PHYSICAL INJURY As to Manner of Infliction

 the effect of some forms of stimulus on the body a. HIT – bolo, blunt instrument, axe
 The effect of the application of stimulus may be b. THRUST or STAB – dagger
immediate or may be delayed c. GUNPOWDER EXPLOSION – projectile or shrapnel
 A thrust to the body of a sharp-pointed and sharp- wound
edged instrument will lead to the immediate d. SLIDING or RUBBING or ABRASION
production of a stab wound, while a hit by a blunt
object may cause the delayed production of a As regards to Depth of the Wound:
contusion a. SUPERFICIAL – involves only layers of the skin
b. DEEP – involves inner structure
CAUSES OF PHYSICAL INJURY o Penetrating – enters the body but did not
A. Physical Violence come out or piercing of a solid organ or
B. Heat or Cold tissue (puncture, stab, gunshot)
C. Electrical Energy o Perforating – piercing or transversing
D. Chemical Energy completely through a part of the body
E. Radiation by Radio-Active Substances causing a point of entry and point of exit
F. Change of Atmospheric Pressure (Barotrauma)
G. Infection As regards to Reaction to Site of the Application of Force and
the Location of Injury:
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES a. COUP INJURY – located at site of application
b. CONTRE-COUP INJURY – located at opposite side of
A. PHYSICAL INJURIES BROUGHT ABOUT the application force
BY PHYSICAL VIOLENCE c. COUP CONTRE-COUP INJURY – located at the site
and opposite the site of the application of force
Wound
 The effect of the application of physical violence on a Special Types of Wounds:
person
 the disruption of the natural continuity of any tissue a. DEFENSE WOUND
of the living body - the result of a person’s instinctive reaction of self-protection
- Injuries suffered by a person to avoid or repel potential
Vital Reaction injury contemplated by the aggressor
- A person who is conscious that he is going to be hit by a
 It is the sum total of all reactions of tissue or organ to
blunt instrument on the head may raise his flexed forearms
trauma.
over his head, causing injuries on the forearms
 May be observed macroscopically or microscopically.
 The following are common reactions of a living tissue
b. PATTERNED WOUND
to trauma:
- Wound in the nature and shape of an object or instrument
o RUBOR – redness due to increased blood
and which infers the object or instrument causing it
supply
- Impact of the face on the radiator grill of any car may cause
o CALOR – sensation of heat or warmth
imprint of the radiator grill on the face
o DOLOR – pain in involvement of pain - A person run over by a wheel of a car, tire marks are shown
sensory nerve on the body
o TUMOR - inflammation - Due to hanging, the nature of the abrasion of the abrasion
o LOSS OF FUNCTION mark on the neck may infer material used

CLASSIFICATION OF WOUNDS c. SELF-INFLICTED WOUND

- Self-inflicted wound is a wound produced on oneself
As to Severity: - As distinguished from suicide, the person has no intention to
a. MORTAL WOUND – capable of causing death; affects end his life.
the major organs of the body:
 Heart and big blood vessels - Motive of Producing Self-Inflicted Wounds:
 Brain and upper spinal cord (1) To create or deliberately magnify an existing injury or
 Lungs disease for pension or workman’s compensation
 Stomach, liver, spleen, and intestine (2) To escape certain obligations or punishment. During war
b. NON-MORTAL WOUND – not capable of causing time soldiers may cut their fingers to avoid frontline
death assignments and prisoners may inflict physical injuries on
their body to avoid hard labor and just be confined in a
As to Kind of Instrument used: hospital to receive food and rest
a. By blunt instrument (contusion, hematoma, (3) To create a new identity or destroy the existing one.
laceration) Fingerprints may be destroyed by acid, by cutting or burning.
b. By sharp instrument: A person may even have plastic surgery
- Sharp-edged (incised wound) (4) To gain attention or sympathy (Munchausen’s syndrome)
- Sharp-pointed (punctured) (5) Psychotic behavior (Schizophrenia)
- Sharp-edged and sharp pointed (stab wound)
c. By tearing force (laceration) - Some Ways of Self-Mutilation:
d. By change in atmospheric pressure (barotrauma) (1) Head banging or bumping — This is commonly observed in
e. By heat or cold (frostbite, burns) overactive and autistic children and causes hematoma
f. By chemical reaction (gunshot or shrapnel wound) (2) Exposure of parts of the body to heat radiation from open
g. By infection fires, radiators, or protective grills over radiator
(thermophilia)
(3) Penetrating nail or spike to the chest wall, or insertion into
the urinary bladder in a female
(4) Castration by amputation of the penis.
(5) Trauma inflicted on the female genitalia to induce abortion
or promotes hemorrhage and creates an anemia
(6) Subcutaneous injection of the fecal matters to promote
abscess formation
(7) Pricking of acne eruption to lead to a severe facial
disfigurement
(8) Subcutaneous injection of air to create a condition or
emphysema
(9) Nail-biting (onychophagia) which may lead to maceration
of the skin and an infection.
(10) Grinding of the teeth (bruxism) is frequently seen in the
mentally retarded and can lead to abnormal tooth wear, a
bilateral hypertrophy of the masseter and a pain on chewing
(11) Pressure on the subcutaneous tissue by a tightly applied
cord or belt around the body:
(a) Tribal customs of metal band around the neck or
a leg by some African tribes may cause a permanent
disfigurement.
(b) Use of shoes made of metal by Chinese women
(12) Pulling of the body hair (Trichotillomania).
MUTILATION
- Art. 262, Revised Penal Code:
The penalty of reclusion temporal to reclusion
perpetua shall be imposed upon any person who shall
intentionally mutilate another by depriving him, either totally
or partially, of some essential organ for reproduction.
- Any other intentional mutilation shall be punished by prison
mayor in its medium and maximum periods.
- is the act of looping or cutting off any part or parts of the
living body
- In order to be punishable under the Code, it must be
intentional, otherwise, it will be considered as a physical
injury
- The loss of an eye due to stabbing is not mutilation. It is
evident that the putting out of an eye does not fall under the
definition
- “Mayhem” is the unlawful and violent deprival of another of
the use of a part of the body so as to render him less able in
fighting, either to defend himself or to annoy his adversary
- Mutilation of other parts of the body other than the organ
of reproduction may be classified as mayhem
Kinds of Mutilation Punishable Under the Code:
1. Intentionally depriving a person, totally or partially of some
of the essential organs for reproduction, and
2. Intentionally depriving a person of any part or parts of the
human body other than the organs for reproduction.
MEDICAL CLASSIFICATION OF WOUNDS
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
a. Petechiae
– pinpoint-sized, red or purple spots on the skin resulting
from small hemorrhages in the skin layer
- a tiny purplish red spot on the skin caused by the release
into the skin of a very small quantity of blood from a capillary
- The cause of passage of blood from the capillaries may be
due to the increase intra-capillary pressure or increased
permeability of the vessel
b. Contusion
– an injury to the body in which skin and bone are not broken
but damage is done to tissues under the skin, causing a bruise
- injury in which tiny blood vessels beneath the skin are
ruptured, but the skin itself is not broken
- The affected area swells and turns shades of blue, red, and
purple as blood from the broken blood vessels seeps into the
tissues
c. Hematoma
– pool of blood trapped in an area of the body outside of a
blood vessel, such as under the skin, in an organ, or in a cavity
between organs
- usually the result of an injury that breaks the wall of a blood
vessel, causing blood to pool in the surrounding tissue
- Unlike the blood in a bruise, the blood in a hematoma is
usually clotted or partly clotted
B. DEEP
A. MUSCULOSKELETAL INJURIES
a. Sprain — Partial or complete disruption in the
continuity of a muscular or ligamentous support of a
joint. It is usually caused by a blow, kick or torsion
force
b. Dislocation — Displacement of the articular surface
of bones entering into the formation of a joint
c. Fracture — Solution of continuity of bone resulting
from violence or some existing pathology.
i. Closed or Simple Fracture — Fracture
wherein there is no break in continuity of
the overlying skin or where the external air
has no point of access to the site of injury
ii. 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
iii. Comminuted Fracture — the fractured bone
is fragmented into several pieces
iv. Greenstick Fracture — A fracture wherein
only one side of the bone is broken while the
other side is merely bent
v. Linear Fracture — When the fracture forms
a crack commonly observed in flat bones
vi. Spiral Fracture — The break in the bone
forms a spiral manner as observed in long
bones
vii. Pathologic Fracture — Fracture caused by
weakness of the bone due to disease rather
than violence
d. 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
e. Subluxation — Incomplete dislocation
B. INTERNAL HEMORRHAGE
- Rupture of the blood vessel which may cause
hemorrhage may be due to the following:
(a) Traumatic intracranial hemorrhage.
(b) Rupture of parenchymatous organs.
(c) Laceration of other parts of the body.
C. CEREBRAL CONCUSSION (COMMOTIO CEREBRI)
- 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
 - is much more severe when the moving or mobile
head struck a fixed hard object as compared
when the head is fixed and struck by a hard-
moving object
2. Open Wound
- There is a breach of continuity of the skin or mucous
membrane
A. 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
Forms of Abrasion:
a. Linear:
- An abrasion which appears as a single line. It may
be a straight or curved line. Pinching with the
fingernails will produce a linear curved abrasion,
while sliding the point of a needle on the skin will
produce a straight linear abrasion.
b. Multi-Linear:
- An abrasion which develops when the skin is
rubbed on a hard rough object thereby
producing several linear marks parallel to one
another. This is frequently seen among victims of
vehicular accidents
c. Confluent:
- An abrasion where the linear marks on the skin
are almost indistinguishable on account of the
severity of friction and roughness of the object
d. Multiple:
- Several abrasions of varying sizes and shapes
may be found in different parts of the body
Types of Abrasion:
a. SCRATCH:
- caused by a sharp-pointed object which slides
across the skin, like a pin, thorn or fingernail
- injury is always parallel to the direction of slide
- The fingernail scratch may be broad at the point
of commencement and may terminate with a
tailing
b. GRAZE:
- usually caused by forcible contact with rough,
hard objects resulting to irregular removal of the
skin surface
- The nature of the injury is dependent upon the
degree of roughness of the object and the
amount of pressure in the course of the sliding
c. IMPACT or IMPRINT ABRASION (Patterned
Abrasion, Stamping Abrasion, “Abrasion A
La Signature”):
- Those whose pattern and location provides
objective evidence to show cause, nature of the
wounding material or instrument and the
manner of assault or death
d. PRESSURE or FRICTION 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
Differential Diagnosis:
a. Dermal Erosion:
- A gradual breakdown or very shallow ulceration
of the skin which involves only the epidermis and
heals without scarring
- It may appear in spots and with no previous
history of friction or sliding
b. Marks of Insects and Fishes Bites:
- The skin injury is irregular with no vital reaction
and usually found on angles of the mouth,
margins of nose, eyelids and forehead
c. Excoriation of the Skin by Excreta
- only found among infants and the skin lesion
heals when the cause is removed
d. Pressure Sore:
- Usually found at the back at the region of bony
prominence
- History of long standing illness, bed ridden
condition although pressure sore may start as a
previous area of abrasion
B. INCISED WOUND(CUT, SLASH, SLICE)
 produced by a sharp-edged (cutting) or sharp-linear
edge of the instrument, like a knife, razor, bolo, edge
of oyster shell, metal sheet, glass, etc
 It may be an impact cut when there is forcible
contact of the cutting instrument with the body
surface, or slice cut when cutting injury is due to the
pressure accompanied with movement of the
instrument
 When the wounding instrument is a heavy cutting
instrument, like axe, big bolo, saber, the wound
produced is called Chopped or Hacked wound
Incised Wounds may be Suicidal, Homicidal or Accidental:
SUICIDAL
- in 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 are on the wrist with involvement of the
radial artery and the neck
HOMICIDAL
- The incised wounds are deep, multiple and
involve both accessible and non-accessible parts
of the body to the hands of the victim
- Defense and other forms of wounds may be
present
ACCIDENTAL
- Multiple incised wound is commonly observed
on the passengers and the driver of vehicular
accidents on account of the broken windshield
and glass parts of windows
- Stepping on oyster shell, broken glasses, sharp
edges of metal sheets are common causes of
incised wound on the sole of the foot
C. STAB WOUND
 produced by the penetration of a sharp-pointed and
sharp-edged instrument, like knife, saber, dagger,
scissors
 It may involve the skin or mucous surface
 As a general rule, like an incised wound, the edges
are clean-cut, regular and distinct
Stab Wound(s) may be Suicidal, Homicidal or Accidental:
SUICIDAL
a. It is located over the vital parts of the body
b. It is usually solitary. If multiple, they are located on one
part of the body
c. If located on covered parts of the body, the clothings are
not involved
d. The stab wound is accessible to the hand of the victim
e. The hand of the victim is smeared with blood
f. The wounding weapon is firmly grasped by the hand of the
victim (cadaveric spasm)
g. If stabbing is accompanied with slashing movement, the
wound tailing abrasion is seen towards the hand inflicting the
injury
h. A suicide note may be present
i. There is the presence of a motive for self-destruction
j. No disturbance in the death scene, wounding instrument is
found near the victim
HOMICIDAL
a. Injuries other than stab wound may be present (defense
wounds)
b. Stab wound may be located in any part of the body
c. Usually there are more than one stab wound
d. There is disturbance in the crime scene
e. There is a motive for the stabbing. If without motive, the
offender must be insane or under the influence of drugs
D. PUNCTURED WOUND
 is the result of a thrust of a sharp pointed instrument
 The external injury is quite small but the depth is to a
certain degree
 It is commonly produced by an icepick, needle, nail,
spear, pointed stick, thorn, fang of animal, and hook
Punctured wound with puncturing instrument “loaded” with
poison:
a. Poison dart — cyanide or nicotine
b. Fish spines
c. Dog bites with hydrophobia virus
d. Injection of air and poison as a way of euthanasia
D. LACERATED WOUND (TEAR, RUPTURE, STRETCH
“PUTOK”)
 Lacerated wound is a tear of the skin and the
underlying tissues due to forcible contact with a
blunt instrument
 It may be produced by a hit with a piece of wood,
iron bar, fist blow, stone butt of firearm, or other
objects without sharp objects
 If the force applied to a tissue is greater than its
cohesive force and elasticity, the tissue tears and a
laceration is produced
 It may be produced by a hit with a piece of wood,
iron bar, fist blow, stone butt of firearm, or other
objects without sharp objects
MEDICO-LEGAL ASPECTS OF DEATH
DEATH
- the termination of life
- It is the complete cessation of all the vital
functions without possibility of resuscitation
- It is an irreversible loss of the properties of living
matter
+ Dying is a continuing process while death is an event that
takes place at a precise time
+ The ascertainment of death is a clinical and not a legal
problem
Based on the Criterion Used in its Determination, Death may
be:
1. BRAIN DEATH - Death occurs when there is deep
irreversible coma, absence of electrical brain activity and
complete cessation of all the vital functions without
possibility of resuscitation
According to the Harvard report of 1968, the following
are characteristics of “irreversible coma”:
a. UNRECEPTIVITY AND UNRESPONSIBILITY
No response even to the most painful stimuli
b. NO MOVEMENTS OR BREATHING
- At least one hour of observation of no movement or
breathing
c. NO REFLEXES
- Pupils fixed and dilated
- Corneal reflexes absent
- Pressure response absent
- No response to airway stimulation
- No response to ice water stimulation
- No deep tendon reflexes
d. FLAT ELECTROENCEPHALOGRAM
2. CARDIO-RESPIRATORY DEATH - Death occurs when there is
a continuous and persistent cessation of heart action and
respiration. Cardio-respiratory death is a condition in which
the physician and the members of the family pronounced a
person to be dead based on the common sense or intuition.
KINDS OF DEATH
1. SOMATIC OR CLINICAL DEATH
- This is the state of the body in which there is complete,
persistent, and continuous cessation of the vital functions of
the brain, heart, and lungs to maintain life and health
It occurs the moment the physician or family members
declare the death of the person
- Immediately after death, the face and lips become pale, the
muscles become flaccid, sphincters relax, the lower jaw
drops, the eyelids remain open, pupils dilate, and the skin
loses elasticity
2. MOLECULAR OR CELLULAR DEATH
- After cessation of the vital functions of the body there is still
animal life among individuals
-Three to six hours later, there is death of individual cells. This
is known as MOLECULAR or CELLULAR death
3. “APPARENT DEATH” OR “STATE OF SUSPENDED
ANIMATION”
- This condition is not really death by merely a transient loss of
consciousness or temporary cessation of vital functions of the
body due to disease or other stimuli (ex. Epilepsy, hysteria,
electric shock)
SIGNS OF DEATH
1. Cessation of heart action and circulation
- There must be an entire and continuous cessation of the
heart action and flow of blood in the whole system
- A temporary suspension of the heart action is still
compatible with life, depending on the length of time the
functions are reestablished
- General rule: if there is no heart function in a period of FIVE
MINUTES, death is certain
- Respiration ceases frequently before the stoppage of the
heart contraction and circulation
- The atrium is usually the last to stop beating: this is called
ULTIMEN MARIENS
- In judicial hanging, the heart continues to beat for 20-30
MINUTES after the person has been executed
- In decapitation, heart beating is present for 1 HOUR after
decapitation has taken place
Methods of Detecting the Cessation of Heart Action and
Circulation:
A. EXAMINATION OF THE HEART
- Palpation of the Pulse
- Weak and irregular
- Auscultation of the Heart Sound
- Fluoroscopic examination
- Electrocardiograph
2. Cessation of respiration
- Like heart action, cessation of respiration must be
continuous and persistent
- A person can hold his breath for a period not longer than 3
minutes.
- In the case of electrical shock, respiration may stop but may
be restored through continuous artificial respiration
Methods of Detecting the Cessation of Respiration:
- Expose the chest and abdomen and observe the
movement during inspiration and expiration
- Examine the person with a stethoscope
3. Cooling of the body (ALGOR MORTIS)
- After death, the chemical processes inside the body stops.
- No heat is produced and the body loses its temperature to
the environment
- The progressive fall of the body temperature is one of the
most prominent signs of death
- The rate of cooling of the body is nor uniform. It is rapid
during the first 2 hours after death and slows down as the
body approaches the surrounding temperature
- The fall of temperature of 15 to 20 degrees Fahrenheit is
considered as a sign of death
+ POST MORTEM CALORICITY
Rise of temperature of the body after death due to rapid and
early internal changes in the body.
Usually observed in the first two hours after death
FORMULA:
(Normal temp) 98.4F – (Rectal temp)
1.5
= Approximate number of hours after death
INFLUENCE OF BACTERIA IN DECOMPOSITION:
Decomposition is due to the action of bacteria in various
tissues of the body.
The microorganism that plays an important and dominant
role in decomposition is CLOSTRIDIUM WELCHII.
Other destructive agents during decomposition:
A. FLIES
1. Maggots (Larvae)
Depends on the accessibility of adult flies to the body
The maggots have a strong desire to live in damaged skin
surface
Maggots may also be observed in bodies buried in shallow
graves and floating decomposing bodies in water pools
2. Adult flies
Common house flies are carnivorous
They eat juicy areas of exposed portions of the body
Decomposition by adult flies is observed better when the
body is found on surface ground
B. REPTILES
Lizards and snakes are attracted to dead bodies and eat the
soft tissues.
Small bones may be fractured in the process and may be
mistaken for physical injury before death
C. MICE
Mice will nibble the skin and other tissues of the
decomposing body.
The bones may also be attacked
D. FISHES AND CRABS
Fish and crabs will feed on the soft tissues of a body in water
Man-eating fish like sharks will eat the body whole
DURATION OF DEATH
1. Presence of Rigor Mortis
In warm countries like the Philippines, rigor mortis sets in
from 2-3 hours after death.
It is fully developed in the body after 12 hours.
It may last from 18-36 hours and its disappearance indicates
onset of putrefaction
2. Presence of Post-Mortem Lividity
Usually develops 3-6 hours after death
It first appears as small petechiae-like red spots which later
form into bigger areas in the most dependent part of the
body
3. Onset of Decomposition
In tropical countries, decomposition is early and the average
time is 24-48 hours after death.
It is manifested by the presence of watery, foul-smelling froth
coming out of the nostrils and mouth, and softness of the
body.
4. Stage of Decomposition
Approximate time of death may be concluded form the
degree of decomposition. However, investigators must take
note of the factors that may hasten or slow decomposition
5. Entomology of the Cadaver
- the usual time for the egg to be hatched into a larva is 24
hours. Thus, if there are maggots in a cadaver, we can
conclude that death occurred for more than 24 hours.
6. Stage of Digestion of Food in the Stomach
It takes normally 3-4 hours for the stomach to evacuate its
contents after a meal.
The approximate time of death may be deduced from the
amount of food in the stomach in relation to his last meal.
This determination is dependent upon the amount of food
taken and the degree of tonicity of the stomach
7. Presence of live fleas in the Clothings in Drowning Cases
A flea can survive for approximately 24 hours submerged in
water
In cold areas, people wear woolen clothes and the fleas are
found in the clothing
If the fleas could still move upon recovery of the body, it has
been in the water for less than 24 hours.
Revival of the fleas is not possible if underwater for more
than 24 hours
8. Amount of Urine in the Bladder
This may indicate the time of death when taken into
consideration when he was last seen voiding his urine
9. State of Clothings
A circumstantial proof of the time of death is the apparel of
the deceased
Whether the victim is wearing street clothes or pajamas may
indicate if the crime happened during the day or night
10. Chemical changes in the Cerebrospinal Fluid (15 hours
after death)
Lactic Acid increases
Non-protein nitrogen increases
Amino-acid concentration increases
11. Post-Mortem Clotting and Decoagulation of Blood
Blood clots inside the blood vessels 6-8 hours after death
Decoagulation of blood occurs at the early stage of
decomposition
12. Presence or Absence of Soft Tissues in Skeletal Remains
Under ordinary conditions, the soft tissues of the body may
disappear 1-2 years time after burial
13. Condition of the Bones
If all of the soft tissues have already disappeared from the
skeletal remains, the degree of erosion of the the long bones
and flat bones are the basis for approximation

ASPHYXIA
- there is a pronounced retention of CO2
- there is a subsequent increase in respiratory action since
there is an obstruction in the respiratory orifices