PHYSICAL INJURIES

MEDICO-LEGAL ASPECTS
Physical injury
It is the effect of some forms of stimulus on the body.

EFFECT OF PHYSICAL INJURY MAY BE:

1. Apparent when the stimulus applied is insufficient to
cause injury and the body resistance is great.
2. Real when it is visible.
 Causes of physical injuries
Physical Violence
Heat or Cold
Electrical Energy
Chemical Energy
Radiation by Radio-Active Substances
Change of Atmospheric Pressure
(Barotrauma)
Infection
PHYSICAL INJURIES BROUGHT ABOUT BY
PHYSICAL VIOLENCE
The effect of application of physical violence on a person
is the production of WOUND.
However, the effect of physical violence may not always
result to the production of wound, but 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 presence of vital reaction differentiates an ante-mortem
from post-mortem injury.

Common reactions of tissue or organs to trauma:

1. Rubor redness or congestion of the area due to an increase of blood supply as a
part of 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 not be able to function normally.
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

Wound as to severity

MORTAL WOUND NON MORTAL WOUND

Capable of causing death Not capable of producing death

Heart and big blood vessels;
Brain and upper portion of
spinal cord;
Lungs;
Stomach, liver, spleen and
intestine.
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

Wound as to kind of instrument
used

1. Blunt Instrument 2. Sharp Instrument 3. Tearing Force

Contusion Sharp-edged instrument Lacerated wound

Hematoma (incised wound)
Lacerated wound Sharp-pointed
instrument (punctured
wound)
Sharp-edged & sharp
pointed instrument
(stab wound)
Wound as to kind of instrument
used

4. Change of 5. Brought about by 6. Chemical

atmospheric pressure heat or cold Explosion

barotrauma Frostbite Gunshot or shrapnel

Burns or scald wound
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

Wound as to manner of infliction

3. Gunpowder 4. Sliding or rubbing

1. Hit 2. Thrust or Stab
explosion or abrasion

By means of bolo, Bayonet dagger Projectile or

blunt instrument, shrapnel wound
axe
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

 Piercing or traversing completely a
particular part of the body causing
communication between the points of
Perforating skin.
entry and exit of the instrument or
substance producing it.
layers of the
beyond the the skin.
inner structure the layers of
involves the involves only
Wounding agent enters the body but did Penetrating Wound Wound
not come out.
Deep Superficial
wound
Wound as regards to the depth of
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

 Wound as regards to relation of site of the
application of force and the location of injury

Contre-coup Coup Contre- Locus Minoris

Coup Injury Extensive Injury
Injury Coup Injury Resistencia

Injury is Injury found Injury located Injury located Injury involving

located at the opposite the at the site and in some areas a greater area
site of the site of also opposite other than at of the body
application of application of the site of the site nor beyond the site
force. force. application of opposite of of the
force. application of application of
force offering force.
the least Wide area f
resistance to injury and
the force varied types of
applied. injury.
CLASSIFICATION OF WOUNDS

SEVERITY INSTRUMENT INFLICTION

SITE OF FORCE
DEPTH OF WOUND
& INJURY

SPECIAL TYPES OF WOUNDS

Special types of wounds

Patterned Self-inflicted
Defense Wound Wound
Wound

Result of ones Wound in the Wound

instinctive nature and produced by
reaction of shape of an oneself.
self- object or
protection. instrument
and which
infers the
object or
instrument
causing it.
Legal classification of
physical injuries
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
 mutilation

It is the act of looping or cutting off any part or parts of the

living body.
It must be intentional, otherwise it will be considered as a
TWO KINDS OF MUTILATION
physical injury.
PUNISHABLE UNDER THE CODE
Totally or partially of some of the essential
Intentionally organs for reproduction.
Of any part or parts of the human body
depriving a other than the organs of reproduction.
(Mayhem)
person
mutilation
Vasectomy and tubal ligation are not mutilation and a
legitimate method of contraception despite the fact that it
is done intentionally and deprives the person of his power
of reproduction because it does not involve removal of
reproductive glands or organs as in the case of castration.
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
Serious physical injuries
Any person who shall wound, beat or assault another shall be guilty of the
crime of serious physical injuries.
Art 263, RPC shall not be applicable to a parent who shall inflict physical
injuries upon his child by excessive chastisement.

It may be due to:

The crime may be due to:
1. wounding
2. beating
3. assaulting
4. administering injurious substances without intent to kill. (May be
committed through simple negligence or imprudence)
 Serious physical injuries
Prision Mayor Prision Correccional Prision Correctional Arresto Mayor
(medium & maximum) (minimum & medium) (maximum to prision
correccional minimum)
Loss of the use of speech
Caused illness or
or the power to hear , or to
Deformity (Condition of incapacity for labor of the
Insane smell or loss of an eye, a
physical ugliness) injured person for more
hand, a foot, an arm or a
than 30 days.
leg;
Imbecile (must be of Loss of any other member
pre-adolescent age, Loss of the use of any such of his body (loss of parts of

there is an arrest of member; the body not mentioned in
mental development), par 2 Art 263)
Impotent (inability to Becomes incapacitated for
grant to the partner the work in which he was
Loss the use thereof
sexual gratification), therefore habitually
or engaged.
Becomes ill or
incapacitated for the
Blind (must be total performance of the work

or both eyes) which he was habitually
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
Administering injurious substances
or beverages

1. The offender inflicted upon another

person any serious physical injury;

Elements of
2. The infliction was done knowing that the
substance or beverage administered is
injurious or took advantage of the
the crime victims weakness or credulity;
3. There was no intent to kill on the part of
the offender.
Administering injurious substances
or beverages
If administration of injurious or beverages is intentional,
the crime committed is frustrated murder.

Treachery is inherent when injurious substances or

beverages are introduced into the body.
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
Less serious physical injuries
Any person who shall inflict upon another physical injuries
not described in the preceding articles, but which shall
incapacitate the offended party for labor for 10 days or
more or shall require medical attendance for the same
period shall be guilty of less serious physical injuries and
shall suffer a penalty of arresto mayor.
Less serious physical injuries
The fact that injury only requires medical attendance for 2
days but incapacitated the victim for a period of 29 days
makes the crime less serious physical injuries. (US v
Trinidad)

There must be proof as to the period of medical attendance.

In the absence of such proof of medical attendance or
incapacity, although the wound actually healed in more
than 30 days, the crime committed is only slight physical
injuries. (Pp v Penesa)
Less serious physical injuries
It may be qualified and a fine or of a higher penalty is
imposed when:
1. There is manifest intent to insult or offend the injured
person;
2. There are circumstances adding ignominy to the offense;
3. The victim is the offenders parents, ascendants, guardian,
curators or teachers; or
4. The victim is a person of rank or person in authority,
provided that the crime is not a direct assault.
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
 Slight physical injuries

Arresto Menor or a fine Arresto menor in its min.

Arresto Menor not exceeding 200 pesos period or a fine not
and censure exceeding 50 pesos

The offender has inflicted The offender has caused The offender shall illtreat
physical injuries which physical injuries which do another by deed without
shall incapacitate the not prevent the offended causing any injury.
offended party for labor party from engaging in
from 1-9 days, or shall his habitual work nor
require medical require medical
attendance for the same attendance.
period.
Legal classification

(Art 262 RPC) Serious Physical Injuries

Mutilation
(Art 263 RPC)

Less Serious Physical Injuries

(Art 265 RPC)

(Art 252 RPC)

Administering Injurious
Slight Physical Injuries
Tumultuous Affray
Substances or Beverages Physical Injuries Inflicted in a
(Art 264 RPC) (Art 266 RPC)
Physical Injuries Inflicted in a Tumultuous
Affray

1. There is tumultuous affray;

2. Participant(s) suffered from serious

Elements of
physical injuries cannot be identified;
and
3. All those who appear to have used
the crime violence upon the person of the
offended party shall be penalized by
arresto from 5 to 15 days.
Types of wounds
Medical Classification
Types of wounds

There is no breach of continuity of the skin

Closed Superficial or mucous membrane.

Wound
Deep

Abrasion
Open

Incised Wound
Stab Wound
There is a breach of continuity of the skin
or mucous membrane.

Wound

Punctured
Lacerated
Closed wound

Superficial Deep

Wound is just underneath the Musculo-Skeletal Injuries

layers of the skin. a. Sprain
Petechiae b. Dislocation
Contusion c. Fracture
Hematoma d. Strain
e. Subluxation
Internal Hemorrhage
Cerebral Concussion
petechiae
This is circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous membrane.

The hemorrhage may be small or pinhead sized. Mosquito

or other insect bites may cause formation of circumscribed
hemorrhages.

It is not always a product of trauma.

contusion
It 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.
It may develop after the lapse of minutes or even hours after the application of the force.
Contusion as indicated by its external pattern may correspond to the shape of object or
weapon used to produce it. Its extent may suggest the possible degree of violence
applied and its distribution may indicate the character and manner of injury as in manual
strangulation around the neck.

Age of contusion

Red/ Purple soon after its complete development

Green 4-5 days
Yellow 7-10 days
Gradually disappears 14th or 15th day.
contusion
Factors influencing the degree and extent of contusion:
1. General condition of the victim
2. Parts of the body affected
3. Amount of force applied
4. Disease
5. Age
6. Sex
7. Application of heat and cold
Hematoma
It is the extravasation or effusion of blood in a newly
formed cavity underneath the skin.
Contusion Hematoma

Effused blood are accumulated in the interstices of the Blood accumulates in the newly formed cavity
tissue underneath the skin. underneath the skin.

The skin shows no elevation and even if elevated, the

elevation is slight and is on account of inflammatory The skin is always elevated.
changes.

Puncture or aspiration with syringe of the lesion no blood Aspiration will show presence of blood and subsequent
can be obtained. depression of the elevated lesion.
Musculo-skeletal injuries
Sprain- partial or complete disruption in the continuity of
muscular or ligamentous support of a joint.
Dislocation- Displacement of the articular surface of bones

entering into the formation of a joint.

Fracture solution of continuity of bone resulting from

violence or some existing pathology.

Strain The over stretching, instead of an actual tearing of

a muscle or ligament which may not be associated with the

joint.
Subluxation Incomplete dislocation.
Cerebral concussion

It is much more severe when the moving head struck a

fixed hard object as compared when the head is fixed and
struck by a hard moving object.
SIGNS AND SYMPTOMS
1. Unconsciousness which is more or less complete;
2. Muscles are relaxed and flaccid;
3. Eyelids are closed and the conjunctivae are insensitive;
4. Surface of the body is pale, cold and clammy;
5. Respiration is slow, shallow and sighing;
6. Pulse is rapid, weak, faltering, and scarcely perceptible to the fingers;
7. Temperature is subnormal.
Types of wounds

There is no breach of continuity of the skin

Closed Superficial or mucous membrane.

Wound
Deep

Abrasion
Open

Incised Wound
Stab Wound
There is a breach of continuity of the skin
or mucous membrane.

Wound

Punctured
Lacerated
Abrasion

Characterized by removal of the superficial epithelial layer

of the skin caused by a rub or friction against a hard rough
FORMS OF ABRASION:
surface.
Linear Multi-Linear Confluent Multiple

Appears as a Develops when a Linear marks on Several abrasions

single line. skin is rubbed on the skin are of varying sizes
a hard rough almost and shapes may
object producing indistinguishable be found in
several linear on account of the different parts of
marks parallel to severity of the body.
one another. friction and
roughness of the
object.
TYPES OF ABRASION

Impact/ Imprint Pressure or Friction

Scratch Graze
Abrasion Abrasion

Caused by a Caused by a Whose pattern Abrasion caused

sharp-pointed sharp-pointed and location by pressure
object which object which provides objective accompanied by
slides across the slides across the evidences to movement
skin, like pin, skin, like pin, show cause, usually observed
thorn or thorn or nature of the in hanging or
fingernail. fingernail. wounding strangulation.
material or
instrument and
the manner of
assault or death.
Open wounds: distinction between ante-
mortem from post mortem abrasions:

Point of Ante-Mortem Post-Mortem

Distinction Abrasion Abrasion
Reddish-bronze in appearance due to Yellowish and translucent in
Color
slight exudation of blood. appearance.

Generally occurs over bony

prominence, such as elbow and
Location Any area.
attributed to rough handling of the
cadaver.

Show no vital reaction and is

With intravital reaction and may
characterized by a separation of the
Vital Reaction show remains of damaged
epidermis from complete loss of the
epithelium.
former.
Incised Wound

This is produced by a sharp-edged or sharp-linear edged of

the instrument like a knife, razor, bolo, edge of oyster
shell, metal sheet, glass, etc.
Changes that occur in an incised wound:
After 12 hours - edges are swollen
After 24 hours proliferation of the vascular endothelium and connective
tissue cells.
After 36-48 hours capillary network complete
After 3-5 days vessels show thickening and obliteration.
Suicidal incised wound
Located in peculiar parts of the body, like the neck, flexor
surfaces of the extremities (elbow, knee), wrist, and
accessible to the hand in inflicting the injury.
There are usually superficial tentative cut (hesitation cuts)

and the direction varies with the location and the hand (left
or right) used in inflicting the injuries.
Homicidal incised wound
Incised wounds are deep, multiple and involves both
accessible and non-accessible parts of the body to the
hands of the victim. Defense and other forms of wounds
may be present. Clothing are always involved.
Accidental incised wound
Commonly observed on the passengers and driver of
vehicular accidents on account of the broken windshield
and glass part of windows.
Those associated in the use of kitchen knives in the

preparation of food, carpenters and handicraft workers who

use sharp edged instruments are frequent victims of
accidental incised wounds.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Direction Oblique from Usually

below left ear, horizontal
downwards, below Adams
across front apple.
neck just
above Adams
apple.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Severity Not so deep and Deep and may

may only cause
involve trachea involvement of
carotid and the cartilage
sometimes the and bones.
esophagus is
involved.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Superficial Cut Usually present Practically

before the absent but may
commencement rarely be
of deeper present when
wound. the victim
struggled when
attacked.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Position of May be Usually

the body sitting victim lying
facing a on bed or in
mirror or other place.
standing.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Wounding Firmly Weapon is

Weapon grasped or absent.
found lying
beside
victim.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Blood Blood found in Blood found at

distribution front part of the back of
the body. neck. Hands
Hand clean.
generally
smeared with
blood.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Motive History of mental Absence of such

depression, history.
domestic,
financial social
problems,
alcoholism, etc.
may prove
suicide.
Distinction between suicidal and
homicidal cut-throat

Suicidal Homicidal

Previous May be Always

history of present absent
self-
destructio
n
Stab wound
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
come in contact, then the wound is a stab wound.
It may be suicidal, homicidal or accidental.
Medical evidences showing intent of the
offender to kill the victim
There are more than one stab wounds.
The stab wounds are located in different parts of the body

where vital organs are located.

Stab wounds are deep.
Stab wound with serrated or zigzag borders infers

alternative thrust and withdrawal of the wounding weapon

to increase internal damages.
Irregular shape skin defects may be due to changing

direction of the weapon with the portion of instrument at

the level of the skin as the lever.
Medical evidences that tend to show
punctured wound is homicidal
It is multiple and usually located in different parts of the
body.
The wounds are deep
There are defense wound on the victim
There is disturbance in the crime scene.
proof to show punctured wound is suicidal
Located in areas where vital organs are located
Usually singular
Parts of the body involved is usually accessible to the hand
Clothing usually is not involved
Wounding is made by the weapon when the victim is in

sitting or standing position.

No disturbance of the crime scene
Presence of suicide note
Wounding instrument found near the body of the victim.
Factors responsible for the
severity of wounds
1. hemorrhage
Loss of blood incompatible with life.
Hemorrhage may result in an increase in pressure in or on

vital organs to affect the normal function.

Hemorrhage may cause mechanical barriers to the function

of organs.
2. Size of injury
Bigger wounds are more exposed to infection and other
physical conditions of the surroundings
3. Organs involved
Trauma on vital organs of the body are always serious.
Crushing wounds of the heart, brain or lungs are almost
fatal.
4. Shock
Shock may occur with or without violence. However violent
traumas to healthy, strong persons may not produce shock.
5. Foreign body or substance introduced
into the body
Bacterial (tetanus, pathogenic microorganism)
Viral (hydrophobia, hepatitis)
Foreign Body (bullet, glass fragments, shrapnel, gauze or

rubber drain)
Chemical (cyanide, nicotine)
Toxin (snake venom, scorpion venom, coelenterate sting-

jellyfish)
Absence of medical or surgical intervention
Fatal effect of wounds
Fatal effect of wounds
1. Wound may be directly fatal by reason of:
Hemprrhage
Mechanical injuries on vital organs
Shock

2. Wound may be indirectly fatal by reason of:

Secondary hemorrhage following sepsis
Specific infection
Scarring effect
Secondary shock
Complications of trauma or injury
1. Shock
Primary Shock
Delayed of secondary shock
2. Hemorrhage
Primary Hemorrhage
Secondary Hemorrhage
3. Infection
4. Ebolism
Healing of wounds
Power of the human tissue to
regenerate
No power or limited
Regenerates Rapidly
capacity to regenerate

Connective tissues Highly specialized

Blood forming tissues glandular epithelium
Surface epithelium of Smooth muscles
the skin. Neurons of the central
nervous system
Time of healing wound
It is dependent on the following:
Vascularity
Age of Person
Degree of Rest or Immobilization
Nature of Injury
Kinds of healing wounds
Healing by primary intention
This type of healing takes place when there is minimal tissue loss, more approximation of the
edges and without significant bacterial contamination.

Healing by secondary intention

This takes place when the injury causes a more extensive loss of cells and tissues.

Aberrated Healing Process

Formation of exuberant granulation or proud flesh (excessive amount of granulation prevent
closing of the wound)
Keloid formation (abnormal amount of collagen formed in the connective tissue thus producing
a large bulging tumorous scar)
Stricture (due to the contraction of fibrous tissue of the scar formed.
Fistula or Sinus formation (Fistula is a communication bet. the inner cavity and the outside.
Sinus is a tract of infection traversing the inner part of the body).