FORENSIC

MEDICINE
JOSEPH C. PALMERO, MD, PESE
POLICE CHIEF INSPECTOR
Chief, Medico-Legal Division
Philippine National Police
Crime Laboratory
 Forensic Medicine
 Deals with the interaction of medical science
with the law.
 “Forum”
 All branches of medicine can have forensic
aspect.
 The main objective is the TRUTH based on
the evidence.
 Chap.3 Time of Death-
Decomposition
 I. Factors used in estimating time of death
-livor mortis (post mortem lividity)
-rigor mortis (muscle stiffening)
-algor mortis (body temp)
-vitreous (eye) potassium
-stomach contents
-environmental factors
LIVOR MORTIS
 Reddish, purplish blue
color
 Begins in 30 mins
 Intensifies over time
 May result in post
mortem petechiae
 Its not a contusion
 Livor vs contusion?
 RIGOR MORTIS
 depletion of ATP
 Begins in 2 hrs
 Jaw, face, arms, legs
 Full rigor in 6-12 hrs
 Lost due to
decomposition
 Usually disappear after
24 hrs
 Cadaveric spasm-rare
 BODY TEMPERATURE
 35.6°C - 38.2°C
 Higher in girls
 Infants cool faster
 Obese cools at lower
rate
 Not accurate
STOMACH CONTENTS
 Gastric emptying varies
from person to person,
amount of meal and
time of the day
 Half gastric emptying
time: 4 hrs
 Stress will delay
digestion
 ENVIRONMENTAL FACTORS
 Insect activity- from egg
stage to adult stage.

 How long he has been

dead? Any guess?
 DECOMPOSITION
 Autolysis: - aseptic breakdown
- pancreas
 Putrefaction: breakdown due to bacteria
- 1st sign is greenish color of LQ abdomen
- greenish-black color of face/neck
- swelling
- protruded eyes and tongue
- purge fluid
 Cont: decomposition
 Gas formation- slippage of skin with blister and
marbling ( rxn of hgb and hydrogen sulfide). Skin
from green to black.
 Hair will slip from the scalp
 brain: liquefied
 Decomposition: after 24hrs in hot weather
 Skeletonization: a week to years
 Adipocere: fats will undergo fatty acid transformation
 MEDICO-LEGAL DEATHS
 1. VIOLENT DEATHS - accidents
- suicides
- homicides
 2. SUSPICIOUS DEATHS
 3. SUDDEN UNEXPECTED DEATHS /
MEDICALLY UNEXPLAINED DEATHS
 4. UNATTENDED DEATHS
 MEDICO-LEGAL DEATHS
 5. DEATH IN CUSTODY
 6. POISONING
 7. POSSIBLE THREAT TO PUBLIC
HEALTH
 8. DEATH RELATED TO EMPLOYMENT
 9. DEATH ASSOCIATED TO
THERAPEUTIC AND DIAGNOSTIC
PROCEDURE
 MEDICO-LEGAL DEATHS
 10. UNLAWFUL TERMINATION OF
PREGNANCY
 11. BODIES TO BE CREMATED
 12. UNCLAIMED CADAVERS
 13. SUSPICIOUS CHILD DEATHS
 14. UNEXPECTED DEATH OF PUBLIC
OFFICIAL
 Cause, Manner, Mechanism
1. Cause of Death: Disease or injury that results in the
individual dying.
- COD: Cardiopulmonary arrest. X
Cardiac Arrest. X

2. Manner of Death: How the cause of death came

about.
a. Suicide d. Natural
b. Homicide e. Undetermined
c. Accident
 Cause, Manner, Mechanism
Manner of Death: Examples
- homicide: sepsis due to GSW
- poisoning?
- rabies?
- boxing?
- therapeutic misadventures?
- electric chair?
- traffic accident?
 Cause, Manner, Mechanism
Manner of Death: Examples
- Death by fear?
- Post-traumatic seizure disorder?
- Failure to prescribe meds?
- HIV?
 Cause, Manner, Mechanism
3. Mechanism of Death: physiological
derangement.
GUNSHOT
GUNSHOT
WOUND Cause of death
WOUND

peritonitis
peritonitis septicemia
septicemia hemorrhage
hemorrhage
Mechanism Massive
of death hemorrhage
Mechanisms of death

GSW SW Blunt Force

causes of death
 DEATH CERTIFICATE
 To consider or probable cause of death is
accepted.
 Time of death, always include.
 Deaths other than natural, FOR AUTOPSY.
 Medico-Legal Investigative System
1. Coroner
 1194 AD, begun as elected official. “for the
crown”
 Later appointed by the local government

 Doctors or lawyers
 Medico-Legal Investigative System
2. Medical Examiner
 Introduced in 1877 in Massachusetts
 Medico-Legal Investigative System
3. Police-Judicial System:
 FORENSIC AUTOPSY
OBJECTIVES:
1. Must establish the cause and manner of death:
a. suicidal
b. natural
c. accident
d. homicidal
2. Identification of the deceased if unknown
 FORENSIC AUTOPSY
3. Time of death or injury
4. R.I.P. of evidence
5. Documentation of injuries or lack of them.
6. Reconstruction and interpretation how the
injuries occurred.
Ex. The scene and the clothing are
included.
 HOSPITAL AUTOPSY
1. Cause of death
2. Extent of the disease
3. Prognosis
 AUTOPSY REPORT
1. External Description. Photo, fingerprint
2. Evidence of Medical / Surgical Intervention
3. Evidence of Injury: recent, external, internal.
a. GSW:
b. SW:
c. Clothing:
 AUTOPSY REPORT
4. Internal Examination: Organs
5. Microscopic Section
6. Toxicology Section
7. Opinion:
-Intended to the public.
-Cause, manner, mechanism.
SELECTED TOPICS
ACUTE PANCREATITIS
 SUDDEN DEATH
1. Ex. Instantaneous death
2. Ex. Sudden death
3. Ex. Sudden unexpected
4. Ex. Sudden unexpected nocturnal death
FIREARM AND
EXPLOSIVE
INJURIES
Firearms which are of Medico-Legal
Interest:
Revolver

Automatic Pistol

Rifle

Shotgun
Revolver
 A revolver has
cylindrical
magazine which
holds six rounds of
cartridges.
 Muzzle velocity:
600 feet per second
Automatic Pistol
 Auto loading
pistol.
 The detachable
vertical magazine
holds 17 rounds.
 Muzzle velocity:
1200 feet or more
per second
 Rifle

 Muzzle velocity: 2,500 feet per second

and range of 3,000 feet
Shotgun
 TYPES OF FIREARMS
A. Shot-guns-smooth bore
- single shot with multiple projectiles
- range: 30-50 meters
B. Rifled weapon
- spiral grooves
- lead, FMJ, hallow point
 Barrel
 Rifling: parallel spiral grooves on the
inner surface of barrel
 Strong barrel grip on the bullet

 Stabilize bullet movement

 Impart a rotational movement on the

bullet
 Important factor in identification of
firearms
 Varies on gun manufacturers
Cartridges or Ammunition
 This is a self-contained
unit that includes an outer
casing, projectile (bullet),
propellant (gunpowder),
and primer (source of
ignition). 
 Only the projectile is fired
from the gun.  The
remainder of the spent
cartridge is ejected from
the weapon.
Shotgun cartridge
 Shotgun pellets vary in
size from 1.27 mm 
birdshot to 9.14 mm
buckshot. 
 Shotgun pellets may be
made from lead, steel,
and various alloys. 
 Things coming out of the Gun
 Bullet
 Flame
 Heated, compressed and expanded gas
 Residues
 Bullet (jacket, lead)

 Powder particles (grains, soot, graphite)

 Primer (lead, barium, antimony)

 Barrel (lubricant, rust, dust, scraping)

 Cartridge case (copper, zinc)

Basic features of Cartridges used
in Guns

 The primer
leaves traces of
lead, antimony,
and barium.
Residues

 This is what the above

components may look
like after discharge and
collision with a target.
 Bullet’s Kinetic Energy
 The wounding power of a bullet is due to the mass
and its velocity.
 Tissue damage of a bullet of a very high velocity is
very much greater than those with much less velocity.
 The damage cause by a bullet with impact velocity is
greater than when the impact occurred at a reduced
speed after the bullet has traveled a distance.
Movements of Bullet as it moves out
of the Muzzle
 Forward Movement
 Spinning Movement
 Tumbling Movement
 End-over-end Rotation
 Wobbling Movement
 Tail wag
 Pull of Gravity
 Bullets

Striae, or
rifling
Bullet Wound Basics

ski
Bullet Wound
 Here is the permanent
wound cavity left by a 0.22
caliber bullet in the
quadriceps muscle of a
coyote.  Permanent wound
cavities are relatively
larger in tissues that are
less expansible, such as
bone, muscle bundles, and
encapsulated organs.
 Gunshot Wound of Entrance
 Caliber of the wounding weapon
 Characteristics inherent to the wound of
entrance
 General Rule: round or oval hole – outer table;
beveling – inner table
 Smudging
 Singeing of hair
 Tattooing
 Abrasion collar
 GSW
ENTRANCE:
A. Contact Fire

- circular / stellate
- muzzle imprint
- no “powder burns”
Entrance site
 When a bullet enters the
skull it produces a
sharp-edged "punched-
out" hole in the outer
table, with a larger
corresponding "beveled-
out" hole on the inner
table
Smoke smudging

 This is a contact range

gunshot entrance wound
with gray-black
discoloration from the
burned powder
Soot
 The surface of the skull
demonstrates the heavy
soot in this contact
range entrance wound,
as well as radiating
fracture lines. The
direction of fire was
thus toward the back of
this picture.
Gunpowder Tattooing

 This is an intermediate
range gunshot entrance
wound in which there is
powder "tattooing"
around the entrance site.
Gunpowder Tattooing
 Powder tattooing is seen
in this intermediate
range gunshot wound.
The actual entrance site
is somewhat irregular,
because the bullet can
tumble in flight.
Contusion collar

 The abrasion ring, and

a very clear muzzle
imprint, are seen in this
contact range gunshot
wound.
 ENTRANCE

PNP Crime Lab

PNP Crime Lab

Muzzle imprint
 GSW
ENTRANCE:
B. Close range
- 20 cm
- “powder burns” / tattooing
- smudging
- singeing/ hair burning
 GSW
ENTRANCE:
C. Longer Range
- up to several kilometers
- no “powder burns” / tattooing
- no smudging
- no singeing/ hair burning
Microscopic Exam

 Histologic examination
of the entrance wound
site on the skin
demonstrates black
gunshot residue and
coagulative necrosis.
 GSW
EXIT WOUNDS:
1. Everted

2. Stellate

3. No burning, tattooing

4. Varied shapes

5. Sometimes more than one exits

Exit site
 As the bullet exits the
cranial cavity, the inner
table appears "punched-
out" with beveling on
the outer table
 Exit Wound
 Slit-like, stellate, irregular
 Edges of wound are everted
 beveling– outer table; round or oval hole – inner table
 Shored gunshot wound of exit
 Wound of exit is pressed on hard object
 Circular or nearly circular with abrasion ring
 Scalloped or punched out abrasion collar
 Sharply contoured skin
Exit wound
 Here is a slit-like exit
wound. The projectile
became deformed and
flattened while
traversing the body,
producing a laceration
upon exit. Note that
there is no powder or
soot visible in this exit
wound.
 Displayed here is an entrance at
the left and an exit at the right.
This particular bullet struck at
an angle to produce the ovoid
entrance.
Keyhole wound
 Tangential source
 One end of the
perforation will
resemble a typical
entrance defect, while
the other end will show
external beveling
consistent with exit
holes
 POX

PNP Crime Lab

PNP Crime Lab

 POE POX

PNP Crime Lab PNP Crime Lab

With soot Without soot

Note: both pictures are from a single

individual
 SHOT-GUN

PNP Crime Lab PNP Crime

Lab
Close range,
Pellets and wad
showing smudging
recovered
 GSW

Grazed wound
Grazed wound
“Raccoon eyes”
Fragmented
FMJ
PNP Crime Lab

Shot gun
 Fracture

PNP Crime Lab

Shot gun
Fused 2 slugs recovered in the
body
 Odd and Even Rule
 If the number of gunshot wounds of entrance
and exit found in the body of the victim is
even, the presumption is that no bullet is
lodged in the body, but if the number of
gunshot wounds entrance and exit is odd, the
presumption is that one or more bullets might
have been lodged in the body
 EXPLOSIVES
1. Blast injuries- greater than the speed of
sound.
2. Primary effect: compression wave causes
burn, lacerations and h’ge
3. Secondary effects: secondary burn, debris,
structural damage
PNP Crime Lab
 GSW
SUICIDE or HOMICIDE:
1. GSW is arm’s reach
2. Weapon should be present
3. Usually the mouth, temple, anterior neck
chest.
4. Not in the eye, abdomen or back
5. Woman rarely use gun.
6. Multiple GSW suggest homicide.
 GSW
DOCTORS DUTY:
1. Take pictures before treatment.

2. Take notes, measure and draw.

3. Preserve the evidence collected.

4. Call the police.

5. All deaths are medico-legal case.
 CLASSIFICATION OF WOUNDS

1. ABRASIONS
2. CONTUSIONS
3. HEMATOMA
4. LACERATIONS
5. STAB WOUNDS
6. INCISED WOUND
7. GUN SHOT WOUNDS
ABRASIONS
CONTUSIONS
HEMATOMA
LACERATIONS
STAB WOUNDS
INCISED WOUND
 INCISED WOUND

 Location, important
 Is it a defense wound?
CHOP WOUNDS
 INCISED WOUNDS
SUICIDE:
1. “The hallmark of self infliction is repetition.”

2. Usually grouped incisions, parallel

3. Usual site: throat and wrist.

4. “trial or tentative cuts”

5. Homicidal cut throat is devoid of tentative

cuts and is severe.
6. Homicidal cut throat can be multiple
and irregular.

7. In suicidal cut throat, left side of the

neck has more deep incision.

8. Suicidal stabbing does not involves the

clothing.
 HANGING, STRANGLING AND
SUFFOCATION
1. Hanging is almost always suicidal.
2. Self manual strangulation is impossible.
3. Strangulation by ligature.
4. Horizontal vs. diagonal marks on the neck.
5. Chemical asphyxia.
6. Choking is almost always accident.
 ELECTROCUTION
 Low voltage- 110 to 220 V
 High voltage- high tension wires 7,000 V
 Death: ventricular fibrillation
 Death: electro-thermal injury,
SEXUAL CRIMES
 ANATOMY

FEMALE GENITALIA
 ANATOMY

MALE GENITALIA
TYPES OF HYMEN
 CRECENTRIC

ANNULAR

SEPTATE
Other Variants
 SEXUAL ABUSE
No evident injury at the time of examination but
medical evaluation cannot exclude sexual
abuse.
INTERPRETATION:
1. No abuse happened
2. Abuse happened but did not cause injury.
3. Caused injuries but healed completely.
 SEXUAL ABUSE
No evident injury at the time of examination but
medical evaluation cannot exclude sexual
abuse.
The ano-genital findings seen in this patient are
to be expected in a child who describes this
type of molestation.
 SEXUAL ABUSE
Medical evaluation shows ano-genital findings
that are suggestive of sexual abuse or
contact.
Criteria:
1. Deep notches/clefts

2. Attenuated hymen

3. Apparent genital warts

4. Herpes type 1 and 2.

 SEXUAL ABUSE
Medical evaluation shows definite evidence of
sexual abuse or (RECENT) sexual contact.
Criteria:
1. Positive for sperm or seminal fluid.

2. Pregnancy

3. Gonorrhea, Syphilis, Trichomonas,

Chlamydia and HIV
 SEXUAL ABUSE
Ano-genital findings are diagnostic of
recent/previous blunt force or penetrating
trauma.
Criteria:
1. Acute hymenal injury-partial or complete

2. Perianal lacerations

3. Healed hymenal lacerations

4. Acute injuries on the labia, fourchette.

DISASTER VICTIM
IDENTIFICATION
Julia Campbell ?
PNP Crime Lab Forensic Experts
 Porcelain
Jacket Crown
Fused to
Metal
I.S.O. Certified
BALLISTIC
S
POLYGRAPH
QUESTIONED DOCUMENTS
FINGERPRINT
MEDICO-LEGAL
CHEMISTRY
PHOTO
 Because of the poor quality of
forensic medicine in this country,
there are individuals languishing in
jail for homicides that was actually
suicide; murderers walking freely
in the street because injuries on the
victims were interpreted as
accident or natural death.---Di
maio
Physical evidence cannot be wrong;
Only its interpretation can err. Only
human failure to find it, study and
understand it, can diminish its value.
----------Presiding Judge
Harris vs U.S (1947)