Module 4 – Forensic Medicine

THE MEDICO-LEGAL: DEATH, WOUND, INJURIES, AND SEXUAL OFFENSES

WARNING: This module contains graphic images some readers may find gruesome and disturbing, reader’s discretion is advised.

Module 3 of this course emphasizes some vital information and steps as to the investigations of death. As a continuation of the previous module, this last part of the course will enhance further your understanding of the role of the medical jurist in the investigation of crime.

In case of death, the INQUEST OFFICER can direct any qualified person to make technical investigations necessary in the solution of crime. Person to make or conduct Medico-Legal Investigation are the following:

(1) District Health Officer;

(2) Local Health Officer;

(3) Members of the municipal board of health who not physicians or a “Cirujano Ministrante”, whenever a registered physician is not available;

(4) Medical examiners of the City of Manila and his assistants;

(5) Medico-legal officers of the National Bureau of Investigations;

(6) Medical staffs of hospitals, centers, and other government physicians;

As mentioned earlier (module 1) Medico-legal Officer has the following functions and capabilities:

(a) Perform autopsies

(b) Establishing the cause of death whether, suicide, homicide, or murder and approximating the time of death;

(d) Performs examination of victims of physical injuries/crimes against chastity and suspected dope addicts;

(e) Perform forensic odontological and pathological examinations

(f) Perform examination for sexually transmitted diseases

(g) Conducts forensic psychiatry

(h) Determine the paternity of individuals with questionable parentage.

Techniques of Examination and Identification

All examinations conducted by the Medico-Legal Officer must be covered by a request from the investigating unit in case the request is to examine a living case. Autopsy or exhumation, consent signed by the victim and/or relative is necessary. However, additional requirements such as a permit from City/Municipal Health Officer or City/Municipal/Regional Trial Judge may be secured.

EXAMINATION OF THE LIVING CASE:

A.1. On Sex Crime Victims. The victim is examined completely and injuries are noted and measured. External and internal genitalia are also thoroughly examined and smears conducted for specific and possible sexually transmitted diseases.

A.2. On Sexual Transmitted Disease: All examination and smear preparations are done in the presence of female attendants. Smears made are then stained and examined microscopically for the presence or absence of intracellular or extra-cellular microorganisms.

EXAMINATION OF DEAD BODY

A post-mortem examination, an ocular inspection of the whole body, taking note of the muscle changes to approximate the time of death, the lividity, and other injuries sustained, if any. During the process, by which the entire cadaver is opened, blood is extracted for chemical analysis. For victims of a gunshot, a dermal nitrate test is conducted.

Close examination of all organs is made, noting the injuries and lesions found. Small pieces of organs are removed for histopathological examination, and for female cadavers, vaginal and pen-urethral smears are made. Routine photography of the body and major injuries is likewise undertaken.

Examination of the Dead Body in the Crime Scene:

After a complete search, the investigating physician must make a thorough inspection of the dead body. Special consideration must be made on the following:

[1] Evidence that will tend to prove identity.

[2] Position of the victim.

[3] Condition of the apparel worn.

[4] Approximate time of death.

[5] Presence of wounding instrument and its approximate distance from the body.

[6] Potential cause of death.

In death by gunshot, the clothing must be left undisturbed at the crime scene. A lot of information may be gathered from it:

(a) The bullet might have produced an exit on the skin but failed to cause a mark or tear on the clothing which through improper handling may not be recovered.

(b) Examination “in situ” may be useful in the determination of the site of entrance and exit of the bullet and also the trajectory of the shot.

AUTOPSY

An autopsy is a comprehensive study of a dead body, performed by a trained physician employing recognized dissection procedure and techniques. It includes the removal of tissues for further examination.

Autopsies vs. Post-mortem Examination:

Post-mortem examination — refers to an external examination of a dead body without incision being made, although blood and other body fluids may be collected for examination.

Autopsy — indicates that, in addition to an external examination, the body is opened and an internal examination is conducted. (Legal Medicine, Solis, 163) Also termed as necropsy or human dissection.

Kinds of Autopsies:

a. Hospital or Non-official Autopsy

This is an autopsy done on a human body with the consent of the deceased person’s relatives for the purposes of

(1) determining the cause of death;

(2) providing correlation of clinical diagnosis and clinical symptoms;

(3) determining the effectiveness of therapy;

(4) studying the natural course of the disease process; and

(5) educating students and physicians

Inasmuch as previous consent of the next of kin is necessary before a non-official autopsy can be performed, the Civil Code states who is the rightful person to give such consent.

The order is provided in Articles 294 and 305. The consent shall be obtained from:

[1] The spouse;

[2] The descendants of the nearest degree;

[3] The ascendants, also of the nearest degree;

[4] The brothers and sisters

In case of descendants of the same degree, or of brothers and sisters, the oldest shall be preferred. In the case of descendants, the paternal shall have a better right (Art. 305, Civil Code).

b. Medico-Legal or Official Autopsy:

This is an examination performed on a dead body for the purposes of:

(1) Determining the cause, manner (mode), and time of death;

(2) Recovering, identifying, and preserving evidentiary material;

(3) Providing interpretation and correlation of facts and circumstances related to death;

(4) Providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and

(5) Separating death due to disease from death due to external cause for the protection of the innocent (Forensic Pathology, A Handbook for Pathologists, Fisher and Petty, July 1977, p. 1).

In cases that require a medico-legal autopsy, the dead body belongs to the state for the protection of public interest until such time as a complete and thorough investigation into the circumstances surrounding the death and the cause thereof has been completed.

The physician tasked to perform such an autopsy is considered to be the authoritative agent and representative of the state who has the “property right” of the dead body. All that needs to be turned over to the next of kin responsible for the burial of the deceased is that the remaining portion or portions of the body not needed for any medico-legal purposes (Forensic Medicine by Tedeschi, Eckert & Tedeschi, Vol. II,p. 972).

Sec. 983, Revised Administrative Code — Investigation into the cause of death (supra p. 156)./Sec. 1089, Revised Administrative Code — Proceedings in cases of suspected violence or crime: (Old Law)

The latest law covering this task is the PD 856, “Disposal of Dead Body”, DOH Code of Sanitation of the Philippines: Section 5, 13, and 14 respectively. (CLICK HERE to get a copy of the law)

If the person who issues a death certificate has any reason to suspect or if he shall observe any indication of violence or crime, he shall at once notify the justice of the peace (now Municipal Trial Judge), if he is available, or if neither the justice of the peace nor the auxiliary justice is available, he shall notify the municipal mayor, who shall take proper steps to ascertain the circumstances and cause of death; and the corpse of such deceased person shall not be buried or interred until permission is obtained from the provincial fiscal if he is available, and if he is not available, from the mayor of the municipality in which the death occurred.

When shall an Autopsy be Performed on a Dead Body/Section 95 (b), P.D. 856, Code of Sanitation:

(a) Whenever required by special laws;

(b) Upon order of a competent court, a mayor and a provincial or city fiscal;

(c) Upon written request of police authorities;

(d) Whenever the Solicitor General, Provincial or city fiscal as authorized by existing laws, shall deem it necessary to disinter and take possession of the remains for examination to determine the cause of death; and

(e) Whenever the nearest kin shall request in writing the authorities concerned in order to ascertain the cause of death.

Persons who are Authorized to Perform Autopsies and Dissections: The following are authorized to perform autopsies and dissections:

(1) Health Officers;

(2) Medical officers of law enforcement agencies; and

(3) Members of the medical staff of accredited hospitals.

(Sec. 95 (a) P.D. 856).
a. Health officers:
The health officers referred to by the Sanitation Code are the district health officer (now provincial health officer) and local health officer (including the rural health officer).

[1] District Health Officer (see Sec. 983, Revised Administrative Code (supra, p. 156).

[2] Local Health Officer: Sec. 984, Revised Administrative Code —Person to make investigation — When it is not practicable for the district health officer to conduct such investigation in person, he may require any local health officer or member of a municipal board of health who is a registered physician to perform such duty; and where the services of a registered physician in the Government service cannot be thus obtained, he may require a “cirujano ministrante” who is a member of the board or a sanitary inspector to act in the matter.

b. Medical Officers of Law Enforcement Agencies:

(a) Medical Examiner of the Local Government that has jurisdiction over the case (medical examiner of the City of Manila under the old law)

(b) Medical Staff of the NBI (their Medico-Legal Section)

The Medical examiner or medico-legal officer “may” investigate cases of sudden deaths, which have not been satisfactorily explained, and when there is suspicion that the case arose from unlawful acts or omissions of other persons, or from foul play, and in general victims of violence, sex crimes, accidents, self-inflicted injuries, intoxication, drug addiction.

c. Members of the medical staff of accredited hospitals.

The distinction between Pathological (Non-official) and Medicolegal (Official) Autopsies:

	Pathological Autopsy	Medico-Legal Autopsy
Requirement	Must have the consent of the nearest kin	it is the law that gives consent. Consent of relatives is not needed.
Purpose	Confirmation of clinical findings of research	Correlation of tissue changes to the criminal acts
Emphasis	Notations of all abnormal findings	The emphasis laid on the effect of the wrongful acts on the body. Other findings may only be noted in mitigation of the criminal responsibility.
Conclusion	Summation of all abnormal findings irrespective of their correlation with clinical findings.	Must be specific for the purpose of determining whether it is in relation to the criminal act.
Minor or Non-pathological	Need not be mentioned in the report	If the investigator thinks it will be useful in the administration of justice, it must be included.

Other Salient Features Peculiar to Medico-Legal Autopsies:

(a) Clinical history of the deceased in most instances absent, sketchy, or doubtful.

(b) The identity of the deceased is the responsibility of the forensic pathologist.

(d) The forensic pathologist must alert himself of the possible inconsistencies between the apparent cause of death and his actual findings in the crime scene.

(e) A careful examination of the external surface for possible trauma including the clothing to determine the pattern of injuries in relation to the injurious agent.

(f) The autopsy report is written in a style that will make it easier for laymen to read and more clearly organized insofar as the mechanism of death is concerned.

(g) The professional and environmental climate of a forensic pathologist is with the courts, attorneys, and police who make scrutiny of the findings and conclusion.

The following Manner of Death should be Autopsied:

(a) Death by violence

(b) Accidental death

(c) Suicides

(d) The sudden death of persons who are apparently in good health

(e) Death unattended by a physician

(f) Death in hospitals or clinics (D.O.A.) wherein a physician was not able to arrive at a clinical diagnosis as the cause of death

(g) Death occurring in an unnatural manner

PROCEDURE OF AUTOPSY

Guidelines in the Performance of Autopsies:

[1] Be it an official (medico-legal) or non-official autopsy, the pathologist must be properly guided by the purposes for which autopsy is to be performed. In so doing the purpose of such dissection will (must) be served.

[2] The autopsy must be comprehensive and must not leave some parts of the body unexamined. Even if the findings are already sufficient to account for the death, these should not be a sufficient reason for the premature termination of the autopsy. The existence of a certain disease or injury does not exclude the possibility of another much more fatal disease or injury. The findings of coronary disease do not exclude the probability of injury or poisoning.

[3] Bodies which are severely mutilated, decomposing, or damaged by fire are still suitable for autopsy. No matter how putrid or fragmentary the remains are, a careful examination may be productive of information that bears the identity and other physical trauma received. Frequently a pathologist’s reluctance to perform an autopsy on decomposed body is due to the odor or vermin rather than to his belief that the examination would not be productive.

[4] All autopsies must be performed in a manner that shows respect for the dead body. Unnecessary dissection must be avoided. A relative who consented to the performance of an autopsy but specifically stated that it must be performed in a “decent” manner.

[5] Proper identity of the deceased autopsied must be established in non-official autopsy. An autopsy on a wrong body may be a ground for damages.

[6] A dead body must not be embalmed before the autopsy. The embalming fluid may render the tissue and blood unfit for toxicological analyses. The embalming may alter the gross appearance of the tissues or may result in a wide variety of artifacts that tend to destroy or obscure evidence. An embalmer who applied embalming fluid on a dead body which in its very nature is a victim of violence is liable for his wrongful act.

[7] The body must be autopsied in the same condition when found at the crime scene. A delay in its performance may fail or modify the possible findings thereby not serving the best interest of justice.

Precautions to be Observed in Making Medico-Legal Post-mortem Examination:

[1] The physician must have all the necessary permits or authorization to perform such an examination. Such a permit must be issued by the inquest officer. The absence of such authorization may hold the physician civilly and criminally liable.

[2] The physician must have a detailed history of the previous symptoms and condition of the deceased to be used as his guide in the post-mortem examination.

[3] The true identity of the deceased must be ascertained. If no one
claims the body, a complete date to reveal his identity must be taken.

[4] The examination must be made in a well-lighted place and it is advisable that no unauthorized person should be present.

[5] All external findings must be properly described and if possible a sketch must be made or a photograph must be taken to preserve the evidence.

[6] All steps and findings in the examination must be recorded.

Rules in the Examination:

1. 1. Look before you cut (illustration above is known as preliminary incision).
  2. Never cut unless you know exactly what you are cutting.
  3. Weigh and measure everything that can be weighed or measured (below are the two known cuts performed in an autopsy, the extreme lower photograph is an actual cut in the human body).

Stages in the Post-mortem Examination of the Dead Body:

1. Preliminary Examination:

(A) Examination of the Surroundings (Crime Scene):

Attention must be focused on the furniture; bullet holes on the ceiling, floor, and walls; amount, color, shape, and degree of spread of the bloodstains, position of the wounding weapon; foot and fingerprints and hairs and clothes.

(B) Examination of the Clothing:

Look for marks to establish identity, kind, and quality of the garment, stains, grease, cut and “tear or other marks of resistance and violence.

(C) Identity of the Body:

Determine the height, weight, color of the hair and eyes, complexion, condition, and number of teeth, bodily deformity, scars, and tattoo marks, clothing, dog tag, and fingerprints.

2. External Examination:

a. Examination of the Body Surfaces:

Inspect the natural orifice of the body. All wounds must be described in detail, bloodstains, and foreign bodies.

b. Determination of the Position and Approximate Time of Death:

In this stage, the presence and degree of hypostasis, rigor mortis and putrefaction, and color of the bloodstain must be noted. Examination of the hands for the presence of cadaveric spasms and wounding weapons may be necessary for the proper solution of the crime.

3. Internal Examination:

Examine all body orifices for blood and foreign bodies. Blood coming out of the nostrils may imply a fracture on the base of the anterior cranial fossa. A hemorrhage of the ears may imply a fracture of the middle cranial fossa.

Advantages of Starting Autopsy on the Head:

(1) If the autopsy starts on the chest or abdomen, excision of the organs will cause the blood content of the brain and the meninges to necessarily lose their original pattern;

(2) There is the unavoidable contamination of the body associated with the autopsy, which prevents liable culturing of microorganisms from the cranial contents;

(3) Manipulation of other blood vessels, especially at the neck may result in air bubbles’ being artificially drawn into the cerebral vessels, impairing fair evaluation of air embolism that might have occurred during life (Forensic Medicine, Vol. 1, by Tedeschi, Eckert and Tedeschi, p. 35).

A primary incision must be made from the suprasternal notch to the pubic symphysis passing to the left of the umbilicus. Cut the rectus abdominis muscle at several points to expose the abdominal cavity and flap the skin at the region of the chest from the primary incision to the lateral aspect of the chest exposing the ribs. Disarticulate the sternoclavicular joint and cut the ribs medial to the costochondral junction. (all internal content of the body must be subjected to examination, analysis, weighing, observation of colors, nature of wounds, and injuries, and possible wounding instrument (CLICK AND DOWNLOAD here the part and portion of the books of Pedro Solis which described parts of the organ that needs to analyzed and weighed that has significance in the investigation of crime).

NOTE: Be able to read such PDF, there might have questions in the final exam that will be taken from there!

PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

PHYSICAL INJURY

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

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

CAUSES OF PHYSICAL INJURIES (Part of Module 3)

[1] Physical violence

[2] Heat or cold

[3] Electrical energy

[4] Change of atmospheric pressure or Barotrauma

[5] Change in temperature (hot and cold)

[6] Chemical energy

[7] Radiation or radioactive substance

[8] Infection

PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

The effect of the application of physical violence on a person is the production of the wound.

A wound is a solution to the natural continuity of any tissue of the living body. It is the disruption of the anatomic integrity of a tissue of the body. On several occasions, the word physical injury is used interchangeably with the wound. However, the effect of physical violence may not always result in the production of a wound, but the wound is always the effect of physical violence.

Vital Reaction:

It is the sum total of all reactions of tissue or organ to trauma. The reaction may be observed macroscopically and microscopically. The following are the common reactions of living tissue to trauma:

[1] “Rubor” — Redness or congestion of the area due to an increase of blood supply as a part of the reparative mechanism.

[2] “Calor” — Sensation of heat or increase in temperature.

[3] “Dolor” — Pain on account of the involvement of the sensory
nerve.

[4] Loss of function — On account of the trauma, the tissue may not be able to function normally.

The presence of the vital reaction differentiates an antemortem from a post-mortem injury.

In the following instances vital reactions or changes may not be observed even if the injury was inflicted during life:

(a) If physical injuries are inflicted during the agonal state of a living person. The body cells or tissue during the period may no longer have the potential capacity to react to the trauma; and

(b) If death is so sudden as not to give the tissues of the body, the chance to react properly. This is commonly observed in deaths due to sudden coronary occlusion.

THE CLASSIFICATIONS OF WOUNDS

1. As to Severity

(a) Mortal Wound — Wound which is caused immediately after infliction or shortly thereafter that is capable of causing death.

Parts of the Body where the Wounds Inflicted are Considered Mortal (see some illustration below):

1. 1. Heart and big blood vessels.
  2. Brain and upper portion of the spinal cord.
  3. Lungs.
  4. Stomach, liver, spleen, and intestine

(b) Non-Mortal Wound — Wound which is not capable of producing death immediately after infliction or shortly thereafter (see photo illustration below).

2. As to the kind of Instrument Used

(a) Wound brought about by blunt instrument (contusion, hematoma, lacerated wound).

A blunt instrument is an object without sharp edges or points that is used as a club, like a piece of wood; a stone, a hammer, and the like (see below illustration). An ax that is not sharp can cause either contusion or laceration.

Blunt force trauma can often lead to bruising and blood clots. Bruising occurs when the blood vessels on the surface of the soft tissue of the skin are broken, typically resulting in temporary discoloration of the skin.

(b) Wound brought about by sharp instrument:

An incised wound is one produced by the pressure and friction of an object with a sharp edge against tissue. Objects which can produce such injuries are straight-edge razors, knives, glass, swords, axes, hatchets, bayonets, and the like.

(1) Sharp-edged instrument (incised wound).

(2) Sharp-pointed instrument (punctured wound)

(3) Sharp-edged and sharp-pointed instrument (stab wound).

Tearing of skin and tissues can occur from impact by or against irregular or semi-sharp objects, such as the door handle of the car. A tear is deeper at starting point than at the termination. Cut lacerations. A messy-looking wound caused by a tearing or crushing force. Doesn’t tend to bleed as much as incised wounds but often causes more damage to surrounding tissues.

(d) Wound brought about by change of atmospheric pressure (barotrauma).

Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body, and the surrounding gas or fluid.

(e) Wound brought about by heat or cold (frostbite, burns, or scald).

(f) Wound brought about by chemical explosion (gunshot/shrapnel)

Shrapnel or gunshot wounds are usually produced with similarly high kinetic energy to those caused by hand- and long guns. However, fragments tend to dissipate the entire amount of energy within the body, which increases the degree of tissue disruption. The nature of the injury can be both regular or irregular depending on the nature of the firearms and the projectiles such as what is shown above compared to the picture below.

(g) Wound brought about by infection

An infected wound is a localized defect or excavation of the skin or underlying soft tissue in which pathogenic organisms have invaded into viable tissue surrounding the wound. Infection of the wound triggers the body’s immune response, causing inflammation and tissue damage, as well as slowing the healing process.

3. Manners of Infliction

(a) Hit – by means of bolo, ax, blunt instrument, etc.

(b) Thrust or stab – by bayonet, dagger, or icepick

(d) Gunpowder & explosion – by firearms or explosives

(e) Sliding or rubbing – floor, ground, or pavement as in accidents

4. As Regards to the Depth of Wound:

a. Superficial

When the wound involves only the layers of the skin.

b. Deep

When the wound involves the inner structure beyond the layers of the skin.

Penetrating — one in which the wounding agent enters the body but did not come out or the mere piercing of a solid organ or tissue of the body.

(1) “Penetrating Wound — Wound where the dimension of depth and direction is an important factor in its description. It involves the skin or mucous surface and the deeper underlying tissues or organs caused directly by the wounding instrument. Punctured, stab, and gunshot wounds usually belong to this type of wound.”(see above photo)

(2) Perforating — When the wounding agent produces communication between the inner and outer portion of the hollow organs. It may also mean piercing or traversing completely a particular part of the body causing communication between the points of entry and exit of the instrument or substance producing it (see below photo, a perforating wound).

5. As regards to the Relation of the Site of the Application of Force and the Location of Injury

a. Coup Injury

A physical injury is located at the site of the application of force.

b. Contre-Coup Injury

Physical injury found opposite the site of the applied force.

c. Coup Contre-Coup Injury

Physical injury located at the site and also opposite the site of application of force.

d. “Locus Minoris Resistencia”

Physical injury is located not at the site nor opposite the site of the application of force but in some areas offering the least resistance to the force applied. A blow on the forehead may cause a contusion at the region of the eyeball because of the fracture on the papyraceous bone forming the roof of the orbit.

e. Extensive Injury

Physical injury involves a greater area of the body beyond the site of the application of force. It has not only a wide area of injury but also varied types of injury. A fall from a height or a run-over victim of a vehicular accident may suffer from multiple fractures, laceration of organs, and all types of skin injuries. (see below an example of “extensive injury”.)

When a stationary head is hit by a moving object, there is the tendency for the development of contusion of the brain at the site of impact. When the moving head hits a firm, fixed, and hard object, brain contusion may develop at the opposite of the site of impact.

A coup-contra-coup location of brain injury may be found when a fixed head is hit with a moving object and then falls on another hard object.

Special Types of Wounds:

a. Defense Wound

This is a wound that is a result of a person’s instinctive reaction to self-protection. Injuries suffered by a person to avoid or repel potential injury contemplated by the aggressor.

b. Patterned Wound

A wound in the nature and shape of an object or instrument and which infers the object or instrument causing it.

Impact of the radiator grill of a car on a face cause imprint of the radiator grill on the face. A person run over by a wheel of a car, tire marks are shown on the body. Due to hanging, the nature of the abrasion mark on the neck may infer material used. Contusion produced by belt, a branch of a tree, metallic rod, etc. may have the shape of the wounding instrument. All of them are called patterned wounds.

c. Self-inflicted Wound

A self-inflicted wound is a wound produced on oneself. As distinguished from suicide, the person has no intention to end his life.

The motive of Producing Self-inflicted Wounds:

(1) To create or deliberately magnify an existing injury or disease for pension or workman’s compensation;

(2) To escape certain’ obligations or punishment. During wartime, soldiers may cut their fingers to avoid frontline assignments and prisoners may inflict physical injuries on their bodies to avoid hard labor and just be confined in a hospital to receive food and rest.

(3) To create a new identity or destroy the existing one. Fingerprints may be destroyed by acid, by cutting or burning. A person may even request the services of a plastic surgeon to create a new identity or destroy existing ones.

(4) To gain attention or sympathy.

(5) Psychotic behavior.

TYPES OF WOUND ACCORDING TO MEDICAL CLASSIFICATIONS

(1) Closed Wound

There is 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.

(1) Petechiae

This is a circumscribed extravasation of blood in the subcutaneous tissue or underneath the mucous membrane. The cause of the passage of blood from the capillaries may be due to the increased intra-capillary pressure or increased permeability of the vessel.

The hemorrhage may be small or pinhead-sized but several petechiae may coalesce to form a bigger hemorrhagic area. Mosquito or other insect bites may cause the formation of circumscribed hemorrhages.

(2) Contusion

A contusion is the effusion of blood into the tissues underneath the skin on account of the rupture of the blood vessels as a result of the application of blunt force or violence. When a blunt force is applied, it momentarily compresses the blood vessels at the point of contact, thereby temporarily forcing the blood out of the area and setting up a fluid wave under pressure.

Inasmuch as it used to take more time for the blood to get out of the blood vessels, contusion does not immediately develop after the application of force. It may develop after a lapse of minutes or even hours after the application of force.

Age of Contusion:

The age of contusion can be appreciated from its color changes. The size tends to become smaller from the periphery to the center and passes through a series of color changes as a result of the disintegration of the red blood corpuscles and liberation of hemoglobin.

The contusion is red sometimes purple soon after its complete development.

Ø In 4 to 5 days, the color changes to green.

Ø In 7 to 10 days, it becomes yellow and gradually disappears on the 14th or 15th day.

Ø The ultimate disappearance of color varies from one to four weeks depending upon the severity and constitution of the body.

Ø The color changes start from the periphery inwards.

(3) Hematoma

This is the extravasation or effusion of blood in a newly formed cavity underneath the skin. It usually develops when the blunt instrument is applied in part of the body where bony tissue is superficially located, like the head, chest, and anterior aspect of the legs.

The force applied causes the subcutaneous tissue to rupture on account of the presence of a hard structure underneath. The destruction of the subcutaneous tissue will lead to the accumulation of blood causing it to elevate

Distinction Between Contusion and Hematoma:

(a) In contusion, the effused blood is accumulated in the interstices of the tissue underneath the skin, while in hematoma blood accumulates in a newly formed cavity underneath the skin.

(b) In contusion, the skin shows no elevation and if ever elevated, the elevation is slight and is on account of inflammatory changes, while in hematoma the skin is always elevated.

(c) In contusion, puncture, or aspiration with a syringe of the lesion no blood can be obtained, while in hematoma, aspiration will show the presence of blood and subsequent depression of the elevated lesion.

(d) Abscess, gangrene, hypertrophy, fibroid thickening, and even malignancy are potential complications of hematoma.

(4) Musculo-skeletal Injuries:

(1) Sprain

Partial or complete disruption in the continuity of muscular or ligamentous support of a joint. It is usually caused by a blow, kicks, or torsion force. (see No. 4 strain for difference)

(2) Dislocation

Displacement of the articular surface of bones entering into the formation of a joint.

(3) Fracture

Solution of continuity of bone resulting from violence or some existing pathology.

(a) Close or Simple Fracture — Fracture wherein there is no break in the continuity of the overlying skin or where the external air has no point of access to the site of injury.

(b) Open or Compound Fracture — The fracture is complicated by an open wound caused by the broken bone which protruded with other tissues of the broken skin.

(c) Comminuted Fracture — the fractured bone is fragmented into several pieces.

(d) Greenstick Fracture — A fracture wherein only one side of the bone is broken while the other side is merely bent.

(e) Linear Fracture — When the fracture forms a crack commonly
observed in flat bones.

(f) Spinal Fracture — The break in the bone forms a spiral manner as observed in long bones.

(g) Pathologic Fracture — Fracture caused by weakness of the bone due to disease rather than violence.

(4) Strain

The over-stretching, instead of an actual tearing or the rupture of a muscle or ligament which may not be associated with the joint.

(5) Subluxation — Incomplete dislocation.

(5) Internal Hemorrhage

Rupture of the blood vessel which may cause hemorrhage may be due to the following:

[1] Traumatic intracranial hemorrhage.

[2] Rupture of parenchymatous organs.

[3] Laceration of other parts of the body.

(6) Cerebral Concussions (Commotio Cerebri)

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

A cerebral concussion is much more severe when the moving or mobile head struck a fixed hard object as compared to when the head is fixed and struck by a hard moving object.

2. OPEN WOUND

(1) Abrasion

(Scratch, Graze, Impression Mark, Friction Mark): it is an injury characterized by the removal of the superficial epithelial layer of the skin caused by a rub or friction against a hard rough surface.

Whenever there is forcible contact before friction occurs, there may be contusion associated with abrasion. The shape varies and the raw surface exudes blood and lymph which later dries and forms a protective covering known as scab or crust.

Characteristics of Abrasion:

Ø It develops at the precise point of impact of the force causing it.

Ø Grossly or with the aid of a hand lens the injury consists of parallel linear injuries which are in line with the direction of the rub or friction causing it.

Ø It may exhibit the pattern of the wounding material.

Ø It is usually ignored by the attending physician for it does not require medical treatment but it has far-reaching importance in the medico-legal viewpoint.

(a) Abrasions caused by fingernails may indicate struggle or assault and are usually located in the face, neck, forearms, and hands.

(b) Abrasions resulting from friction on rough surfaces, either intentional or accidental are located on bony parts of the body and usually associated with contusion or laceration.

(c) The nature of the abrasion may infer the degree of pressure, nature of the rubbing object, and the direction of movement.

Ø Unless there is a supervening infection, abrasion heals in a short time and leaves no scar. If the whole thickness of the skin is involved, healing may be delayed and occasionally with scar formation.

Forms of Abrasions

a. Linear

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

b. Multi-Linear
An abrasion develops when the skin is rubbed on a hard rough object thereby producing several linear marks parallel to one another. This is frequently seen among victims of vehicular accidents.

c. Confluent
An abrasion where the linear marks on the skin are almost indistinguishable on account of the severity of friction and roughness o the object.

d. Multiple
Several abrasions of varying sizes and shapes may be found in different parts of the body.

Types of Abrasions:

a. Scratch:

This is caused by a sharp-pointed object which slides across the skin, like a pin, thorn, or fingernail. The injury is always parallel to the direction of the slide. The commencement and termination are well defined and the depth depends on the pressure applied. The fingernail scratch may be broad at the point of commencement and may terminate with a tailing (see above photo of linear & multi-linear).

b. Graze:

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

c. Impact or Imprint Abrasion

(Patterned Abrasion, Stamping Abrasion, “Abrasion A La Signature”):
Those whose pattern and location provide objective evidence to show the cause, nature of the wounding material or instrument, and the manner of assault or death.

Ø Marks of the grid of the radiator may be imprinted on the skin.

Ø Tire thread marks may be seen on the skin in vehicular accidents.

Ø Muzzle imprint in contact fire gunshot wound of entrance.

Ø Teeth impression mark in skin bites.

d. Pressure or Friction Abrasion:

Abrasion caused by pressure accompanied by movement usually observed in hanging or strangulation. The spiral strands of the rope may be reflected on the skin of the neck. The lesion may dry up and assume a papyraceous or parchment-like consistency.

(2) INCISED WOUND

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

When the wounding instrument is a heavy cutting instrument, like an ax, big bolo, saber, the wound produced is called CHOPPED or HACKED wound. The injury is quite severe, edges may or may not be contused depending on the nature of the edge of the instrument used.

The deep incised wound may cause a clean-cut fracture of the bone, severance of blood vessels and nerves, or amputation. Paralysis may develop on account of the severed nerve and profuse hemorrhage may result in death. Embolism or supervening infection may later develop.

Incised Wounds may be Suicidal, Homicidal, or Accidental:

Suicidal

Located in the peculiar parts of the body, like the neck, flexor surfaces of the extremities (elbow, groin, knee), wrist, and accessible to the hand in inflicting the injury. The most common instrument used is the Barber’s razor blade with an improvised handle. There is usually superficial tentative cut (hesitation cuts) and the direction varies with the location and the hand (left or right) used in inflicting the injuries. The most common site of suicidal incised wounds is on the wrist with the involvement of the radial artery and the neck.

Homicidal

The incised wounds are deep, multiple, and involve both accessible and non-accessible parts of the body to the hands of the victim (see above non-suicidal incision). “Defense and other forms of wounds may be present. Clothing are always involved (crumpled, dirt, soilage, and the like).

Accidental

Multiple incised wounds are commonly observed on the passengers and driver of vehicular accidents on account of the broken windshield and glass parts of windows. Stepping on oyster shells, broken glasses sharp edges of metal sheets are common causes of an incised wounds on the sole of the foot. Those associated with the use of kitchen knives in the preparation of food, carpenters, and handicraft workers who use sharp-edged instruments are frequent victims of accidental incised wounds.

(3) STAB WOUND

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

Just like incision, a stab wound can be suicidal, homicidal, and accidental.

(4) PUNCTURED WOUND

A punctured wound is the result of a thrust of a sharp-pointed instrument. The external injury is quite small but the depth is to a certain degree. It is commonly produced by an icepick, needle, nail, spear, pointed stick, thorn, the fang of animal, and hook.

The nature of the external injury depends on the sharpness and shape of the end of the wounding instrument. Contusion of the edges may be present if the end is not so sharp. The opening may be round, elliptical, diamond-shaped, or cruciate. An accurate cross-section nature of the wounding object may well be appreciated when there is the involvement of flat hard parts of the body especially the skull.

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

(5) LACERATED WOUND

A lacerated wound is a tear of the skin and the underlying tissues due to forcible contact with a blunt instrument. It may be produced by a hit with a piece of wood, iron bar, fist blow, stone, the butt of a firearm, or other objects without sharp objects.

If the force applied to the tissue is greater than its cohesive force and elasticity, the tissue tears and a laceration are produced. Since the skin is composed of several types of tissues, namely epidermis, connective tissue, fat, blood vessels, nerves, glandular cells, etc. each having its own breaking point, the laceration will be irregular and having strands of tissues bridging. The rupture of continuity may only extend deeper to the stronger layer like that of the galea aponeuritica in case of scalp injury.

Classification of Lacerated Wounds

(a) Splitting caused by the crushing of the skin between two hard objects. This is best seen in laceration of the scalp caused by a hit of a blunt instrument, cut eyebrow of boxer, and laceration
of the chin of motorcyclist.

(b) Overstretching of the skin. When pressure is applied on one side of the bone, the skin over the area will be stretched up to a breaking point to cause laceration and exposure of the fractured
bone. An avulsion, the edges of the remaining tissue is that of laceration.

(c) Grinding compression — The weight and the grinding movement may cause separation of the skin with the underlying tissues.

(d) Tearing — This may be produced by a semi-sharp-edged instrument that causes irregular edges on the wound, like hatchet and choppers.

MEDICO-LEGAL INVESTIGATION OF WOUNDS

The following rules must always be observed by the physician in the examination of wounds:

(1) All injuries must be described, however small for it may be important later.

(2) The description of the wounds must be comprehensive, and if possible a sketch or photograph must be taken.

(3) The examination must not be influenced by any other information obtained from others in making a report or a conclusion.

Outline of the Medico-legal Investigation of Physical Injuries:

1. General Investigation of the Surroundings:

(a) Examination of the place where the crime was committed.

(b) Examination of the clothing, stains, cuts, hair, and other foreign bodies that can be found at the scene of the crime.

(d) Examination of the wounding instrument.

(e) Photography, sketching, or accurate description of the scene of the crime for purposes of preservation.

2. Examinations of the Wounded Body:

a. Examinations that are applicable to the living and dead victim:

(a) Age of the wound from the degree of healing.

(b) Determination of the weapon used in the commission of the offense.

(d) Determination of whether the injury is accidental, suicidal, or homicidal.

b. Examinations that are applicable only to the living:

(a) A determination of whether the injury is dangerous to life.

(b) Determination of whether the injury will produce permanent deformity.

(d) A determination of whether the injury will produce complications as a consequence

c. Examinations that are applicable to the dead victim:

(a) A determination of whether the wound is antemortem or postmortem.

(b) A determination of whether the wound is mortal or not.

(c) A Determination of whether death is accelerated by a disease or some abnormal developments which are present at the time of the infliction of the wound.

(d) A determination of whether the wound was caused by accident, suicide, or homicide.

3. Examinations of the Wound:

The following must be included in the examinations of the wound. The report made in connection with such examination must also include in detail the following items:

a. Character of the Wound:

The description must first state the type of wound, e.g. abrasion, contusion, hematoma, incised, lacerated, stab wound, etc. It must include the size, shape, nature of the edges, extremities, and other characteristic marks. The presence of a contusion collar in case of a gunshot wound of entrance, scab formation in abrasion and other open wounds, infection, surgical intervention, etc., must also be stated.

b. Location of the Wound:

The region of the body where the wound is situated must be stated. It is advisable to measure the distance of the wound from some fixed point of the body prominence to facilitate reconstruction. This is important in determining the trajectory or course of the wounding weapon inside the body.

c. Depth of the Wound:

The determination of the exact depth of the wound must not be attempted in a living subject if in so doing it will prejudice the health or life. Depth is measurable if the outer wound and the inner end are fixed. No attempt must be made in measuring the stabbed wound of the abdomen because of the movability of the abdominal wall.

d. Condition of the Surroundings:

The area surrounding the wound must be examined. In gunshot wound near or contact fire will produce burning or tattooing of the surrounding skin. In suicidal incised wounds, there may be tentative cuts (hesitation cuts). Laceration wounds may show contusions of the neighboring skin.

e. Extent of the Wound:

Extensive injury may show a marked degree of force applied in the production of the wound. In homicidal cut-throat cases, it is generally deeper than in cases of suicide. Homicidal wounds are extensive and numerous.

f. The direction of the Wound:

The direction of the wound is material in the determination of the relative position of the victim and the offender when such a wound has been inflicted. The direction of the incised wound of the anterior aspect of the neck may differentiate whether it is homicidal or suicidal.

g. Number of Wounds:

Several wounds found in different parts of the body are generally indicative of murder or homicide.

h. Conditions of the Locality:

(1) Degree of hemorrhage.
(2) Evidence of struggle.
(3) Information as to the position of the body
(4) Presence of letter or suicide note.
(5) Condition of the weapon.

THE GUNSHOT WOUND

Death or physical injuries brought about by the powder propelled substances may be due to the following:

(1) Firearm Shot — the injury is caused by the missile propelled by the explosion of the gunpowder located in the cartridge shell and at the rear of the missile. The direction of the movement of the missile is influenced by the desire of the person firing the firearm. The missile may be single as in the case of a pistol or revolver or may be of multiple shots or pellets as in the case of a shotgun. The cartridge shell is physically preserved after the fire.

(2) Detonation of high explosives, as in grenades, bombs, and mine explosion. An explosion of gunpowder inside the metallic container will cause fragmentation of the container. Each fragment or shrapnel is moving with a certain velocity without any predetermined direction.

Things Coming Out of the Gun Muzzle After the Fire:

1. Bullet.
2. Flame.
3. Heated, compressed, and expanded*gas.
4. Residues coming from:

a. Bullet:

(1) Fragment (jacket, lead).
(2) Lubricant.

b. Powder particles:

(1) Powder grains (unburned, burning).
(2) Soot.
(3) Graphite.

c. Primer:

(1) Lead, barium, antimony, etc.

d. Barrel:

(1) Lubricant.
(2) Rust, dust, etc.
(3) Scraping from a bullet by the previous fire.

e. Cartridge case:

(1) Copper, zinc.

Gunshot injuries are classified as either entrance or exit wounds. A TYPICAL WOUNDS (grazing) may also be present. Physical findings in and around these wounds may offer evidence as to the actual mechanism, supporting or refuting the initial history given to the provider. As these findings may be transient, the emergency physician must be diligent in recognizing and documenting them at the time of presentation.

Entrance Wounds

Gunshot wounds of the entrance are divided into four categories based on their range of fire: distant, intermediate, close, and contact. Range-of-fire is the distance from the gun’s muzzle to the victim.

The size of the entrance wound bears no relation to the caliber of the inflicting bullet. Entrance wounds over elastic tissue will contract around the tissue defect and have a diameter much less than the caliber of the bullet.

Distant Wounds:

The distant wound is inflicted from a range sufficiently distant that the bullet is the only projectile expelled from the muzzle that reaches the skin. There is no tattooing or soot deposition associated with a distant entrance wound. As the bullet penetrates the skin, friction between it and the epithelium results in the creation of an “abrasion collar” (see the photo illustration below). The width of the abrasion collar will vary with the angle of impact. Most entrance wounds will have an abrasion collar; however, gunshot wounds to the palms and soles are exceptions- there, entrance wounds appear slit-like.

Intermediate-Range Wounds: Tattooing is pathognomonic for an intermediate-range gunshot wound and presents as punctate abrasions from contact with partially burned or unburned grains of gunpowder (Fig. 17.2). This tattooing cannot be wiped away. Clothing and hair, as intermediate objects, may prevent the gunpowder grains from making contact with the skin. Tattooing can, but rarely does, occur on the palms and soles owing to the thickness of their epithelium.

Distant Gunshot Wound The elliptical abrasion collars associated with these gunshot wounds of entrance indicates that the projectile passed from right to left. The range of fire is classified as distant or indeterminate based on the lack of carbonaceous material or gunpowder tattooing.

Intermediate-Range Gunshot Wound: Punctate abrasions present on the forehead are the result of impact with unburned or partially burned gunpowder. This phenomenon is termed tattooing. Tattooing is pathognomonic for intermediate-range gunshot wounds.

Tattooing has been reported with a range of fire as close as 1 cm and as far away as 4 ft. The density of the abrasions and the associated pattern will depend on the barrel length, muzzle-to-skin distance, type of gunpowder (ball, flattened ball, or flake), presence of intermediate objects, and caliber of the weapon. Spherical powder travels farther and has greater penetration than flattened ball or flake powder.

Close-Range (Near Contact) Wounds: “Close range” is defined as the maximum range at which soot is deposited on the wound or clothing (see the photo of clothing below and the subsequent illustration, soot on the skin surrounding entrance wound) and typically is a muzzle-to-victim distance of 6 in. or less. On rare occasions, however, soot has been found on victims as far as 12 in. from the offending weapon.

The concentration of soot will vary inversely with the muzzle-to-victim distance and its appearance will be affected by the type of gunpowder and ammunition used, the barrel length, the caliber, and the type of weapon.

Contact Wounds

A contact wound occurs when the barrel or muzzle is in contact with the skin or clothing as the weapon is discharged. Contact wounds can be described as tight, where the muzzle is pushed hard against the skin, or loose, where the muzzle is incompletely or loosely in contact with the skin or clothing. Wounds sustained from tight contact with the barrel can vary in appearance from a small hole with seared, blackened edges (from the discharge of hot gases and an actual flame) (see photo below), to a gaping, stellate wound (from the expansion of the skin from gases).

Large stellate wounds are often misinterpreted as exit wounds based solely upon their size and without adequate examination of the wound.

In a Right contact wound, all materials—the bullet, gases, soot, incompletely combusted gunpowder, and metal fragments—are driven into the wound. If the wound is over thin or bony tissue, the hot gases will cause the skin to expand to such an extent that it stretches and tears. These tears typically have a triangular shape, with the base of the tear overlying the entrance wound. Larger tears are associated with ammunition of greater or magnum loads.

Stellate tears are not pathognomonic for contact wounds. Tangential wounds, ricochet or tumbling bullets, and some exit wounds may also be stellate in appearance. These wounds are distinguished from right contact wounds by the absence of soot and powder within the wound. In some right contact wounds, expanding skin is forced back against the muzzle of the gun, causing a characteristic pattern contusion called a muzzle contusion (see photo immediately below).

Contact Gunshot Wound with Muzzle Abrasion (above photo): A contact gunshot wound to the right temple with stellate tears, seared skin, soot deposition, and muzzle imprint. A muzzle abrasion or muzzle imprint on the patient’s right temple was the result of the injection of gases into the skin, causing a rapid and forceful expansion of the skin against the barrel of a semiautomatic pistol.

These patterns are helpful in determining the type of weapon (revolver or semiautomatic) used to inflict the injury and should be documented prior to wound debridement or surgery. (other illustrations are shown below)

An abrasion collar, also known as an abrasion ring or abrasion rim, is a narrow ring of stretched, abraded skin immediately surrounding projectile wounds, such as gunshot wounds. It is most commonly associated with entrance wounds and is a mechanical defect due to a projectile’s penetration through the skin.

On the other hand, a star-shaped laceration may occur on a bony prominence in a right contact fire just like part of the head as seen below. The examiner must not be misled with these.

Loose Contact Wound

With a loose contact wound, where the muzzle is angled or held loosely against the skin, soot and gunpowder residue will be present in and around the wound (see the image below). The angle between the muzzle and skin will determine the soot pattern.

A perpendicular loose contact or near contact injury results in searing of the skin and deposition of the soot evenly around the wound. A tangential loose or near contact injury produces an elongated searing pattern and deposit of soot around the wound.

“Bullet wipe” is soot residue, soft lead, or lubricant, which may leave a gray rim or streak on the skin or clothing overlying an entrance wound (see below image). This gray discoloration may also be found around the abrasion collar but is usually more prominent on clothing.

Bullet Wipe: “Bullet wipe” is residue and lead deposited on clothing or skin. The presence of this residue on clothing may help to determine whether the wound is an entrance wound.

At Close (Near) Contact: Within 6 feet

The prominence of gunpowder tattooing and smudging can be visibly found surrounding the entrance wound (see illustration below)

● Right Contact Entries – point where the muscles are pressed, thereby producing a sharply defined circular zone peripheral to the entry hole. Tattooing is minimal or absent, gunshot powder or residue is present within the subcutaneous tissues in the bullet track.

● Near Contact Entries – show carbonaceous residue around the margins of entry. Helpful features consist of smoke and flame effect, smoke smudging, and tattooing.

● A distance of 2 – 6 inches – heat effect begins to disappear and cartridge loading, a circle of carbonaceous material surrounds the hole entry. The flame effect, smoke, and smudging, tattooing.

● A distance of 6 – 12 inches – heat effects begin to disappear and discreet particles make their appearance in a circle that spreads with the increase of the distance. Smoke, smudging, and tattooing are still prevalent.

● A distance of 12 – 18 inches – particles remaining in inches the pattern changes from small to large.

● A distance of 18 inches and above – target residue becomes fewer and farther scattered and finally at some point no residues are found except for a dark ring, which distinguishes the hole of entry, from the hole of exit.

SHOTGUN WOUND CHARACTERISTICS ACCORDING TO DISTANCE (see below illustration)

For a detailed reference about the details of gunshot wounds, you can click here for the weblink. Another link is available here as to the description of the characteristics of the wound according to distance.

THE SEX CRIMES

Criminological Characteristics:

[1] It is one of the ancient and universal crimes. It existed since the dawn of history. Although considered a crime by almost all countries of the world, society’s reaction to its repression depends on the moral value and its gravity as a social problem.

[2] There is close physical contact between the offender and the victim. Murder and homicide may be committed with the offender at a distance from the victim. Estafa and many other crimes may be committed even without the physical presence of the victim.

[3] As a general rule, it is a crime committed by one sex against the opposite sex (BUT with RA 8353 it can now be committed with the same sex).

[4] Sex is an inborn instinct. Any person without sex desire is considered abnormal. Satisfaction of the sexual instinct must be, in a way, acceptable by the moral standard. What is punishable is the anti-social means of attaining sexual gratification. In other crimes, no man is normally born with such criminal instinct. Murderers, defrauders, and other violators of the criminal law are not inborn characters of individuals.

[5] Except for probably the crime of rape and forcible abduction, most of the sex crimes do not belong to the so-called conventional crimes. Considering other sex acts as crime depends on the moral value existing in a society. Seduction and consented abduction are considered crimes in the Philippines but not in other countries.

[6] Many sex crimes are committed but not reported; if reported not investigated; if investigated, not prosecuted. This is on account of the fact that undue publicity may be prejudicial to the reputation of the victim.

[7] It is a crime committed in strict privacy. If committed in public the offender must be a mental deviate. Reliance must therefore be made by the investigating officer or court on the testimony of the victim corroborated by the medical findings.

[8] Although it is more frequent among the lower socio-economic class those who belong to the middle and upper classes are not immune to the commission of the crime.

[9] Unlike other crimes, pardon, forgiveness or marriage between the offender and the victim will extinguish the criminal liability of the offender.

[10] There is a seasonal variation in the frequency of commission. It is not the season that causes the variation but the social forces that may be present in a specific season. The month of May, for example, has more cases of sex offenses because Mayflower festivals, fiestas, picnics, excursions, etc. are frequent during this month.

[11] The severity of punishment does not deter its commission. Its frequency has not been appreciably reduced by rule of law.

[12] Its occasional consequence (pregnancy) becomes a legal problem, e.g. support, abortion, legitimacy, unwanted child, inability to find a means of livelihood, etc.

[13] If the offender is of past middle age, usually the victims are children. The primary reason is that old man will be ignored by elderly women so they focus their attention on children who can easily be enticed by candies or other things of value.

[14] The psychic trauma suffered by the victims of sex crimes varies with the moral standard of the victim. Women of the “Maria Clara” type with the morality of the Puritan Standard, may inflict fatal or serious injuries on the offender. Some may develop a feeling of worthlessness and as a consequence, may lead to self-destruction, while others may be mentally deranged. Others may have a strong belief in the machinery of justice and file the complaint, but a great number of those who seek justice later become amenable to an amicable settlement.

[15] Other victims suffer from fear of unfavorable consequences, like pregnancy, social degradation, and maltreatment by parents and other relatives.

Because sex crimes are about rape and other related acts, you need to be familiar with the rape law that had been discussed separately out of this subject. I am encouraging you to download the “LAW ON RAPE – CLICK HERE” and download it for your own readings. It is important for the learner to be familiar with the characteristics of the crime and the elements which are important in the investigation of sexual crimes.

Aside from rape, sexual crimes may also occur in cases involving abduction and seduction, and harassment.

MEDICAL EXAMINATION AND EVIDENCE IN SEXUAL CRIMES

Medical Evidence in Rape and Sexual Crimes:

1. Evidence from the victim:

Before an actual examination is made on the subject, it is necessary to have written consent from the subject herself or from her guardian if the victim is not of age. If the woman is confined in a correctional institution the consent may be given by the head of the institution.

A short history of the alleged rape must be taken and it is advisable to reduce it in writing. The history must include all the circumstances leading to the abuse, the age of the victim at the time of the alleged commission of the offense, and also the menstrual history. It may be used as a guide to the examining physician as to the different points that must be emphasized in the course of the examination. Aside from the history, the following points must also be recorded by the physician.

(A) Date, time, and place of the alleged commission of rape:

This is necessary in order to determine how long a time has elapsed after the alleged commission of the offense before the victim filed the necessary complaint or subjected herself to the medical examination. If several days have gone by before the filing of the complaint, let her explain the cause of the delay. The place where the alleged offense was committed is necessary to determine which court can acquire jurisdiction over the case.

(b) Date, time, and place of the examination:

The date of the examination is material for the determination of the possible findings of the physician on the victim. A long interval of time between the date of commission and the examination will remove the possibility of finding the effects of recent sexual intercourse.

(c) Condition of the clothing:

If force is applied in the commission of the offense, there will be tearing, staining with blood and semen, and soiling of the clothing. The clothing must be preserved after it has been thoroughly dried for further laboratory examination.

(d) The physician must observe the following:

The gait, the facial expression, and the bodily and mental attitude of the subject. If the victim suffered from genital injuries she may walk with legs apart and slowly, with the facial manifestations of signs that she is suffering from pain.

(e) Physical and mental development of the victim:

The height, strength, and degree of muscular development of the woman must be noted to determine whether she has the capacity to resist any unlawful aggression. If the victim is a child, examination of the physical condition is usually not necessary because it is apparent to the age. In most cases, children are “bribed” or lured by attractive articles such as candies by the offender.

The examiner must observe the mental state of the victim. She may be in a state of mental shock, under the influence of depressant drugs, alcohol, or sex stimulants. The offender might have taken advantage of her insanity or mental deficiency.

The victim may appear exhausted, despondent on account of the public humiliation she will suffer or may be hostile to the investigator. Care and a more psychological approach are necessary in order to get her full cooperation and consent.

(f) Examination of the body for signs of violence:

If actual force was applied in the commission of the crime, there must be signs of physical violence on the body of the victim. Her whole body must be subjected to inspection. Physical injuries must be described and the exact location must be determined. Areas of tenderness or swelling must not be overlooked and if necessary X-ray pictures must be taken to determine bone lesions.

Determination of the probable age of the physical injuries found is material. Does it correspond to the alleged date of commission?

(g) Examination of the genitalia, including the breast:

The breasts must be examined for the presence of finger marks or application of pressure. They might have been roughly handled or the nipples bitten. The vulva may show swelling, tenderness, contusion, abrasion, laceration, or maybe smeared with blood, semen, and other
foreign bodies.

The hymen may show fresh laceration, swelling, or bruising. There may be healed lacerations or signs of physical virginity. In the pubic hair, the following medical evidence may be gathered:
(1) Pubic hair of the offender.
(2) Semen and spermatozoa.
(3) Bloodstains.
(4) Body louse.

Abrasion which is normally found in the posterior commissure is usually brought about by friction or a violent attempt of insertion. The vaginal canal may show obliteration of the rugosities or even purulent discharge.

(2) Examination of the alleged offender:

a. Physical development, mental condition, and strength:

The relative physical development and strength of the victim and the offender must be compared to determine whether the offender can overpower the resistance offered by the victim.

b. Evidence of physical injuries:

The whole body must be examined. The victim, in the course of the struggle, may inflict bodily harm to the offender.

Fingernail marks on the neck, arms, and chest may be found. The frenum of the penis may be abraded or lacerated on account of the violent insertion on a relatively small vulvar or vaginal opening.

The frenum of the penis may be abraded or lacerated on account of the violent insertion on a relatively small vulvar or vaginal opening.

(c) Condition of the sex organ:

Aside from the examination of the frenum, washing from the surface of the penis may reveal blood, seminal stain, vaginal epithelium, and doderleins bacillus. The urethral meatus may be moist on account of the recent discharge.

(d) Evidence from the pubic hair:

The pubic hair may be matted together due to blood stains or from seminal fluid discharge. Examine carefully for the presence of a body louse.

(e) Potency of the offender:

The offender may put up a defense that he is impotent and that it could have been hardly possible that he had committed the crime. It may be necessary to subject the offender to a strong sex stimulus sufficiently under normal conditions to produce an erection.

(f) Evidence of genital infection

If the offender is suffering from a venereal disease that is transmitted to the victim during the criminal act, the crime committed is rape with physical injuries because infection in law is a physical injury.

(3) Evidence from the companion of the victim:

(a) A history of the incident must be taken from the companion of the victim. Try to see whether they are consistent with the narration of facts by the victim.

(b) If the companion helped the victim when force was applied by the offender, the companion must be subjected to a physical and medical examination for physical injuries.

(d) An investigation must be made to determine whether the companion might have participated as an accomplice to the crime.

(e) The mental condition, physical power, age, and emotional state must be taken into consideration to determine the capacity to resist unlawful aggression from the offender.

(f) The examination must be made as to the presence of alcohol or other depressants which may diminish the companion’s capacity to defend the victim from the offender.

(4) Investigation of the Crime Scene:

● Disturbances in the place of the commission may infer or affirm the statement of the victim that she did offer resistance.

● Strands of hair, blood, seminal, and other stains may be recovered to prove consummation and struggle.

● Pieces of personal belongings of the offender and /or victim may be recovered to prove identity and physical struggle.

● Investigation of witnesses who may possibly be material to the prosecution of the case may be conducted.

All evidence found must be subjected to thorough laboratory analysis by a competent forensic analyst and examiner.

UNNATURAL SEXUAL OFFENSES AND SEXUAL ABNORMALITIES

Unnatural sexual offenses are not only a deviation from the normal course of nature but also uncommonly observed manifestations of sexual perversion. Most of those persons suffering from the conditions do not exhibit criminal intent but manifest mental aberrations which may be a subject matter for the psychiatrist to treat.

Environment, degree of education, degree of morality, habits, etc. are some of the factors responsible for such sexual maladjustments. There is no specific provision of the Revised Penal Code on any of the unnatural sexual offenses, although certain provisions of the code may be made applicable.

Municipal ordinances of cities and towns may penalize unnatural sexual offenses in consonance with the power to promulgate rules and regulations necessary for the promotion of public safety, morals, and welfare.

SEXUAL ABNORMALITIES:

As to the Choice of Sexual Partner:

1. Heterosexual

Sexual desire towards the opposite sex. This is normal sexual behavior, socially and medically acceptable.

2. Homosexual

(Michaelangelo, Shakespeare, Oscar Wilde, Waltz Whiteman), Sexual desire towards the same sex.

a. Kinds of Homosexuals:

(1) Overt

Persons who are conscious of their homosexual cravings, and who make no attempts to disguise their intention. They make advances towards members of their own sex.

(2) Latent

Persons who may or may not be aware of the tendency in that direction but are inclined to repress the urge to give way to their homosexual yearning.

Tribadism (Lesbianism) — A special name for female homosexuals wherein a woman has the desire to have sexual intercourse with another woman. The “masculine woman” may be the active subject during the sexual act. Most lesbians have antipathy towards men.

3. Infantosexual

Sexual desire towards an immature person.

Pedophilia

A form of sexual perversion wherein a person has the compulsive desire to have sexual intercourse with a child of either sex. Children of various ages participate in sexual activities, like fellatio, cunnilingus, fondling with sex organs, or anal sexual intercourse. Usually committed by a homosexual, between a man and a boy the latter being a passive partner.

A Pedophile may be:

a. Homosexual pedophile

May attempt either oral or anal intercourse with his victim.

b. Heterosexual pedophile

May attempt either oral, vaginal, anal, intracrural intercourse as well as cunnilingus, but attempts at vaginal penetration are most common. Offenders entice their victim through the promise of money,
candy, etc.

Reasons Why Physicians Fail to Detect Child Sexual Abuse:

● The lack of “hard” physical evidence of abuse;

● A belief that sexual abuse does not exist;

● Fear of antagonizing parents; and

● Ignorance of how to obtain a detailed sexual history from the child.

Theories Why Adults become Interested in Children:

a. Emotional congruence

Children are sexually attractive to adult for a number of reasons:

● Children are non-dominant;

● Adults have low self-esteem, immaturity, socialization to male dominance or narcissism; and

● Unconscious impulse, compulsively to repeat child-adult sex contact to master, and his or her own early experience of child-adult sexual abuse.

b. Conditioning Modeling

Behavioral modeling begins with early childhood experience, positive or negative, and is conditioned by hormonal abnormalities, child pornography, and the misattribution of arousal as being only from children.

c. Blockage

Alternative sexual gratification may become blocked due to poor social skills with adults of the opposite sex, anxiety about sex, unresolved oedipal conflicts, unavailability of or conflict with a committed partner, as well as repressive sexual norms.

d. Disinhibition

Sexual controls may become disinhibited due to senility, dementia, mental retardation, psychosis, drug or alcohol, impulse disorders, situational stress, failure of incest avoidance, a general cultural acceptance.

4. Bestosexual

Sexual desire towards animals.
Bestiality (Zoophilia) — Sexual gratification is attained by having sexual intercourse with animals.

5. Autosexual (Self-gratification or masturbation)

It is a form of “self-abuse” or “solitary vice” carried without the cooperation of another person.

Relation of Masturbation to Health and Sex Crime:

(a) It serves as a sedative for a variety of neurotic dispositions. Many persons who suppress the urge to masturbate and give up the habit often develop anxiety neurosis.

(b) It serves as an adequate form of sexual gratification.

(d) It prevents the development of suicidal tendencies on account of the absence of sexual gratification.

(e) It protects certain persons from committing sex crimes.

Types of Masturbation:

Conscious Type — The person deliberately resorts to some mechanical means of producing sexual excitement with or without orgasm:

Ways of Masturbation:
(1) In males:

(a) By manual manipulation to the point of emission.

(b) Ejaculation is produced by rubbing his sex organ against some part of the female body without the use of the hand (frottage).

(2) In female:

(a) Manual manipulation of the clitoris.

(b) Introduction of the penis substitute.

Medical evidence cannot go beyond to prove the emission of semen, and unless caught “in flagrante delicto,” it is not likely that a person could be brought to trial. It may be a criminal act if done in public places or within the knowledge and view of the public. Psychiatric evaluation of the offender may be necessary.

Unconscious type

The release of sexual tension may come about via the mechanism of nocturnal stimulation with or without emission, which may also be considered as “masturbation equivalent”. The explanation is that the conscious urge to masturbate is repressed during the waking state and
expressed during sleep when we are less apt to censor our thoughts and desires (normally called “wet dreams”).

6. Gerontophilia

Sexual desire with an elder person.

7. Necrophilia

A sexual perversion characterized by erotic desire or actual sexual intercourse with a corpse.

8. Incest

Sexual relations between persons who, by reason of blood relationship cannot legally marry.

As to Instinctual Strength of Sexual Urge:

1. Over Sex:

(a) Satyriasis — Excessive sexual desire of men to intercourse.

(b) Nymphomania — Strong sexual feeling of woman. They are commonly called “hot” or “fighters”. Both satyriasis and nymphomania are the general expressions of compulsive neurosis.

2. Under-sex (Sexual frigidity):

(a) Sexual anesthesia — Absence of sexual desire or arousal during sexual activity in women.

(b) Dyspareunia — Painful sexual activity in women.

(c) Vaginisimus — Painful spasm of the vagina during sexual activity.

(d) Old age — Weakening of sexual feeling in the elderly. There may be the desire but there is the difficulty of accomplishment. It may be accompanied by aberrant behavior, like exhibitionism, incest, or homosexuality

As to Mode of Sexual Expression or Way of Sexual Satisfaction:

(1) Oralism

The use of the mouth as a way of sexual gratification.

(a) Fellatio (Irrumation) — The female agent receives the penis of a man into her mouth and by friction with the lips and tongue coupled with the act of sucking initiates orgasm.

(b) Cunnilingus — Sexual gratification is attained by licking or sucking the external female genitalia.

(c) Anilism (anilingus) — A form of sexual perversion wherein a person derives excitement by licking the anus of another person of either sex.

(2) Sado-masochism

(a) Algolagnia– Pain or cruel act as a factor for gratification.

(b) Flagellation – a sexual deviation associated especially with the act of whipping or being whipped.

a. Sadism (Active Algolagnia)

A form of sexual perversion in which the infliction of pain on another is necessary or sometimes the sole factor in sexual enjoyment.

● Cannibalism — Sexual gratification attained by biting without flesh-eating but with the presumed unconscious wish to consume.

● Love bites — These are superficial punctate contusions that are seen most frequently at the side of the neck, overlying or anterior to the sternomastoid muscle, breast, and other parts of the body. The bitten tissue must be loose and the mark is caused by forcible sucking applied to tissue seized by the mouth. Usually, during the act, the teeth are guarded by the lips. Because of the sucking, contusion develops. The infliction of such injury although amorous may be a part of the sadistic attitude of the offender. It is called necrosadism or lust murder if the victim dies. The deviate has a strong homicidal urge, quite often suffering from organic brain disease or maybe schizophrenic, epileptic, or psychopath.

b. Masochism (Passive algolagnia)

The pain and humiliation from the opposite sex is the primary factor for sexual gratification.

(3) Fetishism

A form of sexual perversion wherein the real or fantasized presence of an object or bodily part is necessary for sexual stimulation and/or gratification.

Kinds of Fetishes:

● Anatomic — Where particular portions of the anatomy, such as the breasts, or buttocks are the target of interest for sexual stimulation.

● Clothing — The deviate may have interest centered on shoes, handkerchiefs, undergarments, either on a sexual partner or stolen from a neighborhood washline.

● Necrophilic — The deviate has the desire to be near a dead body and may or may not violate the dead person for sexual gratification.

● Odor (Ospresiophilia) — Fetish whose stimulus is pleasant odor or foul odor for sexual stimulation or gratification.

● Urolagnia — A sexual deviation in which sexual excitement is associated with the sight of women urinating. In some instances, there is a desire to drink the urine.

● Coprolognia — A form of sexual deviation wherein sexual gratification is attained by seeing women defecate.

● Mysophilia — Sexual response to filth or excretion.

● Pygmalionism — A sexual deviation whereby a person has a sexual desire for statues.

● Mannikinism — Sexual desire with manikins.

● Narcissism — A person has extreme admiration and love for one’s self. Sexual gratification is attained by looking at the mirror and appreciating his or her own self.

● Negative fetish — The marked dislike for things, like eyeglasses, beard, hair cut, as the sole stimulus for gratification.

● Saboteur fetish — A deviate does damage while he gets satisfaction, like cutting clothes or hair.

● Incendiarism — Deviate derives sexual pleasure from setting a fire. (Did Nero belong to this category? ).

● Vampirism — Deviate attains sexual stimulation or gratification at the sight of blood.

As to the Part of the Body:

1. Sodomy

Sexual acts through the anus of another human being.

2. Uranism

Sexual gratification is attained by fingering, fondling with the breast, licking parts of the body, etc.

3. Frottage

A form of sexual gratification characterized by the compulsive desire of a person to rub his sex organ against some parts of the body of another. They generally achieve their erotic gratification by rubbing or pressing their organs against the buttocks of women in crowded subways, buses, theaters, or streetcars. The frotteur often pretends that the rubbing is accidental.

4. Partialism

A form of sexual deviation wherein a person has a special affinity to certain parts of the female body. Sexual libido may develop in the breast, buttock, foot, legs, etc. of women. Usually, sexual intercourse is merely secondary to satisfy sexual desire.

A person may prefer rubbing his penis against the woman’s breast or may prefer his partner to lie prone and kiss the buttocks or perform cunnilingus.

Frottage differs from partialism in the sense that in the former there must be rubbing at certain parts of the body to arouse sexual stimulation, while in the latter the act may not only be rubbing but actual intercourse.

As to Visual Stimulus

1. Voyeurism

A form of sexual perversion characterized by a compulsion to peep to see persons undress or perform other personal activities. The offender is sometimes called “Peeping Tom”. Usually, after peeping, he masturbates in excess.

2. Mixoscopia (Scoptophilia)

A perversion wherein sexual pleasure is attained by watching a couple of undress or during their sex intimacies.

As to Number:

Normal sexual relation is only between a man and a woman, but deviation in sexual behavior may attain gratification when more than two persons are participating.

1. Troilism (Menage a trois’)

A form of sexual perversion in which three persons are participating in the sexual orgies. The combination may consist of two men and a woman or two women and a man. The usual activity may be fellatio, kissing the buttock, sucking the breast, a “suixante-neuf” (sixty-nine) arrangement, or coitus combined with other sexual practices. Sexual gratification is attained in the “eternal triangle”.

2. Pluralism

A form of sexual deviation in which a group of people participates in sexual orgies. Two or more couples may perform a sexual act in a room and they may even agree to exchange partners for “variety sake” during the “sexual festival”.

Other Sexual Deviates:

1. Coprolalia

A form of sexual deviation characterized by the need to use obscene language to obtain sexual gratification. Sometimes they go beyond uttering profane words by making some writings and sketches on the walls of toilets.

2. Don Juanism

The term applied by psychiatrists to describe a form of sexual deviation characterized by promiscuity and making seduction of many women as a part of his. career. The pervert cannot find anyone to be a permanent companion.

3. Indecent Exposure (Exhibitionism)

This is the willful exposure in public places of one’s genital organ in the presence of other persons, usually of the opposite sex. Usually, the exhibitionist is naked. It is the act of men whose sexual satisfaction is attained principally by an exhibition with or without the performance of the masturbatory act. Women may expose themselves naked in public as in “bubble and fan” dances and the “striptease” acts in nightclubs, but this is part of their work. In a civilized society, exhibitionism committed in public places is harmful to the sense of decency and good morals, hence it is punishable.

Sexual Reversal:

1. Transvestism

(“Sexo-esthetic inversion”, “Psychical hemaphroditism” or “Metamorphosis sexualis paranoica”) — A form of deviation wherein a male individual derives pleasure from wearing the female apparel.

This condition is found sometimes in females who desire to dress in male attire. The transvestite has a psychic identification with the opposite sex. A female transvestite may imagine that she possesses a penis. It is quite difficult to detect a female transvestite since it is quite common for women to wear slacks or dress in masculine tailored ways.

Transvestites are, as a rule, harmless insofar as they have no desire to assault anyone. Like exhibitionists, they are merely interested in attracting attention. Transvestitism is a symptomatic expression of some deep underlying sexual maladjustment amenable to psychotherapy.

2. Transexualism

There is a dominant desire in some persons to identify themselves with the opposite sex as completely as possible and to discard forever their anatomical sex. So strong is the compulsion to have the opposite sex that they hate their genitalia as persistent evidence that they are not what they want to be, and sometimes attempt to castrate themselves or mutilate their external genitalia. They may go to the extreme of taking for a long period of time sex hormones to develop secondary sex characteristics of the opposite sex. They may go to the extent of subjecting themselves to surgery to change their anatomical sex. (if oneself was subjected to surgery, they are called TRANSGENDER)

3. Intersexuality

A genetic defect wherein an individual shows intermingling, in varying degrees, of the characteristics of both sexes including physical form, reproductive organs, and sexual behavior.

Classification of Intersexuality:

a. Gonadal Agenesis

The sex organs (testes or ovaries) have never developed. This condition can be determined very early in fetal life.

b. Gonadal Dysgenesis

The external sexual structures are present but at puberty, the testes or the ovaries fail to develop.

● Klenefetter’s syndrome — A male type of dysgenesis in which although the anatomical structure is entirely male, the nuclear sexing is female (Chromatin positive), characterized by the presence of small testes with fibrosis and hyalinization of the seminiferous tubules. It is associated with X X Y chromosomes.

● Turner’s syndrome — Structurally and phenotypically female but the ovaries are small. There is sterility with the absence of the second X chromosomes.

c. True hermaphroditism

A state of bisexuality, having both ovaries and testicles. The nuclear sex is usually female. The character may be neutral or whichever is dominant.

d. Pseudohermaphrodite

The sex organ is anatomical of one sex but the sex character is that of the opposite sex.

● Male pseudohermaphrodite — Gonads are testicles but the character is effeminate.

● Female pseudohermaphrodite — Gonads are ovaries but with masculine character.

END OF OUR COURSE

This module has the largest coverage, but your FINAL EXAM will be 40 items only. Items are taken from the topic covering, death, wound, injuries, and sexual crimes and deviations.

WHEN READY, GO TO THE TEST FOR YOUR FINAL GRADE… GOOD LUCK!

Forensic Medicine

Curriculum