide Killing of ones relative
5. Entomology of the cadaver: 24 H before eggs are hatched, maggots Murder Art. 248
6. Stage of digestion: 3-4 H gastric empty, 6-8 distal ileum, cecum Homicide Art 249
7. Presence of live flies in the clothing in the drowning victim: less than 24H Natural death Caused by natural disease condition in the body
8. State of clothings: pajama, night
Violent death Or sudden death, its arrival is no expected
9. Changes in CSF
10. Blood clots inside the b.v. in 6 –8 H after death.
PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH
11. Soft tissues of the body may disappear 1 to 2 years after burial.
a. Death due to syncope – fatal and sudden cessation of the action of the heart.
b. Death from asphyxia – a condition in which the supply of oxygen to the blood or to
PRESUMPTION OF DEATH
the tissues or to both has been reduced below normal working level.
Disputable presumption - not heard in 7 years
Stage of increasing dyspnea [hyspneic phase] = 1 min
Presumption of death
Stage of Expiratory convulsion [convulsive phase]
Absence of 7 years except succession 10 years
Stage of exhaustion [phassic phase] = 3 min
Vessel for 4 years
c. Death from coma
Armed forces 4 years
In danger of death 4 years
SPECIAL DEATHS
1. Judicial deaths – Art. III Sec.1 Par. 19 Phil. Const. “cruel and unusual punishment shall not
PRESUMPTION OF SURVIVORSHIP
be inflicted; electrocution, hanging, musketry, gas chamber.
1. Under 15 y.o. – older survives
2. Euthanasia or mercy killing
2. above 60 y.o.- younger
3. Suicide
3. Under 15, above 60 - former
Automatism - due to drug may be considered as accidental rather than suicidal.
4. over 15 and under 60 y.o. – male, older
5. Under 15, or over 60 y.o. and the other in between - latter
Sec. 91 (h) P.D. 856 Code of Sanitation
1. Remains shall be buried within 12 hours after death. Cause of death is due to a
Stages of MEDICO-LEGAL INVESTIGATION:
dangerous communicable disease;
1. Crime Scene Investigation – investigation of place of commission of the crime
2. Not to be taken any place of public assembly.
2. Autopsy - investigation of the body of the victim
3. Only adult members of the deceased are allowed to attend the funeral.
PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY
Sec. 1100 of RAC, Sec. 91© of P.D. 856 Code of Sanitation
1. Requirement Consent of next of kin Law that gives the consent
The depth of the grave must be at least 1 ½ meters deep, filled well and firmly.
2. Confirmation Clinical findings of research Correlate tissue changes to criminal act
3. Emphasis Notation at all abnormal findings Effect of wrongful act
Sec. 2695 RAC Penalizes the desecration of burial premises; tombstone, plant, tree, fence, post
4. Conclusion Summation of all abnormal findings Specific to the purpose
or wall. P200/ not greater than 6 months.
5. Minor Need not be mentioned Included if useful
Sec. 90 code of Sanitation Burial Grounds requirements
The following manner of death should be autopsied:
1. It shall be unlawful for any person to bury the remains in places other than those
2. Death by violence
legally authorized.
3. Accidental deaths
2. At least 25 meters from any dwelling house and no house shall be constructed
4. Suicides
within the same distance from any burial ground.
5. Sudden death of persons who are in good health
3. Not within 50 meters from any water source.
6. Death unattended by physician
7. D.O.A. with no clinical diagnosis
Other burial requirements:
8. Death occurring in an unnatural manner
1. Shipment of remains abroad shall be governed by the rules and regulations of the
Bureau of Quarantine.
If signs of violence are associated with the natural cause of death:
2. The burial or remains in city or municipal grounds shall not be prohibited due to race,
nationality, religious or political reasons.
* Did the person die of a natural cause and were the physical injuries inflicted
3. Except when required by legal investigation or when permitted by the local health
immediately after death? Violence applied in a dead person : Impossible crime.
authority, no embalmed remains shall remain unburied longer than 48 hours.
* Was the victim suffering from a natural disease and the violence only accelerate the
FUNERALS
death?
Art. 305 CC The duty and the right to make arrangements for the funeral of a relative shall be in
= Offender responsible of the death of the victim.
accordance with the order of support under Art. 294.
= Criminal liability shall be incurred by any person committing a felony although the wrongful act
Descendants: Eldest
done be different from which he intended.
Ascendants: Paternal
(Art.4 no.1 RPC)

* Did the victim die of a natural cause independent of the violence inflicted?
Use of body for scientific purposes
- Corpse of prisoners
= accused will not be responsible for the death but merely for the physical injuries he had
- Any person to be buried for public expense and which is unclaimed for 24 hours.
inflicted. Ex. Slapping a person with heart problem, only slight physical injury.
= to make the offender liable for the death of the victim, it must be proven that the death is the
EXHUMATION - the deceased buried may be raised or disinterred upon the lawful order of the
natural consequence of the physical injuries inflicted
proper authorities.
Sec 1082 RAC - Cemetery permits even to NBI agents
PENAL CLASSIFICATION OF VIOLENT DEATHS
Sec. 1097 RAC - Exhumation in case of death from dangerous communicable disease after 5
years from burial.
Sec 92 Code of Sanitation - 3 years if non-dangerous communicable disease. Remains shall be
disinfected before burial.

VITAL REACTION: It is the sum total of all reactions of tissue or organ to trauma, either
observed micro or macroscopically.
a. RUBOR – redness or congestion of the area due to an increase of blood supply as a part of
the reparative mechanism.

8
 b. CALOR – Sensation of heat or increase in temperature.
c. DOLOR - pain due to involvement of the sensory nerve.
d. LOSS OF FUNCTION- due to trauma, the tissue may not function.
NOTE: The presence of vital reaction differentiates an ante-mortem from a post-mortem injury.
EXCEPT: vital reactions not seen even if injury inflicted during life:
1. During agonal state of a living person were cells don’t react to the trauma.
2. Sudden death as in sudden coronary occlusion.
CLASSIFICATION OF WOUNDS:
1. AS TO SEVERITY
a. Mortal wound – caused immediately after infliction that is capable of death.
Parts of body that are mortal – heart, vessels, CNS, lungs, other organs.
b. Non-mortal wound - Not capable of producing death after infliction.
2. AS TO KIND OF INSTRUMENT USED
a. Blunt instrument – contusion, hematoma, lacerated wound.
b. Sharp instrument
= Sharp-edge instrument > incised wound
= Sharp pointed > punctured wound
= Sharp edge and sharp-pointed > stab
c. Wounds brought about by tearing force – lacerated wound
d. By change in atmospheric pressure – barotraumas.
e. Wounds brought about by heat or cold – frostbite, scald, burns.
f. Wounds brought about by chemical explosion – GSW, shrapnel wound
g. Wounds brought about by infection.
1. Prison mayor – because of the physical injuries inflicted, the injured person becomes insane,
imbecile, impotent or blind.
2. Prision correctional in its medium and maximum periods - loss of speech, hear or smell, loss
of eye, hand, foot, arm, leg, loss of the use or incapacitated for the habitual work he used to
do
3. Prision correctional in its minimum and medium periods - person injured shall be deformed.
Lost any other part of the body, incapacitated for more than 90 days.
4. Arresto mayor in its maximum period to prision correctional - If the physical injuries shall have
caused the illness or incapacity for labor for more than 30 days.
SLIGHT PHYSICAL INJURIES AND MALTREATMENT [Art 266 RPC]
1. Arresto menor- when the offender has inflicted physical injuries which shall
incapacitate the offended party for labor form 1 to 9 days or shall require medical
attendance of the same period
2. Aresto menor or fine not exceeding P200 and censure when the offender has cause
physical injuries which do not prevent the offended party from engaging in his
habitual work nor require medical attendance.
3. Arresto menor in its minimum period or a fine not exceeding P50 when the offender
shall ill treat another by deed without causing any injury.
TYPES OF WOUNDS (MEDICAL CLASSIFICATION)
1. CLOSED WOUND – no breach of continuity of the skin or mucous membrane.
a. Superficial – When the wound is just underneath the layers of the skin or mucous
membrane.
a.1 –PETECHIAE: Example : mosquito bite, blood disease, hanging
a.2 – CONTUSSION: Example: Black eye> Forehead

3. AS TO THE MANNER OF INFLICTION Medico-legal point of view:

a) HIT – means of bolo, blunt instrument, axe. A contusion as indicated by its external pattern may correspond to the
b) TRUST or STAB – bayonet dagger > Shape of the object or weapon used.
c) GUN POWDER EXPLOSION – Projectile or shrapnel wound. Extent > the possible degree of violence applied.
d) SLIDING or RUBBING or ABRASION Distribution> indicates the character and manner of injury as in manual strangulation
around the neck.
4. AS REGARDS TO THE DEPTH OF THE WOUND Age of Contusion: appreciated from its color change
A) Superficial – wound involves only the layers of the skin. The size tends to become smaller from the periphery to the center and passes through
B) Deep – inner structures beyond the layers of the skin. a series of color changes as a result of disintegration of the RBC and liberation of
hemoglobin.
Defense wounds Results of a person’s instinctive reaction of self-protection The contusion is red, purple soon after its complete development.
Mortal wounds Wounds w/c are immediately after infliction or shortly after death 4 to 5 days > green
Penetrating wound When it has pierced a solid organ or tissue 7 to 10 days > yellow and gradually disappears on the 14 th or 15 th day.
Perforating wound When there is communication btw inner & outer parts of hollow organ
Close wounds When there is no breech of continuity of skin or mucous membrane The ultimate disappearance of color varies from 1 to 4 weeks depending upon the
Incised wound Produced by forcible contact of body w/ sharp edge instrument severity and constitution of the body. The color changes starts at the periphery.
Stab wound Produced by penetration of a sharp pointed & sharp edge instrument
CONTUSION [bruise] POST-MORTEM HYPOSTASIS
Punctured wound Brought about by sharp-pointed instrument
Below the epidermis In the epidermis or in the cutis
Lacerated wound Tear of skin due to forcible contact w/ a blunt instrument
Cuticle was probably abraded Cuticle unabraded
Suicidal wounds Usually located in peculiar parts of the body, accessible to the hand.
Most common site is the wrist, radial artery and the neck. Often elevated Not elevated
Homicidal wounds Usually deep, multiple and involves both accessible and non-
accessible parts. Clothing is usually involved Incision shows blood outside Blood is still in its vessels
Accidental wounds Multiple incised wounds observed on the passenger and driver of Color variegated Color is uniform
MVA due to broken windshields. Kitchen knives in food preparation. Surface of contact may be a little lighter than White lines or patches of pressure bordered
Defense wounds Instinctive reaction of self-preservation. > hands/fractures the rest of the bruise but will not be white. by the dark color of hypostasis are produced.
Patterned wound Wound in nature and shape of instrument Wheels, abrasions of rope. Appears at the seat of and surrounding the Always in a part which for the time of
injury information is dependent.
Self-inflicted wound Wound produced on oneself but no intention to end his life.
Contusion Hematoma
5. AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE AND Efused blood are accumulated in the Blood accumulates in a newly formed cavity
THE LOCATION OF INJURY interstices of the tissues underneath skin underneath the skin.
Skin shows no elevation and is ever elevated, Skin is always elevated. Abscess, gangrene,
a. Coup Injury – Physical injury which is located at the site of the application of force. the elevation is slight and is on account of hypertrophy, fibroid thickening and even
b. Contre-coup injury – opposite the site of the application of force. inflammatory changes malignancy are potential complications.
c. Coup contre-coup injury – site and also opposite of application of force. In contusion, puncture or aspiration with In hematoma – shows presence of blood and
d. Locus minoris resistencia – Physical injury not located at the site nor opposite the site of the syringe of the lesion, no blood can be obtained. subsequent depression of the elevated lesion.
application of force but in some areas offering the least resistance to the force applied.
OPEN WOUNDS
6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED A. Abrasion (Scratch, graze, impression mark, friction mark)
Injuries in various parts of the body Forms of abrasion
= Linear abrasion, Multi-linear, Confluent or Multiple
NOTE: Vasectomy/Tubal ligations 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. Types of abrasion
= Scratch, Graze, Impact or imprint abrasion (patterned abrasion, stamping abrasion, abrasion a la
SERIOUS PHYSICAL INJURIES [Art. 263 RPC] signature) or Pressure or friction abrasion
Any person who shall wound, beat or assault another Art. 263 and administering injurious
substance, without intent to kill Art. 264. ANTEMORTEM ABRASION POSTMORTEM ABRASION
COLOR reddish-bronze due to slight yellowish and transparent
The main purpose of dividing the provision into four paragraphs exudation of blood
a) Is to graduate the penalties depending upon the nature and character of the wound inflicted LOCATION any area over bony prominence
b) Their consequences on the person of the victim. Rough handling of the cadaver

9
VITAL with intravital reaction shows not vital reaction and
REACTION may show remains of damaged is characterized by a separation ANTE-MORTEM WOUNDS POST-MORTEM WOUNDS
Epithelium of the epidermis from HEMORRHAGE More profuse, arterial Slight or none, venous
Complete loss of the former. due to loss of tone of vessels,
Changes that occur in an incised wound: Absence of heart action
1. After 12 hours – edges are swollen, adherent with blood & w/ leukocyte infiltration. Post-mortem clotting of
2. After 24 hours – proliferation of vascular endothelium & connective tissue cells. blood inside b.v.
3. After 36 to 48 hours –capillary network complete, fibroblasts running to the vessels. Marks of spouting of blood No spouting of blood
4. After 3 to 5 days – vessels show thickening and obliteration. from arteries
Clotted blood Bld not clotted,or soft clot
Throat SUICIDAL WOUNDS HOMICIDAL WOUNDS SIGNS OF Inflammation & reparative None
DIRECTION Oblique from below left ear, Usually horizontal below INFLAMMATION process
downwards across front neck the adams apple Swelling in the area,
just above Adams apple Effusion of lymph, pus
Adhesion of the edges
SEVERITY Usually not so deep and Usually deep and may cause Unless if victim is weakened
may only involve trachea, involvement of the cartilage SIGNS OF Fibrin formation No time of repair
carotid and esophagus and bones. REPAIR growth of epithelium
Scab or scar formation
SUPERF’L Usually present before the Practically absent but may RETRACTION Deep staining of the edges Not deeply stained
CUT commencement of deeper rarely be present when the OF THE EDGES and cellular tissues can be removed by washing
wound. victim struggled when attacked OF THE WOUND not removed by washing
Edges gape owing to the reaction Edges do not gape, but are
POSIT’N OF May be sitting or facing a Usually victim lying on bed of the skin and muscle fibers closely approximated to
THE BODY mirror or standing or in other place. Each other unless if the
wound is 1 to 2 hrs
WOUNDING Firmly grasp (cadaveric spasm) Weapon is absent after death
WEAPON or found lying beside the DETERMINATIONS IF WOUND IS:
Victim. HOMICIDAL SUICIDAL ACCIDENTAL
ABRASIONS Not common unless Rarely observed Extensive
BLOOD Bld found in front part of body Bld found at the back of neck. If dragged abrasions MVA
DISTRIBUTION Hand smeared with blood. Hands are clean. Or if victim resisted
CONTUSION Rare except when Found in any portion
MOTIVE History of mental depression, Absence of such history jumping from a height of the body - Fall

INCISED WOUNDS LACERATED WOUNDS INCISED Commonly observed Commonly observed Frequent but rarely WOUNDS
Edges are clean, cut; regular, well defined edges are roughly cut, irregular, and ill-defined
No contusion or swelling around wound swelling and contusion around wound POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE
Extremities of the wound are sharp, may be extremities are ill-defined and irregular INJURIES
Round, or contused Contusion Blunt instrument
Examination by means of a hand lens hair bulbs are preserved Lacerated wound Blunt instrument
Shows that hair bulbs are cut Incised wound Sharp-edged instrument
Healing is faster healing is delayed Punctured wound Sharp-pointed instrument
Caused by sharp edged instrument caused by a blunt instrument Abrasion body surface is rubbed on a hard surface
GSW The diameter of the wound of entrance may approximate
Practical ways of determining how much of the skin surface is involved in an injury or the caliber of the wounding instrument.
disease:
= burns of 70% in children and older age group are fatal. GUNSHOT WOUNDS
= rule of nine is used. Head and neck 9% 9% Types of small firearms which are of medico-legal interest:
one upper extremity 9% 18% 1. revolver – usual muzzle velocity is 600 feet per second
front chest and abdomen 18% 18% 2. automatic pistol – self-loading firearm, muzzle velocity of 1200 feet per second
posterior chest and abdo 18% 18% 3. Rifle - muzzle velocity of 2500 feet per second and a range of 3000 feet.
one lower extremity front 9% 18% 4. shotgun - projectile is a collection of pellets
one lower ext(back) 9% 18% A weapon in order to cause injury must have two principal component parts:
pudendum 1% 1% 1. Cartridge or ammunition - bullet primer, cartridge case, powder charge
TOXINS 2. Firearm – instrument for the propulsion of a projectile force of gases from a burning powder.
1. Snake bites: > 2 punctured wounds at the center of the reddened affected area. The
venom is injected through its fangs which are connected to the poison gland.
ENTRANCE WOUND EXIT WOUND
Snake venoms are two principal classes:
Appears to be smaller than the missile Always bigger than the missile
A. Neurotoxic – primarily paralysis the respiratory and cardiac center of the brain. May cause NAV,
Owing to the elasticity of the tissue
ascending paralysis, coma, convulsion, c/p arrest
B. Hematoxic - affects particularly the blood. Manifestations are pain, swelling on the affected Edges are inverted Edges are everted
area, IV hemolysis, NAV, pulmonary and cardiac edema Usually oval or round depending upon Does not manifest any definite shape
2. Scorpion venom the angle of approach of the bullet
- Venom has toxic, hemolytic, hemorrhagic Contusion collar or contact ring is present Absent
- One punctured wound on the center of a reddened area, w/ pain, edema and reddening due to skin invagination & spinning of missile
3. Coelenterate sting (Jellyfish) Tattooing or smudging may be present when Absent
- Tentacles penetrate into the skin and cause explosion of the nematocyst and liberation of when firing is near
the venom. Manifested by extreme pain. Urticarial rash, dilated pupils, paleness, labored Underlying tissues are not protruding Underlying tissues may be seen protruding
breathing Always present after fire May be absent, if missile is lodged in the body
Paraffin test may be positive Negative
MEDICO-LEGAL INVESTIGATION OF WOUNDS
Examinations of wound 1. Factors which make the wound of entrance bigger than the caliber :
- Character of wound: abrasion, hematoma, laceration etc a. in contact or near fire
- Location of wound: from some fixed area > to determine trajectory/course b. deformity of the bullet which entered
- Depth of wound: not in the living , only if the outer and inner are fixed c. bullet might have entered the skin sidewise
- Conditions of the surroundings of the wound - d. acute angular approach of the bullet
= near GSW – burning, tattooing 2. Factors which make the wound of entrance smaller than the caliber
= suicidal cuts – superficial tentative cuts or hesitation cuts a. fragmentation of the bullet before penetrating the skin
= lacerated wounds – contusion on neighboring skin b. contraction of the elastic tissues of the skin

10
Instances when the number of GSW of entrance is less than the number of GSW of exit Microscopically: Vacuolization, degeneration of epidermal cells
in the body of the victim: : Necrosis of the collage of the SQ tissue
1. A bullet might have entered the body but split into several fragments, each of which made : Occlusion of the vessels due to clumping of RBC
separate exit.
2. One of the bullets might have entered a natural orifice of the body. Ex. nose Thermal burns: Caused by heat or chemical substances like fire, radiant heat, friction, solid
3. There might be two or more bullets which entered the body through a common entrance and substances, electricity.
later making individual exit wounds. Classification of burns/DUPUYTREN’S CLASSIFCATION
4. In near shot with a shotgun, the pellets might have entered in a common wound and later 1st Degree –erythema
dispersed while inside the body and making separate wounds of exit. 2nd - vesicle formation
3rd - destruction of the cuticle, part of true skin, painful
Instances when the number of GSW of entrance is more than the number of GSW of exit 4th - whole skin is destroyed, ulceration, not painful
in the body of the victim: 5th – deep fascia, muscles
1. When one or more of the bullet is not through and through and the bullet is lodged in the body. 6th - charring of the limbs
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. BURNS SCALDS
3. When different shots produced different wounds of entrance but two or more shots produced a CAUSE Dry heat – flame, heated Moist heat – liquid, steam
common exit wound. solid, radiant heat
LOCATION At or above the site of contact Occurs at or below
Instances when there is no GSW of exit but the bullet is not found in the body of the SINGEING Singeing of hair is present Absent
victim: BOUNDARY OF NORMAL Not clear Distinct
1. When the bullet is lodged in the GIT and expelled through the bowel or lodged in the pharynx INJURY Severe Limited
and expelled through the mouth. CLOTHINGS Involved Not burned
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
Findings w/c may prove that death is due to burning
have the wound of entrance as the wound of exit.
1. presence of vital reactions at heated area
2. presence of carboxyhemoglobin in blood
DETERMINING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC PISTOL OR
3. presence of carbon particles in tracheo-bronchial lumina
A REVOLVER
1. Location of the empty shells – revolver the empty shells are found in the cylindrical magazine
Proofs that the victim was ALIVE BEFORE burned to DEATH:
chamber after the fire
1. Presence of carbon particles in the air passage.
2. Nature of the spent shell – automatic firearm = bullet is copper jacketed
2. Increase carboxy-hemoglobin blood level.
3. Nature of the base of the cartridge or spent shell = base of a revolver has a wider diameter than
3. Dermal erythema, edema and vesicle formation.
that of the cylindrical body to keep the cartridge stay in the magazine chamber.
4. Subendocardial left ventricular hemorrhage.
NOTE:
 It may be possible for a person who is accustomed to the sounds of firearms of different
BURNS ANTE-MORTEM BURNS POST MORTEM BURNS
calibers to identify the firearm by the sound produced.
BLISTERS Abundant albumin/chlorides Scanty albumin/chlorides
 It is not possible to determine direction of the shot by determining direction of the sound
AREA OF INFLAMMATION Around the antemortem burn Absent
except when the flash or the person firing the shot is seen at the time the shot was fired.
BASE OF THE VESICLE Red Not much change in color
Accidental GSW Homicidal GSW TRACHEOBRONCHIAL LUMEN Particles of soot or carbon No findings
Usually 1 shot POE has no point of election BLOOD Abundance of carboxy-Hgb Absent
No special part of body involved Fire is made assailant is from a distant
Testimony of assailant w/ sign of struggle CHEMICAL BURNS THERMAL BURNS
Testimony of witness disturbances of the surrounding BLISTERS Absent Present
wounding firearm usually not found in crime scene SKIN/CLOTHINGS Stained by chemicals No staining
testimony of witness ANALYSIS OF SUBSTANCE Shows chemical cause of corrosion Absent
LESION Borders are distinct Diffused
Tests for the Presence of Powder residues
1. On the skin – Dorsum of the hand or Wound of entrance ANTE-MORTEM BLSITERS POST-MORTEM BLISTERS
Dermal nitrate test (Paraffin test, Diphenylamine test, Lung’s test , Gonzales’ test) Contain fluid rich w/ albumin & chlorides May contain air or scanty albumin & chloride
= melted paraffin heated at 150 degrees fahrenheit – Lung’s reagent Heating of its fluid will cause solidification Show slight cloudening w/o solidification
= small particles with nitrate or nitrite > blue reaction Base of blister is reddish w/ signs of No such finding
= not conclusive: fertilizers, cosmetics, cigarettes, urine inflammatory changes in periphery
= Negative is not conclusive: thorough washing Abundant fluid content Scanty fluid content
2. On clothings
Walker’s test ( C-acid test, H-acid test)
= glossy photographic paper fixed in hyposolution for 20 min to remove the silver Characteristic lesions by different chemicals:
salts and washed for 45 min. and dries. Sulphuric acid / Oil most intense action, considerable destruction, ulcerations where acid
of Vitriol flowed, clothings destroyed, blackish-brown sloughs
Tests for the presence of Primer Components – metallic primer residues like barium, Nitric acid Clothing is destroyed, brown, yellow or yellowish brown slough
antimony, and lead. Hydrocloric acid Not so destructive, intense irritation, localized ulceration red/reddish-gray.
1. Harrison and Gilroy test: Cotton swab moistened with 0.1 molar HCl to gather the primer Caustic soda Corrosive action on the tissues with bleached appearance
component.
= Reagent sodium rhodisonate yields red color with the primer components.
= Add 1.5 HCl to the red area> blue-violet or pink in lead or barium TYPES OF DEATH BY ASPHYXIA
= lacks specificity, sensitivity Anoxic death Failure of arterial blood to be normally saturated with O2
2. Neutron Activation Analysis (NAA) Anemic anoxic Decrease capacity of the blood to carry O2 due to Hge, CO poisoning,
= Sample obtained by paraffin or by washing with dilute acid death and Low Hgb
= Extremely sensitive, even with small quantity Stagnant anoxic Failure of circulation due to Heart failure, shock, arterial venous
3. Flameless Atomic Absorption Spectroscopy (FAAS) death obstruction
4. Use of Scanning electron microscope with a Linked X-ray analyzer Histotoxic anoxic Failure of the cellular oxidative process, cannot be utilized in the
death tissues. Cyanide & Alcohol
Effects of COLD:
A. Local effect ( Frostbite, Immersion foot, Trench foot ) Phases of asphyxial death:
1st – Blanching , paleness of the skin due to vascular spasm. 1. Dyspneic phase – Breathing is rapid and deep, PR inc., Rise of BP [due to lack of O2 and
2nd – Erthyma, edema, swelling due to vascular dilatation, paralysis and retention of CO2]
increased capillary permeability. 2. Convulsive phase – Cyanosis more pronounced, pupils dilated, unconscious
3rd - Blister formation Tardieu spots = petechia /hges in the visceral organs due to stimulation of CNS by CO2
th
4 – Necrosis, vascular occlusion, thrombosis and gangrene.

11
3. Apneic phase – Breathing is shallow, gasping due to paralysis of respiratory center Floating of the body in drowning:
- Within 24 H due to the decomposition which causes the accumulation of gas in the body, the body
Hanging is ante-mortem when: floats.
1. [+] redness/ecchymosis at ligature site - Body is flexed because of the dominance of the flexor muscles
2. [+] ecchymosis of pharynx & epiglottis -“tete de negri” – bronze color of head and neck; face as the most dependent portion of the body.
3. line of redness or rupture of the carotid artery
4. subpleural or subpericardial punctiform hemorrhages ASPHYXIA BY BREATHING IIRESPIRABLE GASES
1. Carbon monoxide “silent killer”, colorless, insoluble in water and alcohol.
Causes of death in hanging - Formed by the incomplete combustion of carbon fuel.
1. dislocation or fracture of upper cervical vertebra - Main action is O2 deprivation
2. partial/complete severance of spinal cord Qualitative test for CO in the blood
3. rupture of cervical muscles a) Kunkel’s test – 4 volume of water + 3x its volume of 1% tannic acid, crimson red if positive
4. asphyxia + syncope due to pressure on vagus nerve b) Potassium Ferrocyanide test – bright red
5. cerebral anemia c) Spectroscope exam
d) Gas chromatograph
HANGING STRANGULATION e) Infra-red analysis
WITH LIGATURE
HYOID BONE Frequently injured Frequently spared 2. Carbon dioxide – CO2, Carbonic acid gas
DIRECTION OF LIGATURE MARK Inverted V-shape Usually horizontal - Blown out of the lungs during respiration
LIGATURE LOCATION At level of Hyoid bone Below larynx - Product of complete combustion of carbon containing compounds
LIGATURE GROOVE Deepest opposite the knot Uniform depth Tests for the presence of CO2
1. Barium nitrate – white precipitate of Barium carbonate with carbonic acid
VERTEBRAL INJURY Frequently observed Not observed 2. Silver nitrate – white ppt. of silver carbonate when carbonic acid is added.

3. Hydrogen sulfide (H2S, Sulphuretted hydrogen) = rotten egg odor

Amount of tension in ligature sufficient to occlude - Formed during decomposition process of organic substances containing sulphur
- Causes titanic convulsion, delirium, coma, death
vital structures in Neck
Jugular veins 2 kilos [4.4 lbs] 4. Hydrogen cyanide – one of the most toxic, rapid acting gas
Carotid artery 5 kilos [11 lbs] - Formed by the addition of acid to potassium or sodium salt of cyanide
Trachea 15 kilos [33 lbs] - Contains AMYGDALIN which in the presence of water and natural enyzme
Vertebral artery 30 kilos [66 lbs] EMULSIN is readily decomposed to HYDROCYANIC ACID, glucose and benzaldehyde.
= 60-90 mg of Hydrogen cyanide is fatal, death in 2 to 10 min.
Time required for death in drowning:
- Submersion for 1 ½ minutes considered fatal. 5. Sulfur dioxide - Heavier than air, pungent odor
- Average time required for death in drowning is 2 to 5 minutes. - employed as disinfectant, bleaching agent

Phases of drowning
1. “respiration de surprise” – at the moment when mouth & nose are covered by fluid
Causes of death & corresponding color of lividity
2. phase of resistance Asphyxia Dark
3. dyspneic phase w/ forceful respiratory movement CO poisoning Bright red
4. another apneic phase Hemorrhage/ anemia Less marked
5. terminal respiration Hydrocyanic acid Bright red
Phosphorus Dark brown
Emergency treatment in Drowning Potassium chlorate/ HCO3 Dark brown
1. Schaefer’s method–Face down, prone position:operator exerts pressure in ribs
2. Sylvester’s method- Lying on his back, astride over body, swinging arms MEDICOLEGAL ASPECTS OF SEX CRIMES
Duration of laceration:
Internal findings 1. fresh bleeding laceration = recent origin
A. RESPIRATORY SYSTEM 2. fresh healing w/ fibrin formation & edema of surrounding tissue = after 24 hrs
1. “Emphysema aquosum” – Lungs are distended overlapping the heart 3. healed laceration w/ congested edges & w/ sharp coaptible borders = 4-10 days
= Due to irritation made by the inhaled water on the mucous membrane of the air passage 4. healed laceration w/ sharp coaptible borders w/o congestion = 10 days or 2-3 wks.
which stimulate the secretion of mucous. 5. healed laceration w/ rounded non-coaptible borders & retraction of edges = > 1 month
2. “Edema aquosum”– Due:Entrance of water into air sacs, Lungs are doughy
3. “Champignon d’ocume” – whitish foam accumulates in the mouth/nostrils
= Due: abundance of mucous secretion
Kinds of virginity
Moral virginity State of not knowing nature of sexual life 7 have not experienced
sexual relation
Unexpanded vs. expanded lung Physical Condition whereby a woman is conscious of the nature of sexual life
Unexpanded Expanded lung virginity but have not yet experienced sexual intercourse.
Small volume Greater, fills the chest cavity True physical Wherein the hymen is intact, w edges distinct & regular w/ small
Sharp, project beyond thymus & heart Rounded edges & cover he thymus & heart virginity opening, barely admitting tip of smallest finger w/ less resistance.
Dark brown or uniform purplish gray w/ Bright vermillion w/ mottling alternating w/ blue False physical Wherein the hymen is unruptured but orifice is elastic & permitting 2
no mottling patches virginity or more fingers of the examiner w/ less degree of resistance.
Feel solid Feel spongy & crepitant Demi-virginity Woman who permits men any form of sexual liberties as long as they
x-section: little blood exudes Blood-stained frothy serum exudes, squeezing abstain from rupturing the hymen.
450-600 mg 900-1000 mg
Hydrostatic test [-]
w/ collapsed air sacs on microscopy
Hydrostatic test [+]
w/ expanded air sacs
Classification of fully developed breast according to
shape
B. HEART Hemispherical Breast is like a hemisphere; contour lines are not straight
1. Both sides of heart may be filled or emptied with blood. Conical breast Outline consists of 2 converging lines w/c meet at nipple
2. Salt water drowning – Blood chloride content is greater than left side. Infantile or flat Breast slightly elevated from chest w/o distinct boundary & no
Fresh water- Blood chloride is more I the right side. FRESH- RIGHT definite shape
Pendulous breast Breast skin is lose making it capable of swinging in any direction;
C. STOMACH seen in lactating parturients
- Presence food in the stomach but absence of water.> Death is rapid or submersion made after
death. Impossible for water to get into the stomach if body is submerged after death.
Classification of hymen according to size & shape of opening

12
Annular/circular Oval opening, located at center of hymen, w/ indented border DRUG DEPENDENCE
Infantile hymen Small opening, usually linear, fleshy & resistant Dangerous drugs – drug whose use is attended by risk & therefore unsafe, perilous & hazardous
Semilunar or Concavity may be facing either side or upwards or downwards. to people or to society.
crescentric The tapering sides may be frequent sites of laceration Prohibited drugs
Linear hymen Opening is slit-like & usually running vertically 1. opium – heroin, morphine
Cribrifrom w/ several openings, some are not visible to naked eye 2. coca leaf – cocaine
Stellate hymen Star-shaped opening 3. hallucinogenic drugs; LSD
4. Indian hemp & derivatives
Septate w/ 2 openings w/c may be of equal or different sizes
5. other drugs w/ physiologic effect of narcotic drug
Fimbriated w/ small irregular protrusions towards the opening
Regulated drugs
Imperforate No hymenal opening
1. Self-inducing sedatives – secobarbital, Phenobarbital
2. amphetamine-like – benzidrine
RAPE: by having carnal knowledge 3. hypnotic drugs - methaqualone
1. using force or intimidation – manifested & tenacious resistance
2. deprive of reason, unconscious - insane, under alcohol, drugs Identification of some dangerous drugs: color test
3. under 12 y/o – statutory rape even if prostitute or w/ consent, even if woman is Drug Tests
inchaste
Opium & derivatives, amphetamine Marquis test
Barbiturates Dillie Koppanyl test, Zwikker’s test
Requisites for crime of seduction & abduction
Marijuana Duquenois-Levine test
Simple
seduction 12.18 .o, single/widow of good respiration , carnal knowledge, LSD Van Urk test
act was committed by means of deceit Coccaine Cobalt Thiocyanate test
Qualified virginity of offended party, 12-18 y.o, carnal knowledge act was done
seduction by abuse of authority, confidence or relationship
Consented offended party must be a virgin, 12-18 y.o, taking away was w/ her
Slang terms in local drug cultures of the following
abduction consent, taking away must be w/ lewd design dangerous drugs
Forcible person abducted must be a woman, abduction is against her will, w/ LSD Mind altering Acid, blue heavens, flash, “lason sa daga”
abduction lewd signs Marijuana Mind altering Damo, “lakbay diwa”, mary jane, joints, sticks, cannabis
Acts of The offender commits any act of lasciviousness, it is done using force, Opium Depressant Kalamay, panutsa, ballot, sleep, death
lasciviousness if victim is unconscious or deprive, under 12 y.o, either sex of victim
Heroin Depressant Gamut, motga, horse, junk, dynamite
Morphine Depressant Dope, morf, pink, dreamer, heard stuff
Examination of seminal fluids & sperms
Barbiturates Depressant Barbs, red devil, downers, yellow jackets
1. gross examination
2. micro-chemical examinations Amphetamines Stimulant Pep pills, uppers, wake-ups, hearts, berries, diet pills
a. flurence test
b. berberio’s test – specific for spermatic fluid Absorption & distribution of alcohol:
c. puramen reaction – very reliable: yellow precipiate  Maximum period of absorption occur 30-60 mins after initial intake.
d. acid phosphaase test  Optimum concentration of alcohol in beverages btw 10-20% is the most rapidly absorbed.
3. microscopic examinations  Windmarks formula = ounces of BW x 0.68x blood alcohol concentration / 0.8
a. dr. hankin’s mehod

4.
b. ganguli’s method
biologic examinations
Clinical S/Sx in relation to alcohol level
a. precipitin test [biological test of Farnum] – semen is of human origin Blood alcohol Clinical S/Sx
b. seminal grouping 10 mg % Pleasant clearing of the head
20 mg % Physical feeling of well-being
The fetus is considered born if: 50 mg % Feels on top of the world, ↑ self-confidence, talkativeness
1. it is alive at the time I is completely delivered from the mother’s womb. 100 mg % “under influence” innocent not convicted = mental confusion & drowsiness
2. if fetus had an intrauterine life of < 7 mos., it is not deemed born if it dies win 24 hrs 150 mg % All are intoxicated, decrease performance
after its complete delivery from maternal womb. 150-300 mg % All loose muscular coordination
300 mg % Stuporous, loose sphincter control
Children born after 10 days following celebration of marriage and before 300 days following is 400 mg % Anesthetic level, death
dissolution or separation of the spouses shall be presumed to be legitimate provided there is no
impossibility of the husband having access o his wife. Stages following alcohol ingestion
1. stage of excitement – few minute after ingestion, feeling of well-being
INSANITY: 2. stage of incoordination & confusion – blunting of perception
Sociological concept: persistent inability thru mental causes to adapt oneself to the ordinary 3. stage of narcosis or coma – slow breathing, pupils dilated
environment.
Medicine: prolonged departure of the individual from his natural mental state arising from bodily
disease. Presumptive limits of alcohol
Law: the relation of a person & the particular act which is the subject of judicial investigation. 0.05 % Uninfluenced by alcohol
0.05-10% Considered to be under influence of alcohol
FEIGNED INSANITY TRUE INSANITY 0.10- Presumption that person is drunk
Develops suddenly Insidiously 0.15%
No peculiar facial expression Commonly observed 0.2 % Intoxicated
Sx complete & numerous Not refer to a specific disease 0.5 % Coma
Violent exertion – exhausted No exhaustion NOTE:
Personal hygiene None  The amount of alcohol in breath is proportional to concentration of alcohol in the blood.
 Diseases associated w/ or w/o complications of alcoholism – fatty liver, crrhosis
Intelligence quotients Methods used in alcohol detection
I.Q Classification Mental retardation Classification 1. chemical method – oxides, chromate
Above 140 Genius < 20 Profound 2. enzymatic method – coenzyme NAD
120-140 Very superior 20-35 Severe 3. gas chromatographic method
110-120 Superior 36-51 Moderate 4. infrared absorption method
90-110 Normal / average 52-67 Mild NOTE:
80-90 Dullness 68-83 Borderline  the longer the time interval between extraction & examination, the more it increases the
70-80 Borderline / feeble-minded alcohol contents of the sample.
< 70 Definitely feeble-minded  MC method used is blodd examination

MEDICOLEGAL ASPECT OF POISONING

13
Post-mortem findings in opium poisoning 3. sign board license fee – paid to municipality where you would practice
1. pupils – pinpoint 4. income tax – paid to national government based on your income.
2. brain – congested
3. lung – engorged, edematous, exudes frothy fluid Not considered practice of medicine
4. face - livid 1. medical intern under supervision of registered doctor
2. dentist engaged in practice of dentistry
3. any duly registered masseur or physiotherapist
Characteristic postmortem findings 4. optometrist who sells lenses
Asphyxia by drowning Emphysema aquosum 5. any person who renders service in emergency where no MD is available
“le facies sympathetic” Asphyxia by hanging 6. prosthetists who fits artificial limbs
Inverted V ligature mark Asphyxia by hanging 7. clinical psychologists
Pugilistic body position Burns
Washerwoman’s hands Asphyxia by drowning Certificate of registration is withheld in the ffg cases:
“champignon d acume” Asphyxia by drowning 1. crime involving moral turpitude has convicted the doctor
Pinpoint pupil Opium poisoning 2. guilty of immoral or dishonorable conduct
Contusion collar GSW 3. declared of having an unsound mind
Tardieu’s spot Asphyxial death
Bright pink-colored blood CO poisoning Types of medical services w/ the px may solicit from his doctor
1. perform specific tests
2. examine px & inform his state of health
Physiological classification of suicide 3. examine & recommend remedy
1st degree Planned, deliberate, self-murder 4. give emergency tx
2nd degree Impulsive, unplanned, under provocation 5. tx but no follow-up care
3rd degree “Accidental suicide” by voluntary self-injury relatively harmless 6. tx w/ follow-up care
Circumstantial Suggest lack of capacity for intention as when person was
psychotic or highly intoxicated from effects of drugs Physician-patient relationship is both:
Self- Secondary to negligence such as reckless driving, chronic 1. consensual – mutual consent is obtained
destruction alcoholism, smoking. 2. fiduciary – based on mutual trust & confidence
Justifiable type Self-destruction of a person w/ terminal illness
No physician-patient relationship in the following
1. pre-employment PE
2. insurance purposes
Important facts in Medical Jurisprudence 3. MD appointed by court
Objectives of Medical act of 1959 4. surgeon doing autopsy
1. standardization & regulation of medical education 5. casual questions in a party
2. examination for registration of physician
3. supervision, control & regulation of the practice of medicine in Philippines PPR is terminated when:
Duties of PRC 1. recovery of px from condition
1. enforce regulatory policies 2. withdrawal of physician – consent, ample time
2. conduct licensure exams 3. discharge of px by physician
3. maintain the register of MD, etc. 4. death of px
4. supervise foreign nationals 5. death or incapacity of doctor
5. perform acts to implement its function 6. fulfillment of obligations in contract
7. in cases of emergency, upon arrival of AP
Duties of the Board of Medicine 8. expiration of period
1. determines contents of exam 9. mutual agreement btw MD and px
2. promulgates rules of exam w/ PRC approval
3. administer oath Terms NOT included in PPR
4. study conditions affecting medical practice 1. not imply a successful tx
5. investigates violations 2. tx will benefit px
6. conduct hearings 3. will produce certain results
7. suspend, revokes, re-issue certificate of registration 4. will not harm px
5. will not commit errors
Prerequisite to practice of medicine in Philippines
1. he/she must be at least 21 y.o Kinds of Medical fees
2. proper educational background 1. simple contractual fee – AP for a sum
3. has satisfactorily passed the board exam 2. retainer’s fee – not an employee of the px
4. holder of a valid certificate of registration – Filipino, not convicted of moral turpitude 3. contingent’s fee – result of tx
4. dichotomous/fee-splitting – unethical
NOTE: 5. straight fee/pakyaw system
 Non-Filipino citizens are allowed to take the physician licensure exam provided that the
foreigner has submitted competent & conclusive documentary evidence confirmed by PF if patient dies or incapacitated – in order
DFA. This is the reciprocity of the provision of Medical act. 1. spouse
 Medical students 19 y.o who had completed the 1 st 2 years of medical course & of good 2. descendants of nearest degree
moral character are allowed to take the preliminary exams. 3. ascendants of nearest degree
 Balikbayan physicians may while in the Philippines practice their departure, paid the 4. brothers or sisters
required fees of the PRC that he had paid all the corresponding income tax. 5. third person

Who are qualified to practice medicine? RIGHTS OF DOCTORS

1. those who complied to practice medicine in accordance to medical act 1. Rights inherent to the privilege to practice medicine
2. those who can have limited practice w/o cert. of registration like foreign physicians or 1. right to choose patients
medical sudents 2. right to limit practice of the profession
3. balikbayan physicians 3. right to determine the appropriate management procedure
4. foreign physicians qualified to practice by reciprocity 4. right to avail hospital services
5. nurses, dentist, opto, MT, MW, PT, masseur, chiropodist/chiropractor
2. Rights incidental to the privilege to practice medicine
Requirements to practice medicine 1. right of way while responding to the call of emergency
1. registration fee – paid to PRC covering 3 yr period, failure to pay for 5 consecutive 2. right of exemption from execution of instruments & liberty
yrs causes suspension 3. right to public or private office
2. professional license fee – PTR [professional tax receipt] P300 annually 4. right to perform certain services

14
 5. right to compensate 2. private charitable voluntary or eleemosonary hospitals – also they do not operate for
6. right to membership to medical society profit thus they are not to be held liable
3. private hospital – since they operate for profit so are held liable
Instances when physician cannot recover PF
1. agreement that service is gratuitous 2 liabilities of a hospital
2. government physician services in charity wards 1. Corporate liabilities – failure furnish accommodations, facilities, safe & reliable equipments, or
3. private charitable institutions careful selection & supervision of its employees
4. waiver in par of physician 2. Vicarious liabilities – borrowed servant”, nursing staff, student nurse, medical interns & residents
5. expressed contract to cure & nonfulfillment NOTE: A specialist is an independent contractor
6. covered by medicare
7. colleague is a doctor 3 responsibilities of hospital in emergency cases
8. industrial physicians to employees 1. admission
9. to school, faculty & students 2. transfer of px
3. discharge
Scope of a consent
1. general or blanket Justifiable grounds to refuse admission
2. limited or conditional 1. all accommodation are filled
3. non-viability or exculpatory clause in consent 2. px is chronically ill
3. px needs only convalescent care
Consent is not necessary 4. no available accommodation for the disease
1. emergency cases – provided px does not possess his mental faculties or no one in 5. contagious & at risk to other pxs
his behalf is present
2. law require submission to procedure – ex. Immunization When may the contents of medical record be disclosed?
3. the subject matter is legal – ex. Abortion is illegal 1. when requested by the px made into writing
2. when the law requires such disclosure
Persons who can give the consent 3. upon court order
1. px
2. if minor, consent from parents When is a physician not liable for his act?
3. grandparents id parents are absent 1. mistake in diagnosis
4. eldest brother or sister of legal age 2. inability to cure
5. substitute parental authority [SPA] – guardians or teachers 3. untoward & unexpected results

Instances when informed consent requires MORE disclosure of Facts Punishment of a physician who violates the ethical law of profession
1. when the procedure will entail much risk 1. suspension or revocation of certificate of registration
2. when the procedure is experimental or innovative 2. civil liability
3. public censure
Instances when full disclosure may NOT be necessary
1. cause emotional upset of px Examples of privilege communication
2. when medical procedure is experimental 1. Husband or wife during marriage or aafterwards
2. an attorney w/o client’s consent
Classification of liabilities of physician arising from his wrongful act or omission 3. physician who cannot go in a civil case w/o pxs consent
1. administrative liability – imposed by board of medicine thru PRC, right granted to heal 4. priest w/o consent of person making a confession
withdrawn > police power. Either to reprimand, suspension, or revocation of cert. 5. public officer during his term of office
2. criminal liabilities – imposed by court, imprisoned or fined as penalty
3. civil liabilities – imposed by court, moral & punitive damages Requisites to admissibility of dying declaration
1. declaration must concern the cause & surrounding circumstances of declarant’s
Grounds for reprimand, suspension or revocation of registration certificate of a physician death
A. personal disqualification 2. that at the at declaration was made, the declarant was under the consciousness of
1. immoral or dishonorable conduct an impending death.
2. insanity 3. that the declarant is a competent witness
3. gross negligence or incompetence 4. that the declaration is offered in a criminal case for homicide, murder or parricide in
4. addiction to alcohol or drugs w/c declarant is the victim
B. criminal acts
5. conviction by court of any criminal offense involving moral turpitude Elements of malpractice
6. fraud in the acquisition of certificate of registration 1. duty to his px
7. performance or aiding in criminal abortion 2. derilection – physician failed to perform such duty to his pxs
8. issuing false medical certificate 3. damage – as a consequence of failure of the physician to perform his duty, injury
9. aiding or acting as dummy of unregistered person to practice medicine was sustained by the px
C. unprofessional conduct 4. direct – the failure of the physician to perform his duty is the proximate cause of the
10. issuing rumors against another physician injury sustained by the px.
11. false or extravagant on unethical advertisements
12. violation of code of ethics Kinds of medical malpractice
1. administrative
Principal elements of tort action 2. criminal
1. existence of legal duty from defendant 3. civil
2. w/ breach of legal duty
3. injury is the result of such breech 5 acts or omissions done by physician w/c is punishable by law [criminal malpractice]
1. False medical certificates, certificate of merit, service, etc.
2. Prescribing opium unnecessary for the px
Requisites for emergency operation w/o consent 3. Practicing abortion
1. Px is unconscious or unable to give a valid consent 4. Substitution of child for another
2. necessary to act before the opportunity to obtain consent 5. Imprudence & negligence
3. surgeon best judgement that px may die unless w/ operation
Elements of a felony:
2 instances when consent is not needed 1. there must be an ac or omission
1. in emergency cases 2. such act or omission must be done voluntarily
2. When law made it compulsory to everyone o submit to a procedure 3. such act or omission must be punishable by law at time of commission

Liabilities of hospitals in relation to their classification Who may sign a death certificate?
1. government hospital – since it does not operate for profit then it is not held liable 1. attending physician

15
 2. local health or municipal health officer
3. municipal mayor
4. municipal secretary
5. any councilor

Requisites of the presumption of legitimacy

1. a valid marriage
2. childbirth took place after 180 d following celebration of marriage or w/in 300 d
3. no physical impossibility of husband having the 1 st 120 d of the 300 d preceding birth
of the child

Doctrine of Res ipsa loquitor does not apply when:

1. sponge was left during an emergency operation [surgeon not liable]
2. sponge because saturated w/ blood & was difficult to detect [surgeon not liable]
3. where doctrine of calculated risk is applicable
4. in case of bad results rule
5. honest errors of judgement as to the appropriate procedure
6. mistakes in the diagnosis

Doctrine of contributory negligence does not apply when?

1. failure to give the doctor an accurate history
2. failure to follow tx recommende by physician
3. HAMA
4. Failure to seek medical assistance if Sx persists

16