Forensic Material 3

FORENSIC MEDICINE
& TOXICOLOGY
MATERIAL
By
DR. M. NADEEM ZAFAR
ARISE
MEDICAL ACADEMY
Building Better Doctors
FORENSIC MEDICINE
CHAPTER PAGE NUMBER
1. GENERAL ASPECT 2
2. MEDICAL JURISPRUDENCE 16
3. MEDICAL LAW & ETHICS 27
4. SEXUAL JURISPRUDENCE 37
5. POSTMORTEM CHANGES 50
6. ASPHYXIAL DEATHS 66
7. ABORTION AND MTP (Medical

81
Termination of Pregnancy)
8. FORENSIC PSYCHIATRY 89
9. MECHANICAL INJURIES -
90
TRAUMATOLOGY
10. FORENSIC BALLISTICS 123
11. FORENSIC TOXICOLOGY 135
12. HUMAN IDENTIFICATION 161
13. Indian Laws 182
ARISE – DELHI ARISE – HYDERABAD ARISE – KERALA (KANNUR) ARISE – CHENNAI

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GENERAL ASPECTS – 1
TRANSPLANTATION OF HUMAN ORGAN ACT
THOA - 2014
TRANSPLANTATION OF HUMAN ORGAN ACT- THOA (Latest amendment 2014):

•
- This act regulates the removal of organ from living as well as the dead.
• - As per the recent amendment, any hospital having intensive care facility – can retrieve and transport the organs
to transplantation centre
• Earlier – only government sector
• Q. According to Transplantation of Human Organ Act, Which of the following specialist is not authorized
for pronouncing brain death?
• a. Treating physician of the patient
• b. Neurosurgeon
• c. A surgeon who is going to perform renal transplantation
• d. RMP in charge of hospital
A Medical Board (BRAIN DEATH COMMITTEE) consists of;
• RMP, in charge of same hospital of patient

• RMP treating the patient
• A neurosurgeon/neurologist nominated by panel
• An independent RMP – a specialist
• Note: in case of non-availability of neurologist or neurosurgeon, any surgeon, physician, anaesthetist or
intensivist, nominated by medical in-charge of the hospital may certify brain death
AUTHORIZATION GIVEN IN CASES OF ORGANS DONATED

Living Donor: Near relative or a non-related donors Bone marrow
A near-relative needs permission of the doctor in-charge Kidney
of the transplant centre to donate his organ. Liver (some part)
A non-related donor needs permission of an authorization Pancreas (some part)
committee Blood
Cadaveric Donor (after brainstem death) Most organs
May be given by the person before death
By the lawful guardian
Note: Near relative means spouse, children, grandchildren, siblings, parents and grandparents
SWAP TRANSPLANATION:
• When a near relative living donor is medically incompatible with the recipient, the pair is permitted to do a swap
transplant with another related unmatched donor/recipient pair.
• Swap donation is permitted as per 2014 rules.
• EUTHANASIA
Q. Which type of euthanasia is legally permitted in India?

• A. Active
• B. Passive
• C. Voluntary
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• D. Involuntary
EUTHANASIA
• Euthanasia (Mercy Killing) : pentobarbital 2-10 g, death within 15-30 min
TYPES:
• Active or Positive: when a doctor administer lethal dose of medication to a patient.
• Passive or Negative: withdrawing life supporting devices from a serious patient.

• Voluntary: with expressed desire and consent of the patient
• Involuntary: when euthanasia is done against the will of the patient who oppose euthanasia; and would clearly
amount to murder.
• Non-Voluntary: ending of life of a person who is non mentally competent to make an informed request to die,
such a s a comatose patient. In Non-Voluntary euthanasia, the patient has left no such living will or given any
advance directives.
DEATH DECLARATION
DEATH
• Cessation of life
• Denotes death of human being (46 IPC)
THANATOLOGY: study of death
Two types of death: Somatic and Molecular
SOMATIC DEATH: (SYSTEMIC DEATH/CLINICAL DEATH)

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Complete and Irreversible stoppage of;
Circulation Syncope
Brain Function Coma
Respiration Asphyxia
BISHOP’S TRIPOD OF LIFE
Somatic death is associated with immediate signs:

Flat EEG (brain death)
Flat ECG
Complete stoppage of lungs function
• Somatic death is due to stopped aerobic processes. However anaerobic enzymatic processes are still
continuing. Hence;
• Muscles still respond to mechanical, electrical and thermal stimuli
• Pupils still respond to miotics and mydriatics
CLINICAL CRITERIA to diagnose BRAIN DEATH:

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CLINICAL CRITERIA to diagnose BRAIN DEATH:
1. COMA 2. ABSENCE OF BRAINSTEM REFLEXES 3. SIGNS OF BRAIN STEM (LOWER)

DESTRUCTION
Pupillary reflexes, Apnea,
Oculovestibular reflex, Pulse rate invariant
Corneal reflex, Unresponsive to atropine
Pharyngeal and Tracheal reflexes
All these tests are to be repeated, after minimum interval of 6 hours.
BRAINSTEM REFLEXES

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Note: Certain conditions can cause reversible comatose situations.
First exclude such reversible causes like:

• Primary hypothermia – body core temperature <35 0C
• Drugs/poisons – alcohol, muscle relaxants, depressants
• Metabolic/endocrinal disorders

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• Q. A patient was brought with alcoholic poisoning case. BAC was found to be >200 mg/dl. He is completely
unconscious. GCS was found to be 3/15. ECG is as shown in photo. What is the appropriate management in
this case?
A. He can be declared as dead
B. Inform police
C. Resuscitate him and wait for the response
D. None
MOLECULAR DEATH (CELLULAR DEATH):

• Death of all individual cells
• It occurs when anaerobic processes stop, due to non availability of ATP.
AT THIS STAGE:
• Muscles do not respond to stimuli
• Pupils do not respond to stimuli or drugs.
EARLY SIGNS LATE SIGNS

Livor mortis: Discoloration of dead body Putrefaction
Algor mortis: Cooling of dead body ↓
Rigor Mortis: Stiffness of dead body Autolysis: Self breakdown (by lysosomal enzymes.
- Without bacterial involvement
Decomposition: With bacterial involvement
MOLECULAR DEATH OF VARIOUS ORGANS OCCURS AT DIFFERENT INTERVALS AFTER SOMATIC DEATH;
Blood After 6 hours
Cornea After 6 hours
Muscles After 3 hours
Kidney After 1 hour
Heart After 45 minutes
Liver After 15 minutes
Nervous tissue After 5 minutes
Note: Gap between somatic death and molecular death is called as SUPRAVITAL PERIOD (important for harvesting
organs)
• Q. Organ harvesting team is waiting to get a kidney from a brain dead patient. How much time is
appropriate to harvest the kidney?
a. After 2 hours
b. Within 45 minutes
c. After 1 hour
d. Within 6 hours

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BEATING HEART CADAVER/BEATING HEART DONOR:

• A beating heart cadaver is a body that is pronounced dead in all medical and legal definitions, connected to
a medical ventilator, and retains cardio-pulmonary functions. This keeps the organs of the body, including
the heart, functioning and alive.
• The heart contains pacemaker cells that will cause it to continue beating even when a patient is brain-dead.
• A beating heart cadaver requires a ventilator to provide oxygen to its blood, but the heart will continue to
beat on its own even in the absence of brain activity.
• This protects the oxygenated status of the organs; thereby improving the success rate of transplantation.
SUSPENDED ANIMATION (APPARENT DEATH)
Q. Signs of life are reduced to very minimum that it cannot be detected by routine clinical methods. In this
situation, a Person appears to be dead, and he can get back to life on resuscitation. This is called as;
A. Brainstem Death
B. Suspended Animation
C. Commotiorentis
D. Bishop’s tripod of life
SUSPENDED ANIMATION
• (The person appears to be dead but he is not actually dead)
• The signs of life are reduced to very minimum that it cannot be detected by routine clinical methods.
• It can be produced Voluntarily & involuntarily
• During this state, the individual cells utilize the dissolved oxygen in body fluids and remain viable.

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• In – Insanity / iatrogenic as in cardiopulmonary surgeries & anesthesia

• N - New bornQ (Most Common)
• E – Electrocution
• M – Mesmeric trance, Morphine overdose
• Y – Yoga practitioners
• W – Wasting diseases like cholera
• H – Heat stroke/ Hypothermia/ Hanging
• D – Drowning/ Drugs like barbiturates
• Tv – Typhoid
Medicolegal Importance: Suspended animation should not be mistaken for death.

If death is declared and certified in this case prematurely the doctor can be punishable for issuance of false
medical certificate under IPC 197.
DEATH CERTIFICATION:
• All births/deaths should be reported in 21 days of their occurrence to the concerned Registrar/Sub Registrar of
the jurisdiction. (Registration of birth and death act 1969)
• Death certificate should be issued by the doctor WITHOUT CHARGING ANY FEE.
• If the cause of death is not sure, death certificate should not be issued and body should be forwarded for
autopsy.
• Death certificate must not be withheld for pending professional fees from the deceased patient.
• Refusal to issue a legitimate death certificate is a punishable offence.
PRESUMPTION OF SURVIVORSHIP and PRESUMPTION OF DEATH:
PRESUMPTION OF SURVIVORSHIP
• If 2 persons from same family die in common disaster, it may be necessary to know who died earlier and who died
later.
• In that situation, the case is decided based on facts and evidence available like age, sex, nature and severity of
injuries and the mode of death.
• This can be vital for property inheritance.
COMMOTIORENTIS: persons who died together on same occasion, where it cannot be ascertained who died earlier.
PRESUMPTION OF DEATH
• This is a legal issue for a person missing for a long period (when the individual is alleged to be dead and body
is not found).
• This can be necessary for claiming insurance money or property inheritance.
• It is dealt by Sec 107 and 108 IEA (Indian Evidence Act)
PRESUMPTION OF DEATH
Sec 107 IEA: states that a person is presumed being alive, if there is nothing to suggest the probability of death within 30
years.
• Burden of proving death of a person to have been alive within 30 years.
Sec 108 IEA: states that, if it is proved that the said person has not been heard of for 7 years by them, who are expected to
hear about him, if he would be alive, then death is presumed.
• Burden of proving that person is alive who has not been heard for 7 years.
• This section deals with proving that a person is alive who has not been heard of for past 7 years

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AUTOPSY: Postmortem Examination.
• First Medicolegal autopsy in the world was conducted by Bartolomeo varignana, in Italy in 1302
• First autopsy in India was conducted by Dr. Edward Buckley on the body of Mr. Wheeler in 1693.
It should be carried out by an RMP with training in forensic medicine.
OBJECTS OF AUTOPSY -
To find out
• Cause of death
• Manner of death
• Time since death
• To establish identity
• To collect physical evidence to identify object causing death and to identify the criminal.
• In newborn infants to determine the question of viability and livebirth.
Q. Which of the following is against the rule of conducting a medicolegal autopsy?

a. Body must be identified by the police constable who accompanies it
b. It should be conducted only when there is written order from the police or magistrate along with FIR
c. It can be performed in a private hospital
d. No unauthorized person should be present at the autopsy
RULES FOR MEDICOLEGAL AUTOPSY:

• Body should be labelled as soon as it arrives in mortuary.
• The autopsy should be conducted in a mortuary (not in a private room)
• Preferably done in day light.
• Body must be identified/confirmed by the police constable who accompanies it.
• It should be conducted only when there is written order from the police or magistrate.
• Dead body is accompanied by challan, inquest report or panchnama and FIR. Doctor should first read the
inquest report and find out apparent cause of death and obtain all available details.
• No unauthorized person should be present at the autopsy.
• Autopsy should be complete. Whole body should be examined and all cavities should be opened and every organ
must be examined.
• The doctor must preserve viscera and send for toxicological examination in case of poisoning.
• After an opinion is formed as to the cause and mode of death, the doctor prepares a detailed postmortem (PM)
report in TRIPLICATE.
• One copy is send to investigating police officer, 2nd to superintendent of police or magistrate and 3rd is retained as
office copy.
• PM report should not be issued to the party
• After autopsy is complete, the body is handed over to investigating police officer or the authority that has
conducted the inquest in that case.
TYPES OF AUTOPSIES:
MEDICOLEGAL CLINICAL/PATHOLOGICAL PSYCHOLOGICAL VITROPSY NEGATIVE
AUTOPSY AUTOPSY AUTOPSY AUTOPSY
In suspicious, In natural/hospital deaths, - Usually Virtual autopsy All findings

unnatural death where cause of death is suicidal negative & cause
uncertain cases of death
unknown

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Police Consent from legal Done by Using imaging No definite

authorization is guardian is mandatory questionnaire & techniques like CT & opinion can be
mandatory interviews with MRI scan given after
survivors of the complete
diseased-families, examination and
friends other tests
Consent from To assess the Non- 2-5% of all
relative is not person’s state of invasive/minimally autopsies are
required mind prior to death invasive procedure negative
• Q. In medicolegal autopsy, which of the following is incorrect?

a. Performed in unnatural death
b. Consent of relatives is mandatory
c. Police authorization is mandatory
d. Only questionnaire is not enough
TYPES OF SKIN INCISION USED IN AUTOPSY:
• ‘I’ shaped incision: (chin to symphysis pubis) –

Most common method followed.
• Y- shaped Incision: Acromion to Xiphisternum and then to pubis
• Modified Y-shaped incision: it is used when a detailed study of neck is required, like in hanging or strangulation.
• T-shaped or ‘bucket handle’ incision:
• X-shaped incision: it is made at back. One acromion to other side of gluteal region.
To demonstrate the deep bruises in custodial death cases.
Custodial Death

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METHODS OF AUTOPSY
VIRCHOW’S TECHNIQUE
• Individual organs removed one by one
• Anatomical relations are not preserved
LETTULE’S TECHNIQUE
• Various system organs are removed as en-masse (all together) – cervical, thoracic, abdominal and pelvic
organs and organ dissection.
• Anatomical relations are preserved
• Rapid technique
GHON’S TECHNIQUE
• Organ blocks and organ dissection
• Cervical, thoracic, abdominal and urogenital system are removed as organ block (separate blocks)
ROKITANSKY’S TECHNIQUE
• In-situ dissection of organs
• Fetal brain dissection
• Infectious disease like HIV, Hep B
• Radiation hazards
IMPORTANT INDIVIDUAL ORGAN DISSECTION:

• Hollow structures, such as blood vessels, GI tract (esophagus, stomach & intestine) is cut opened in order to reveal
the pathology present inside.
• For solid organs, many parallel cuts, in a fashion similar to slicing a loaf of bread (bread loafing) is done.
HEART DISSECTION
Inflow Outflow Method
• Following the direction of blood flow.
• Right atrium – Right ventricle – Left atrium – Left ventricle
BRAIN DISSECTION
In most autopsies, the brain is examined in the fresh state.
• In selected cases, the brain is fixed and then examined.
• Best routine fixative is 10% formalin and requires 2-3 weeks for satisfactory fixation.
• In fetuses and infants, acetic acid is to be added to the fixative solution.
• In cranial autopsy, facial incision is started at: BEHIND THE EAR LOBE

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SPINAL CORD DISSECTION

• Routinely it is not opened.
• In case of suspected spinal injury:
Posterior > Anterior is opened.
POSTERIOR APPROACH ANTERIOR APPROACH

- Best approach - Simple and quick
- Recommended in neck injuries - Nerve roots, dorsal ganglia and peripheral
nerve can be visualized
STOMACH DISSECTION (Double Ligation Method):

• Two ligatures are applied at the cardiac end of the esophagus and two ligatures below the pyloric end of the
stomach. The stomach is removed by cutting between the double ligatures at both ends.
• Stomach wall is opened along the greater curvature

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COLLECTION OF SAMPLES DURING AUTOPSY:

• Blood: Femoral vein (best)
• Urine: suprapubic puncture or directly from bladder
• CSF: Lumbar or cistern magnum puncture
PRESERVATION OF DEAD BODY IN MORTURY;
• Dead body should ideally be stored on 40 C. if it is to be preserved for longer duration, -20 °C is the ideal.
• After completion of autopsy, all viscera should be replaced in the body and body should be well embalmed to
facilitate a second autopsy in case one is desired at some future point.
EMBALMING
EMBALMING: THANATOPRAXIA
Artificial method of preserving dead bodies.
• It is the treatment of the dead body with antiseptics and preservatives to stop putrefaction and preserve the body.
• Embalming a body within 6 hours – satisfactory result
• It produces a chemical stiffening similar to rigor mortis
• Embalming rigidity is permanent and normal rigor does not occur.

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EMBALMING FLUID
CONSTITUENTS OF A TYPICAL EMBALMING FLUID:

• Preservative – commonly a mixture of FORMALDEHYDE, gluteraldehyde. METHANOL is used to hold the
formaldehyde in solution.
• Humectant (to preserve the moisture) – GLYCERINE
• Germicide – PHENOL
• Buffer ( to maintain the pH) – Sodium bicarbonate/sodium borate
• Anticoagulants – SODIUM CITRATE/SODIUM OXALATE
• Dyes (to restore the body’s natural colouration) – EOSIN
• + Perfume – wintergreen
• Vehicle – water upto 10L
Note: ETHANOL is not a constituent of embalming fluid
Extra points:
• Best method of injection: Discontinuous injection and drainage
• Injection should be done in high pressure and low flow
• Autopsy must be done before embalming
Q. Method of autopsy in which various systems organs are removed en masse?

Lettule
Virchow
Rokitansky
Ghon
Q. In a custodial death, which type of incision should be given for autopsy?

A. T shaped
B. I shaped
C. X- shaped
D. Y shaped
Q. While performing embalming, difficulty encountered due to arterial system problem. How should the
embalming fluid be introduced to overcome this problem?
A. High pressure high flow
B. Low pressure low flow
C. High pressure low flow
D. Low pressure high flow
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Q. Which of the following is not a constituent of embalming fluid?

A. Phenol
B. Glycerine
C. Water
D. Ethanol
Q. Artificial preservation of dead body is called as;

A. Thanatology
B. Echopraxia
C. Thanatopraxia
D. Entomology
Q. How many copies of detailed postmortem report is to be formed by a doctor?

A. 1
B. 2
C. 3
D. 4
Q. Find out the correct statement related to post mortem examination?

A. duplicate copies of PM report should be made
B. Ethanol is used in embalming fluid
C. Autopsy should be done after embalming
D. Double ligation method is done for stomach
Q. Which method is to be applied to do autopsy of stomach in a case of poisoning?

A. Inflow outflow method
B. Double ligation method
C. Single ligation method
D. Rokitansky’s technique
MEDICAL JURISPRUDENCE
IPC and Cr.P.C

INDIAN PENAL CODE (I.P.C.), 1860:
• it defines offences and prescribes punishments.
• It deals with substantive criminal law of India.
CRIMINAL PROCEDURE CODE (CR.P.C), 1973:
• It provides the mechanism for punishment of offences against the substantive criminal law.

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• It deals with police duties in arresting offenders, dealing with absconders, in the production of documents, etc.
and in investigating offences.
• It deals with actual procedure in trials, appeals, references, revisions and transfer of criminal cases.
Indian Evidence Act (I.E.A.), 1872:

• It deals with Law of Evidence (different categories of evidence, the procedure of collection, preservation and use
of different evidences) and applies to all judicial proceedings in any court.
• It is common to both the criminal and civil procedure.
LEGAL PROCEDURES
Inquest
- Enquiry into the cause of unnatural death.
Types of Inquest
Inquests practiced in India Inquests Not practiced in India

- Police Inquest (Most common) - Coroner’s inquest (abolished in India on
- Magistrate Inquest 26/6/1999 from Mumbai)
- Medical examiner system ( Most superior)
- Procurator fiscal system
Police inquest (Most common type)

Police inquest is dealt in Sec. 174 CrPC.
• The office in charge (usually sub-inspector but not below the rank of head constable) of a police station
conducts the inquest.
• Such police is known as Investigating officer. After informing the nearest executive magistrate, he goes to the
place of offence and conducts the inquest.
• Police will do enquiry with local people – called as PANCHAS and PANCHNAMA (report) will be prepared and
sent to magistrate
• The Inquest officer may summon persons who know the facts of the case & the person is bound to attend and
answer questions.(Sec. 175 CrPC).
• Refusal to answer is punishable under Sec. 179 IPC with imprisonment upto 6 months and/ or fine.
POLICE INQUEST IS DONE IN:

• Death by suicide
• Death by killing by another person (murder) or an animal or machinery
• Death by accident
• Death under circumstances raising a reasonable suspicion that some other person has committed an offence.
MAGISTRATE INQUEST: (Sec 176. CrPC)

• Not regularly held, done only in special cases.
• Inquest is conducted by the District Magistrate, Judicial Magistrate, SDM(Sub divisional magistrate) or any
Executive MagistrateQ empowered by State Government, such as the Sub-CollectorQ or TahsildarQ.
JUDICIAL MAGISTRATE EXECUTIVE MAGISTRATE

All cases are handled by them Appointed by the government, To maintain the law
and order.
Eg;
- Collector
- Deputy collector
- Tahsildar
- RDO

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MAGISTRATE INQUEST IS DONE IN CASE OF:

DEATH IN CASE OF:
• Asylum
• Brostal Juvenile
• Custody
• Dowry
• Exhumation) Digging dead body
INDICATIONS OF MAGISTRATE INQUEST:
EXECUTIVE MAGISTRATE (176 (1) CrPC JUDICIAL MAGISTRATE (176 (1) CrPC
Dowry deaths 304 B Death in prison
498 A
Exhumation Death due to police firing
Early morning ( no time limit) Death in police custody
Death while under police interrogation
Death in a psychiatric hospital
Death in child reformatory schools
POLICE INQUEST MAGISTRATE INQUEST

↓ ↓
CrPC 174 CrPC 176
Q. Inquest in case of a death in psychiatric asylum, is conducted by;

A. Executive magistrate
B. Judicial Magistrate
C. Police
D. Both A and B
Note:
• Inquests in India: Police and Magistrate inquest
• Most common inquest in india: Police inquest
• Most superior inquest in india: Magistrate inquest
• Most superior inquest (overall): Medical Examiner system
COURTS OF LAW
COURTS OF LAW
• Court includes and signifies the person, legally authorized to record evidence and pass judgment.
• Section 6 to 25 of CrPC deal with constitution of criminal courts and officer.

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TYPES OF COURTS
CIVIL COURTS CRIMINAL COURTS
- Related to civil law - Related to criminal Law
- Deals with disputes between two parties. - Deal with crimes committed as per IPC
Eg. Land disputes, family disputes, marriage/divorce, Eg; Murder, rape, assault, suicide, injuries, poisoning,
inheritance disputes, compensation etc kidnapping, robbery, unnatural sexual offenses etc.
Party who files a case is “plaintiff” and Accused is State’ is the party represented by public prosecutor and
“defendant” (in both civil and criminal cases) accused (defendant) is the other party.
JUVENILE COURTS: are special criminal courts which try offences committed by juveniles i.e. below 18 years of age.
CONSUMER COURTS:
• Deal with consumers disputes.
• Their powers and procedure are as civil courts.
CONSUMER COURTS FINE LIMIT
District forum <20 lacs
State commission 20 lacs to 1 crore
National commission >1 crore
CRIMINAL COURTS IN INDIA – HIERARCHY

• 1. Supreme court
• 2. High court
• 3. Sessions Court (Additional sessions court) Death sentence
• 4. Assistant sessions court
• 5. Chief judicial magistrate (In metroploitan magistrate, it will be called as chief metroplitan magistrate)
• 6. 1st class judicial magistrate
• 7. 2nd class Judicial magistrate
Note: Supreme and high courts are called as APPELLATE COURTS and remaining others are TRIAL COURTS.
Criminal Courts in India

1. THE SUPREME COURT:
• It is the highest judicial tribunal, and is located in New Delhi.
• It has power of supervision over all courts in India.
• The law declared by it is binding on all courts (Article 134 of constitution of India)
2. THE HIGH COURT:
• Usually located in the capital of every state and is the highest tribunal for the state.
• Supreme court and the high court act as courts of appeal only in criminal cases and do not hold trial prima facie.
3. The SESSION COURT: in district
THE SESSIONS COURT (or DISTRICT SESSION COURT)

• It is established by the state government and is usually located at the district headquarters.
• It can only try cases which have been committed to it by the magistrate.
• It can pass any sentence authorized by law, but a sentence of death passed by it must be confirmed by the
high court.
• District court deals with civil cases.

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MAGISTRATE COURTS:
Magistrates are of three types;

• Chief judicial magistrate
• First class judicial magistrate
• Second class judicial magistrate
In metropolitan cities with more than one million population, the chief judicial magistrate and first class Judicial
Magistrate are designated as Chief Metropolitan Magistrate and Metropolitan Magistrate respectively.
Session judges and magistrates are appointed by the high court.
POWERS OF CRIMINAL COURTS
COURTS MAXIMUM IMPRISONMENT FINE

Supreme court judge Any sentence Q Unlimited
High court judge Any sentence Q Unlimited
Sessions court judge/ Any sentence Q Unlimited
Additional sessions judge (Death to be confirmed
by high courtQ)
Assistant sessions judge 10 yearsQ Unlimited
Chief Judicial Magistrate 7 yearsQ Unlimited
I Class Judicial Magistrate 3 yearsQ 10000 rupees
II Class Judicial Magistrate 1 yearQ 5000 rupees
• Q. Lowest court which can give death sentence is;

a. Supreme court
b. High court
c. Sessions court
d. Assistant sessions
OFFENCES
OFFENCE:S.2(n) Cr.P.C. and (S.40, I.P.C.)
• Means any act or omission made punishable by any law.

• Classified as Bailable and Nonbailable.
• In bailable offences, the court cannot refuse bail and the police cannot keep the person in custody.
COGNISABLE OFFENCE: Non bailable

• it is an offence in which a police officer CAN ARREST A PERSON WITHOUT WARRANT from the magistrate.
• Eg; Rape, murder, dowry death, sex offences, robbery, ragging, death due to rash or negligent act, etc.
Bailable
In NON-COGNISABLE OFFENCES:
• Accused CANNOT BE ARRESTED WITHOUT A WARRANT issued by the magistrate.
BAILABLE OFFENCES: Bail can be granted

• Eg: Sec 304-A IPC, Sec 312 IPC, Sec. 323 IPC & Sec. 325 IPC
NON BAILABLE OFFENCES: Bail cannot be granted.

• Decision is taken by a judicial magistrate only.
• Eg: Sec. 302 IPC, Sec 307 IPC, IPC 304-B IPC & Sec 326 IPC

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PUNISHMENTS
The sentences authorized by law are:

• Death
• Imprisonment for life
• Imprisonment: (a). Rigorous, i.e. with hard labour, including solitary confinement. (b). Simple
• Forfeiture of property
• Fine
Q. Death penalty in india is given by:

A. Shooting
B. Electrocution
C. Hanging
D. Gas chamber
CAPITAL PUNISHMENT (Death Penalty):

Methods of carrying out death sentences are;
• Hanging
• Electrocution
• Lethal injection (continuous I.V. injection of sodium thiopental (unconscious), pancorium bromide
(paralytic, stops breathing) and potassium chloride (stops heart).
• Shooting
• Gas chamber
• Garroting
• Guillotine (a method of decapitation)
In india:
• The capital punishment or death penalty is by hanging by neck till death (sec.354 (5) CrPC)
Section 416 CrPC:

• If a woman sentenced to death is found to be pregnant, the high court shall postpone the execution, and
may, if it thinks fit, commute the sentence to imprisonment for life.
Note: The higher court can always increase or decrease the punishments given by lower court.
SUBPOENA OR SUMMONS:
Deal with summons
• Subpoena (sub = under, poena = penalty) is a document compelling the attendance of a witness in a court of law
under penalty, on a particular day, time and place, for the purpose of giving evidence.
• A summons must be obeyed, and the witness should produce documents if asked for.
• Witness will b excused from attending the court if he has a valid and urgent reason.
• A summons is for a case in the Magistrates' Court, while a subpoena is sent to witnesses for cases in the
County or Supreme Courts.
If the witness fails to attend the court;

• In civil case; he will be liable to pay damages.
• In criminal cases; if the court finds that witness neglected to attend the court without any justification, may
sentence to fine or imprisonment.
Note:
Criminal courts have priority over civil courts. If a witness is summoned by two courts (criminal and civil) on the same
day, he should attend the criminal court and inform the civil court of his inability to attend, giving the reason.

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Higher courts have priority over lower courts.
Conduct Money/Diet money:

Fee offered or paid to a witness in civil cases, at the time of serving the summons to meet the expenses for attending the
court.
• Party who is calling the witness will pay the money.
• The Judge will decide the amount to be paid.
In criminal cases, no conduct money is paid to the witness at the time of serving summons.
• In criminal cases, the witness must attend the court and give evidence because of the interest of the State.
• After giving the evidence, the expert witness is paid by the court or by the instituition (in case of Govt.
employee)
MEDICAL EVIDENCE:
• Evidence refers to written documents and oral statements on oath, which help the court, to decide a case; and
when evidence refers to medical science, it is known as medical evidence.
Types of medical evidences are:
Written/Documentary:
• Medical certificates
• Medicolegal reports
• Dying declaration
• Dying deposition
Oral/Parole: direct and indirect
Circumstantial
WRITTEN/DOCUMENTARY EVIDENCE
MEDICAL CERTIFICATES:
• Simplest type of written medical evidence issued by medical officer, at request of patient or his relatives.
• Eg; for sickness, fitness, vaccination, birth or death.
• Death certificate should be issued without any fee
MEDICOLEGAL REPORTS: M.L.C.
• Report prepared by a RMP, at request of investigating officer or the court.

• Report is considered as evidence, only after the doctor attends the court and testifies to the facts under oath.
Eg; injury, poisoning, burns, alcohol, rape, insanity, post-mortem.
• All major accidents should be labeled as M.L.C. to avoid complications at later date. It is left to the police to
investigate.
• A private hospital or nursing home can treat and admit medicolegal cases except victims and accused of
rape cases.
• While writing M.L.C., note at least two identification marks which are individualistic.
• Postmortem report is not a public document. It should be given only to the police.
• No time limit is prescribed by law for preserving medicolegal reports.
Dying Declaration: Section 32 IEA

• Written or oral statement of a person, who is dying as a result of some unlawful act, relating to the facts of the
cause of death.
• Dying declaration can be recorded by anyone in the presence of 2 witnesses.
• Ideally it should be recorded by magistrate.
• Police, doctor or any village headman can record, if patient condition is serious and there is not time to call a
magistrate.

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Dying Declaration
• Main duty of the doctor in dying declaration is certifying COMPOS MENTIS(the person is conscious & mental
faculties are normal)
• No oathQ administered (Because of the belief that dying person tells the truth)
• Statement should be recorded in the man’s own words, without any alteration of terms and phrases.
• No leading questions asked
• Declaration is signed & forwarded to the Magistrate in a sealed cover.
• If the declarant survives, the declaration is not admitted, but has corroborative value.
Dying Deposition (bed side court)

• Oath is to be taken
• - It is not practiced in India.
• - It is more superior to dying declaration (It is like mini trial).
• - It is a statement of a person on oath, recorded by the magistrate in the presence of the accused or his lawyer,
who is allowed to cross-examine the witness.
Note:
• Cross examination can be done.
• Leading questions are permitted.
ORAL EVIDENCE (parole):

• Oral evidence (testimony) refers to the evidence, under oath, in court of law.
• In all cases, oral evidence must be direct
• It must be evidence of a person who saw, heard, or perceived it by that sense or in that manner.
• A deaf and mute witness may testify by signs, by writing or through an interpreter.
• Oral evidence is more important than documentary evidence, as it permits cross-examination.
• Documentary evidence is accepted by the court only on oral testimony by the person concerned.
RES GESTAE:
• Remarks made by the victim at the time of or immediately after the crime are admissible as evidence. Eg;
statement made to people at scene or to the physician in hospital.
CIRCUMSTANTIAL EVIDENCE:
• It refers to evidence collected from the circumstances or surroundings of a case. Eg; suicide note, blood stain,
bullet, finger prints, foot prints etc. it has only limited legal values.
EXHIBITS
• Receive in a sealed packet with accompanying letter
• Issue receipt
• Always touch with gloved hands
• Take photographs with scale
• Examine in detail
• Give reply to the question put by investigating officer
• Attach an identifying tag
• If exhibit has blood stains, send it to FSL in a sealed packet and obtain receipt
CHAIN OF CUSTODY OF EVIDENCE:

• Method of verifying the actual possession of an object from the time it was first identified until it is offered as
evidence in the court.
• Each specimen when obtained, should be labeled with the victim’s name, the time and date . the nature of
specimen, identification number and signed by the doctor.
WITNESSES: (Sec 118 to 134)

• A witness is a person who gives evidence regarding the facts.
• Two types: Common and Expert

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COMMON WITNESS:
• Witness of fact; occurrence witness
• A person who gives evidence about the facts observed or perceived by him (personally)
• In india only EYE WITNESS is valid and hearsay witness.
• It is commonly known as “First-hand knowledge rule”
• Eg; A has seen B and C, fighting on a certain road on particular day and time. In case of traffic accident the person
who witnessed the accident becomes a common witness.
EXPERT WITNESS:
• Is a person who has been trained or is a skilled or has knowledge, experience or education in technical or
scientific subject, and capable of drawing opinions and conclusions from the facts observed by himself or noticed
by others.
• Eg; Doctor, Firearms expert, Fingerprints expert, Handwriting expert etc.
• A doctor can be both a common witness and expert witness. When he describes wounds on the body, he acts
like a common witness. But when he says that the wounds are antemortem or postmortem, or they were suicidal,
homicidal or accidental, he acts as an expert witness.
HOSTILE WITNESS:
• One who is supposed to have some interest or motive for concealing part of the truth or for giving completely false
evidence.
• The court will declare a witness as hostile on the suggestion of the lawyer of the party who has summoned the
witness or prosecution lawyer.
• On declaration of a witness as hostile (adverse), he can be cross-examined by the same side lawyer.
• Any of the above two types of witness can be hostile.
PERJURY
• Giving willful false or fabricated evidence after taking oath (Sec. 191 IPCQ)
• Liable to be prosecuted for perjury under Sec. 193 IPC with imprisonment (3 – 7 years)
PROCEDURE OF RECORDING EVIDENCE IN THE COURT OF LAW
PROCEDURE OF RECORDING EVIDENCE IN THE COURT OF LAW

Order of examinations: (Section 138 IEA)
• Oath →Examination in chief → Cross examination → Re-examination
RECORD OF EVIDENCES
• Evidence of witness is recorded as follows (S.138 to 159, I.E.A.);
• Indian Oath Act 44, S.2,4 and 6, 1969.
• Oath: witness has to take an oath in the WITNESS BOX, before he gives his evidence. He should take the oath as
follows:
• “I do swear in the name of God, that what I shall state shall be the truth, the whole truth, and nothing but the
truth”
• If the witness is an atheist, he has to “solemnly affirm” instead of “swearing in the name of God” (S.51, I.P.C.).
• Note: A child below 12 years is not required to take an oath.
Order of Examination (138, I.E.A.)/Recording of evidence

1. Examination-in-chief (direct examination) (S.137, I.E.A.):
• This is the first examination of a witness
• It consists of questions put to him by the lawyer (counsel or advocate) for the side which has summoned him.
• The objective is to elicit all relevant, and convincing facts.
• No leading questions are permitted. However if the witness is declared hostile, leading questions can be asked.

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2. Cross-Examination
• Examination of the witness is conducted by the lawyer of the opposite party. In government prosecutions, it is
done by defence lawyer.
• The objective is to elicit, remove or modify facts and to test the accuracy of statement or witness.
• Leading questions are allowed.
3. Re-examination (Redirect examination):

• This is conducted by the lawyer for the side which has called the witness.
• The object is to correct any mistake or to clarify or add details to the statements the witness has made in cross-
examination.
• Leading questions are not allowed.
4. Question by Judge/Court questions:

• At any stage, during the recording of evidence, the judge may ask questions to clear his doubts.
Chief examination and Re-examination – Same side lawyer

Cross examination – By Opposite side lawyer
Leading Questions
• Any question prompting the answer which the lawyer expects to receive.
• Requiring a simple ‘yes’ or ‘no’ answer.
• Was the length of the knife 25 cm?
Leading question permitted in:

• Cross examination (Section 143 IEA)
• Hostile witness (Section 154 IEA)
• Dying deposition.
Leading questions are not permitted in;

• Direct examination and Re-examination
• Dying declaration
Note: if witness is declared hostile by the judge, even in these, leading questions will be permitted.
Q. A person after taking oath, speaking the false evidence, is punishable under;
• A. IPC 191
• B. IPC 193
• C. IPC 195
• D. IPC 84
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Q. Subpoena is a;
• A. Medicolegal document
• B. Legal Document
• C. FIR
• D. Money for travelling of witness to court
Q. In criminal cases, conduct money is paid by;

• A. Court
• B. Opposite party
• C. Judge
• D. No money is given
Q. Arrange in the order of power:

• 1. Session court
• 2. Assistant session court
• 3. 2nd class magistrate
• 4. High Court
• A. 4 > 3 > 2 > 1
• B. 1 > 3 > 4 > 2
• C. 4 > 1 > 2 > 3
• D. 4 > 2 > 1 > 3
Q. Leading questions are not allowed in;

• A. Cross examination
• B. Dying deposition
• C. Hostile witness
• D. Dying declaration
Q. A 29 year old woman died in unnatural conditions within 4 years of marriage. Her parents complained
of frequent demand of money from her in laws. Her autopsy will be performed under which section?
• A. IPC 304 B
• B. IPC 304 A
• C. CrPC 174
• D. CrPC 176
Ans: D
• Police inquest: CrPC 174
• Magistrate inquest: CrPC 176 (Dowry death in given case)

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MEDICAL LAW & ETHICS
Schedule to MCI Act:

 MCI is replaced by NMC in September 2020.
 MCI was established in 1934 and dismissed in 2020
 The schedules of MCI includes list of medical degrees recognized by MCI.
 Schedule 1: includes list of recognized degrees by Indian universities and also DNB
 Schedule 2: includes list of medical degrees awarded by foreign universities
 Schedule 3: Other than MBBS degrees. Eg; diploma
FUNCTION OF MCI:
 Medical register: maintains medical register of medical practitioners.
 Medical education: maintains the standard of UG and PG education
 Recognition of foreign medical education
 Appeal against disciplinary action
 Warning notice
 Medical ethics: the earliest code of medical ethics was Hippocratic oath. It is modified by World Medical
Association, and was named as “DECLARATION OF GENEVA”; It is followed by MCI as code of medical ethics.
 Every doctor while applying registration with MCI has to sign a pledge that he will obey medical ethics.
 Issuing certificate of good conduct: to those who want to go abroad.
Reforms to be Taken as per NMC Bill

 Major reforms in medical education, which can be taken up as per the NMC Bill:
 NMC Bill replaces MCI with National Medical Commission (NMC)
 NMC will be responsible for approving and assessing medical colleges.
 Common MBBS entrance and exit exams will be conducted as per the new Bill.
 The final-year MBBS exam will now be known as NEXT (National Exit Test)
 NMC Bill also proposes to set up Medical Advisory Council as a separate entity.
MEDICAL ETHICS & ETIQUETTE
Medical ethics:
 The moral principles which guide the members of the medical profession in their dealings with each other, their
patients and the State.
 Self-imposed code of conduct.
 Assumed voluntarily by medical professionals.
Medical etiquette:
 Conventional laws of courtesy which are followed between members of the same profession.
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STATE MEDICAL COUNCIL

Functions
 Maintenance of Register of Medical Practitioners.
 Renewal of registration:
 Participation of doctors in CME programmes for at least 30 hours to renew their registrations every 5 years.
Warning notice:
 SMC displays a list of offences which are considered as infamous conduct.
Disciplinary controlQ:
 The state medical council has the disciplinary powerQ over those doctors registered in the council.
 In cases of unethical practice, SMC can issue warningQ, suspension or penal erasureQ of the name of medical
practitioner.
PUNISHMENTS BY SMC FOR UNETHICAL ACTS:

 WarningQ
 Temporary suspensionQ
 Permanent erasure of name from the register (Penal erasureQ)
PENAL ERASURE/PROFESSIONAL DEATH SENTENCE

 Removal of the name of the doctor from the medical register
 Done by the State medical councilQ
 Main cause - Serious Professional MisconductQ/Infamous conduct
 Other instances of removal of name
 After death
 Name entered by fraud, impersonation
INFAMOUS CONDUCT
 PROFESSIONAL MISCONDUCT/ INFAMOUS CONDUCT
 Disgraceful & dishonorable act by the doctors.
 Judged by other doctorsQ of good repute.
Warning notice:
 It is the list of acts which are considered as infamous conducts.
 The list is incomplete, updated by SMC periodically.
Examples of infamous conduct:

 Abortion: Conduction of criminal abortion
 Adultery
 Alcoholism: Treating the patient under alcoholic influence
 Addiction
 Advertising

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 Association: Association with unqualified quacks - Covering

 DichotomyQ
 Violation of any of the provisions of the acts which govern the medical profession.
 Issuing false certificatesQ
Patent and copyrights:

 Patent surgical instruments, appliances, procedures and medicine.
 The benefits of such patents are not made available in situations where the interest of large population is
involved.
 Running an open shop for dispensing of drugs prescribed by other physicians.
 Prescribing secret remedial agents of which he does not know the composition.
 Aiding or abetting torture.
 Practicing EuthanasiaQ
 Pharmaceutical and allied health sector industry:
 Receiving any gift, cash or monetary grants, travel facility or hotel accommodation. from any pharmaceutical
industry, for vacation or conferences, seminars, workshops as a delegate
RIGHTS OF A REGISTERED MEDICAL PRACTITIONER:

 Right to choose his patient (but not in emergency cases)
 Right to use the title and description of the qualification to his name
 Right to practice medicine
 Right to possess and supply dangerous drugs to his patients
 Right to issue medical certificates and medicolegal reports
 Right to give evidence in the court of law, as an expert of witness
 Right to recovery of fees
 Right to appointment in public and local hospitals
DECLARATIONS:
Geneva 1948, amended upto 2006 Revision of Hippocratic oath
Helsinki (adopted with Nuremberg code 1947) Ethical principles for medical research.
Involving human subjects
Tokyo (Istanbul protocol) Guidelines for doctors concerning torture, degradation or
cruel treatment of prisoners
Lisbon Rights of the patients
Sydney Organ transplantation
Hong kong Elderly abuse

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MEDICAL NEGLIGENCE
MEDICAL NEGLIGENCE/ PROFESSIONAL MALPRAXIS/MALPRACTICE

 Absence of reasonable care and skillQ by a doctor in treating the patient, resulting in bodily injury or death of the
patient.
Act of omission or commission:

 Act of omission: not doing something which a reasonable doctor would do
 Act of commission: doing something which a reasonable doctor would not do
 Generally, the innocence of doctor is assumed and in cases where negligence is alleged, the plantiff
(complainant, patient) has to establish the guilt.
 The patient is expected to prove that the defendant (doctor) was negligent; therefore the onus(responsibility) of
proof lies on patient.
The patient (or relative if patient is died) should prove 4 (D) elements of negligence;
 Duty – doctor was on duty during the negligence
 Dereliction (breech) of duty – doctor failed to perform the duty
 Damage – negligence cause damage to patient
 Direct causation – direct and causal connection exist between negligence and injury without intervening cause.
Examples of criminal negligence:

 Surgery on wrong extremity or on wrong patient
 Leaving sponges or instrument in body
 Operation without consent
 Mismatched/infected blood transfusion
 Not doing sensitivity test when indicated
 Giving wrong drug causing blindness or deafness
 Too tight plaster leading to gangrene
 Over exposure of radiation
 Dressing with corrosive
 Not attending the patient in labour
 Criminal abortion or operation

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Actions for professional negligence:

Civil professional negligence: Compensation is required
 Note: Consent for the act and contributory negligence are good defenses for doctors in civil court (but not in
criminal court)
Criminal: Fine and imprisonment (as it is a gross negligence)

 Section 304-A IPC deals with criminal negligence and punishment upto 2 years or fine or both.
Types of negligence:
 Civil negligence
 Criminal negligence
 Contributory negligence
 Corporate negligence
CIVIL NEGLIGENCE:
 Negligent act of the treating physician which causes some suffering or damage to the patient.
 Damage is such, which can be compensated by paying money
 Does not come under the purview of CrPC and IPC.
CRIMINAL NEGLIGENCE:
 Criminal negligence is gross incompetency & carelessnessQ in the treatment of the patient, gross indifference to
the patient’s safety.
 More serious than civil negligence.
 Practically limited to cases in which the patient has died.
 Sec. 304-A IPC Qdeals with criminal negligence - Punishable with imprisonment upto 2yearsQ and with/without
fine’.
Examples of criminal negligence:
 Operation on wrong limbQ
 Removal of wrong organ
 Mismatched blood transfusionQ
 Conducting criminal abortion
RES IPSA LOQUITUR OR THE THING SPEAKS FOR ITSELF

 The negligent act is so obvious that the patient need not prove the doctor’s guilt with medical evidence.
Examples
 Leaving surgical instruments/ sponges in the abdomen.

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 Failure to give tetanus toxoid in cases of injury.

 Surgery on the Wrong side/ wrong organ/ wrong person.
 Mismatched Blood transfusion.
DOCTRINE OF COMMON KNOWLEDGE:

 Expert evidence is not needed as it is regarding matters of ‘common knowledge’
 It is a variant of res ipsa loquitor.
 It is based on the assumption that the doctor will be held responsible for negligence in particular case which are
within the common knowledge of medical practitioner. Eg; not giving fluids in dehydration/cholera.
CALCULATED RISK DOCTRINE:

 It is a defense to doctor.
 It states that ‘resp ipsa loquitor should not be applied when the complained injury may have occurred even
though proper care has been taken.
 Every accepted method of treatment has certain percentage of unavoidable risks.
THERAPEUTIC/DIAGNOSTIC MISADVENTURE:
Injury or death of the patient is due to unintentional/inadvertent act by a doctor.
 Misadventure (mischance/accident/disaster)
 Eg; adverse effect of a drug (hypersensitivity reaction due to penicillin/aspirin, Thyroid cancer with I-131)
Chemical peritonitits during barium enema
INEVITABLE ACCIDENT/MEDICAL MALOCCURANCE/ACT OF GOD:

 It is due to biological variations in different people.
 On certain occasions, despite all proper care given by doctor during treatment, the patient may fail to respond
properly or may suffer adverse reactions of drug.
NOVUS ACTUS INTERVENIENS:

 This principle applies to cases of assault or accidental injuries.
 However, sometime such continuity of events is broken by an entirely new and unexpected happening, due to
negligence of some other person i.e. “novus actus intervenient” (an unrelated action intervening).
 Eg: a surgeon is operating on liver laceration case (assaulted case). If patient dies intra-operatively, the person
who assaulted will be responsible for this.
 But if doctor has done some negligence during surgery, like forgetting any swab or instrument in abdomen during
surgery and if patient dies, then the responsibility may pass from original incident to later negligent act of
surgeon.
RES JUDICATA (The things that have been decided)

 When the case is completed between two parties in the court, it cannot be tried between the same parties.
 Eg; if a patient sues a hospital for any negligence and the things are decided, he cannot subsequently sue the
doctor again separately for the same negligence.

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RES INDICATA
 The patient should file the case against the doctors within 2 years from the date of alleged negligence.
CONTRIBUTORY NEGLIGENCE:
 Simultaneous negligence of doctor and patient so as to lead to damage to the patient.
 Eg: improper history from patient and patient does not follow doctor’s instructions
 It can be used as defense by the doctor, but in civil cases only, and not in criminal case.
 The burden of proof lies with the doctor.
 Damages awarded by the court may be reduced.
Contributory negligence
It cannot be used as defense in following:
 Criminal negligence
 Last clear chance doctrine: i.e. if doctor has discovered it before causing injury and failed to avoid that.
 Avoidable consequences rule: i.e. due to negligence of doctor, there occurs damage to patient, but due to later
damage of patient, damage becomes more. (Eg: Battery, burns case)
GOOD SAMARTION DOCTRINE:

 One who has assisted another in serious need cannot be charged for contributory negligence, provided that the
assistance is not rash and reckless.
CORPORORATE NEGLIGENCE:
 Failure of hospital administration to follow standard of care in providing the treatment, accommodation and
facilities.
 Selecting incompetent doctors, providing defective instruments etc.
PRODUCT LIABILITY:
 Manufacturer is liable for quality of drug and medical equipment.
DOCTRINE OF RESPONDENT SUPERIOR/ VICARIOUS LIABILITY

 ‘Let the master answerQ’
 An employerQ is responsible not only for his own negligent act, but also for the negligent act of his employees.
 Hospital and senior medical staffs are responsible for negligent act of junior medical staffs.
 It is there only in civil cases and not in criminal cases.
BORROWED SERVANT DOCTRINE:

 The nurse employed by a hospital to assist in surgeries will be the ‘borrowed servant” of the operating surgeon
during the surgery, and the servant of the hospital for all other purposes.
Burden of proof lies on patient Burden of proof lies on doctor Burden of proof lies on
manufacturer
Civil negligence case Contributory negligence Product liability
Res ipsa loquitor
 Note: Normally, professional negligence of a doctor must be proved in the court by expert evidence of another
doctor.
 Expert evidence is not needed in;
 Res ipsa loquitor
 Doctrine of common knowledge
Professional secrecy:
 During the treatment of a patient, the doctor is obliged to maintain the secrets that he comes to know concerning
the patient during the course of a professional relationship.
 Doctor is liable to damages for its breech
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Privileged communication
Privileged Communication:
 It is justified in some cases to disclose the information of patient to proper authority.
 It is defined as a communication made by doctor to a proper authority that has corresponding legal, social and
moral duties to protect the public.
 It is an exception to professional secrecy.
Examples of Privileged Communication are:

 In court of law: when asked by judge
 As compulsory duty: every doctor has to give details of birth, death and communicable disease.
 As a social duty; if health of a patient can cause danger to society. Eg
 Bus/train driver – being color blind/epileptic/drug addict
 Pilots – refractive error
 Hotel waiter – TB or any infectious diseases
 Person likely to marriage who is suffering from STD or HIV
 Swimming pool user suffering from STDs/Infectious diseases
 Water pollution
Examples of Privileged communication are:

 In self interest – both in civil and criminal cases by patient
 In the interest of patient: relatives/family should be informed in some cases of treatment like anti-
psychotics/anti-depressants etc
 Suspected crime cases
 In insurance reports – can report only about diseases
 In negligent suits – when doctor is employed by opposite party to cross examine patient who filed the suit.
CONSENTS
Consent in medical examination and treatment:

 Consent means agreement or compliance.
1. IMPLIED CONSENT:
 Consent is presumed to be there.
 The very fact that patient has come to the doctor for treatment, so it is presumed that he/she is given a consent for
physical examination.
 It is non-written but legally effective form of consent.
2. EXPRESSED CONSENT:
 - it is stated (oral or written) in clear and explicit language. Written is better.
3. WRITTEN INFORMED CONSENT:

 - it is s a type of expressed consent in written form which is given by the patient after being informed of nature of
illness, or nature of procedure or operation to be done, its alternatives, its consequences and complications.
4. BLANKET CONSENT:
 - it refers to consent which is taken usually on a printed form, at the time of admission of the patient, authorizing
the doctor to do any surgery under any anesthesia.
 - legally, it is no consent, i.e. it is of no value in court
 - to be legally valid, consent is to be obtained for each specific procedure and operation.
VALIDITY OF CONSENT:
 Given by person himself, if above 12 years, conscious and mentally sound.
 By a guardian if below 12 years or unconscious or insane.
 Should be given in presence of two witnesses

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 Given freely, voluntarily and directly, without fear, force or fraud.

 Signed by doctor, patient (or guardian) and witnesses.
NO NEED FOR CONSENT:

 In emergency
 In case of attempted suicide
 If there is chance of spread of infection to others
 Cases of alcohol consumption
 If an emergency involving child crisis (child <12 years); at times. Consent of teachers or hostel warden can be
taken, whoever is person in charge of children (LOCO PARENTIS)
 Prisoners and criminals
 For vaccination
CONSENT IN SPECIAL CIRCUMSTANCES:

 For MTP (medical termination of Pregnancy): patient should be >18 years to herself give consent.
 For sterilization, hysterectomy, artificial insemination, sperm donation: consent of both partners is required.
(any procedure which hampers sexual activity)
 For criminal abortion or criminal operation: No question of consent since they are crime.
 Medicolegal cases: In criminal cases, victims cannot be examined without his/her consent, but the accused can
be examined without consent.
 Discharge against medical advice (DAMA): it can be done only after the consent of patient or guardian.
 Consent to suffer any harm (boxing): >18 years can give consent
 For postmortem: no consent is required for medicolegal PM, but for clinical PM consent, consent to two close
relatives is a must.
 For removal of organ for organ transplantation: Person above 18 years with sound mind can give consent for
organ transplantation.
 For a person below 18 years or with unsound mind, no one can give consent i.e. organs cannot be removed.
 No need of mass required for mass immunization. Law provides consent for mass immunization.
 CONSENT IN AUTOSPY:
 Medicolegal Autospy: Consent not needed
 Pathological autopsy: consent from relatives mandatory
RED CROSS EMBLEM

 Who can use this sign? (as specified by the Geneva Conventions)
 International Red Cross Organizations
 Facilities for the care of injured and sick armed forces members
 Armed forces medical personnel equipment

 Misuse is punishable with a fine of 500 and forfeiture of the goods or vehicles on which the emblem has been
used.

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PUNISHMENT FOR ACCEPTING GIFTS FROM PHARMA COMPANIES:

 MCI has recently notified the quantum of punishment for doctors accepting bribe (gifts, cash or travel facility)
from pharma companies:
 Gifts worth 1000-5000: warning
 5000 – 10000: suspension from SMC for 3 months
 10,000 – 50,000: suspension from SMC for 6 months
 >50,000: suspension from SMC for 1 year
Q. Person employed without medical qualification in medical field is;

 A. Covering
 B. Adultery
 C. Perjury
 D. Dichotomy
Q. Surgical instrument left in abdomen postoperatively amounts to;

 A. Res judicata
 B. Res ipsa loquitor
 C. Vicarious liability
 D. Novus actus interveniens
Q. A doctor getting referral money from the labs for sending the patient for unnecessary investigations
amounts to;
 A. adultery
 B. infamous conduct
 C. Contributory negligence
 D. criminal negligence
Q. A female patient was supposed to be operated for a lump in right breast. Surgeon operated and
removed her left breast due to confusion. The negligent act of the surgeon amounts to;
a. Calculated risk doctrine
b. Novus actus interveniens
c. Res judicata
d. Res Ipsa loquitor
Res ipsa loquitor – the thing speaks for itself

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 Doctrine that infers negligence from the very nature of an accident or injury itself proves the negligent action of
the physician in the absence of direct evidence.
Res Judicata: the things have been decided
 Medical negligence case adjudicated by a court and therefore may not be pursued further by the same partied in
another court.
Vicariuos Liability: Let the master answer
 An employer is responsible not only for his own negligent act, but also for the negligent act of his employees.
Calculated Risk Doctrine: Every accepted method of treatment has crtain percentage of unavoidable risk
Q. An employer is responsible not only for his own negligent act, but also for the negligent act of his
employees. This is;
 A. Calculated Risk Doctrine
 B. Vicarious Liability
 C. Res Judicata
 D. Novus Actus Interveniens
Doctrine of Respondent Superior – Vicarious Liability – Let the master answer
Q. There is no need of taking consent in case of;

 A. Before elective cholecystectomy
 B. Physical examination of a rape victim
 C. Pathological autopsy
 D. A case of RTA with severe bleeding in ER
SEXUAL JURISPRUDENCE

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Important Terminologies
• Impotence: Inability of a person to perform sexual intercourse and achieve gratification.
• Frigidity: Sexual unresponsiveness in Females (Analogue of Impotence in male)
• Sterility: Inability of either a male or a female to procreate.
• Satyriasis: Excessive sexual desire in males.
• Nymphomania: Excessive sexual desire in females.
• Virgin: A female who has not experienced sexual intercourse.

• False Virgin: Woman who has had sexual intercourse but has an intact hymen
• Defloration: Loss of virginity.
• Carunculae hymenales or myrtiformes: Hymen remnants after the birth of a child.
• Marriage: Legally, marriage is a contract between a man and a woman which implies physical union by coitus.
• Nullity of marriage: The marriage is declared null &void, it does not exist from the beginning.
• Divorce: Dissolution of previously valid marriage.
• Infanticide: Killing of an infant (less than 1 year of age)
• Neonaticide: Killing of child within 24 hours of birth.
• Feticide: Killing of fetus any time prior to birth.
• Filicide: Deliberate killing of the fetus by the parents.
• Criminal abortion: It is the termination of a pregnancy against the existing laws.

• Natural sexual offences: Offences which are committed in the order of nature, i.e. by penetration of the vagina by
the penis.
• Unnatural sexual offences: Sexual intercourse against the order of nature, i.e. no penetration of the vagina by the
penis.
• Sexual paraphilias: Sexual excitement or orgasm is associated with deviant acts, without actual sexual
intercourse.
VIRGINITY:
• A virgin is a woman who never had any sexual intercourse.
• Defloration means loss of virginity

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SIGNS OF VIRGINITY NON-VIRGIN

LABIA MAJORA Thick, rounded, firm, fleshy and Thin, lax and do not completely
elastics. They are opposed to each close the vaginal orifice.
other to completely close vaginal
orifice
LABIA MINORA Small, thin, pink and lies inside the Enlarge, cutaneous, and projecting
labia majora outside labia majora
CLITORIS Small Enlarged
VESTIBULE Narrow Spacious
VAGINA Small, narrow, tight, reddish with Spacious, loose, roomy and
rugose wall elongated
HYMEN Intact Ruptured
FOURCHETTE & POSTERIOR Intact Torn
COMMISSURE
FOSSA NAVICULARIS Normal Conspicuous
HYMEN
• It is a thin, firm fold of mucous membrane at vaginal orifice. It usually has one opening which hardly admits the tip
of the little finger in a virgin. It is like a tight stretched membrane.
SHAPE:
• Annular or semilunar, i.e. cresentric with the broader part lying posteriorly
• Imperforate, leaving no opening
• Cribriform: having a number of small opening
• Septate: having two opening

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RUPTURE OF HYMEN:
• Usually ruptures at the time of first sexual intercourse and usually ruptures POSTERO-LATERALLY (4 or 8
o’clock position or 5 or 7 o’clock position.
• After 3 to 4 days, the edges are congested and swollen, which heal completely in 1 week
• Masturbation by fingering results in hymen rupture at 11 or 1 o’clock position.
• Hymen rupture is not seen in rape among children due to its deeper location
True Virgin: A female who has not experienced sexual intercourse and has intact hymen.
False virgin: A female who has had sexual intercourse but has an intact hymen.
TRUE VIRGIN FALSE VIRGIN
INTACTNESS Hymen intact and inelastic Hymen intact but elastic
HYMEN OPENING Barely admit the tip of little finger Admits two fingers easily
EDGES Distinct Undulated
HYMEN CAN ALSO BE RUPTURED WITHOUT SEXUAL INTERCOURSE IN FOLLOWING CONDITIONS:

• Masturbation
• Sanitary tampons
• Local injury to hymen
• Injury to genital area, or fall on a projected substance injuring genital area
• Surgical operation or gynecological examination
• Ulceration from diphtheria, fungus or other diseases
• Salapith is a weed which is introduced into vagina and the girl is made to sit in a tub of water. Pith absorbs water
and swells up.
• Constant itching due to thread form, fungal infection or poor hygiene.
Note:
• Hymen cannot rupture by separation of thighs, running, jumping, cycling, swimming, horse riding and
dancing.
• GLAISTER KEENE RODS: used to determine the degree of rupture of hymen and whether the rupture is recent or
old.
SEXUAL OFFENCES AND SEXUAL PERVERSIONS:
Natural Sexual Offences: (Penile - vaginal intercourse)

• Rape
• Incest
• Adultery
Unnatural: (Intercourse against the order of nature)

• SodomyQ
• Bestiality
• LesbianiasmQ
• Buccal coitusQ
Sexual Perversions/Paraphilia (Sexual gratification without sexual intercourse)

• SadismQ
• MasochismQ
• FetishismQ
• Transvestic fetishism
• ExhibitionismQ
• Masturbation
• Voyeurism
• FrotteurismQ
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RAPE
Section 375 IPC: Definition of rape
A man is said to commit rape, if he has sexual intercourse with a woman;

• Against her will
• Without her consent
With her consent if she is;

• <18 year (statutory rape)
• With his own wife <18 years
• Intoxicated or unsound mind
• Consent is obtained by unlawful means, i.e. fear of death or hurt to herself or to someone whom she is
interested and/or impersonation.
Rape will also be considered if a man;

• Penetrates his penis into the vagina, mouth, urethra or anus; or
• Inserts any object or any part of his body (not being the penis); or
• Applies his mouth into the vagina, urethra or anus; or
• Manipulates any part of her body
• Slightest penetration of penis within the vulva (with or without emission of semen or rupture of hymen)
constitutes the rape.
• Complete vaginal penetration is not needed to declare a rape.
EXCEPTIONS FOR 375 IPC

• Any medical intervention or procedure will not constitute rape
Note:
• Minimum age for giving consent for sexual intercourse: 18 years (not 16 years)
• Minimum age for consent, in case of wife: 18 years (not 15 years)
TYPES OF RAPE
• Statutory Rape: sexual intercourse with a girl <18 years
• Marital Rape: sexual intercourse by husband upon his wife during separation without her consent.
• Custodial Rape: Rape of a woman under custody by persons of authority. Eg; police officers, jail warden or
hospital staff
• Date Rape: Rape on date by using date rape drugs, Eg; Flunitrazepam. It is also called as acquaintance rape.
• Gang/Pack Rape: More than one person acting with common intention, rapes a woman. Each one is deemed to
have committed rape.
• Stranger Rape: rape by a man on a woman who had no previous contact with the victim.
Section 376: Deals with Punishment for Rape
Extensions of 376 IPC:
SECTION DESCRIPTION PUNISHMENT

376 A IPC Causing death or persistent Death sentence, 20 years jail or Jail for
vegetative state of rape victim the remainder of his natural life
376 AB IPC Rape on woman 20 years jail or Jail for the remainder
< 12 years of age of his natural life or Death sentence.
376 B IPC Sexual intercourse by husband upon 2 – 7 years jail
his own wife during separation
without her consent
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376 C IPC A person in authority inducing or 5 – 10 years jail

seducing a woman under his
custody to have sexual intercourse
with him (Police, public servants,
management or the staff of the jail,
remand home)
376 D IPC Gang rape 20 years jail of life imprisonment
376 DA IPC Gang rape of a woman < 16 years of Life imprisonment till the reminder of
age life
376 DB IPC Gang rape of woman < 12 years of Jail for the remainder of his natural life
age or Death sentence.
376 E IPC Rape by Repeat offenders Death sentence or Jail for the
remainder of his natural life
Extra Points:
• As per Indian law, only a man can rape a woman.
• (in France, a woman can also be charged for rape on a man)
• In India, the law does not presume any limit of age under which a boy is considered physically incapable of
committing rape. Similarly, there is no age limit for girl, below or above which rape cannot be committed on her.
• Revealing the identity of the rape victim by the media is punishable with imprisonment for 2 years or fine
(Sec. 228-A IPC).
MEDICAL EXAMINATION OF THE VICTIM OF RAPE (under Sec. 164 (A) CrPC)
Victim cannot be examined without written informed consent. Informed written consent should be taken if she is > 12
years or if <12 years or mentally unsound, then guardian/parents should give consent.
Sec 375 (C) CrPC

• All hospitals (including private), should provide medical treatment to the rape victim
• Private hospitals cannot refuse treatment to rape victim
• Police intimation to be made immediately.
• Free of cost treatment
Per Vaginal Examination:

• Vaginal examination of an adult female is done with a sterile speculum.
• Per speculum exam is not must in case of children/young girls when there is no history of penetration and no
viable injuries.
• Cervix, vaginal walls and vault is inspected for redness, bruising or tears.
• Contusions of the vagina are seen as dark red areas against the overall redness of the vaginal mucosa.
• They are more frequently seen in the lower third of anterior vaginal wall and in the upper third of posterior
vaginal wall.
• Take two swabs from the vaginal walls and posterior fornix.
PURPOSE OF MEDICAL EXAMINATION
• Search for physical signs and evidences

• Treat the victim for injuries, STDs or pregnancy
• To prevent psychological damage
FINDINGS SUGGESTIVE OF RAPE:
Signs of struggle on clothes (tear, blood, semen, mud etc), body and genitals (abrasion, contusion, bites or nail
marks etc.)

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• Presence of the semen in vagina (proof of sexual intercourse)

• Presence of spermatozoa in the vagina
Locards Principle Of Exchange: states that whenever two bodies come in contact with each other, there is exchange of
material between them and so a criminal can be linked to crime.
24 hr
• Presence of smegma (Penile cancer) Circumstances give 100 % immunities from
penile cancer
Hymen tear:
• Fresh: bleeding, margins swollen, reddish, tender & inflated
• 2-3 days: swollen margins, congestion
• 1 week: Margins show healing (but do not unite)
TESTS DONE DURING VICTIM EXAMINATION:
TOLUDINE BLUE TEST COLPOSCOPIC EXAMINATION WOOD’S LAMP

- For micro injuries It is particularly sensitive for subtle To identify foreign debris and
- 1 % toludine blue is sprayed genital injuries. semen on the skin.
and excess wiped out.
- Subtle injuries will stand out in
blue
- Micro abrasions can be
demonstrated easily

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Collection Of Samples During Victim Examination For Central/State Forensic Science Laboratory:
• If a woman reports within 96 hours (4 days) of the assault, all evidence including swabs must be collected, based
on the nature of assault that has occurred.
• The likelihood of finding evidence after 72 hours is greatly reduced; however it is better to collect evidence upto
96 hours in case the survivor may be unsure of the number of hours lapsed since the assault.
• The spermatozoa can be identified only after 72 hours after assault. In such cases swabs may only be sent for
tests for identifying semen, not for spermatozoa.
• Evidence on the outside of the body and on materials such as clothing can be collected even after 96 hours.
TYPES OF SWAB:
• Vaginal swab in penovaginal offence (to detect semen/sperm/DNA)
• Anal swab in Peno-anal offence (to detect semen/sperm, DNA and fecal matter)
• Oral swab in peno-oral offence (to detect semen/sperm, DNA, saliva)
• Body swabs in all offences (to detect semen/sperm and saliva)
Trachoma. Azithromycin 500mg ,facial cleansing ,environment
SAFE Rape Kit hygiene
• Used for gathering and preserving physical evidence following sexual assault.
• A rape kit consists of small boxes, microscope slides and plastic bags for collecting and storing evidence such
as clothing fibers, hairs, saliva, blood, semen or body fluid.
• Also called sexual assault forensic evidence (SAFE) or physical evidence recovery kit (PERK)
EXAMINATION OF ACCUSED:
• An accused can be examined even without his consent (Sec 53 (A) CrPC).
Findings may be;
• Presence of torn frenulum or abrasion over glans is consistent with a recent intercourse
• Presence of smegma under prepuce is inconsistent with recent intercourse, as it gets rubbed off during sexual
intercourse and may be deposited in vagina. It takes about 24 hours to accumulate. Thus presence of smegma may
indicate sexual intercourse, provided no bath is taken.
• Presence of vaginal epithelial cells on penis can be detected by Lugol’s Iodine.
Procedure of Lugol’s Iodine Tets

• Wipe the penile shaft with filter paper.
• Expose the filter paper to Lugol’s Iodine vapor

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RESULT:
• Brown color
• Due to the presence of glycogen in vaginal epithelial cells.
TIME: the test will be positive, till the 4th day after intercourse.
Natural Sexual Offences
INCEST:
• Sexual intercourse by a man within blood relationshipsQ or prohibited degrees of relationships. e.g. father with a
daughter, grand-daughter, sister, stepsister or aunt.
• In India, incest is not a criminal offence.
• Electra complex: between daughter and father
• Oedipus complex: between son and mother
• Pharonic complex: Between brother and sister
ADULTERY:
Definition:
• Voluntarily having sex with someone who is not his/her legally wedded spouse.
• Adultery is not a punishable crime, as per the Supreme Court Judgment 2018.
• If proven, adultery is a valid ground for divorce and nullity of marriage.
UNNATURAL SEXUAL OFFENCES
UNNATURAL SEXUAL OFFENCES Bestiality means sex with

Bestiality, Sodomy, lesbianism & Buccal coitus animals
• Unnatural offences are punishable under 377 IPC with 10 years or life imprisonment. 377 define partial
SODOMY sexuality which is
partially
• It is the anal intercourse between two males or between a male and a female. decriminalized
• Habitual passive agents are called fairies, gays or queens in the west.
• In India they are called hijras (castrated males) and zenanas (male transvestites).
OTHER NAMES OF SODOMY;
- Buggery
- Greek love
Gerontophilia: When passive agent is an adult
Pederasty: When passive agent is a child
PEDERASTY:
An adult male having habitual sodomy with a male child.
PEDERAST/PEDOPHILE Active agent

CATAMITE Passive agent
TRIBADISM/LESBIANISM
• Female homosexuality by mutual acts of sexual indulgence to achieve gratification.
Active Lesbian Known as BUTCH or DYKE
Passive partner Known as FEMME Passive
partner

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• Continued lesbianism is valid ground for divorce under Hindu Marriage Act.
• Lesbians who are morbidly jealous of one another when rejected may commit homicide, suicide or both.
BESTIALITY/ ZOOPHILIA
• Sexual intercourse with lower animals

• Generally, sheep are used by males, and dogs or cats by females.
• The surest evidence is the demonstration of human spermatozoa in the genital tract of the animal.
BUCCAL COITUS
• Oral coitus.
• Also called the ‘Sin of Gomorrah’ (It is alleged that buccal coitus was prevalent in Gomorrah, the Biblical twin city
of Sodom)
• Can be performed by both sexes.
• In India, under the Hindu Marriage Act, insistence on buccal coitus constitutes a valid ground for divorce.
FELLATIO Oral stimulation of penis by male or female

CUNNILINGUS Oral stimulation of female genitals
ANILINGUS Oral stimulation of anus
Legal perspective of unnatural sexual offences:

• In india, nonconsensual sodomy is punishable under Sec 377 IPC
Supreme court 2018 verdict on 377 IPC:
• The Supreme Court on 6th September 2018, ruled that consensual adult gay sex is not a crime and decriminalized
377 IPC
• Consensual adult gay sex is not a crime.
Note: unnatural offences are not decriminalized completely, rather partially. IPC 377 can still be evoked.
354 ipc
SEXUAL PERVERSIONS A- assault
B - using power to disrobe
↓ of female
PARAPHILIAs Erotophonophilia C - voyorism
D- stalking
• SADISM/ALGOLAGNIA: sexual gratification is obtained by infliction of pain on one’s partner
• LUST MURDER: extreme form of sadism. Killing the partner by stabbing, slashing or mutilating the sex organs.
• MASOCHISM/PASSIVE ALGOLAGNIA: sexual gratification is obtained or increased by the suffering of pain.
• BONDAGE/ALGOLANIA: sadism + Masochism
• VOYEURISM/SCOTOPHILIA/PEEPING TOM: sexual gratification by watching the act of sexual intercourse or
witnessing undressing by a women or any person.
• EXHIBITIONISM: the act of exposing one’s genitals to unsuspecting persons for sexual arousals.
FLASHING The act of momentarily exposing or revealing sexual body part by quickly moving the
clothing
STREAKING The act of running naked through a public place
MOONING The act of displaying one’s bare buttocks, by lowering the pants and bending over
• NECROPHILIA: desire of sexual intercourse with dead bodies

• NECROPHAGIA: eating the dead body (eating the flesh/drinking the blood of dead body)
• FETISHISM: Perversion associated with the compulsive usage of an inanimate objects in order to attain the sexual
gratification.
Common fetish objects are: hand kerchief, undergarments like panties, bras, stockings.

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• TRANSVESTISM/EONISM: sexual gratification is obtained by wearing the dress of opposite sex.

• FROTTEURISM: Sexual satisfaction is obtained by rubbing against persons in crowd.
• BOBBIT SYNDROME: female amputates the genitalia of male partner with a knife due to sexual jealousy of
infidelity.
• TROILISM: inducing his wife to have sexual intercourse with another man and by observing the same.
• SCATOLOGIA: Sexual arousal by using Obscene language over phone.

• UROLAGNIA/UNDINISM: tendency to derive sexual pleasure from the sight, thought or touch of urination.
(golden showers)
• COPROPHILIA: sexual gratification at sights of feces
• KLISMAPHILIA: sexual gratification by enema
• MASTURBATION/IPSATION/ONANISM: self-stimulation which effects sexual arousal
• PYROMANIA: setting the buildings and things on fire for gratification Impulsive control disorder
• PORNOGRAPHOMANIA: sexual arousal is obtained by collecting, viewing pornographic materials, books etc.
• EROTOGRAPHOMANIA: sexual arousal is obtained by drawing obscene pictures in lavatories, public urinals or by
writing obscene letters.
• ECOUTEURISM: sexual arousal is obtained from listening the sounds associated with sexual intercourse.
Kleptomania - stealing
and sex
Oniomania
Dipsomania

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Legally Punishable Perversions:

• Frotteurism: 290IPC (fine) and 291 IPC (6 months jail)
• Exhibitionism: 294IPC (3 months jail)
• Necrophagia & necrophilia: 297 IPC (1 year jail)
• Sexual assault – 354A
• Use of criminal force to disrobe a woman: 354 B IPC (3-7 years jail)
• Voyeurism: 354 C IPC (1-3 years jail)
• Stalking: 354 D IPC (upto 3 years jail)
First offence of Voyeurism and stalking Cognizable and bailable

Second offence of Voyeurism and stalking Cognizable and non-bailable
STALKING:
• Any man is said to have committed stalking.
• If he follows or contacts a woman repeatedly despite a clear indication of disinterest by such woman.
• Or monitors through internet, email or any other form of electronic communication
• Punishable under 354 D IPC

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Q. Excessive sexual desire in male is;

• A. Nymphomania
• B. Satyriasis
• C. Frigidity
• D. Fetishism
Q. In cases of examination of victims of sexual offences, spray of toluidine blue is used for;
• A. Identify dried semen traces
• B. Identification of clotted blood
• C. Recent micro injuries
• D. Healed injuries
Q. Onanism is also called as;

• A. Sodomy
• B. Masturbation
• C. Buccal coitus
• D. Fetishism
Q. Hymen in a child who has been raped will be;

• A. Intact, as it is elastic
• B. Perforated, as it is very thin
• C. Intact, as it deeply situated
• D. Perforated, as it is superficially located
Q. A 17 year old comes to you with fractured forearm. She told that she tripped and fell but cigarette burns
were observed on her forearm. What will be your next step?
• A. Inform higher authorities
• B. Inform fellow collegues and discuss that she is a case of abuse
• C. call local social worker for help
• D. Do complete physical examination
Q. The perversion as shown in photo is punishable under which section of IPC?

• A. IPC 354 A
• B. IPC 354 B
• C. IPC 354 C
• D. IPC 354 D

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Q. All are correct about Legal perspective of unnatural sexual offences except;
A. Nonconsensual sodomy is punishable
B. Consensual adult gay sex is not a crime.
C. IPC 377 can still be evoked.
D. Unnatural offences are decriminalized completely
Q. Sexual gratification of a women is obtained by another woman is called as;

A. Cunnilingus
B. Incest
C. Tribadism
D. Buggery
14. POSTMORTEM CHANGES - THANATOLOGY
THANATOLOGY – STUDY OF DEATH
TAPHONOMY – STUDY OF PROCESS OF DECOMPOSITION OF BODY
Postmortem Changes - appear in the following order.

• Immediate signs (Due to somatic death)
• Early signs (Due to molecular/cellular death)
• Late signs (decomposition or decay after molecular death)
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IMMEDIATE SIGNS: Due to Somatic death
• Permanent and complete cessation of functions of lung:

• Complete cessation of respiration for more than 5 minutes i.e. there is no breath sound on chest or larynx for 5
minutes.
TESTS FOR CONFIRMING CESSATION OF RESPIRATION

• Mirror test: No vapors and blurring over mirror held in front of nose
• Feather test: No movement of feather if held in front of nose
• Winslow’s test: No movement of reflection of light shown on mirror/surface water in bowel, kept on chest.
PERMANENT AND COMPLETE CESSATION OF FUNCTIONS OF HEART AND FLAT ECG;
Tests for confirming cessation of circulation:

• Magnus test (ligature test): Fingers fail to show congestion and swelling to a ligature applied at their base.
• Diaphanus test (transillumination test): failure to show redness in finger web spaces on transillumination
from behind
• Icard’s test: failure to produce yellowish green discoloration of skin on injection of fluorescein dye.
• Finger nail test: no blanching and filling of blood on applying pressure and release of pressure.
Permanent and complete cessation of functions of brain and flat EEG;

• There is complete cessation of function which leads to insensibility, unresponsiveness to external stimuli or
internal needs, loss of muscle tone and flat EEG.
EARLY SIGNS (Due to Molecular/Cellular death):

• Pallor and loss of elasticity of skin
• Primary relaxation of muscles
• Eye changes
• Cooling of body – Algor mortis

• Staining of body – Livor mortis
• Stiffening of body – Rigor mortis
CHANGES IN THE EYES:

• Loss of pupillary and corneal reflex (unreliable)
• Cornea becomes hazy and opaque
• Flaccidity of eyeball (due to decrease in IOT).
Normal IOT is 10-22 mmHg.

It is 12 mmHg immediately after death,
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3mmHg at 3 hours after death and

0 at 4-8 hours after death.
• Retina: Retinal blood vessels are seen as continuous line in living person.
• Dotted appearance (1-2 hours after death)
• Segmented or rail road appearance called KEVORKIAN SIGN (Earliest Sign After Death)
• Pale optic disc (>3 hours after death)
Vitreous Changes
• Best medium to measure TSD
• Vitreous changes (there is increased in level of potassium, ascorbic acid and lactic acid in vitreous humor.
POTASSIUM is the most useful component of vitreous humor for determining the time since death.
• Main advantage of vitreous potassium method is that it may be carried out upto 4-5 days after death.
• Rise of potassium concentration per hour is 0.17 – 0.24 mmol per hour.
• Formula used for postmortem interval form of Vitreous K+: Madea’s formula and Sturner’s formula
TACHE NOIRE SCLEROTICA
• Cause:Drying/desiccation, deposition of cellular debris &dust

• Location: Sclera & conjunctiva
• Appearance: two triangles at each side of the iris, (base on the limbus, apex at the outer canthus)
• Colour change: First yellow, then brown finally black
• Time since death: 3 – 4 hours
Kevorkian sign
• Kevorkian sign/ cattle trucking/ railway trucking sign: Retinal changes
• The earliest sign after death in eyeQ.
• Appearance: Fragmentation or segmentation of blood columnsQ in retinal vessels
• Cause: Loss of blood pressure; Visualized by opthalmoscopeQ
• Time since death: appears within seconds to minutesQ after death, persists till 1 hour

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ALGOR MORTIS
ALGOR MORTIS (CHILL OF DEATH)

• POSTMORTEM COOLING OF BODY:
• After death, the heat production stops, due to inactivity of the heat regulating centre after somatic death. Because
of which, there is fall of body core temperature after death.
• Body core temperature is measured.
• Algor mortis helps in determination of time since death
SITES OF MEASURING CORE BODY TEMPERATURE:

• Rectum (8–10 cm above anus) – Common siteQ (Except sodomy cases)
• Subhepatic (inferior surface of liver) – IDEAL SITE
• External auditory meatus (tympanic membrane)
• Nose
• Lower end of esophagus
• Note: Mouth and axilla will give body surface temperature and rectum will give BODY CORE
TEMPERATURE.
• Instrument: CHEMICAL THERMOMETER (thanatometer) or Electronic Thermocouple. (10-12 inches long
with graduation from 0-50 0C.
• The fall in temp starts in 15 minutes to ½ hour

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Formula to calculate Time Since Death (TSD):
TSD (in hours) = Normal body temperature – Rectal temperature / rate of fall of temperature
• The body attains environmental temperature in 16-20 hours.
• Rate of fall of temperature: 0.5 °C/hr
• If atmospheric temperature is low, body loses its heat by conduction, convection, radiation and evaporation. No
cooling of dead body occurs if atmospheric temperature is higher than that of body.
FACTORS AFFECTING ALGOR MORTIS:

• Environmental factors
• Humidity: moist > dry
• Media of disposal: water > buried
• Built of cadaver: Lean bodies > Obese
• Age and sex: children > elderly
• Clothing: covered body retains heat for a longer time
RATIO OF THE RATES OF FALL OF TEMPERATURE IN THE THREE MEDIA:

Water : Air : Soil = 4:2:1
Rate is maximum in water, moderate in air and minimum in a buried body
POSTMORTEM CALORICITY
• Normally temperature falls after death. But in some situations, for initial 2-3 hours the dead body may gain heat
i.e. postmortem caloricity.
• Mechanism: increased endogenous heat production during death
Can be seen in:
• Due to disturbed heat regulation: Sun-stroke (heat stroke), pontine hemorrhage
• Heat production due to muscle convulsion: Tetanus, strychnine poisoning
• Heat production due to excessive bacterial activity: Septicemia, pneumonia, cholera, typhoid, meningitis etc.
LIVOR MORTIS/ POSTMORTEM STAINING
Synonyms:
• Lividity
• Hypostasis
• Vibices
• Darkening of death
• Cadaveric lividity
• Suggilation
• Bluish purple discoloration in the dependent parts of the body after death
• Staining is in the superficial layers of the dermis (rete mucosum)

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Development of Livor Mortis:

• Starts as patches in 30min – 1 hour
• Patches coalesce with each other to form uniform staining in 3- 4 hours
• Complete in 6 -12 hours
• FIXATION OF LIVOR MORTIS: 6 – 12 HOUR
• Fixation: Apply pressure
Blanching seen – not fixed
Blanching not seen - Fixed

Note:
• If the position of the body is moved before fixation, the lividity disappears and reappears according to the new
position. The livor mortis will appear over the dependent parts of new position (secondary lividity).
• If the position of the body is moved after fixation, the lividity does not change.
Distribution of postmortem staining – Depends on the position of the body (dependent parts)
POSITION OF THE BODY PATTERN OF LIVOR MORTIS
Supine Neck and entire back (except areas directly pressed on the
ground)
Prone Front of body
Hanging ( suspended vertically) Legs, external genitalia, lower parts of forearms and hands
(GLOVE & STOCKING)
Drowning ( submersion in water) Face, upper part of the chest, hands, lower arms and feet
Drowning in running water ( running water) NO LIVIDITY
Color of Livor Mortis:

• The color of livor mortis depends on the type of hemoglobin
• Normally, the lividity is bluish or purple due to the presence of deoxy hemoglobin.
CONDITIONS COLOUR OF LIVIDITY

Normal Blue/ purplish
Carbon monoxide Cherry redQ
Burns
Cyanide Brick Red/bright red
Hypothermia/ Bright PinkQ
Refrigeration
NaCl / Nitrite / Nitrate/ aniline Chocolate BrownQ
Potassium chlorate (PAN)
Aniline Deep blue
Septic abortion Bronze
Hydrogen sulphide Bluish GreenQ
Opium Black
LIVIDITY IS ABSENT IN
• Body is tossed and turned continuously - fast flowing water in riversQ
• Severe haemorrhage (blood loss of 65% in adults and 45% in infants)
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Medico-Legal Importance
• Helps in estimating the time of death
• Indicates the posture of the body at the time of fixation & death
• Indicates the moving of the body to another position
• Color of lividity may indicate the cause of death – poisoning
AREAS OF PALLOR IN LIVIDITY:

CONTACT PALLOR/PRESSURE PALLOR
• Parts of the body which are in tight contact with the ground do not show staining.
• Eg; occipital area, shoulder blades, buttocks, posterior aspects of thigh, calves and heels.
• Butterfly shaped pattern over back
VIBICES
• Often, skin under collar band, waist bands and belts remain pale due to tight contact and seen as pale stripes or
bands known as vibices
RIGOR MORTIS
RIGOR MORTIS - CADAVERIC RIGIDITY OR DEATH STIFFENING
SYNONYMS:
• Cadaveric rigidity
• Postmortem Rigor
• Postmortem Rigidity
• Postmortem Stiffening

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• - The state of the muscles becoming stiff or rigid in a dead body.

• - Due to depletion of ATP stores after death.
• - Onset: ATP level 85% of normal (critical level)
• - Max rigidity: ATP level 15-30%
• Rigor mortis begins in 1 -2 hoursQ after the period of primary relaxation.
• Primary flaccidity – Rigor mortis – Secondary flaccidity
Muscular Involvement:
• Rigor mortis involves both voluntary & involuntary muscles (involuntary muscles earlier than voluntary
musclesQ)
Order of appearance of rigor mortis:
• Rigor involves myocardium initially within 1 hourQ. Then it spreads externally. (Heart > Eye)
NYSTEN’S RULE:
External: First in the upper eyelids, neck, muscles of the face, jaw, upper limbs, chest, abdomen and lastly the
lower limbs and the fingers and toes.
• Rigor mortis disappears in the same order of appearance in, which it develops.
• Rigor mortis begins in 1-2 hours, progress in 3-4 hours and complete in 6-12 hours
Rule of 12:
• It takes roughly 12 hours to appear, Persists for another 12 hours & Disappears in another 12 hours
Note:
• 1st site of rigor mortis involvement is Myocardium
• 1st external site of rigor mortis involvement is Eyelids
• It does not occur in fetus < 7 months
CONDITIONS SIMULATING RIGOR MORTIS

1. Cadaveric spasm - (unknown mechanism, may be neurogenic)
2. Heat stiffening - (due to muscle protein coagulation) – Pugilistic attitude
3. Cold stiffening - (due to solidification of subcutaneous fat)
4. Gas stiffening - (due to gas accumulation evolved from putrefaction)
CADAVERIC SPASM (Instantaneous Rigor)

The group of voluntary musclesQ which were at strenuous work just before death goes into a sudden state of stiffening,
instead of passing to primary flaccidity after death.

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Salient Features of cadaveric spasm:

• Seen immediately after death with No primary relaxation phaseQ.
• Involves only a group of voluntary muscles (which were in contraction before death)
• Exclusively AntemortemQ in nature.
• Cadaveric spasm cannot be produced artificially.
• Great force is required to overcome the stiffness.

• The attitude/ last act of the person at the time of death is preserved Q. The cause & manner of death can be
determined (grass/weed in hand, weapon in hand etc.)
• Mechanism: Unknown, Neurogenic
• Conditions: Firearm in the hands of victims in suicidal gunshot injuries, plants and weeds in the hands of victims
in drowning, the weapon in the hands of victims in cut throat injuries suggesting the manner of death.
Heat Stiffening:
If the body is subjected to heat exposure at > 65°C, rigidity is produced.
Synonyms:
• Pugilistic attitude
• Boxers attitude
• Fencing attitude
• Defence attitude
Mechanism:
• Muscle protein coagulationQ due to heat.
• Muscles are contracted
• Conditions:
• Burn
• High voltage electric shock

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Attitude:
• The legs are flexed at the hips and knees, the arms are flexed at the elbows and held out in front of the body and
the fingers are hooked like claws.
Note:
• The stiffening remains until decomposition
• The normal rigor mortis does not occur in heat stiffening.
Cold Stiffening:
If a body is exposed to freezing temperatures, the tissues becoming frozen and stiff, simulating rigor.
Mechanism:
• Freezing of body fluids
• Hardening of the subcutaneous fatty tissues
Fate:
• On exposing the body to warm atmosphere, cold stiffness disappears, followed by normal rigor mortis occurring
rapidly and passes off quickly.
LATE SIGNS- POSTMORTEM CHANGES

There are three environmental factors around the body which decide the type of late change to be occurred.
• Warmth
• Moisture (humidity)
• Air flow
DEAD BODY
Presence of Warmth Presence of Warmth Presence of Warmth
Presence of Moisture Presence of Moisture Absence of Moisture
Presence of Air flow Absence of Air flow Presence of Air flow
PUTREFACTION ADIPOCERE FORMATION MUMMIFICATION
PUTREFACTION – LATE CHANGES

• Autolysis- without bacterial involvement
• Decomposition – with bacterial involvement
AUTOLYSIS: (‘auto’: self; ‘lysis’: breakdown) – (by lysosomal enzymes)

• Body’s own enzymes are acting on itself, causing tissue and cellular destruction.
• The earliest autolytic changes occur in glandular tissues, and in the brain.

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DECOMPOSITION:
• Bacteria involved:
• Derived mostly from GITQ, sometimes from injuries (open wounds)
• Clostridium welchii, Staphylococcus, non-hemolytic Streptococcus, diptheroids, and Proteus are the important
ones involved.
• Among these bacteria, Clostridium is the chief destructive agentQ as it produces ‘LECITHINASE’ enzyme.
DECOMPOSITION
3 important changes
• Color changes
• Production of gases
• Liquefaction of tissues
COLOR CHANGES
First external sign of putrefaction is the greenish discoloration in right iliac fossa.
• Internally, first site of discoloration is aortic intima and then the undersurface of liver
Why green color?

• H2S is produced by bacteria in large intestine. Green color results from the conversion of hemoglobin of blood into
sulphhaemoglobin by the H2S.
Why first noted externally in right iliac fossa?
• Cecum lies superficially. Contents of the bowel are more fluid and full of bacteria
Time of appearance:
• The color appears in 12-18 hours in summer and in 1-2 days in winter.
• The discoloration gradually spreads all over the abdomen, external genitalia, face, neck and thorax, and lastly on
the limbs.
Effects of Gas Formation

• Gases formed are: H2S (principal gas), ammonia, CO2, methane
Effects Timeline
Skin Blisters 18 – 24 hoursQ

First seen on the lower surface of trunk and thighs
Abdomen gets distended due to accumulation of gases in 18 -36 hours
the intestines (Gas stiffening)
i. Skin slippage 2-3 days
ii. Anus and uterus prolapsed
iii. Hair and nails become loose and may be taken
out easily

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Skin of hand and feet may come off in a “glove and 3-5 days
stocking” manner
MARBLING
(Linear branching patterns on the skinQ)
• Areas noted: Shoulder, roots of the limbs, thighs, sides of abdomen, chest and neck
• Time: 36 – 48 hoursQ.
• Greenish staining of inner walls of the vesselsQ, which is seen as linear branching patterns, a ‘marbled’
appearance of the skin.
Difference between postmortem blisters and burns blisters:

POSTMORTEM BLISTERS BURNS BLISTERS
CONTENT Air/gas bubbles Inflammatory fluids
BASE Pale Erythematous
Putrefactive changes of organs in the following order

Larynx and trachea (Earliest organ) Q
• Stomach, intestines and spleen. (SISter Lucy Beautiful Heart)
• Liver, Lungs
• Brain
• Heart
• Kidney, bladder
• Prostate, uterus
• Skin, muscle, tendon
• Bones
Note:
• In general, bone is the last organ to putrefy.
• But among the visceral organs, prostate and mulliparous uterus are the last to putrefy. They help to identify the
sex of the dead bodies in advanced state of decomposition.
POSTMORTEM LUMINESCENCE:
• Usually due to contamination by bacteria, like photobacterium fischeri
• Light comes from the bacteria
• Luminescent fungi, Armillaria mellea, are other sources of light

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PUTREFACTION IS RETARDED BY;

• Temperature < 0 0C and >48 0C
• Hot dry air
• Wasting diseases like anemia
PUTREFACTION IS ENHANCED BY;

• Peritonitis
• Septicemia
• Summer
• Anasarca
POISONS INHIBITING PUTREFACTION:

• Strychnine
• Metallic poisons like Arsenic, Zinc chloride, thallium, antominy
• Cyanide, CO, Carbolic acid (phenol)
MNEMONIC: SMC
POISONS PRODUCED DURING PUTREFACTION:

• CO
• Alcohol
• Cyanide
• Ptomaines
CASPER’S DICTUM:
• A body decomposes in air twice as rapidly as in water and 8 times as rapidly as in earth.
• Rate of decomposition in soil water & air: 1: 2: 8Q
• 1 week of putrefaction in air = 2 week in water = 8 week in soil
ADIPOCERE (SAPONIFICATION)
• It is modification of putrefaction, which occurs in the absence of air. That is when there is excessive moisture
(humidity) and warmth (warm temperature), but absence of air i.e. warm humid climate.
• Commonly seen in bodies immersed in waterQ or in damp warm environment
• In this, the fatty tissues of the body change into a substance known as adipocere
• It is also called grave wax
• It starts in subcutaneous fat and is marked in areas having excessive fat. Eg; cheeks, female breasts, buttocks &
abdomen.
Slowly the whole body including muscles and internal viscera change into adipocere.
Properties of adipocere:
• ODOUR:
• sweetish smellQ(it smells like ammonia
in early stage)
• Rancid butter smell
REQUIREMENTS:
• Warm moist climateQ
• Lecithinase enzymeQ produced by clostridium welchiQ
• Intrinsic lipases
DURATION:
• Shortest 3 weeksQ in summer
• Complete conversion in an adult limb requires at least 3 to 6 months

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MEDICOLEGAL IMPORTANCE:
• Cause of deathQ – injuries are preserved
• Time since deathQ
• When involves face, the features are well preserved, helps to establish the identity.
NOTE:
• Fetuses <7 months do not show adipocere formation.
• In running water, adipocere formation is not seen as the electrolytes are washed away from the surface of the
body.
MUMMIFICATION (DRYING & DEHYDRATION OF THE BODY)

When there is excess air and warmth, but no moisture, i.e. hot, dry and windy climate.
• It is the rapid dehydration and shriveling of the dead bodyQ from evaporation of water.
• The entire body loses weight, becomes thin, stiff, brittle and odorless. (more than 70% weight is lostQ)
ODOUR:
• Odourless
REQUIREMENTS:
• Absence of moisture
• Hot dry climateQ
• Free circulation of air
DURATION:
• 3 months to 1 yearQ
MEDICOLEGAL IMPORTANCE:
• Cause of death – injuries are preservedQ
• Time since deathQ
• helps to establish the identity
ADIPOCERE MUMMIFICATION
Warm, moist climate Dry hot climate
Lipase, Clostridium welchii
Ammonical smell Odourless
3w–6m 6m – 12 m
FORENSIC ENTOMOLOGY:
• The study of insects and other arthropods, which infest dead bodies.
• MYIASIS: infestation of the body by maggots
• The larvae of flies are called maggots.
Eggs – Larva – Maggots – Pupa – Flies (life stage in insects)
Medicolegal Significance of Entomology:
• Time since death – from the larval stage
• Place of body disposal – from the predominant species of fly
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• Cause of death (poisons) – from chemical analysis of larva

• Chemical analysis of maggots are helpful in determination of poisoning cases (called as Forensic
Entomotoxicology)
• Maggots should be preserved in boiling absolute alcohol or hot 10% formalin.
• Q. Identify the condition according to the posture;

A. Heat stiffening
B. Cadaveric spasm
C. Pugilistic attitude
D. Lividity
• Q. Staining shown in photo will be seen in which condition?

• A. Drowning
• B. Hanging
• C. Cadaveric spasm
• D. Supine position
Q. Which of the following is not an early sign of post-mortem changes?

a. Algor mortis
b. Autolysis
c. Livor mortis
d. Rigor mortis
Q. Which of the following is an earliest sign after death?

a. Kevorkian sign
b. Greenish discoloration in right iliac fossa
c. Loss of voluntary movement
d. Flaccidity of eyeball

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Q. Eye presentation in a post-mortem case as shown in photo, is called as;

a. Kevorkian sign
b. Tache Noir Sclerotica
c. Flaccid eye ball
d. Railway trucking sign
Q. Rate of fall of temperature in a dead body is faster in;

a. Air > water > soil
b. Soil > water > air
c. Soil > air > water
d. Water > air > soil
Q. Find out the wrong match related to poisoning and color of lividity;
a. Carbon monoxide – Cherry red
b. Cyanide – Bright red
c. Hypothermia – Deep blue
d. Hydrogen sulphide – Bluish green
Q. Which of the following is not related to mummification of a dead body?

a. Hot dry climate
b. >70% weight is lost
c. Odourless
d. Moisture environment
Q. One of the following is a wrong match related to the processes and their timeline of appearance;
a. Marbling – 36- 48 hours
b. Mummification - > 6 months
c. Rigor mortis - complete in 1 – 2 hours
d. Livor mortis - complete in 6-12 hours
Q. A case of RTA brought for autopsy. On post mortem examination, a group of muscles were stiff and rigid with no
state of primary relaxation. Which of the following depicts the condition?
A. Rigor mortis
B. Cold stiffness
C. Heat stiffness
D. Cadaveric spasm

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15. ASPHYXIAL DEATHS
ASPHYXIA:
Interference in respiration: Deprived of O2 and failure to eliminate CO2 causing unconsciousness or death.
• Asphyxia literally means PULSELESSNESS
Asphyxia death is diagnosed by triad of the following:
1. Cyanosis
2. Congestion: due to increased venous pressure
3. Petechial hemorrhages (tardieu’s spots): present above the level of obstruction like scalp, eyebrows, face in hanging
or strangulation and above the level of compression in traumatic asphyxia.
MECHANICAL CAUSES OF ASPHYXIA: can cause violent asphyxia

1. Hanging
2. Strangulation
3. Suffocation
4. Drowning

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HANGING
• Hanging is a form of asphyxia caused by suspension of the body by a ligature encircling the neck.
• The constricting force being the weight of the bodyQ
TYPES OF HANGING:
Based on position of knot: Typical and atypical
TYPICAL HANGING ATYPICAL HANGING

• Knot is at occiput • Knot of ligature is anywhere other than on the
• Point of suspension is placed centrally occiput
Judicial
hanging
BASED ON DEGREE OF SUSPENSION:

COMPLETE HANGING PARTIAL HANGING
• Body is fully suspended • Any part of the body is touching the ground
• No body part touches the ground • Eg; lying, kneeling, sitting position etc.
• Constricting force is weight of the body • Weight of the head is the constricting force.
Completely - hypoxia
Partial - ischimia
CAUSES OF DEATH IN HANGING

CAUSES MECHANISM FORCE OF CONSTRICTION
Compression of carotid artery Cerebral ischemia and anoxia 3-5 Kg
Compression of jugular vein Cerebral congestion 2 Kg
Compression of airways (larynx & Asphyxia 15 Kg
trachea)

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Pressure on vagus nerve or carotid Vagal inhibition/neurogenic

sinus shock/sudden cardiac arrest
Fracture/dislocation of upper Damage of spinal cord and
cervical vertebrae brainstem
Trachea 15 Kg
Vertebral arteries 30 Kg
Thyroid cartilage lamina fracture 14.3 Kg
Cricoid cartilage 18.8 Kg
Note:
• Asphyxia is the cause of death in complete hanging, occlusion of vessels in partial hanging
• Combined asphyxia and cerebral venous congestion is the most common cause of death.
• Fatal period is usually 3-5 minutes Crpc 344
POSTMORTEM APPEARANCES IN A CASE OF HANGING

External findings
• Signs on Face
• Protrusion of tongueQ due to pressure on floor
• Tardieu’s spots: over eyelids, under the conjunctiva & near the temple
• Swollen, cyanosed face (due to impaired venous return)
• Subconjunctival hemorrhages & bleeding from nose/ears
• Le facie sympathiqueQ
• Dribbling of salivaQ
Le facie sympathique
• Sign of antemortem hangingQ.
• If the knot presses on cervical sympathetic chainQ, eyelid of the same side remains open and the pupil is dilated Q.
Dribbling of saliva
• Surest sign of antemortem hangingQ.
• Excessive salivaitionQ due to pressure and irritation of submandibular and parotid glands by ligature
Signs on neck:
• Ligature mark: (SuprathyroidalQ, ObliqueQ, IncompleteQ)

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Ligature mark depends on type of suspension and 2 types of knot:
1. TYPE OF SUSPENSION;
IN TYPICAL COMPLETE HANGING IN PARTIAL HANGING
- Above thyroid cartilage - Below thyroid cartilage
- Oblique - Usually transverse
- Bilateral symmetrical
- Incomplete
2. TYPES OF KNOT:
Knot tied may be:
FIXED NOOSE
• The rope is tied round the neck & the rope is knotted to form fixed knot. This is most common pattern.

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• In suspension, limbs of the noose near the knot pulled up assuming shape of inverted V, thus ligature mark is in
INVERTED V SHAPE.
RUNNING NOOSE:
• One end of rope is passed through the loop made from the other end.
• On suspension the knot remains but ligature around neck tightens, therefore ligature mark is horizontal.
LYNCHING:
• Lynching is a form of homicidal hangingQ.
• A suspect is overpowered & hung by several personsQ by means of a rope from a tree or some similar object.
Signs on the body:

• Post-mortem staining in the lower part of upper limbs & lower limbs: Glove and Stockings FashionQ.
Internal findings:
Neck
• Hyoid bone fracture:
• More commonly above the age of 40 yearsQ.
• Amussat’s signQ: Transverse carotid intimal tearsQ seen in long drops (Judicial hangingQ).
• Fracture of superior horn of the hyoid bone may be present.
JUDICIAL HANGING
• In India, Knot is placed under the angle of jawQ.
• Knot under the chin is more effectiveQ (sub-mental)
• Length of rope from the point of suspension is equal to the height of the individual.
• The ligature around the neck causes a
forceful jerky impact on the neck & results
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in Hangman’s fracture. C2 fracture
SEXUAL ASPHYXIA: (AUTOEROTIC HANGING)

• It is a paraphilia in which sexual arousal and orgasm depend on self-induced asphyxia.
• Mostly young males
• Partial asphyxia causes cerebral disturbances with feeling of sexual gratification. The impaired consciousness
caused by pressure on carotid vessels or partial obstruction of air passages may lead to hallucinations of an erotic
nature.
• This condition is usually associated with masochism and transvestism
• Manner of death is accidental
• No suicidal note present.

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FORENSIC MEDICINE +91 73967 57 585
Email: [email protected]
STRANGULATION
THROTTLING/ MANUAL STRANGULATION:
When handsQ are used to compress the neck, it is referred to as manual strangulation/throttling.
• Signs of asphyxia more evident.
Neck findings:
• Externally, Crescentic or linear finger nail abrasions Q seen. 6 penny
• Multiple discoid bruisesQ due to compression by finger tips seen. bruise
• Intense extravasation of blood in subcutaneous tissues under the external abrasions & bruises is the most
significant internal signQ
• Adduction fractureQ of hyoid bone present. Abduction fracture - hanging
• Throttling is almost always homicidalQ.
STRANGULATION
• LIGATURE STRANGULATION (when ligature material is used to constrict neck)

• Signs of asphyxia more marked.
• Face is congested, livid & marked with petechiae.
Ligature mark:
• Ligature mark is transverse, completely encircling the neck, below the thyroid cartilage Q (usually).
• Base is reddish with ecchymosis.
• Fracture of thyroid cartilage is more commonQ.

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BANSDOLA
• Constriction of neck by bamboo sticksQ, one across the back of the neck and another across the front.
MUGGING (choke hold)

• Strangulation of neck by the bend of the elbowQ or forearm of the assailant.
• The attack is usually from behind, and may leave no external or internal injury mark.
GARROTING
• It is compression of neck by a rope thrown from behind, in which a single assailant can kill a healthy adult male.
SPANISH WINDLASS: is a type of garroting, which used to be the official mode of execution in Spain. In this, an iron
collar around the neck was tightened by a crew for strangulation.
LIGATURE MARK IN HANGING AND STRANGULATION:

STRANGULATION ITC HANGING IOC
- Below thyroid - Above thyroid

- Horizontal - Oblique
- Complete - Incomplete
- Continuous - Symmetrical

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IMPORTANT FINDINGS OF STRANGULATION:

• Since strangulation is more violent than hanging, the injury to neck structures is more severe in strangulation.
HYOID fracture is more common, as are other neck injuries, Eg; fracture of tracheal rings/laryngeal and thyroid
cartilage.
• Manual strangulation (throttling) causes maximum damage.
• Usually no dribbling of saliva from angle of mouth.
• Eyes are bulging out, congested, hemorrhagic with dilated pupil. Tongue is protruded out, bitten and swollen.
There may be bleeding from nose.
• There is marked congestion of face with multiple petechial hemorrhages
• Usually bloody froth at nose and mouth.
• All internal viscera are congested
SUFFOCATION DEATHS:
• Form of asphyxia caused by mechanical obstruction to the passage of air into the respiratory tract by means other
than constriction of neck or drowning.
SMOTHERING
• Asphyxia caused by mechanical occlusion of external air passagesQ (nose & mouth) by hand, cloth, etc
• Smothering is usually homicidal
• Lips, gums, tongue, inner side of nose may show bruising or lacerations.
CHOKING
• Asphyxia caused by mechanical occlusion of internal air passagesQ by a foreign object like coin, seeds, fish,etc
• Choking is usually accidentalQ.
• Common in children
GAGGING
• A form of asphyxia due to pushing a gagQ (rolled up cloth or paper balls) into the mouth & blocking the pharynx.
• Almost always homicidalQ
BURKING
• A combination of homicidal smothering and traumatic asphyxiaQ.
• METHOD:
• Victims were invited, made to drink alcohol and thrown on the ground.
• Method used by Burk and Hare: Burke would kneel or sit on the chest and close the nose and mouth with his
hands, and Hare used to pull him around the room by the feet till he is dead.

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TRAUMATIC ASPHYXIA:
• Asphyxia resulting from respiratory arrest due to mechanical fixation of chest, so that the normal
movements of chest wall are prevented.
CAUSES: Burking= smothering + Tr Asphaxia
• Stampede in crowd
• Crush by heavy objects: collapse of wall/house, RTA, railway accident
• Run over by a vehicle
Fresh water drowning salt water drowning
Salt - 0.5%. Salt - 3/4%
Airways ~lungs~ syst. Circulation. Airways ~ lungs ~ sever
pulmonary edema ~ C.A.
~ hemodilution ~
hemodialysis~ RBC× ~ C.A.
Postmortem examination:
• MASQUE ECCHYMOTIQUE:
• Florid red or blue congestion of face and neck
• Demarcation line: level of compression is indicated by a well-defined demarcating line between the discolored
upper portion of body and lower normal part.
• Numerous petechial hemorrhages or ecchymotique
• Rib and clavicle fractures are common; extremity and pelci fractures may be seen.
• Mostly accidental in nature.
CAFÉ CORONARY:
• It refers to accidental choking by bolus of food obstructing larynx
• Death is mostly due to asphyxia or due to reflex cardiac arrest caused by stimulation of laryngeal nerve endings.
• Victim, who was apparently healthy, collapses suddenly turning blue while eating.
• It mimics heart attack and is usually seen in an intoxicated restaurant person.
OVERLYING (COMPRESSION SUFFOCATION):
• It is a type of asphyxia which results due to compression of chest, so as to prevent breathing
DROWNING
• Type of asphyxial death caused by displacement of air from the lungs by any fluid, usually water.
TYPICAL DROWNING ATYPICAL DROWNING Laryngospasm
- Obstruction of air passages and lungs by - After submersion of body in water, little or no
water/liquid. water enters respiratory passages and lungs.
- Therefore it is also called as WET DROWNING - Hence typical findings of wet drowning in the
and findings of fluid and froth are present in PM form of froth ad edema aquosum of lungs are not
examination. found.
1. Fresh water drowning 3. Dry drowning
2. Salt water drowning 4. Immersion syndrome
5. Submersion of unconscious
6. Near drowning (secondary drowning
syndrome/post immersion syndrome)

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Wet drowning (primary or typical drowning)

• In this type, Water in inhaled into the lungs.
• Two types: Fresh water drowning & sea water drowning.
PATHOPHYSIOLOGY OF DROWNING
FRESH WATER DROWNING: (0.5 – 0.6 % NaCl)
• Large quantities of water cross the alveolar membrane into circulation causing hypervolemia and hemodilution.
• RBCs imbibe water and burst (hemolysis) with liberation of potassium
• Therefore, heart is exposed to volume overload, potassium excess, sodium deficit (hyponatremia) and anoxia.
• Anoxia and hyperkalemia cause ventricular fibrillation and death in 4-5 minutes
.
SALT WATER DROWNING: (3 – 4% salinity)
• Hypertonicity of inhaled water causes loss of fluid from circulation into the lungs giving rise fulminating
pulmonary edema with progressive hypovolemia, circulatory shock and eventually cardiac standstill (asystole)
with death in 8-12 minutes.
DRY DROWNING:
• Water does not enter the lungs.
• Death results from Laryngeal spasmQdue to sudden inrush of water into nasopharynx & larynx.
IMMERSION SYNDROME/ HYDROCUTION/ SUBMERSION INHIBITION/VAGAL INHIBITION:

Death results from sudden cardiac arrest due to vagal inhibition of heart.
• Occurs in drowning in cold water, which stimulates the vagal nerve endingsQ at surface of the body or water
striking the epigastrium or cold water entering the ear passage.
SUBMERSION OF UNCONSCIOUS:
• If person is unconscious since before submersion in water, little or no water enters respiratory passages.
• It may occur in MI, hypertension, cerebrovascular accident, epilepsy, cerebral aneurysm and in drunk state.
NEAR DROWNING (SECONDARY DROWNING SYNDROME/POST IMMERSION SYNDROME):
• In this drowning, a person is survived and death occurs at a later stage after removal from water. Either the
person himself comes out of water or he is recovered alive, but due to complications of submersion, he dies at a
later stage.
• It is due to hypoxic encephalopathy and fibrosing alveolitis.
• Death occurs due to combined effect of cerebral hypoxia, pulmonary edema, aspiration pneumonitis, electrolyte
disturbances and metabolic acidosis.
POSTMORTEM APPEARANCE:
EXTERNAL FINDINGS
• Washer woman’s hand: bleached and corrugated appearance of palm and soles.
• Cutis anserine(goose skin): granular appearance of skin with erect hair due to contraction of erector pili.
• Froth in nostrils (white, fine, lathery and sticky (tenacious)
• Cadaveric spasm
Weeds, grass, plants, mud or stones in tightly clenched hand. It is due to cadaveric spasm and strongly suggests that the
person was alive when drowned, as it indicates the struggle of person for life.

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PM- INTERNAL FINDINGS Ballooning lungs

• Emphysema aquosum: water lodged heavy voluminous lungs. It is found only in wet drowning (not in dry)
• Presence of sand particles in the airway
• Paltauf’s hemorrhages: petechial hemorrhages/subpleural hemorrhage lungs surface. Mostly seen in the lower
lobes on anterior surface and margins of lungs.
• Temporal bone hemorrhages
• Presence of water in stomach & small intestine (diagnostic manifestation of antemortem drowning)
• Sehrt’s sign: Micro ruptures of the gastric wall due to the swallowed fluid
• Wydler’s sign: The gastric content is taken into beaker and allowed to settle for an hour. Three layers are formed
– foam in the uppermost, liquid in the middle and sediment in the lowermost.
• Ueno’s sign (middle ear): Presence of water and hemorrhage in the middle ear is one of the positive proof of
antemortem drowning.
• Sveshnikov’s sign: Presence of water in respiratory sinuses.
Note:
- Froth formation will not be seen in case of dry drowning and hydrocution.
- Hyperventilation before drowning causes rapid death, because hyperventilation causes flushing out of CO2, which is
necessary for respiratory drive.

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EMPHYSEMA AQUOSUM OEDEMA AQUOSUM HYDROSTATIC AQUOSUM
When victim is submerged in It is seen in submersion of It occurs when dead body is thrown
conscious state unconscious into water
Lungs contain both water and froth Mere flooding of lungs with the Passive filling of lungs with water due
airless water and no formation of to hydrostatic pressure
froth
LABORATORY INVESTIGATIONS:
DIATOM TEST
• Diatoms are microscopic unicellular algae which secrete silicaQ skeletons called frustules.
• They are chemically inert and almost indestructible, being resistant to strong acids
• Diatoms of size 60µ enters the circulation.
• Presence of diatoms in the distant tissues like bone marrow of femurQ (best site for analysis) is the proof of
antemortem drowning.
• Diatoms test is useful even in decomposed bodiesQ as diatoms resist putrefactionQ.
• The test is negative in dead bodies thrown in water and in dry drowning Q.
GETTLER TEST
• Based on chloride contentQ of blood in heart chambers.
• Normally, the chloride contentof the right and left side of heart is nearly same, about 600 mg/100 ml.
• If the difference is 25 mg% or more, it is suggestive of antemortem drowning.
• In Freshwater drowning, Chlorides reduce by 50% in left ventricle
• In seawater drowning, Chlorides increase by 30-40% in left ventricle
Q. Characteristic feature of antemortem drowning is;

• A. Water in stomach
• B. Paltauf’s haemorrhage
• C. Emphysema aquosum
• D. Cutis anserine
Q. Compression of neck by a rope thrown from behind, is called as;

• a. Mugging
• b. Throttling
• c. Garroting
• d. Bansdola
• Q. Which of the following is a pattern of typical hanging?
a. a
b. b
c. c
d. b and c

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Q. Dribbling of saliva is a feature of;

• A. Postmortem hanging
• B. Strangulation
• C. Antemortem hanging
• D. Drowning
Q. Cutis anserina is seen in which of the following condition?

a. Hanging
b. Drowning
c. Burns
d. Snake bite
Q. Which of the following is a wrong match?

a. Gustufson’s method – age estimation from teeth
b. Galton’s method – dactylography
c. Gettler’s test – Drowning
d. Diatom’s test – Hanging
Q. What is the type of injury shown in the case of hanging?
a. Patterned abrasion
b. Pressure abrasion
c. Graze anrasion
d. Friction burn
Ans: B
• Picture shows ligature mark of hanging, which is an example of pressure abrasion.
• Since exact pattern of ligature is not reflected in this mark, it is not a patterned abrasion.
• Q. A 25 year old female was found dead in her bedroom. Room was not locked from inside. Blood value of
alcohol was 350 mg/dL with image of face, open neck and viscera. Picture was given of bruises on neck
(likely 6 penny bruises), cyanosed lip. Dissected neck was showing soft tissue ecchymosis. What is the
cause of death?
• A. Cafe coronary
• B. Suicide
• C. Throttling
• D. Garrotting

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Q. A dead body is recovered from cold water. Froth and liquid findings are absent. Which of the following
cannot be the cause of death?
• A. Immersion syndrome
• B. Wet drowning
• C. Dry drowning
• D. Submersion of unconscious
Q. A person was found dead in bushes with tied arms and legs. On post mortem examination, his face was
deeply congested and the nails were blue. Abrasions and nail marks were marked on chin, face and
nostrils. Lips were lacerated internally. Hypostasis was fixed on back and rigor was seen all over the body.
Find out the wrong statement related to this case;
• A. Homicidal
• B. Throttling
• C. Asphyxia
• D. Duration of death is within 24 hours from post mortem examination

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7. ABORTION AND MTP (Medical Termination of Pregnancy)
Abortion
• Refers to expulsion of the product of conception at any period of gestation before full term.
ABORTIONS MAY BE:
• Natural/spontaneous/accidental: occurs without any intervention
• Artificial: occurs as result of direct interference with the pregnancy. It may be;
• Legal (justifiable) abortion: it comes under MTP act.
• Criminal abortion: Illegal
Old concept
MTP ACT 2021: Upto 12 week (1)
• Opinion of one RMP for MTP: upto 20 weeks 12-20 week (2)
• Opinion of two RMP for MTP: 20-24 weeks
• Pregnancy can be terminated upto 24 weeks, only in cases of survivors of rape
• In case of failure of contraceptive in a woman of her partner, MTP can be done only upto 20 weeks.
• MTP can be done even after 24 weeks, in case of substantial foetal abnormalities diagnosed by a medical board.
Note: MTP can be performed at any time, if it immediately necessary to save the life of pregnant women.
There are 4 conditions that have been identified in the Act, w here MTP can be performed:
Medical:
• Where pregnancy might endanger mother’s life, or cause grave injury to her physical or mental life.
Eugenic:
• Where there is substantial risk of the child being born with serious handicaps due to physical or mental
abnormalities.
Humanitarian:
• Where pregnancy is the result of rape.
Failure of contraceptive devices
• Unwanted pregnancy can cause severe mental injury to mother.
Where can MTP be performed?

• Government or semi-government hospitals
• Private hospitals approved by hospital
CRIMINAL ABORTION:
Section 312 to 316 of IPC deal with criminal abortions.
Two methods are commonly used to produce criminal abortion: DRUGS & ABORTION STICK
ABORTIFACIENT DRUGS:
• ECBOLICS: drugs which increase uterine contraction. Eg; ergot, quinine.
• EMMENAGOGUES: they increase menstrual blood flow. Eg; Synthetic estrogen, oil of savin, borax and apiol.
ABORTION STICK:
• Causes abortion by inducing uterine contraction.
• It may be a thin wooden or bamboo stick or a twig from some irritant plant such as madar (Calatropis), kaner
(Nerium odorum), chitra (Plumbago zeylanica) or lalchitra (plumbago rosea)
EMERGENCY SITUATIONS:
• By any RMP, at any place, irrespective of the duration of pregnancy.

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PREGNANCY AND FORENSIC
NULLIPAROUS UTERUS PAROUS UTERUS

- Body and cervix same length - Body twice the length of cervix
- Inner walls convex - Inner walls concave
- Triangular cavity - Rounded cavity
- Internal OS well defined - Internal OS ill defined
- External OS circular - External OS transverse slit
LOCHIA:
• Alkaline discharge from uterus
• Sign of recent delivery
• Peculiar, disagreeable fishy odor
• Time duration: Lasts for 2-3 weeks after delivery
• Order: Lochia Rubra – Lochia Serosa – Lochia Alba
LEGITIMACY
• Legitimate is a child, who born either (section 112 IEA);
• During continuation of a legal, valid marriage between his parents
• Within 280 days of dissolution of marriage, the mother remaining unmarried.
Important terms related to Legitimacy

SUPERFECUNDATION:
• Fertilization of 2 ova discharged within the same menstrual cycle by two different acts of coitus
committed at shot intervals.
• Possibility of twins also being half siblings. Eg: one baby is white and another is black
SUPERFETATION:
• Fertilization of two ova discharged from ovary at different periods of ovulation.
• It is the fertilization of second ovum in a pregnant woman. SF
• Possiblity is more with septate uterus or double uterus. 2o
2s
1m
SUPERFECUNDATION SUPERFETATION
Sfi.
2o
2s
2m
ILLEGITIMATE CHILD or BASTARD:

• Child born outside the lawful wedlock
SUPPOSITITIOUS CHILD (FICTITIOUS CHILD)

• A woman may pretend pregnancy and delivery, and later produce a living child as her own
• For obtaining money or for the purpose of claiming property
• DNA fingerprinting is confirmatory
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POSTHUMOUS CHILD:
• Birth of a child after death of father
ATAVISM:
• The child may not resemble his parents, but resembles his grandparents.
DISPUTED PATERNITY OR MATERNITY CAN BE SOLVED BY;

• Examination of blood groups
• HLA typing
• DNA finger printing – Most confirmatory
• Resemblance of features and behavioral patterns with or father. (Atavism refers to resemblance of features of a
child with grand-parents)
BATTERED BABY SYNDROME or CAFFEY’S SYNDROME or CAFFEY-KEMPE SYNDROME:

• Repetitive physical injuries as a result of non-accidental violence
• Produced by a parent or guardian
CLINICAL FEATURES:
• Laceration of mucosa inside the upper lip and often tear of frenulum noted – Most Characteristic lesion.
• Bruises of varying color noted
• Butterfly shaped bruises due to skin pinching
• Retinal detachment and intraocular bleeding
• Fractures and injuries will be at different stages of healing
• INFANTILE WHIPLASH SYNDROME: shaking a child causes subdural hematoma & intraocular bleeding.
CLASSICAL FEATURE:
• Discrepancy between the nature of injuries and the explanation offered by the guardian
• Unexplainable delay between the injury and medical attention
• Injuries in different stages of healing are found in the child
RADIOLOGICAL FEATURES
• Metaphyseal fracture (so called bucket handle fracture or corner fracture): Virtually pathognomic
• Nibbling fractures- multiple rib fractures in the posterior angle
• String of beads appearance in the paravertebral gutter aster callus formation

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Skull fractures:
• Egg shell fracture
• Nonparietal skull fracture
• Involves multiple bones
• Depressed fracture
ARTIFICIAL INSMEINATION (AI):

• Process of introduction of semen from the husband or a donor by instruments into the genital tract of a female to
bring about pregnancy.
TYPES:
• Artificial insemination homologous/husband (AIH): semen of husband used
• Artificial insemination donor (AID): semen of donor used Illegitimate child
• AIHD: ‘Pooled’ donor semen to which semen from the husband has been added.
INDICATIONS:
If husband is;
• Impotent
• Sterile
• Unable to deposit semen due to hypospadiasis
• Suffering from hereditary disease
• Rh incompatibility between husband and wife
MEDICOLEGAL ASPECTS:
Nullity of marriage and divorce:
• If AI is done without the consent of the husband, the husband can file for divorce.
• AI due to impotence is a ground for divorce
• AI due to sterility is not a ground for divorce.
Note:
• IMPOTENCY IS A VALID GROUND FOR DIVORCE, WHILE STERILITY IS NOT
• LEGITIMACY:
• Child born out of AID is illegitimate and cannot inherit property (since, the husband is not the actual father of the
child in AID)
SURROGACY (WOMB LEASING)

A surrogate mother is a woman who carries a child for a couple or a single person with the intention of giving away the
child to the parents, once it is born.
ALTRUISTIC SURROGACY:
• No monetary compensation to the surrogate mother other than the medical expenses during pregnancy.
COMMERCIAL SURROGACY:
• Surrogacy undertaken for a monetary benefit or reward exceeding the basic medical expences.

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THE SURROGACY (Regulation) BILL, 2016

This bill was introduced by Minister of Health & Family Welfare , Mr. JP Nadda in Lok Sabha on November 21, 2016. This
bill was passed on December 9th 2018.
SALIENT FEATURES OF THIS BILL:

• The bill prohibits commercial surrogacy, but allows altruistic surrogacy.
• Surrogacy clinics cannot function unless registered under the Act.
PURPOSES FOR WHICH SURGERY IS PERMITTED:

• For intending couples who suffer from proven infertility
• Couples has to be married for at least 5 years and must be Indian citizens.
• No charges or monetary incentive except medical costs
• Not for producing children for sale, prostitution or other forms of exploitation.
THOSE WHO ARE BARRED:

• Complete ban on commercial surrogacy
• Homosexuals, unmarried couples, single parents, foreigners, liv-in partners barred.
SURROGATE MOTHER:
• A close relative, married with at least one child of her own
• Only once in lifetime, cannot be paid except medical expenses.
PUNISHMENT:
• 10 year jail term; 10 lakhs fine
INFANTICIDE
Infanticide:
• Refers to killing a child after delivery, to till 1 year after birth.
• Infanticide in India is considered equivalent to murder and is tried under section 302 IPC.
• Law considers every child as born dead and therefore in a case of infanticide, it has to be proved that the child was
born alive and was then killed.
• Thus, the first question in the investigation of a case of infanticide is, whether the child was stillborn or
dead or whether it was born live.
VIABILITY:
• Stage of maturity at which a fetus is able to lead a separate existence after birth.
• As per law, a child is viable in 210 days (7 months)
• Vagitus uterinus: Respiration (cry) of the fetus while in the womb after the rupture of membranes.
• Vagitus vaginalis: Respiration while the head is in the vagina
LIVE BIRTH:
• Viable child (>210 days) Parturition - procces of delivery
• Well expanded lungs
• Inflammatory reaction in umbilical cord
• Presence of milk in stomach
STILLBIRTH:
• Born after 28 weeks of pregnancy, and baby did not breathe or show any signs of life.
• Baby died during labour
DEAD BORN:
• Baby died in utero
• Baby shows any of (rigor mortis, maceration, and mummification)

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DEAD BORN FETUS

- Rupture of membranes - Intact membranes - Intact membranes
- Entry of air - Adequate liquor amnii - Scanty liqoramnii
- No air - Absent blood supply
PUTREFACTION MACERATION MUMMIFICATION
(bacteria gains entry into body) (Fetus dries up in 2 weeks)
PUTREFACTION
(bacteria gains entry into body)
• Unpleasant odour
• Greenish discoloration of skin
• Formation of foul smelling gases
MUMMIFICATION
• (Fetus dries up in 2 weeks)
MACERATION
Autolysis
• Pre-conditions:
• Dead child remains in the uterus for about 3-4 days
• Liquor amnii with no air
• Earliest sign of maceration is skin slippage/reddening of skin in 12 hour after death in utero, over face, back
and abdomen.
• Sweetish disagreeable odor present
• Gas in great vessels and heart chambers: ROBERT’S SIGN
• Overlapping of cranial bones: SPALDING SIGN. A pathognomic sign of IUD.
• Hyperflexion of spine – BALL’S SIGN
EXAMINATION OF LIVE BORN BABY

LIVE BIRTH (baby respired) STILLBIRTH (baby not respired)
Chest Drum shaped Flat shaped
Chest circumference > abdominal Chest circumference < abdominal
circumference circumference
DIAPHRAGM 6-7th rib level 4-5th rib level
Lungs colour Pink Dark blue
Lungs size Voluminous Small
Lungs edges Round Sharp
Lungs consistency Spongy, crepitant Firm, liver like, non-crepitant
TESTS FOR LIVE BIRTH:
PLOCQUET’S TEST:
• Weight of lung is measured in relation to body weight.
• Before respiration: Ratio of lung weight to body weight – 1/70
• After respiration: Ratio of lung weight to body weight – 1/35
HYDROSTATIC TEST (RAYGAT’S TEST, 1st life test):

The residual air (not the tidal air) is demonstrated by this test.
• Specific gravity of non-respired lung is 1040 – 1050 and it becomes 940 – 950 after respiration.
• This makes the respired lung to float.
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Procedure:
• Dissect out the fetal lungs and put into a trough of water and observe.
Inference:
• If they sink – unrespired lung
• If they float – remove them from water, cut into small pieces and put into water.
• If they sink – unrespired lung
• If they float – respired lung
FLASE NEGATIVE TEST (Sinking of expanded lung) FALSE POSITIVE TEST (Floating of unexpanded lung)
- Atelactasis - Putrefaction
- Pneumonia, infection - Attempted Artificial respiration
- Pulmonary edema
- Congenital syphilis
BRESLAU’S SECOND LIFE TEST/STOMACH BOWEL TEST

• A live born child would respire and therefore, would also swallow some air into the stomach and bowel.
• During autopsy, stomach and intestines are removed after tying double ligatures at each end. They are kept under
water and incision is given between the ligatures. Air bubbles will come out, if respiration has taken place.
WREDIN’S TEST:
• Before birth, middle ear contains gelatinous embryonic tissue which is replaced by air after respiration
• It is also called Wredin-Wendt tympanic cavity on middle ear test.
FODERE’S TEST:
• After respiration, blood flow increases resulting in increase in the weight of lungs.
• Unrespired lungs weight: 30-40 g
• Respired lungs weight: 60-66 g
• Note:
• Presence of altered mil in stomach confirms live birth and presence of blood, liquor amnii and meconium in
stomach confirms live birth
• Q. In which of the following case, hydrostatic test is performed?

• A. Drowning
• B. Throttling
• C. Electrocution
• D. Infanticide
• Q. A live born child would respire and therefore, would also swallow some air into the stomach and bowel.
This is consistent with which of the following test?
• A. Wredin’s test
• B. Raygat’s test
• C. Breslau’s test
• D. Plocquet’s test
• Q. Stage of maturity at which a fetus is able to lead a separate existence after birth is called as;
• A. Stillbirth
• B. Viability
• C. Second life test
• D. Surrogacy
• Q. Spalding sign is seen in;

• A. Stillbirth
• B. Dead born
• C. Live born
• D. All of the above
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• Q. Twins photo is shown here. It can be associated with which of the following heteropaternal condition?
• A. Superfetation
• B. Suppositious child
• C. Spurious pregnancy False belief of pregnancy
• D. Superfecundation
• Q. Child may not resemble his parents, but resembles his grandparents;
• A. Bastard child
• B. Posthumous births
• C. Atavism
• D. Fictitious child
• Q. A 40-year-old woman pretended pregnancy and delivery. After some time she brought a child claiming
it to be her enighbor’s child and trying to blackmail him for getting benefit in property. This is called as;
• A. Surrogacy
• B. Suppositious child
• C. Spurious pregnancy
• D. Superfecundation
• Q. Which of the following conditions can be associated with the given picture?
• A. Pederasty
• B. Caffey’s syndrome
• C. Café coronary syndrome
• D. Infanticide

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8. FORENSIC PSYCHIATRY
DIAGNOSIS OF INSANITY
• Individual should be kept under observation for 10 daysQ, which can be extended upto a maximum of 30 days
with the permission of magistrate.
• Certificate should be issued after a minimum of 3 examinations.
DIFFERENCE BETWEEN TRUE & FEIGNED INSANITY

TRAIT TRUE INSANITY FEIGNED INSANITY
Onset GradualQ Sudden
Motive Absent Present
Predisposing factors Present Absent
Signs & symptoms Present & uniform whether the Present only when he is observedQ
patient is being observed or not
Facial expression Peculiar vacant/ worried look Frequently changing, exaggerated and
voluntary
Insomnia PresentQ Cannot persist
Exertion Can persist extreme hunger, fatigue Cannot stand exertionQ
and sleep for days
Habits Dirty & filthy Not dirty & filthy
Skin & lips Dry, harsh Normal
Repeated examination Does not mind Resents for fear of detectionQ
RESPONSIBILITIES OF AN INSANE PERSON
• Civil responsibilities:
• Management of property and affairs:
• If he is incapable of managing his property due to insanity, the court may appoint a manager or a guardian
depending on the condition of the patient.
• Consent: Consent given by an insane person is not a valid consentQ.
• Contract: Any contract signed by an insane person is not valid.
• Contract signed by an insane person during the period of lucid interval is valid.
Marriage:
• If any of the couple is proved to be insane at the time of marriage, then the marriage can be declared as ‘Null
&VoidQ’
• If any one of the partners becomes insane after marriage, then it can be a ground for divorce.
Competency as witness in the court of law:
• An insane person is not competent to be a witness in the court of law, unless he is in the period of lucid interval.
Testamentary capacity:
• The mental ability of a person to make a valid willQ.
The requirements are:
• The will should be a written, properly signed and witnessed document.
• The testator must be a major and of sound mind (compos mentisQ).
• It should be certified by a doctor.
• There should be no force, undue influence or misrepresentation of facts.

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Criminal responsibility of an insane person:
Mac Naughten’s rule:

• Right or wrong testQ/ Legal testQ
• In India, Criminal responsibility of insane person is dealt by section 84 IPCQ
• Testing the criminal responsibility of a person.
• An accused person is not criminally responsible if it is proved that, at the time of committing the crime he was
suffering from such a defect of reason or from disease of mind that he did not know the nature and quality of act
that he was doing.
Other tests are:
• Durham’s rule
• Curren’s rule
• The Irresistible Impulse test
• The American Law Institute test
9. MECHANICAL INJURIES - TRAUMATOLOGY
Blunt force injuries Sharp force: Sharp force: Sharp force:

(Ground, stone, Light cutting weapon Heavy cutting weapon Pointed weapon
hammer) (Surgical blade) (Chopper, axe) (Kitchen knife,
screw driver, pencil)
Abrasion (scratch) IncisedQ Chop injury Stab injuryQ
Contusion (bruise) (cut injury)
LacerationQ (skin
tear)
Fracture of bones
ABRASION
General characters of abrasion
• It is a superficial injury involving superficial layer of epidermis and is caused by hard, blunt and rough
object due to friction between skin and the object.
319 hurt
320 grievous hurt ( blindness deafness teeth dislocation emasculation)
20 days bed
1°
burn
2°
• Slight bleedingQ, heal rapidly and no scar formationQ. burn
3° All superficial burns are
burn painfully
4°
burn All deep burn are
painless

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TYPES OF ABRASION:
SCRATCH:
• Linear abrasion caused by pointed or sharp object
• Finger nailQ/Thorn /Pin
GRAZE:
• Friction with rough surface over wider area
• Multiple uneven, longitudinal parallel linesQ
• Most common typeQ of abrasion,
• In road traffic accidents.
• Also called as brush burn
Gravel
rash
PRESSURE
• Direct impact or pressure over the skin.
• ligature markQ in hanging and
• strangulation,
PATTERNED
• Pattern of the weapon is imprinted on the skin
• Ligature mark
• Teeth bite marks
• Tread marks of tyreQ

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Time since injury from Abrasion

• R - Raw without scab (fresh) - < 12 hours
• R - Reddish scabQ - > 12 hours
• R B- Reddish brown scabQ - 2 – 3 days
• B- Brown scab - 4 – 5 days
• B – Black scab - 6 – 7 days
• Abrasion heals from the periphery by growth of new epithelial cells.

• After 7 days, Scab dries and falls off, leaving depigmented area underneath
• It gradually gets pigmented.
Note:
• Usually abrasions are simple hurt (as they are superficial), except corneal abrasion.
• Corneal abrasion is grievous hurt (Sec. 320 IPC), because abrasion over cornea may cause corneal opacity &
permanent visual restriction.
MEDICOLEGAL SIGNIFICANCE OF ABRASION:

• It gives an idea about the direction of force
• Patterned abrasions are helpful to find out the causative weapon
• Age of injury can be determined
ABRASION DISTRIBUTION AND MANNER:

• Crescentric finger nail abrasions over neck: THROTTLING
• Abrasions on breasts, genitals and thigh: SEXUAL ASSAULT
• Abrasions around mouth and nose: SMOTHERING
DIFFERENTIAL DIAGNOSIS OF ABRASIONS

1. Ant bites:
• Superficial, brown erosions with irregular margins are mostly seen at mucocutaneous junction, around the
eyelids, nose, mouth, axilla and groin.
Appearance:
• Irregular margins
• Normal skin in between (Sand paper appearance)
• Vital reaction is absent
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2. Excoriation of skin napkin area of infants by excreta

3. Pressure sores
Abrasions: Antemortem and Postmortem
FEATURES ANTIMORTEM ABRASION POSTMORTEM ABRASION

Site Anywhere on the body Bony prominence
Scab formation Present Absent
Color changes Present Absent., mostly yellowish without any
change
Vital reaction Present Absent
CONTUSION/ BRUISE
• Contusion is the extravasation of bloodQ under the skin due to rupture of blood vessels, usually capillaries, as a
result of blunt force injury.
Note:
• Extravasation i.e blood outside the vessel is an important feature of contusion, by which postmortem lividity can
be easily differentiated.
TYPES OF CONTUSION:
Superficial/subcutaneous:
• common type
• Location: subcutaneous tissue in fatty layer
Deep bruise: below deep fascia
ECTOPIC BRUISES
• Site of bruise is at the site of impact most of the time however it may be away from the site of impact due to
gravity shifting of blood, i.e. ectopic bruises. So, site of bruise does not always indicate site of violence.
Eg of Ectopic Bruise:
• Black eye (spectacle hematoma in eyes and eyelids) – may be
due to fracture of floor of anterior cranial fossa or
trauma of forehead.

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• Bruise behind ear indicates basal fracture
• Jaw fracture may produce bruise in neck, fracture pelvis can produce bruise in thigh, calf injury can produce
bruise in ankle.
Q. Red marks over the neck as shown in photo depict;
• A. Abrasion
• B. Contusion
• C. Laceration
• D. Brush burn
Patterned bruise: mirrors the size and shape of a portion of object which caused it.
• Eg:
Tyre marks: alternating groove and ridges i.e. thread of tyre produce a pattern; bleeding and red lines are produced by
grooves, by squeezing the capillaries.
suction of biting on neck or breast, producing Love marks: shape of the lips
Railway line or tramline type:

• Blows with a rod, stick or a whip produce two parallel, linear haemorhhage.
• The intervening skin appears pale
• Diameter of the pale area may indicate the diameter of the weapon.

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SIX PENNY BRUISE (as it resembles six penny)

• Discoid-shaped bruises
• Due to pressure from fingertips
• Seen in neck of throttling cases and arms, forearm
• or wrist of child abuse cases.
BUTTERFLY BRUISE:
• Due to skin pinching
• May be seen in child abuse cases
Ageing or Dating of bruise:
• Based on the color changes.

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• These are due to disintegration of RBCs by hemolysis and breakdown of hemoglobin into the pigments
haemosiderin, haematodin and bilirubin.
• As bruises heal, there is a gradual destruction & removal of the extravasated blood
• Color change starts at the periphery and extends inwards to the center.
DIFFERENTIAL DIAGNOSIS OF CONTUSION:

Postmortem lividity (in early phases)
Artificial bruise/Pseudo bruise
CHARACTER TRUE BRUISE PSEUDO BRUISE

Cause Blunt trauma Plant poisons like Semicarpus,
calotropis and plumbago
Location Anywhere in body Accessible parts of body like forearm,
thigh abdomen
Itching Not present Present
Redness, Inflammation Present Absent
Blister/Vesication Not present Present
Color changes Color changes as it heals Absent
Contents Blood Acid serum
Chemical analysis Negative Chemical/plant juice detected
DIFFERENCES BETWEEN ANTEMORTEM & POSTMORTEM CONTUSION
Features Antemortem contusion Postmortem Contusion

Swelling Present Nil
Size More Less
Color Changes Nil
Margins Diffuse into surroundings Clear cut
Color uniformity Not uniform, pale at centre Uniform
Inflammation and vital reaction Seen Absent
Enzyme levels Raised Nil
Microscopic examination Infiltration of surrounding tissues Nil
with blood cells seen
Blood Cannot be easily washed away Can be easily washed away

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Battle Sign Racoon Sign
LACERATION:
Lacerations are tears or split of skin, mucous membranes and underlying tissue (eg; muscle or internal organs)
• Produced by application of blunt force to broad area of the body, which crush or stretch tissues beyond
the limits of their elasticity.
Features of Laceration:
• Hair and hair bulb, nerves and blood vessels are crushed – there may be paralysis (nerve crushed) and
hemorrhage is not pronounced (blood vessels crushed)
• Irregular Shape
• Irregular & uneven Margins
• Contused edges
Lacerations

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• Floor of laceration shows following features

• Tissue bridges (tissue, blood vessels and nerves bridging across the gap of the wound)
• Foreign particles like mud may be seen embedded in the wound, which gives clue about the scene of crime
TYPES OF LECARATION:
SPLIT LACERATION:
• Skin is split
• Tissues are crushed between two hard surfaces i.e the weapon & the underlying bone
• Incised Like / Incised Looking laceration
• Examples of such area are: scalp, eye brows,, check bones, knee, iliac crest, perineum and skin
SPLIT LACERATION
STRETCH LACERATIONS:
• Overstretching of the skin till it ruptures. Eg; sudden deformity of bone after fracture
TEARS:
• Common form of laceration
• Tearing of skin & SC tissue due to localized impact
AVULSION/GRINDING (SHEARING LACERATION):
• It is produced by sheering force delivered to an acute angle to detach a portion of a traumatized surface or viscus
from its attachment, the searing and grinding force by a weight.
• Seen in Run over injuries
• FLAYINGQ / FLAPPING
• Direction of force can be determined
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Severity of avulsion ranges from skin flaps (minor) to degloving (moderate) and amputation of a finger or limb
(severe).
• FLAYING: the rotating force of a wheel tears off the skin over a large area – flaying, and most frequently on the
legs.
• DEGLOVING INJURY: a severe type where the large area of skin and subcutaneous tissue is rolled off a limb (like a
glove).
• SCALPING: a large area of skin and subcutaneous tissue is rolled off the scalp (especially when the hair is trapped
and being trapped in machinery)
AVULSION
Flaying
FOOT and LEG DEGLOVING INJURY

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INCISED WOUND: (CUT / SLASH / SLICE)

Characteristic feature of incised wounds are:
• Length is the greatest dimension (most important)
• Hair, hair bulb, nerve and vessels are cut – bleeding is profuse as vessels are cut
• Width of injury is more than the thickness of blade, due to gaping of wound. Langer’s line of skin determines
gaping; gaping is more when cut is across these lines.
• Margins: Everted, clear and clean cut
Depth/ direction:
• Head end: deeper at the beginning of the wound
• Tail end: Shallow at the terminationQ
• Tailing and Bevelling cuts are features of incised wound.
• Incised wound on nose, ear and genital are usually homicidal (due to jealousy or revenge in case of
adultery)
HESITATIONAL CUTS/TENTATIVE CUTS/TRIAL CUTS:

• Indicates suicidal attempt.
• Multiple, small, superficial, parallel cuts noticed over the accessible body parts. Eg; wrist, throat, elbow,
front of chest and abdomen

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FEATURES SPLIT LACERATION INCISED WOUND

Injury object Heavy, hard and blunt Sharp edged
Site of injury Parts overlying bone Anywhere
Size of injury Does not correspond to impacting Corresponds
surface of object
Muscles, hair, hair bulbs, blood Crushed Cut
vessels and nerves
Bones May be fractured Cut
Margins abraded or contused, irregular, Clear and regular
swollen
Surrounding skin Abraded or contused Clear
Common cause of death Injury to internal viscera Hemorrhage from cuts to blood
vessels
CHOP WOUNDS/SLASH WOUNDS;

• These are different types of incised wounds
• They are injuries cause by violent blow with a heavy sharp cutting object. Eg; sword, axe, chopper, meat
cleavers etc.

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STAB WOUND (PUNCTURED WOUND)
Produced from penetration of weapons with pointed ends

• DepthQ is the maximum dimension of stab wound
Types:
• Penetrating wound: Weapon enters into the body cavity producing only one entry wound.
• Perforating wound (through and through punctured wound): Weapon after entering into one side of the body
will come out through the other side, producing two wounds (Entry wound and Exit wound)
FEATURES ENTRY WOUNDS EXIT WOUNDS

Margins Inverted Everted
Size Larger Smaller

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Shape of stab wound:

• Single-edged weapon - wound will be triangular or wedge-shapedQ (one angle of the wound will be sharp and
the other rounded, blunt or squared off)
Double-edged weapon – Wound will be elliptical or slit-like, and both angles will be sharpQ.
Langer’s Line or cleavage lines

• The pattern of collagen fiberQ arrangement are the lines of cleavage of the skin and their linear representations
are known as “Langer’s line of cleavage”
• Lines of langer determines the GapingQ of stab injury.
• An incised/ stab wound at right angles to the cleavage lines - gaping will be more.
• An incised/stab wound that runs parallel to these lines – gaping will be lessQ and slit-like shaped.
Defense / Protective Wounds
• It results from victim’s spontaneous instinctive reactionQ towards self-protection.

• If the weapon is blunt, bruises and abrasions are produced.
• If the weapon is sharp, the injuries will depend upon the type of attack, whether stabbing or cutting.
• The presence of defence wounds indicate homicidal natureQ of the injuries
ACTIVE DEFENCE INJURIES:

• They are seen when the victim tries to grasp the weapon.
• Location: palms, flexor sides of fingers and interdigital spaces, more common in the web between the thumb and
index finger.
PASSIVE DEFENCE INJURIES:

• These are seen when the victim raises the hands or arms for protection.
• Location: ulnar surfaces of forearms, wrists, knuckles and the back of the hands.
Defense wounds are absent if the victim is;

• Unconscious
• Attacked from behind
• Under the influence of alcohol/drugs
• Taken by surprise
HARAKIRI (SEPPUKU):
• This is an unusual form of suicide stab injury and disembowelment.

• Practiced by Japanese Samurai warriors
• Abdomen is boldly punctured by a short sword in a sitting positing resulting in one large fatal wound (L-shaped
cut), causing sudden evisceration of internal organs resulting in sudden fall of intra-abdominal pressure, followed
by collapse and death.
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REGIONAL INJURIES
TYPES OF SKULL FRACTURES:

Fractures of skull vault:
TYPE OF FRACTURE DESCRIPTION

Fissure Fracture • Due to general deformation of skull
• Most common fractureQ
• Linear cracks passing over the vertex or base without any displacement of
the fragments.
• The fracture line is no more than a hair’s breadth.
• Difficult to detect, may not be seen on X-ray, and can only be detected at
autopsy.
Depressed fracture • Due to local deformation of skull.
(fracture ala signature) • A portion of fractured bone is depressed inwards into the cranial cavity
• The fractured segment resembles the pattern of the striking surface of the
weaponQ.
• It is also called ‘fracture ala signature’ (signature fracture)
Comminuted fracture • There are two or more fracture lines intersecting & dividing the bone into
three or more fragments. Q
• When there is no displacement of fragments, it resembles a spider’s web or
mosaic.

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Pond fracture • A simple dent in the skull without a fracture

(indented fracture) line.
• The inner table is not fractured, but fissured
fractures may occur in the outer table around
the periphery of the dent.
• Dura and brain are not damaged.
• Occurring only in the skull of infants and
childrenQ due to pliability.
• Also known as ping-pong fracture, as it looks
similar to a dent in ping-pong ball.
Diastatic/ • Separation of skull suturesQ
Sutural fracture • Common in sagittal suture
• Occurring in the skull of children & young adults.
Gutter fracture • When a part of the thickness of the skull bone is
removed so as to form a gutter/ channel/ trench.
• It is usually accompanied by comminuted
depressed fracture of the inner table of skull, and
the fragments causing injury to the meninges and
brain.
Perforating Fracture • Both the tables are involved

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SKULL BASE FRACTURES
Ring or foramen Fracture • Fall from a heightQ landing • It is a type of fissure fracture
on feet or buttocks that encircles the base of
• Fall of heavy load on head skull around the foramen
• Heavy blow to chin magnumQ.
• As a result, the skull gets
separated from the spine.
Hinge/transverse fracture • With heavy blows or side • Linear fracture separating the
impacts to head. skull into two halves,
creating a hinge (‘nodding
face’ sign) Q.
• The fracture line extends from
petrous ridge on one side to
the contralateral petrous ridge
through sella turcica.
• It is also called as
‘motorcyclists fracture’.
INTRACRANIAL HAEMORRHAGES
• Extradural hemorrhage
• Subdural hemorrhage
• Subarachnoid hemorrhage
• Intracerebral hemorrhage
Incidence:
• Traumatic: Subdural hemorrhageQ > Sub arachnoid hemorrhage > Extradural hemorrhageQ
• Spontaneous: Intracerebral hemorrhage is the most common. Worst headache of time
Thunder clab
EXTRADURAL SUB DURAL SUB ARACHNOID INTRACEREBRAL
Location Between skull and Between dura and Between arachnoid & Within the brain
dura arachnoid Pia parenchyma
Most common MIDDLE MENINGEAL BRIDGING VEINS Arterial aneurysms, Lenticulo-striate
vessel affected ARTERY AV Malformation branch of MCA
SDH – Child abuse, Shaken baby syndrome Subdural
Extradural Hemorrhage:
Causes
• Mostly traumatic in origin, and unilateral.
Salient Features
• It occurs usually on the side of the impact (coup injury)
• Never a contre coup injury
Age group:
• Fracture (fissure type) Q is present in most of the cases
• Site and Vessels Involved
• Blow Impact over lateral convexity of head → fissure fracture of squamous temporal bone → rupture of underlying
middle meningeal artery.
• Clinical Features
• Loss of consciousness due to concussion.
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• Dilation of pupil on the side of hemorrhage with conjugate deviation of eyes to opposite side.
• Lucid intervalQ: It is a state of consciousness between two episodes of unconsciousness.
• CT scan:
• biconvex lenticular-shapedQ hemorrhage,
EDH
Medico-legal Aspects
• Patient may be discharged from hospital during lucid interval and may die at home; doctor may be charged with
negligence.
• Extradural hemorrhage may resemble drunkennessQ and patient may die in police custody.
Sub Arachnoid Hemorrhage

Causes: Atraumatic and Traumatic
Site: Mostly in the Basal surface of brain (due to the location of the circle of willis)
Spontaneous (Atraumatic) Traumatic

Due to rupture of aneurysms in Circle of Willis. • Head trauma: Direct injury
• Younger age: Rupture of berry aneurysmQ • Blow over jaw or side of upper part of neck may
• Elderly age: Rupture of hypertensive aneurysms cause rupture of vertebral artery with basal SAH.
Clinical features:
• Thunder clap headacheQ: Sudden onset of severe headache with vomiting.
• Features of raised intracranial pressure.
• Focal neurological deficits: hemiplegia, dysphasia.
• Sudden loss of consciousness.
• In 40% of recovered patients, rebleeding occurs in 6-8 weeks which is commonly fatal.
Investigations:
• Lumbar puncture: XanthochromiaQ seen.
Whiplash injury
• In Road traffic accidents, involving acceleration/ deceleration trauma.

• Sustained by the occupant of a carQ
• Sudden hyperextensionQ & hyperflexion of neck
• Resulting in fatal contusion or laceration of spinal cord without fracture of spine.

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TRANSPORTATION INJURIES
Injuries due to Road traffic accidents are of three types:

• Pedestrian
• Motor cyclist
• Occupant of the vehicle
INJURIES TO PEDESTRIAN:
PRIMARY IMPACT INJURIES

• Injuries caused by vehicle when it first struck the person
SECONDARY IMPACT INJURIES
• Injuries caused by second impact of victim & vehicle
• After primary impact injury, the victim is scooped off the ground and thrown on the vehicle & suffers secondary
impact injuries.
SECONDARY INJURIES/TERTIARY IMPACT INJURIES

• Injuries sustained by a victim when falls on the ground
• After second impact, the victim is thrown on the ground & suffers secondary injuries.
Patella
or

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Bumper injuries:
• Primary impact injuryQ
• Injuries on skin, soft tissues & fracture of bone (bumper fracture)
• The level of bumper injuries varies with the height of bumper in different vehicles.
Bumper fracture:
• Usually in tibiaQ (sometimes in fibula)
• TriangleQ or wedge shaped.
• The base of triangle is the site of impact & the apex of triangle points the direction of vehicle.
INJURY TO OCCUPANTS OF A VEHICLE:
DRIVER FRONT PASSENGER

Face: Face:
Impact against windscreen – DICING impact against windscreen - DICING INJURY/SPARROW FOOT
INJURY/SPARROW FOOT MARKS MARKS
Spine: WHIPLASH INJURY Spine: WHIPLASH INJURY
Leg: impact against clutch, brakes – Abrasion, bruise Leg: impact against dashboard – fracture femur, posterior
and laceration over foot, fracture ankle dislocation of hip
SPARROW FOOT MARKS:

• Multiple small facial lacerations produced by shattered glass of windscreen of a car
DICING INJURY:
• Superficial cuts of the skin produced by the shattered glass of the side and the back windows of a car.
LADDER TEARS:
• Seen in aorta in deceleration injuries
• Multiple transverse intimal tear in aorta, adjacent to the main rupture

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DASHBOARD FRACTURE:
• Posterior dislocation of hip joint with fracture of posterior rim of acetabulum
• Due to impact of knee against dashboard
• Patellar fracture and posterior cruciate ligament injury associated
SEAT BELT INJURY/SYNDROME
THERMAL INJURIES:
HEAT INJURIES
General heat Local heat
Heat cramps Burns (due to dry heat)
Heat syncope Scald (due to moist heatQ)
Heat stroke

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COLD INJURIES
General cold Local cold
Hypothermia Frost bite (due to dry cold)
Trench foot (due to moist cold)
Terminologies
SCALD BURN Hot liquid
THERMAL BURN Heat
CHEMICAL BURN Acids and alkalies
JOULES BURN Electricity
FILIGREE BURN/ARBORESCENT BURN Lightening
SCALD BURN
Measurement ?
1. Wallace R 9
2. Laud browder's chart
3. Palm. ( pachy pachy )
Most common cause of death in

bons on spot :
*Asphaxia
*Hypovolemic shock
*Late phase (infection, sepsis )
Rx
IV fluids + Antibiotics+ Antacid +
analgesic
Formula parkland's:
THERMAL BURN 4* TBSA * wt(pt.) Covert into ml
1st 8hr - 50%
Next 16hr - 50%
Next Day - 50%
Who is burn ever anterior part of
trunk, right lower limb, left upper
limb, calculate TBSA ??
45
Burns - SSD {SILVER SULFA

DIZINE 1%} black stanning. (
neomycin )

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CHEMICAL BURN
LIGHTENING BURN – FILIGIREE BURN

Admit patient;;
Child +10%
Adult+20%
Deep burn
Joints
Face
Electrical injury
Chemical injury
Involvement of genital organ
Hypertension
Respiratory problem
Psychiatric pt
Destitute pt ( lawarish )
LIGHTENING INJURIES
(Arborescent Burns/Filigree BurnsQ/Lichtenberg’s Flowers)
• Lichtenberg flowers are pathognomonic of lightning strikeQ.
• Superficial thin irregular tortuous markings on skin resembling branches of a tree.
• Does not correspond to vascular channels
• Found over shoulders or flanks.
• Not associated with burning
ELECTRIC BURN

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Joules Burns: Firm contact with low voltage current
SPARK BURN/FLASH BURNS: Loose contact with air gap
Crocodile burns: Loose contact with high voltage current

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Bone Pearls: Heat generated by the current may melt the calcium phosphate in bone.
Radiographically seen as rarefactive foci in X-ray limbs.
Current Pearls
• Deposition of molten metal from the conductor into the tissues.
• It can be identified by scanning electron microscopy
Cussing ulcer will seen after injury of head

Curling ulcer will seen in burns
BURNS- AUTOPSY FINDINGS
Specific findings of ante-mortem burns Nonspecific findings (Can be present in postmortem

burns also)
• Soot in respiratory tractQ • Pugilistic attitudeQ
• Carboxy hemoglobinQ in blood • Heat ruptureQ
• Line of redness • Heat hematomaQ
• AlbuminQ & chlorideQ in vesicles • Heat fractureQ
• Healing granulation tissue
• Infection
Stress ulcer - GIT
• Curling ulcerQ
ELECTROCUTION INJURIES
Factors that determine the pattern of electrocution injuries:
• Kind of current:
• Alternating current (AC) is 4–5 times more dangerous than direct current (DC).
• DC injuries are uncommon, except in lightning.
Current:
• 5 mA – numbness, pain.
• 10 – 15 mA - tetany within the flexor muscles of hand and forearm
• 40 mA – ventricular arrhythmia
• >50 mA – instantly fatal.

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Effects of electrocution:
• Joule burnsQ: Firm contact with low voltage current

• Spark burnQ flash burn: Loose contact with air gap
• Crocodile burns: Loose contact with High voltage current
Current pearls:
• Deposition of molten metal from the conductor into the tissues
• Identified by scanning electron microscopy.
• Zenker’s degeneration in skeletal muscle
Bone pearls:
• Heat generated by the current may melt the calcium phosphate in bone.
• Radiographically seen as rarefactive foci in x-ray limbs.
Cause of death
• Ventricular fibrillation (low voltage current)—most common cause.
• The cause of death depends on the path of current.
• Whichever organ is present in the path of current, that organ will get affected because of the current.
• When the current flow is from head to foot, victim will die of respiratory failure due to the involvement of
brain stem.
Medico-legal Aspects
• Deaths are usually accidental.
• Judicial electrocution: Death penalty is carried out using the electric chair in some States in the US.
EXPLOSION INJURIES:
INJURIES PRODUCED BY BOMB EXPLOSION
BLAST INJURIES ARE OF FIVE TYPES:
Primary blast injuries Blast waveQ

Secondary blast injuries Flying projectilesQ
Tertiary blast injuries Victim displacementQ
Quaternary blast injuries Structural collapse/fireQ
Quinary blast injuries Hyperinflammatory state
due to chemical/radiation

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Order of organ involvement in primary blast injuries:

• In air: Tympanic membrane, Lungs and GIT
• Under water (head above water level): GIT, Lungs and Ear
• Under water (head under water level): Ear, GIT and Lungs
Primary blast injuries:

• Air blast:
• Organ involvement: Ear > Lung > GIT.
• Ear involvement: Tympanic membrane perforation & middle ear damage.
• Blast lung
Secondary blast injuries:
• Injuries produced by flying shrapnels & projectilesQ.
• A triad of abrasions, bruises & puncture lacerations are diagnostic - Marshal’s triad.
Tertiary blast injuries:

• Due to victim displacement

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• Skeletal Injuries resulting from traumatic impact against rigid structures

Quaternary blast injuries:
• All other injuries that are not included in the first three categories.
• These include flash burns, crush injuries, traumatic injuries & respiratory injuries.
TORTURE METHODS
METHODS OF TORTURE:
Falanga (bastinado) Q
• Canes or rods used to beat on the soles
TelefonoQ
• Repeated slapping on the side of head over ears
Wet submarineQ
• Forced immersion of head in water contaminated with urine or feces
Dry submarineQ
• Tying a plastic bag over the head until suffocation
Parrot’s perch
• Head down from a horizontal pole placed under the knees with wrists bound to ankle
Cattle prod
• Electric shock especially over the genitals
Dunking
• Victim is immersed into water, taken out after some time and given a chance to confess
Saw horse
• Forced straddling of a bar
Black slave
• Heated metal skewer inserted into the anus

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Saw Horse
INCAPRETTAMENTO
• The method of strangulation used by the Mafia whereby a rope is passed around the victim's wrists,
ankles and throat.

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• Q. A man got hit by a car thrown up and hits the road driver and falls on the ground, sustains head injury
then run over by another car. What is the cause of head injury?
• A. Primary impact injury
• B. Secondary injury
• C. Primary injury
• D. Secondary impact injury
Answer: B
• Primary impact injuries: due to first impact of the vehicle with the victim
• Secondary impact injuries: due to the second impact of the vehicle with the victim
• Secondary injuries: due to vivtim falling on the ground
• Q. Sparrow foot marks are associated with which type of injury?

• A. steering wheel impact
• B. wind screen impact
• C. under running or tail gating
• D. motor cyclist’s fracture

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• Q. During a cricket match, a batsman was hit by the ball on his head and lost consciousness momentarily.
He quickly regained his senses, composed himself and continued with the play. A while later he again fell
unconscious and was rushed to the hospital this time. What can be the probable nature of injury in this
kind of presentation?
• A. EDH
• B. SAH
• C. SDH
• D. Intracerebral hemorrhage
Q. After a building catches on fire, a pulseless body recovered from the building after few hours. Body was taken
to hospital for postmortem examination and presentation of body was similar to the given photos. Which type of
hypoxia could have caused his death?
a. Hypoxic hypoxia
b. Anemic hypoxia
c. Stagnant hypoxia
d. Histotoxic hypoxia
Answer: B
• Colour of lividity is CHERRY RED. It is seen in CO poisoning. A person who gets trapped in house on fire,
dies because of smoke (CO).
• Anemic hypoxia:
• If hypoxia is due to a decrease in the oxygen carrying capacity of blood, it is called anemic hypoxia.
• The O2 content of blood is low despite normal PO2. This is due to low oxygen saturation of hemoglobin.
• Similar situation also arises in CO poisoning, because CO has a much greater affinity for Hb than oxygen. In
CO poisoning, CO uses up the Hb by combing with it, thereby leaving very little Hb for combining with
oxygen. That’s why the hypoxia produced by CO poisoning is also called anaemic hypoxia.
• In CO poisoning the color of CO-Hb is cherry red and further HbO2 dissociates less readily, hence no
cyanosis is seen in CO.
•
• Note: Cyanide poisoning: causes histotoxic hypoxia, where tissues cannot utilize O2 and therefore
capillaries have more oxygenetaed Hb than deoxy-Hb
• Q. Which of the following is false about the shown injury?

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• A. Irregular shape
• B. Irregular and uneven margin
• C. Profuse bleeding
• D. Tissues are torn as a result of application of blunt force
• Q. Which injury is most susceptible in given cases?
• a. Seat belt syndrome

• b. Whiplash injury
• c. Hinge fracture
• d. Steering wheel impact type injury
• Q. A person is punished by the method as shown in photo. Which method of torture is this?
• A. Black slave
• B. Saw horse
• C. Parrot’s perch
• D. Felanga
• Q. Injury shown in photograph is due to:
• A. Electric Injury
• B. Burns
• C. Marbling
• D. Lightening

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• Q. Marshal’s triad is seen in;

• A. Earthquake
• B. Bomb explosion
• C. Firearm injury
• D. Chop Injury
• Q. Which of the following injuries are correlated with the explosion as shown in photo?
• A. Skeletal Injuries
• B. Tympanic Perforation
• C. Abrasions + Bruises + Lacerations
• D. Crush injuries
• Q. Find out the type of burns:
• A. Crocodile burns
• B. Filigree burns
• C. Joule burns
• D. Scald burn

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10. FORENSIC BALLISTICS
Forensic ballistics: Science that deals with the study of firearms, ammunition and their effects.
• Internal or proximal ballistics: Study of the projectile within the gun.
• External or intermediate ballistics: Study of the passage of the projectile through the air.
• Wound or Terminal ballistics: Study of the effects of projectile on the tissues.
Basic structure of a firearm:

Any firearm has three main parts:
• Butt/ handle
• Action – Bolt, percussion pin, hammer, spring & trigger.
• Barrel (long hollow metal cylinder)
• Lumen of barrel is known as bore.

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Classification of firearm
Firearms can be broadly classified into Rifled firearms & smooth bore firearms.
RIFLED GUN SMOOTH BORE GUN
Have rifling in the bore The bore is uniformly smooth without any grooves in shot
- Bullets are used gun.
Lead shots/pellets are used (hence c/a shot gun)
Eg; Eg;
- Revolvers – 200Y - Depending on loading: Muzzle loading or breech
- Pistols – 400Y loading
- Military Rifles – 2000Y - Depending on barrel: single barrel, double
- Single shot pistols barrel
- Auto-loading pistols Depending upon choking:
- Submachine guns - Unchoked or cylinder bore
- Machine guns - Quarter choked
- Half choked
- Fully choked
Shot gun – 50-60Y
Muskets
Rifling:
• Spiral grooves in the bore of rifled gun.

Advantages of rifling:
• Imparts Spinning motionQ to the bullet.
• Greater power of penetration.
• Straight trajectory
• Prevents wobbling of bullets.
• Increases accuracy & rangeQ
Bore/callibre/Gauge
• The interior of barrel i.e bore has 4- 6 grooves running parallel to each other from breech end to muzzle end.
• The elevated areas are called as lands & depressed areas called as grooves.
• Size of lead ball = size of the barrel
• 1 pound (454 g) of lead taken

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• Bore = number of spherical lead balls taken to fill the barrel

• Eg; 12 bore gun – 12 balls made from 1 pound lead,
24 bore gun – 24 lead balls made from 1 pound lead
Choking:
• In shotgun, the distal 10 cms of barrel is constricted.
• It can be of different grades.
Advantages of choking in shot gun:
• Reduces the pellets dispersionQ
• Increases the explosive forces of the pellets.
• Increases the velocity of the pellets.
• Projectiles used in rifled gun: BULLET

• Projectiles used in smooth bore gun: Lead shots/ Lead pellets
(Smooth bore guns are called as shot guns, as lead shots are used projectiles)

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Structure of Ammunition:
Constituents of shotgun cartridge (from base to top) Constituents of riffled gun bullet (from base to top)
• Percussion cap containing primer mixture • Percussion cap containing primer mixture
• Gun powder • Gun powder
• Thick felt-wad • Bullet
• Lead shots
Note:
Primer constituents: BLAST
- Barium nitrate, Lead peroxide, Antimony, Styphanate (lead), Tetrazine
WAD:
• Made up of soft material, like felt, cardboard, plastic, cork or straw.
• It separates the gun powder and lead shots
FUNCTIONS OF WAD:
• Acts like a piston
• Seals the bore effectively and thereby allows optimum pressure to develop
• Helps in lubrication
• Prevents the escape of gas from the breech end

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Gun Powder
BLACK GUN POWDER SMOKELESS GUN POWDER
Potassium nitrateQ (75%) Single base: Nitrocellulose
CharcoalQ (15%) Double base: Nitrocellulose + NitroglycrineQ
Sulfur (10%) Triple base: Nitrocellulose + Nitroglycerine +
Explosive power: Nitroguanidine
- Each gram of black gun powder produces 3000 – 4000 Explosive power:
cc of gas - Most effective explosive with minimal smoke
- Each grain produces 200 – 250 cc of gas - Each gram of black gun powder produces 12000 – 13000
cc of gas
- Each grain produces 800 – 900 cc of gas
• Semi- Smokeless gun powder: 80% black & 20% smokeless gun powder.

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EFFECTS OF DISCHARGES OF A GUN:

• Fire / Flame -→ Burning at entrance wound along with burning or singeing of hairs.
• Smoke → Blackening effect or smudging
• Hot gases→ Scorching effect
• Unburnt gun powder → Tattooing effect, peppering or stippling effect
• Felt wad → Minor abrasion and bruise.
RIFLED GUN INJURIES

• Contact shot – Muzzle end of the gun is in tight contact with skin.
• Close shot – Victim lies within the range of flame
• Near shot – Victim lies outside the range of flame but within the range of gun powder
• Distant shot – outside the range of gun powder.
Appearance of wound of rifled firearm in different ranges:

CONTACT(point blank) CLOSE SHOT
(range of flame)
Muzzle impression Circular entrance wound
StellateQ or cruciate margins Burns & Singeing- Present
Burns, blackening & powder tattooing seen along the track BlackeningQ - Present
of the wound (not seen in skin externally) Tattooing - Present
Abrasion collar -Present
NEAR RANGE LONG RANGE (beyond the range of gun power)

(range of gun power)
Circular entrance wound Circular wound smaller than the diameter of the bullet
Burning/ blackening - Absent Burning, blackening, tattooing - absent
TattooingQ - Present Abrasion collar - Present
Abrasion collar – Present
SHOT GUN INJURIES:
• In shot gun, there is dispersion of lead shots.

• As the distant increases, the dispersion increases.
• In contact shot, cruciate or stellate appearance is noted due to blast effect.
• Effects of flame, smoke, tattooing are noted within 1m. (beyond 1 m, only lead shot injuries seen).
• Beginning of lead shots dispersion is seen at 2 – 4 m.
• Complete dispersion is seen at 4m.

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Definition of ranges in shot gun:

• Contact range: Muzzle end of gun is in tight contact with skin.
• Close range: less than1 m
• Near range: 1- 2 m
• Intermediate range: 2 -4 m
IMPORTANT POINTS
• Wound is cruciate/ stellate in contact shot.

• Burns, blackening & tattooing around entrance wound till 1 m.
• Between 1 – 2m, Lead shots are about to disperse (but has not begun to disperse) making the wound rat – hole
appearance.
• All the lead shots enter the skin as single mass till 2 m.
• After 2 m, lead shots begin to disperse & individual pellet holes can be found in addition to central big hole.
• At 4 m, there is complete dispersion of lead shots and only individual pellet holes are seen.
Appearance of wound of shot gun in different ranges:

CONTACT SHOT CLOSE RANGE(<1 m)
- Single entrance wound Single circular entrance wound
- Stellate or cruciate wound Burns/ singeing - Present
- Burns/ blackening/ tattooing seen along the track of Blackening - Present
wound Tattooing - Present
- Muzzle impression present
NEAR RANGE INTERMEDIATE RANGE

(1- 2 m) (2-4 m)
- Single entrance wound - Central hole due to shot mass surrounded by Individual
- Irregular margins - Rat hole appearanceQ pellet hole.
- As the distance increases from 2- 4 m, the size of central
hole decreases & the pellet dispersion increases
DISTANT RANGE(>4m)
• Individual pellet holes due to complete dispersion

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Entry wound Vs Exit wounds

CHARACTER ENTRY WOUND EXIT WOUND
Size Smaller than the diameter of the Larger
bullet
Edges Inverted EvertedQ
Abrasion collar & grease collar PresentQ AbsentQ
Scorching, smudging & tattooing May be present Absent
Bleeding Less MoreQ
Fat extrusion Absent May be present
Cherry red colour May be present Absent

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ATYPICAL BULLETS
Dum – dum bullet:
• It expands or mushrooms on striking the target, producing a large hole & more damage.
Tandem bullet (Piggyback bullet):

• Cause: Old unused gun or faulty ammunition.
• When an unused gun is fired, the first bullet gets struck in the barrel.
• When it is fired again, the second bullet carries the first bullet and comes out.
• Two bulletsQ come out of the muzzle end.
Yawning bullet: A bullet travelling in an irregular fashion instead of travelling nose-onQ is called a yawning bullet. May
cause key hole entry woundQ.
Tumbling bullet: A bullet that rotates end-on end during its motionQ

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Souvenir Bullets:
• Retained bulletQ inside the body for a long time.
• Dense fibrous tissue surrounds the bullet.
• Due to absorption of lead from the bullet into the body fluids, chronic lead poisoning may occur.
Frangible bullet:
• These bullets are designed to fragment & disintegrateQ on impact.
• Usually made up of copper, iron or lead.
• They do not ricochet.
Incendiary bullets:
• Incendiary bullets contain phosphorusQ.
• Type of army bullet used to cause fire in the target.
Tracer bullet:
• It leaves a visible mark or ‘trace’ while in flightQ, so that the path of bullet can be seen.

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Ricochet bullet:
• A ricochet bullet is one which before striking the victim, strikes some intervening object firstQ, and then after
ricocheting, hits the victim.
• The path of a ricochet is completely unexpected.
• Cause: Inferior firearms and low velocity bullets
• Wound appearance in external ricocheting:

• The bullet may be deformed.
• Entrance wound is large, irregularly oval, or cruciate wound with irregular margins.
• Abrasion collar is absentQ, as the bullet loses its spinning motion.
• Burning, blackening and tattooing are also not seen.
• Depending on the surface hit, paint may be found adhering to the bullet.
Kennedy phenomenon:
• Iatrogenic surgical alterationQ of the entrance wound.
• The evaluation of whether the wound is entrance or exit becomes difficult.
PUPPE’S RULE:
For skull injuries due to multiple impacts (gunshot/blunt impact)
- Sequence of the impact can be established
- When there are two fracture lines in the skull, the second fracture will always be stopped by the preexisting fracture line.

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BULLET FINGER PRINTING:

• Primary markings: Due to grooving/riflings
• Secondary markings: Due to irregularities in barrel (due to manufacturing defect/metallic failing
• Primary markings: (CLASS CHARACTERISTICS) Unique to a manufacturing company

• Secondary markings: (INDIVIDUAL CHARACTERISTICS) Unique to a particular gun
BULLET FINGER PRINTING – BY COMPARISON MICROSCOPE – Discovered by Calvin Goddard
GUNSHOT RESIDUE TESTS:

• Dermal Nitrate testQ or Paraffin test
• Harrison and Gilroy test
• Neutron activation analysis
• Atomic absorption spectroscopy (AAS) &
• Flameless atomic absorption spectrophotometry
• (FAAS)
• Scanning electron microscope-energy dispersive
X-ray spectrometryQ (SEM-EDX)
Q. Which type of choking in shot gun produce maximum dispersion of pellets?

• A. Fully choked
• B. Quarter
• C. Half
• D. Unchoked

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Q. Bullet which is left inside the body for long is called as;
• A. Tracer bullet
• B. Souvenir bullet
• C. Tandem bullet
• D. Tumbling bullet
Q. Presence of spiral grooves in the barrel of weapon is referred to as;

• A. Choking
• B. Incendiary
• C. Rifling
• D. Smoothening
Q. Choking occurs in;

• A. shotgun
• B. Revolver
• C. semiautomatic pistol
• D. 303 rifle
Q. A patient with bullet injury is brought to emergency department. Gunshot circular wound with
blackening and tattooing were seen on examination. Burning of skin and singeing of hairs were absent.
How much could be the range of firing according to given situation?
• A. Near
• B. About 2 meters
• C. Contact
• D. Distant
11. FORENSIC TOXICOLOGY
Basics:
- Corrosive
- Irritant
- Neural
- Cardiac
- Asphyxiants
IDEAL HOMICIDAL POISON IDEAL SUICIDAL POISON
- Cheap & easily available - Cheap & easily available

- Colorless, odorless and tasteless - Pleasant taste
- Can be mixed with food easily - Easily taken with food
- Highly toxic - Highly toxic
- Symptoms should resemble natural disease - Painless death
- No postmortem changes - Cyanide (ideal)
- No antidote - Others are opium, barbiturates
- Should not be detected by chemical tests and - OPC and endrin (commonly)
must be rapidly destroyed from body
Organophosphate
- Eg; Fluorine, Thallium
- Arsenic, aconite (commonly used)
Measles rashes
Can deposit on
bones
Not a ideal HP

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In all cases of poisoning:

- Police information should be done by a doctor under 39 Cr.P.C
- Not informing the police is punishable under 176 IPC
- Giving false information is punishable under 177 IPC
- Causing hurt by means of poison, with intent to commit an offence is punishable under 328 IPC
- Intentional omission to inform police about the offence is punishable under 202 IPC.
- Intentional giving false information about the offence is punishable under 203 IPC
Note: Sections 176, 177 and sections 202, 203 are quite similar.
If there is any suspected article of food, stomach wash should be preserved by the doctor. Intentional omission to preserve
amounts to destruction of evidence and punishable under 201 IPC.
GENERAL LINES OF TREATMENT:

• Decontamination: Emesis, Gastric lavage, Catharsis, Activated charcoal, whole bowel irrigation.
• Gastric lavage:
- Very effective within 1 hour of poisoning
- Patient in left lateral or sitting position
- Tubes used are: Lavacuator (best), Ewald’s tube, Ryles tube and Boas tube.
- Contraindications: Comatose patients, corrosive (except phenol), esophageal varices, volatile poisons,
convulsant poisons.
1).
A(Airway)
B(breathing )
C(bp, pulse rate, sbp-100, pr+100) (paradoxical resp. ~
flail chest)
GCS(
Activated Charcoal:
- Mechanical antidote
- Contains small, low volume pores for adsorption of poisons
- 1 gram of activated carbon has surface area of 3000 m2
- Contraindications: Pesticides, heavy metals/hydrocarbons, acids/alkalies, iron, Lithium, Solvents (mnemonic:
PHAILS)
CORROSIVES
ACIDS
Produce coagulative necrosisQ.
CAUSTIC ALKALIS
Produce liquefaction necrosisQ resulting in deeper penetration

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ACIDS CAUSTIC ALKALIS

- Produce coagulative necrosis - Produce liquifactive necrosis resulting in
- Mineral/Inorganic acids: Sulphuric, Nitric and deeper penetraton
Hydrochloric acids – ONLY LOCAL ACTION - Produce more severe injury than acids, because
- Organic acids: Carbolic, Oxalic and acetic acid – they are hygroscopic (absorb water from
LOCAL AND SYSTEMIC ACTION intestine)
- Hydrofluoric acid causes Liquefactive necrosis - Oesophagus mucosal involvement > stomach
- Caustic potash, caustic soda and ammonia.
INORGANIC ACIDS
SULPHURIC ACID NITRIC ACID

• Black tongueQ • Xanthoproteic reaction: (yellow to orange)
• Chalky white teethQ • Yellow discoloration of tissues (picric acid
• Black stomach wall or black charred formationQ)
stomachQ • Yellow teethQ
• Blotting paper stomachQ • Yellow staining of clothings, tissues
• Stomach is brown With HCL
Sec. 326 B IPC (5-7 years)
• VITRIOLAGE: (throwing acid over face to disfigure)

- Sulphuric acid (mc), carbolic acid, caustic soda, caustic potash, iodine, marking nut juice or calotropis.
- Voluntarily causing grievous hurt by acids: Sec 326 A IPC (10 years/life imprisonment)
- Attempt of vitriolage: Sec. 326 B IPC (5-7 years)
• MAGENTRASSE (street of the stomach)

- It is along the lesser curvature (location of greater damage)
- The pathway corrosive agents follow in food-filled stomach.
- In case of empty stomach, damage is seen in lower half (fundus spread)
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ORGANIC ACIDS: (They have systemic absorption – both local & systemic effects present)
CARBOLIC ACID (PHENOL)
It is used as antiseptic or disinfectant
• Phenol gets converted into hydroquinone and pyrocatecholQ and excreted in the urine; the metabolites on
further oxidation produces green colourQ urine - carboluriaQ.
Properties of Phenol:
- It damages the sensory nerve endings (initially causes tingling sensation, later numbness and finally anesthesia.
- Phenol and metabolites get deposited in cornea, cartilage and ligaments (OCHRONOSIS)
CARBOLIC ACID/PHENOL POISONING
Acute poisoning (CarbolismQ)

• Miosis
• Skin: burning & numbness due to nerve endings damage, white eschar on skin.
• PCT necrosisQ, hemoglobinuria.
• Green color urine due to the oxidation of metabolites – carboluria
Chronic poisoning (Phenolic marasmus)
• Anorexia, Progressive weight loss
• Dark urine, and pigmentation of skin and scleraQ (ochronosis).
• White leathery stomachQ is seen
• Gastric lavage can be doneQ (Gastric lavage contraindicated in other corrosives)

• Putrefaction is delayedQ
OTHER FEATURES:
- White/brown leathery stomach is seen
- Putrefaction is delayed
- GASTRIC LAVAGE CAN BE DONE
Carbolic acid/Phenol Poisoning:

- Carbolism (miosis, burning and numbness due to nerve endings damage, white scar over skin)
- Carboluria (green urine)
- Constriction of pupils
- Corneal deposition
- Convoluted tubule damage (PCT)
- CNS depression
- Cartilage deposition

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OXALIC ACID
- It is used in ink remover solution (used to erase writing in attempts at forgery)
- Used in color printing and as bleaching agent. Reimplantation of parathyroid gland,
• Coffee ground vomitusQ is seen sternocleidomastoid muscle
• Treatment: Calcium gluconate (antidote), parathyroid extract Under the brachio radialis muscle
• Black color/ brown stomachQ seen in postmortem
• (Note: in a case of poisoning, history of ink remover solution – OXALIC ACID)
BOILED LOBSTER SYNDROME:

In Boric acid poisoning, there are massive areas of erythema, desquamation and exfoliation (looking like a boiled lobster)
Rashes are seen commonly on the palms, soles and buttocks.
IRRITANTS: METALS
MERCURY (Quick silver)
• Chronic mercury poisoning is HydragyrismQ.
• Toxicity: Organic mercury > Mercuric salts > mercurous salts
Features of chronic mercury poisoning:
- Excessive salivation, gingivitis, loosening of teeth, blue lines on gums
- Mercuria lentis
- Coarse intentional tremorsQ (Danberry tremors/ Hatters shakes/ Glass blowers shakesQ):
- Erethism – Neuropsychiatric features
- Acrodynia (pink disease) Q
- Mad hatter syndrome
- Minamata disease
DANBURY TREMORS/SHAKING PALSY/INTENTION TREMORS:

Occupational: workers of hat industries (hatter’s shakes) and glass blowing industries ( glass blower’s shakes)
- Site: First in hands – lips – tongue – arms and legs
- Features:
- Worsening of handwriting – early feature
- In advance stage: person is unable to dress himself, write legibly or walk properly
- Most severe form of tremors is CONSUSSION MERCURIALIS.
MERCURIA LENTIS:
- Exposure mercury vapor
- Brownish deposition of mercury in anterior lens capsule
- Site: Anterior lens capsule, Bilateral
- Slit lamp examination: MALT BROWN REFLEX
- Visual acuity: Normal
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ERETHISM:
- Mad hatter syndrome
- Personality changes
- Neuropsychiatric symptoms
- Irritability, shyness, dementia, insomnia
- Common among glass industry and hat industry workers
ACRODYNIA
- Pink disease/swift fever disease
- Toxicity: Idiosyncratic hypersensitivity reaction, due to mercurous chloride (calomel)
- Age group: CHILDREN
PINK DISCOLORATION in the hands and feet:

- Pink
- Puffy
- Painful
- Paraesthetic peripheries
Associated with dental fillings, teething powders.
MINIMATA DISEASE:
- Due to organic mercury
- Chronic organic mercury intoxication caused by eating contaminated fish and shellfish
• Symptoms: disturbances in hand coordination, gait and speech, tremors, rigidity and seizures

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HUNTER RUSSEL SYNDROME

- Due to toxicity of Methyl-mercury
- Classically, patients present with dysarthria, paresthesia, sensory deficits, deafness, cerebellar ataxia and
progressive constriction of visual fields.
ARSENIC
Toxic compounds of arsenic:
- Arsenic gas (most toxic form)
- Inorganic arsenic (eg: Arsenic trioxide – most toxic salt)
- Organic arsenic
- Elemental arsenic
Clinical features:
Acute poisoning:
• Gastroenteritis like choleraQ Cholesterololis
• In postmortem, pink velvety stomach mucosa or strawberry stomachQ seen.
• Freshly prepared ferrous hydroxideQ is used for treatment
Chronic poisoning:
• Metallic taste, excessive salivation, and garlic odor of breath and sweat.
• Alopecia
• Skin:
• A rash resembling fading measles rashQ
• Rain drop pigmentationQ
▪ Brown pigmentation over skin flexures, temples, shoulders, eyelids and neck
• Leucomelanosis: Macular areas of depigmentation (earliest signQ)
• HyperkeratosisQ of the palms and soles bilaterally.
• Aldrich Mees lineQ: White bands of opacity in the nails of fingers and toes.
BLACK FOOT DISEASE

• Chronic exposure also causes vasospasm and peripheral vascular insufficiency
• Dry gangrene and spontaneous amputations of affected extremities

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PERIPHERAL NEUROPATHY
• Peripheral neuropathy with tingling, numbness of hands and feet (glove & stocking distributionQ)
• Polyneuritis, anesthesia, paraesthesia with painful swelling (erythromelalgia)
• Hematological signs:
• Bone marrow suppression, microcytic hypochromic anemia, thrombocytopenia and leukemia.
• DIAGNOSIS OF ARSENIC TOXICITY:
- Acute poisoning: Blood sample
- Chronic poisoning: Hair, Nail and Bone
- Marsh test, Reinsch test
- Atomic absorption spectroscopy
Disadvantages of Arsenic usage as homicidal poison:

• It delays putrefactionQ
• Can be detected in completely decomposed bodies. Q
• Can be found in bonesQ, hairsQ and nails for several years.
• Can be detected in charred bones or ashesQ.
LEAD
Toxic salts of Lead:

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Lead acetate Most common source of lead poisoning

Lead tetroxide (Vermillion) Used as SINDOOR
Lead sulphide Least toxic form
Tetra ethyl lead Antiknock in petrol
Lead carbonate Paints
Tetraethyl lead Lead encephalopathy
TOXIC ATIONS:
- Lead combines with sulfhydral group and interferes with mitochondrial oxidative phosphorylation.
- Inhibit haeme synthesis (enzymes: ALA dehydratase, ferrochelatase)
- CNS: affects nerve cells and myelin sheaths and causes lead encephalopathy in children.
- ↓Uric acid excretion - ↑ blood urates – SATURNINE GOUT Heme cause demyelination
Lead will decrease uric acid
Plumbism (hyperuricemia )
• Chronic lead poisoning is called Plumbism (saturnism)
• Lead is a cumulative poison. In chronic exposure, lead deposits in bones (90%)Q, liver and kidneys.
BURTONIAN LINE:
- blue line along gums
- opposite to caries tooth
- deposition of lead sulphide ( Lead + H2S by bacteria)
- 1 week of exposure
COLIC (SATURNINE COLIC):

- Spasmodic abdominal pain lasting for few minutes
- Pain relieved by pressure
- Late symptom
- Nocturnal
LEAD PALSY:
- Degeneration of nerves and muscular atrophy
- Wrist drop and foot drop
- Common in adults
- Late symptom Pica appetite of (children )
LEAD ENCEPHALOPATHY:
- Present in all cases of plumbism
- Due to tetra ethyl lead in children
- Irritability, restlessness, hyperkinetic, delirium, hallucinations
- And coma
- Brain damage is irreversible and permanent

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LEAD OSTEOPATHY/LEAD LINE

- Seen among children
- Deposition of lead in growing ends of bones
- Radio-opaque bands along metaphysic of long bones and iliac crest margins.
- Width of lines implies the duration of exposure
- Minimum 4 weeks
ANEMIA: Microcytic Hypochromic

- Blood picture: Punctate basophilia, reticulocytosis, poikilocytosis, anisocytosis
- Mechanism: inhibition of ALA dehydratase and Ferrochelatase
- Elevated levels of ALA, Coproporphyrins, free erythrocyte protoporphyrin
PLUMBISM FEATURES:
- Anaemia
- Burtonian line/Basophilic stippling, Bone lines
- Colic, constipation (dry belly ache)
- Drop (wrist/foot drop) – lead palsy
- Encephalopathy
- Facial pallor (EARLIEST SIGN)
- Gout (SATURNINE GOUT)
- Hypertension
- Impotence
- Treatment: Chelating agents, EDTA, Pencillamine
COPPER POISONING
- Metallic taste
- Ptyalism (increased salivation) in chronic poisoning
- Green color vomitus
- Bluish green stomach mucosa present in POST MORTEM
- Chalcosis: copper deposits in tissues
- VINEYARD SPRAYER’S LUNG DISEASE: chronic inhalation of copper sulfate
- GREEN HAIR DISCOLORATION: chronic contact with swimming pool water containing algicidal copper chemical
compounds may cause this.
THALLIUM POISONING:
- Features resemble Gullain Barre Syndrome
- Mees lines present
- Triad: alopecia + neuropathy + diarrhea
- Pseudomotor neuropathy
- Ideal homicidal poison features
CADMIUM POISONING:
- Nephrotoxicity
- Golden yellow staining of teeth
OUCH DISEASE (ITA-ITA DISEASE – “it hurts- it hurts disease)

- Contamination of food and water by mining effluents with cadmium in japan.
- Weak and brittle bones
- Waddling gait
- Osteomalacia

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NON-METALLIC IRRITANTS
PHOSPHOROUS
WHITE PHOSPHOROUS (YELLOW PHOSPHOROUS) RED PHOSPHOROUS
- Toxic Non toxic
- Garlic odor Odorless
- Luminous (phosphorescence) Nonluminous
- Inflammable (unstable, should be kept under Non inflammable
water)
- Emits smoke No smoke
- Accidental poisoning cases with fire crackers (diwali poison) and rat killers.
(Note: DIWALI POISONS: Phosphorous and Mercury)
• Signs and symptoms:

- Garlicky odor
- Luminous vomit and stool, because of presence of phosphorous
- Smoking or smoky stool syndrome: fumes emanate from the stools
- Acute poisoning causes liver cell necrosis, fatty liver and acute yellow atrophy.
• Chronic Phosphorous Poisoning (PHOSSY JAW/GLASS JAW/LUCIFER’S JAW):

- Due to inhalation of fumes over years
- Tooth ache (earliest symptom) – swelling of jaw – loosening of the teeth – necrosis of lower jaw –
sequestration of bone in the mandible – Multiple sinuses discharging foul-smelling pus.
ORGANIC IRRITANTS
MAJOR ACTIVE PRINCIPLE & TOXICITY
Ricinus Active Principle: RicinQ Ricin is a Biological warfare agent
communis (category BQ)
(Castor) Entire plant is poisonous
Castor oil non poisonous
Unbroken seeds are not poisonous when

swallowed or cooked.

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Abrus Active Principle: AbrinQ Similar to Viper snake venomQ

Precatorius
Others: Abrine & Abraline Used as SUI needlesQ
Entire plant is poisonous Anti abrinQ (antidote)
Seeds are bright scarlet red with a black spot

at one pole
Semicarpus Active Principle: Semicarpol & BhilawanolQ Applied to the skin
anacardium Irritation, itching and a painful blisterQ with acrid
(Marking Nut) serumQ and eruptions of the surrounding skin.
Calotropis calotoxin & calotropinQ Skin: Blister

gigantea Eye: conjunctivitis & blindness
Ingestion: Vomiting & diarrhea
Calotropis root - highly poisonous

to cobras and other poisonous snakes.
Ricinus communis (Castor)
Abrus precatorius

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Semicarpus anacardium
(Marking Nut)
Calotropis gigantea
Medicolegal Importance:
ABRUS PRECATORIUS
- Ideal cattle poison
- Seeds- Sui needles & arrow poison
- Resembles viperine snake bite
- Seeds-abortifacient
- ARROW POISON
SEMECARPUS ANACARDIUM:
- To produce artificial bruise/conjunctivitis
- Juice may be introduced into the vagina, as a punishment for infidelity
- For criminal abortion, juice is applied to the cervix by means of abortion stick.
• CALOTROPIS:
- Abortifacient
- Infanticide (mixed with milk)
- Cattle poison: by mixing with fodder or inserting a cloth smeared with the juice inside the rectum of the animal
- To produce artificial bruise
- ARROW POISON.
•
• RICINUS COMMUNIS:
- Accidental poisoning
- Biological warfare weapon
•
• CROTON:
- Accidental poisoning
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- Abortifacient
- ARROW POISON
SUI NEEDLES:
- Powdered abrus seeds mixed with dhatura and opium and made into paste with water and spirit.
- Small sharp needles are made from this paste and dried under sun
- Needles are inserted into wooden logs and cattle are struck with great force which drives the needle into the flesh
(so as to resemble SNAKE BITE)
- At the site of injection: painful swelling with inflammation and necrosis, sepsis and death
- Ideal cattle poison – used in Indian villages
- Poisoning resembles VIPERINE SNAKE BITE
HUNAN HAND SYNDROME:

- Painful contact dermatitis to capsaicin (active principle of capsicum)
- Seen in cooks and chilli pepper workers
ANIMAL IRRITANT: SNAKES

• OPHIOLOGY: study of snakes
• OPHITOXAEMIA: circulation of snake venom in blood
APPEARANCE POISONOUS SNAKES NON POISONOUS SNAKES

Habit Nocturnal Not specific
Head scales Usually smallQ Usually large
3 exceptions
(Poisonous snakes with large
head scales)
1. Pit Vipers
2. Cobra – 3rd
supralabial is largest
3. Krait – 4th infralabial
is largest
1. Pit viper: pit below

the eye
2. Cobra: 3rd labial
touches eye and
nasal shields
3. Krait: 4 infralabials
scales below mouth
& 4th being largest
Belly scales Large and cover the entire Small
breadth of bellyQ
Distal scales Single row Double row
Tail Compressed Not compressed
Flat in case of SEA SNAKE
MOUTH - Fangs 2 fangs - Long and canalized, Short or small grooved teeths
like hypodermic needle
Bite mark Two fang marksQ Small teeth marksQ

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ELAPIDAE: Cobra, Krait VIPERIDAE: Viper HYDROPHIDAE: Sea snake

NEUROTOXIC Hemotoxic Myotoxic
vasculotoxic
King cobra, common cobra, Russels viper, saw scaled Sea snake
Krait vipers, Hump nosed vipers
King cobra, common cobra, Krait, Russels viper, saw scaled vipers, Hump nosed vipers (Red – ASV – India)
• They are referred to as the big four.

The Big Four
1. Indian cobra, Naja najaQ
2. Common krait, Bungarus caeruleusQ
3. Russell's viper, Daboia russeliiQ
4. Saw-scaled viper, Echis carinatusQ
Fatal dose:
• Common Cobra - 15 mg.
• King cobra - 12 mg
• Krait - 2.5 - 6 mgQ
• Russel Viper - 40 mg
• Saw scaled viper – 8 mg
Indian anti snake venom is effective against

1. CobraQ
2. KraitQ Neastigmine _ for reverse neuroparalysis
3. Russel ViperQ
4. Saw Scaled ViperQ

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King Cobra Common cobra Krait Russel Viper
SYMPTOMS:
MC: fright (anxiety, abdominal pain) - psychological
Local symptoms/findings in Snake bite:
Fang marks:
• Not seen in krait
• Minimal/No local symptoms – Krait
Local symptoms are very high with vipers
• Local pain
• Local bleeding/swelling progressing
• Regional lymph nodes enlargement
• Blistering, necrosis, Infection, Gangrene
Neurotoxic – with ELAPID BITES

• Ptosis, Diplopia (paralysis of extraocular muscles), flaccid descending paralysis – patient can die of respiratory
failure
Vasculotoxic – Viper
• DIC, Spontaneous bleeding, renal failure
• Cardiotoxic features, shock, hypotension, arrythmia
Sea snake –
• Pain, Muscle tenderness,
• Swelling, myonecrosis, renal failure
EXTRA EDGE:
- SUTHERLAND WRAP: it is a modification of tourniquet used as a crepe bandage in snake bite cases.
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- DRY BITE: a bite by a venomous snake in which no venom is released.
INVESTIGATIONS:
20WBCT:
- 20 Minute Whole Blood Clotting Test
- The most reliable test of venom-induced defibrinogenation
- Correlate with clinical condition
SNAKE VENOM OPHTHAMIA:

- From spitting cobra
- If the venom exposed to eyes, intense burning, stringing pain, followed by profuse watering of the eyes with
congested conjunctivae, clouding of vision and temporary blindness.
SOME FACTS ABOUT KRAIT:

- Nocturnal
- Krait bite is more dangerous as there is no pain at the bite site, so the victim is unaware of the bite.
- More dangerous than cobra. Its venom is 16 times more powerful than cobra
- It is neurotoxic, causes immediate paralysis of muscles
- Ineffective treatment and no response to anticholinesterases.
- Fatality: 70-80%
TREATMENT
First aid approach:
Carry No Right
• Carry – do not allow patient to walk
• No – No incision/suction/ligature/tourniquet
• No Cautery/electrotherapy
• No coffee/alcohol (increase heart rate which will increase blood flow)
RIGHT:
• Reassurance
• Immobilization (sutherland’s wrap) – pressure immobilization 55 mmHg – to compress lymphatics
• GH – get to hospital
• Tell the dr about all systemic toxic signs
Treatment:
1. ASV: first made by Albert Calmette
• Source: Horse serum
• Given I/V
• Dose: 8-10 vials
• ASV + Adrenaline (As chance of anaphylaxis is there)

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Indications:
• Severe local envenomation – rapidly progressive swelling
• Severe systemic envenomation – cardiotoxicity
2. I/V Neostigmine: reverse neuroparalysis – only for cobra bite and not fro krait
SCORPION STING
• >100 species in india
• Most imp – Indian Red Scorpion (Mesobuthus tumulus)
• Venom: Resembles snake venom
• Quantity is very less, so mortality is very less
• Neurotoxic and hemotoxin
• Scorpion bite: One puncture mark (snake 2 or more)
• Action: acts on sodium and potassium channels
• Stimulates sympathetic and parasympathetic
• Uncontrolled release of catecholamines in circulation – which causes autonomic Storm – patient will have excess
sympathetic stimulations
• Clinical features:
Local: Pain, paresthesia, positive tap sign
Systemic: vomiting, sweating, salivation, chest pain, anxiety, cardia arrhytmia, pulmonary edema (most imp.)
More fatal in children
Treatment:
Immobilise Immobilization
Pain relief
Prazosin
Scorpian antivenom (if available )
CNS DEPRESSANTS:
ALCOHOL
BEVERAGE % OF ALCOHOL
Beer 4-8Q
Wine, champagne 10-15
Port, sherry 20
Whisky, gin, brandy 40-45Q
Rum, liquor 50-60Q
Vodka 60-65
• Three stages of alcoholism: Stage of influence, stage of incoordination & stage of coma
• Pupils are dilated in the initial two stages, constricted in comatose state.

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McEwan’s sign
• Seen in alcoholic comaQ.
• Pupils are contracted, but on stimulation of the person, e.g. by pinching or slapping pupils dilate with slow return
• This differentiates alcoholic coma from coma due to other causes Q
EXTRA EDGES
• Statutory limit for driving in India: 30mg%Q (Sec. 185 of Motor Vehicles Act)
• Widmark’s formulaQ: a=prc(blood); a=3/4prq (urine)
• Q. A person was using 6 pegs of alcohol everyday for last 15 years. Now he is getting kick only after 1 peg.
This phenomenon is called as;
• A. Dependence
• B. Tolerance
• C. Reverse Tolerance
• D. Abuse
Symptoms are dependent upon the blood alcohol concentration.
• Blood levels Symptoms

• 20-30 mg/dl decreasing thinking ability and slowness
of motor performances.
30mg/dl is the legal limit for driving india.
• 30-80-mg/dl Further decrease in thinking ability and. worsening of motor performance.
• 80-200mg/dl incoordination, judgment errors, mood lability.
• 200-300 mg/dl Nystagmus, slurring of speech, alcoholic blackouts
• >300 mg/dl impaired vital signs and possible death.
TOXICITY: Isopropyl alcohol > Methyl alcohol > Ethyl alcohol

- Formaldehyde is 33 times more toxic than methanol
- Formic acid is 6 times more toxic than methanol
Note: Any crime committed by a person suffering from DELIRIUM TREMENS, is not punishable.
OPIUM/AFIM:
Toxic part: Unripe fruit capsule, latex juice
- The juice is obtained by cutting the unripe capsule. It is dried to a brown residue.
- POISON OF CHOICE FOR SUICIDE: as it produces painless death
- Pinpoint pupil, respiratory depression Naloxone 30 min
Naltrexone 96hr
- MARQUIS TEST: to detect opium
- Antidote: Nalaxone
- Treatment for morphine withdrawal: methadone
DELIRIENTS
DATURA
• Datura fruit is thorn appleQ.
• Active principle: AtropineQ, HyoscyamineQ & ScopolamineQ
• Road side poison: commonly seen on roadside
• Railway poison: used by criminals for stupefying the passengers prior to robbery, rape or kidnapping.
• CarpholagiaQ present
• Physostigmine is the antidote of choice

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9 Ds of DATURA POISONING:
- Dilated pupils
- Dry skin
- Dry mouth
- Dysphagia
- Dysphasia
- Drowsiness
- Drunken gait
- Delirium
- Death
CANNABIS (INDIAN HEMP)

• Cannabis sativa, cannabis indica: (Synonyms: Pot, Weed, Rope, Dope, Joint, Hash, Reefer)
• Active Principle: Cannabidiol which is inert, is converted to active tetra hydro cannabinolsQ (THC) on exposure
to heat
• PREPARATIONS OF CANNABIS
• Bhang:
• Decoction from dried leavesQ and fruit shoots;
• 15% of active principle
• Ganja
• Leaves and flower tops of female plantQ;
• 25% of active principleQ
• Charas or Hashish
• ResinQ exuding from leaves and stems;
• 25-40% of active principleQ
• Most potentQ
Run-amok - Homicidal impulse to killQ

Criminal responsibility:
• The person is not held responsibleQ for his acts since ‘run amok’ is considered a disorder of mind and not
intoxication.
COCAINE POISONING ( ‘Coke’, ‘Snow’, ‘Cadillac’, ‘White lady’ )
Chronic cocaine abuse (‘Cocainism’/ Cocainophagia/ Cocainomania)
• Black tongueQ & Teeth
• Nasal septal perforationQ (due to chronic snorting)
• Palatal perforationQ (due to placing cocaine under the palate)

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• GangreneQ in peripheries (ear pinna, nose tip etc.)

Note: A triad of septal/palatal perforation, black tongue and peripheral gangrene is diagnostic of cocaine abuse
• BODY PACKER SYNDROME/MINI PACKER SYNDROME:

- BODY PACKER/MULE: an individual who ingests wrapped packets of illicit drugs such as cocaine, heroin to
transport them.
- After they reach their destination, cathartics are administered so that packets can be passed and
delivered.
•
• BODY STUFFER SYNDROME:
- Individuals who rapidly swallow drugs as cocaine or heoine in an attempt to conceal when confronted by
the police or authorities.
SPINAL POISON- STRYCHNOS NUX VOMICA

• Poisonous Seeds are flat, circular discsQ, concave on one side & convex on the other, covered with silky hairs.
• They resemble enlarged RBCs.
Active Principles
• StrychnineQ—Alkaloid
• BrucineQ—Alkaloid
• Loganin—Glucoside.
Toxic Action:
• Strychnine competitively antagonizes glycineQ (inhibitory neurotransmitter) in the anterior hornQ cells of
spinal cord (Renshaw cells).
Clinical features
• Bitter taste.
• Increased rigidity of muscles and muscular twitchings.
• Convulsions: Initially, clonic but eventually become tonic, and affect all the muscles at the same time.
• In between convulsions, muscles are completely
• Consciousness is not lost and the mind remains clear till death.
Risus sardonicus
• Opisthotonus – body is arched posteriorly
• Emprosthotonus – body is arched anteriorly
• Pleurosthotonus – involuntary muscle contraction
DIFFERNCES BETWEEN STRYCHNINE POISONING AND TETANUS

FEATURES STRYCHININE POISONING TETANUS
Onset Sudden Gradual
Convulsions All parts of the body are involved at Not affected at the same time
the same time
Lower jaw Does not start from lower jaw Usually starts from lower jaw
Muscular condition between Relaxed Rigid
convulsions
Fatal period 1-2 hours >24 hours
Lab analysis Poison can be detected from food Clostridium tetani bacillus can be
demonstrated in microscopy

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Fatal dose: 1 crushed seed
Management:
- No specific antidote
- Treat convulsions with barbiturates
- Gastric lavage with KMnO4
- Hyperthermia is treated by active cooling
ASPHYXIANTS:
CYANIDE
- It is a vegetable acid found in nature in many fruits and leaves. Such as almond, apricot, apple, cherry, peach, plum,
pear.
- Hydrogen cyanide (gas) – most rapid poison (bitter almond smell)
- Hydrocyanic acid is HCN in water, either 2% or 4% (4% is called Scheele's acid)
- Potassium ferrocyanide and ferricyanide are non poisonous
ODOUR: Bitter almond smellQ

All cannot perceive this smell
MECHANISM OF ACTION: Causes histotoxic anoxiaQ by blocking the final step of oxidative phosphorylation and prevents
the formation of ATP
Bright redQ/ Brick redQ postmortem staining: Increased venous hemoglobin oxygen saturation.
- Spleen is the best specimen for cyanide analysis
- Inhalation of cyanide, causes instantaneous death by causing coma with seizures, apnea and cardiac arrest.
- Survivors of acute poisoning may develop delayed neurological sequelae in the form of parkinsonism.
- The basal ganglia is particularly sensitive to to cyanide toxicity.
- LEE JONES TEST: a quick bedside test that can qualitatively detect cyanide.
- In some countries: hydrocyanic gas is used for legal execution
Treatment:
1. Decontamination
2. Antidote therapy
- Hydroxycobalamine
- Nitrites
- Sodium thiosulphate
Eli lilly antidoteQ: ( Sodium nitrite, amyl nitrite & sodium thiosulphate)
• The principle of adding nitrate is to form methemoglobinemiaQ
Other anitdotes are: CyanokitQ (hydroxycobalamin) & KelocyanorQ (Dicobalt edetate)
CARBON MONOXIDE
Physical properties of CO:
- Colorless
- Tasteless
- Non-irritative
- Odorless gas
- Lighter than air

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MECHANISM OF TOXICITY
Anemic hypoxia
• It has a high affinity for Hb (about 250 times more than O2)
• CO combines reversibly with hemoglobin to form carboxyhemoglobin producing anemic hypoxiaQ.
• It inhibits the electron transport by blocking Cytochrome A oxidase and cytochrome P450
Brain findings:
- Bilateral symmetrical necrosis and cavitation of basal ganglia (globus pallidum and putament) is the most
characteristic finding.
- Cerebral edema
- Punctate haemorrhages in meninges, cortex
- Cellular necrobiosis in ganglionic cells in cortex
CARDIAC POISONS:
Important cardiac poisons are:
- Aconite
- Nicotine
- Digitalis
- Oleander (cerebra thevetia, cerebera odorum)
ACONITE/MONK’S HOOD
Common names:
- Meetha zaher
- Bish
- Wolf’s bane
- Women’s bane
- Devil’s helmet or blue rocket
• Entire plant is poisonous, however, the root is most potentQ.

• Dry root is conical or tapering, shows bases of the broken rootlets and shriveled with longitudinal
wrinkles.
• Active principles: AconitineQ, pseudo-aconitine, indaconitine, picraconitine and aconine.
• NO odor, Sweet taste (mitha bishQ)
Mechanism of action:
- Aconitine binds with high affinity to the voltage sensitive sodium channel causes membrane depolarization by
prolonging sodium influx.
Clinical features:
• Tingling followed by numbness of mouth and throat Q is characteristic symptom of aconite poisoning
• Xanthopsia – Yellow coloured halos seen around objects in vision.
• CNS: hypotension, bradycardia or sinus tachycardia, ventricular ectopics and other arrhythmias.
• CNS: Numbness & paresthesia of face, perioral area and four limbs; muscle weakness in four limbs
• GIT: nausea, vomiting, abdominal pain, and diarrhea
Cause of death: Due to hyperkalemiaQ
Hippus:
- HippusQ is a classical sign of aconite poisoning
- Pupillary athetosis, is the rhythmic alternate contraction and dilatation of pupils
- NO specific antidoteQ for aconite, atropine given to avoid vagal inhibition.

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TREATMENT:
- Gastric lavage
- Atropine – 1 m, given to prevent vagal inhibition of heart
- 0.1 % novocaine – to control the cardiac arrhythmias
ORGANOPHOSPHATES POISONING (OPC)
ORGANOPHOSPHOROUS POISONS ORGANOCHLORINES

ALKYL PHOSPHATES ARYL PHOSPHATES
TEPP, HETP, OMPA Parathion DDT, BHC (Lindane)
Malathion Methyl parathion Aldrin, chlordane
Dimefox, isopestox Chlorthion Dieldrin, endosulfan
trichorfon paraoxon Endrin (plant penicillin)
Toxaphenem paraquat
Mechanism of action: inhibition of acetylcholinesterase (AChE), true cholinesterase and pseudo cholinesterase.
MUSCARINIC SYMPTOMS (SLUDGE B3) NICOTINIC SYMPTOMS

- Salivation - Mydriasis
- Lacrimation - Tachycardia
- Urination - Weakness of muscles
- Diarrhea - Hypertension
- GIT upset - Fasciculations
- Emesis
Blurring of vision
Bronchorrhea
Bradycardia
DIAGNOSIS:
- Cholinesterase determination in blood
- Normal values 77-142 in red cells and 41-140 in the plasma
TREATMENT:
ORGANOPHOSPHOROUS CARBAMATES ORGANOCHLOROINE
COMPOUND
- Atropine - Atropine - Symptomatic
- Oximes (diacetyl - cholestyramine
monoxime (DAM),
pralidoxime (2-PAM)
Extra Edge:
- CHROMOLACHRYORRHOEA (red tears) due to accumulation of porphyrin in lacrimal glands
p-Nitrophenol test:
- confirmatory test for OPC poisoning
- p-nitrophenol is a metabolite of some OPCs (eg; parathion, ethion) and is excreted in the urine
Q. Black foot disease is seen in a poisoning case of:

• A. Mercury
• B. Lead
• C. Arsenic

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Q. A 5 year old girl with neuropsychiatry symptoms has a habit of licking paint in walls. These symptoms
are due to inhibition of which enzyme?
• A. Heme oxygenase
• B. ALA synthase
• C. ALA Dehydratase
• D. CPG oxidase
Q. Which of the following is an arrow poison?

• A. Opium
• B. Curare
• C. Cyanide
• D. Cannabis
Q. Alopecia + Diarhhea + Neuropathy. This triad can be seen in which poisoning case?
• A. Opium
• B. Dhatura
• C. Thallium
• D. Mercury
Q. Gastric lavage is contraindicated in all of the poisoning except;

• A. Phenol
• B. Nitric acid
• C. Sulphuric acid
• D. Kerosene
Q. Minimata disease:
• A. Lead poisoning
• B. Arsenic poisoning
• C. Mercury poisoning
• D. Dhatura poisoning

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12. HUMAN IDENTIFICATION
IDENTIFICATION
PRESUMPTIVE IDENTITY/INCOMPLETE COMPLETELY/DEFINITIVE IDENTITY
Race Tattoo
Sex Scar
Age Finger printing - Dactylography (MOST RELIABLE)
Stature DNA finger printing (Monozygotic twins can have same
DNA pattern)
• Identification: Determination of the individuality of a person based on physical characteristics.

• Corpus delicti: It is the body of offence or the essence of crime.
• Concealed Sex: Individuals concealing their sex to avoid detection, by wearing costumes of opposite sex.
• Hasse Rule: To determine gestational age of the fetus. Morrison
• Dactylography: System of identification of an individual based on Finger Prints.
• Poroscopy: System of identification of an individual based on the arrangement of sweat pores in finger Prints.
• Cheiloscopy: System of identification of an individual based on lip Prints.
• Rugoscopy: System of identification of an individual based on palatal rugae.
• Superimposition: Technique applied to determine whether the skull is that of the person in the photograph or
not.
• Locard’s Principle of Exchange: “When two objects come into contact with each other, there is always transfer of
some material between them”
• Trichology: Study of hair.
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Maternal hospital
• Podography: footprints: skin patterns of toes and heels are distinct and permanent.
1. Commotio rentis
2. Compus matis
3. Casper's dictum
4. Corpus delicti
CHEILOSCOPY

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RUGOSCOPY
RACE DETERMINATION
• Skull:
• Cephalic IndexQ or index of breadth or cranial index: is the percentage of breadth to length in any skull.
• The Indian skull is CaucasianQ with few Negroid characters.
• Cephalic index of Indian skull: 75–79.9Q
• Indian skull is mesaticephalicQ

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Craniometry – Spreading Calliper
3 MAIN RACES:
• CAUCOSOID – EUROPEANS & Chinese
• MONGOLOIDS – Japanese & ASIANS
• NEGROIDS – AFRICANS &Aryans
Race can be determined by BONES & TEETH

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Negroid Caucasoid Mongoloid

Orbit Square Triangular Round
Palate Rectangular Triangular Round

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RACE DETERMINATION FROM VARIOUS INDICES:
• CRURAL INDEX = Length of tibia/length of femur x 100

• BRACHIAL INDEX = Length of radius/length of humerus x 100
• INTERMEMBRAL INDEX = Length of (humerus + radius) /Length of (Femur + Tibia) x 100
• HUMERO-FEMORAL INDEX = Length of humerus/length of femur x 100
RACE DETERMINATION FROM TOOTH

MONGOLOID CAUCASOID NEGROID
Shovel shaped upper central incisors Carabelli’s cusp Large teeth with more cusps in
- Enamel pearls (seen in pre- their molars with two lingual
molars) cusps on mandibular first
- Taurodontism (bull tooth) premolars are common
- Congenital lack of upper 3rd
molars
-SHOVEL INCISORS: posterior surface of the incisors has a depression centrally with marginal ridges (like a
shovel)
- ENAMEL PEARLS: small nodules of enamel on the tooth surface
- CARBELLI’S CUSP: small additional nodule on lingual surface of maxillary molar (Molar1)
- TAURODONTISM (bull tooth): the pulp cavity of molars is wide and deep. The roots are fuse and bent
SHOVEL INCISORS
ENAMEL PEARLS

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BULL TOOTH – TAURODONTISM
CARABELLI CUSP
SEX DETERMINATION
• Primary sexual identification: By testis and ovary

• Secondary sexual characters:
Chromatin study:
• NUCLEAR SEX:
1. Barr Body
2. Davidson’s body
3. Demonstration of chromosomes

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BARR BODY
basophilic intranuclear structure located in the nuclei of the somatic cells of females. (near the inner surface of
nuclear membrane)
• Due to inactivation of an extra X chromosome
• It is found during interphase of cell cycle
• Sample can be taken from buccal smear, hair follicle and saliva
• In females: 20-80% count
• In males: 0-4%
Females having absent barr body: TURNER’S
Males having barr bodies: KLINEFELTER’S
• DAVIDSON’S BODY: the neutrophils of females, show a small uclear drumstick shaped lobe in the nucleus.
Sample should be taken from blood.
• In females: 0-6% In males: Negative
Demonstration od Chromosomes:
• X-chromosome: Using Acriflavin Schiff Reagent (Fluorescent Feulgen Reaction)
Differentiating male and Female on Skeleton Basis

• All muscle markings /ridges/tuberosities are more prominent in males except: frontal eminence, parietal
eminence and preauricular sulcus(pelvis)
• MEDULLARY INDEX:
• From tibia, humerus, ulna and radius
• MI = Diameter of medulla/diameter of whole bone x 100
DETERMINATION OF SEX FROM BONES:

KROGMAN’S ACCURACY: diagnostic accuracy in sexing from bones
KROGMAN’S ACCURACY
Entire skeleton 100%
Pelvis alone 95%
Skull alone 92%
Pelvis + skull 98%

Long bones 80%
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In pelvis: Greater sciatic notch

Is the best parameter.
Sex determination from pelvis:

• Best suitedQ for sex determination.
• Important features for sex differentiation: greater sciatic notch, pre auricular notch, sub-pubic angle, shape of
pubis.
• The greater sciatic notch is the single most important differentiating feature even in fetal life.
• MALE: deep and narrow sciatic notch
• FEMALE: wide and shallow sciatic notch

+ 9 1 7 6 8 0 9 2 9 2 92
+ 9 1 8 13 6 9 32 6 6 6 + 91 8 97 7 9 41 7 2 3
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FEATURE MALE FEMALE
Pelvic inlet Heart shaped Circular shapedQ

Pelvic cavity FunnelQ Flat bowl
Pre auricular Narrow, shallow BroadQ, deep

Sulcus Not frequent More frequentQ
(evidence of
Pregnancy)
Sub pubic ‘v’ shaped ‘u’ shaped
Angle Acute ObtuseQ
Greater sciatic NarrowerQ & deeper WiderQ & shallower
notch (75%)
Ischial tuberosity Inverted Everted
Sex determination from skull:

FEATURE MALE FEMALE
Architecture Rugged Smooth
Frontal eminence Small LargeQ

Parietal eminence Small LargeQ
Orbits SquareQ with smooth margin Rounded with

Sharp margin
Fore head SteeperQ Vertical
Glabella More pronouncedQ Less pronounced
Fronto nasal junction Distinct & angulated Smooth
Supra orbital ridges ProminentQ Less

Prominent
Diagastric groove More deep Less deep
Mastoid process Large & blunt Small & pointed
Occipital protuberance Well marked Less marked

+ 9 1 7 6 8 0 9 2 9 2 92
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VITAL INDICES FOR SEX DETERMINATION FROM BONES
NAME OF THE INDEX FORMULAE MALES FEMALES
SCIATIC NOTCH INDEX Width of notch/depth of notch 4-5 5-6

x 100
WASHBURN ISCHIOPUBIC Pubic length/ischial length x 73-94 91-115
INDEX 100
CORPOROBASAL INDEX OF Breadth of 1st sacral 45 40.5
SACRUM vertebrae/breadth of base of
sacrum x 100
STERNAL INDEX Manubrial length/body length 46.2 54.3
x 100
- All indices are more in female except CORPORO-BASAL INDEX
- Best index to determine sex from pelvis is ISCHIOPUBIC INDEX
AGE ESTIMATION
By:
• Dentition: Eruption and secondary changes
• Skull sutures
• Ossification of long bones

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GESTATIONAL AGE OF FETUS: From Crown to Heel Length (IUL)
1st 5 months 2nd 5 months (6-10 m)

RULE OF HASSE RULE OF MORRISON
GA = Square root of CHL GA = CHL/5
FETUS EXAMINATION
MONTH LENGTH (cm) GRWOTH EVENTS
1 1
2 4 Limb buds appear
3 9 Nails appear
4 16 Lanugo hairs
5 25 Scalp hair
6 30 Eye brows, eye lashes
7 35 Eyes open
8 40 Left testis coming to scrotum
9 45 Right testis in scrotum
10 50
Note: Sex can be recognised by 4th month (16th week of IUL) by USG and physical examination of fetus
OSSIFICATION CENTRES - During IUL

• 1st centre to appear - Clavicle
5th month Calcaneum
7th month Talus
9th month Lower end of femur and Cuboid

10th month Upper end of tibia
CARPALS:
SCAPHOID LUNATE TRIQUETRAL PISIFORM
She Looks Too Pretty
5y 4y 3y 9-11y
TRAPEZIUM TRAPEZOID CAPITATE HAMATE

Try To Catch Her
6y 6y 2m 3m-1y

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+ 9 1 7 6 8 0 9 2 9 2 92
+ 9 1 8 13 6 9 32 6 6 6 + 91 8 97 7 9 41 7 2 3
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UPPER LIMB JOINT LOWER LIMB JOINTS

Wrist 18 Ankle 16-17
Elbow 16 Knee 18
shoulder 18 Hip 16-17
Age estimation by: DENTITION

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AGE ESTIMATION FROM DENTAL ERUPTION
Temporary dentition/Primary/Milk teeth/Decidious Permanent dentition/Secondary

teeth
• 20 teeth in number • 32 teeth in number
• 2 incisors 1 canine 2 molars in each quadrant • 2 incisors 1 canine 2 premolars 3 molars in
each quadrant
Note: Premolars are absent in Primary/ temporary dentition
Sequence of temporary teeth eruption:

Incisiors (central and lateral), Molar (1st ), Canine, Molar (2nd ) = 5 in 1 quadrant
Temporary Dentition Average age of eruption Age in ranges

(months) (months)
Lower central incisor (CI) 6 6-8
Upper central incisor (CI) 7 7-9
Upper lateral incisor (LI) 8 7-9
Lower lateral incisor (LI) 9 10-12
Fist molar (M1) 12 12-14
Canine (C) 18 17-19
Second molar (M2) 24 20-30
Sequence of temporary incisors eruption:

• LCI – 6 months
• UCI - 7 months
• ULI - 8 months
• LLI - 9 months
RULE OF HALF DOZEN: (multiples of 6)
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Eruption sequence of temporary teeth

• Incisors: 6 months
• 1st Molar: 12 months
• Canine: 18 months
• 2nd Molar : 24 months
Permanent dentition Average age Age

of eruption (years)
(years)
First molar (M1) 6 6-7
(First to erupt)
Central incisor (CI) 7 6-8
Lateral incisor (LI) 8 7-9
First premolar (PM1) 9 9-11
Second premolar (PM2) 10 10-12
Canine (C) 11 11-12
Second molar (M2) 12 12-14
Third molar (m3) 17-25 17-25

(Last to erupt) – Wisdom tooth
Period of Mixed dentition:

• The permanent dentition starts with first Molar by 6 years.
• During that process, both the temporary teeth & permanent teeth present in the oral cavity between 6 years
and 11 years – Period of Mixed Dentition
• Number of permanent teeth = (Age – 5) x 4
SUPERADDED TEETH SUCCESSIONAL TEETH
• Teeth which don’t have • Teeth which erupt in the

deciduous predecessors place of deciduous teeth.
• All permanent molarsQ. • Permanent incisors,

canines & premolars.
• 12 in numberQ
• 20 in numberQ
CHRONOLOGICAL SEQUENCE OF PERMANENT DENTITION ERUPTION
AGE ERUPTING TOOTH

6 months Temporary incisors
12 months Temporary 1st Molar
18 months Temporary Canine
24 months Temporary 2nd Molar
6 yearsQ Permanent 1st Molar (First)Q

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7 years Permanent central incisors

8 years Permanent lateral incisors
9 years Permanent 1st Premolar
10 years Permanent 2nd Premolar
11 years Permanent Canine
12 years Permanent 2nd Molar
17 - 25 years Permanent 3rd Molar (Last)Q
Other methods of age estimation from teeth

BOYDE’S METHOD:
• Enamel grows @ 4µ/day
• On electron microscopy: these are seen and called as incremental lines (STRIAE OF RETZIUS)
• It is noted on 2nd/3rd day – 1st line-darkest – neonatal line - Sign of live birth
• 1 line / day will be added
• Age is calculated by counting the number of lines from the neonatal life
• Useful to estimate the age of a dead infant.
• Age can be determined in terms of days
STACK’S METHOD
Age is estimated from the height and weight of the erupting tooth
Used in fetus and infants
GUSTAFSON’S METHOD:
- Age estimation of adults >21 yrs
- Depends on the secondary changes in the teeth
- Anterior teeth are more reliable than posterior (incisors more reliable than premolars)
Criteria used: (mnemonic – SCRIPT)
AttritionQ: Wear and tear seen over the occlusal surface.
Paradentosis: The gum margins become retracted and there is loosening of teeth.
Secondary dentinQ: Deposition of dentin (secondarily) within the pulp cavity. (2ND MOST RELIABLE CRITERIA)
Root resorption: Root resorption due to ageing.
Transparency of rootQ: It is the transparency of the dentin at the root level. (MOST RELIABLE CRITERIA)
Cementum apposition: Apposition of cementum at and around the root of the teeth.
Some important points related to DENTAL ERUPTION:

• Temporary dentition starts at 6 months of age
• Temporary dentition gets completed at 2 years of age
• No premolars in temporary dentition
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• Permanent dentition starts at 6 years of age (1st molar)

• From the age of 6-11 year, the total number of teeth in the jaw is 24. because, the erupting successive teeth
replaces all the temporary teeth one by one,
• Temporary molars are replaced by permanent premolars.
• Delayed dentition: Rickets and ill-nourished children
• Early eruption: Syphilis
• Period of mixed dentition: between the age 6 and 11 years, both temporary & permanent teeth are seen in the
jaw
• Last temporary tooth to fall is canine.
DACTYLOGRAPHY – FINGERPRINTING STUDY

These are the impressions produced by dermal ridges on a surface
• Starts appearing in 12th week of IUL and it gets completed by 24th week of IUL
• In practice 10-12 points of comparisonQ are accepted as proof of identity.

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POROSCOPY
• Poroscopy is the study of pore structureQ found on the papillary ridges of the fingers as a means of
identification.
• Developed by Edmund LocardQ, as a means of identification.
Principle:
• The pores are the openings of sweat glandsQ.
• The pores’ characteristics are unique to each individual & permanentQ.
LIP PRINTS (CHEILOSCOPY)

• CheiloscopyQ is the study of lip prints.
• Lip prints are unique & used for personal identification.
Determination of Stature
• Can be determined from skeletal bones by formulae:
• Karl Pearson’s and Trotterand Glesser’s
• Usually long bones are ideal
• Femur is the best bone
Newer methods of age estimation:

• From teeth:
• Aspartic acid racemization
Chemical method:
• Estimation of nitrogen content of enamel (increases with age)
• Carbonate content (decreases with age)
Radiocarbon dating of tooth enamel:
• Precise estimation of an individual’s date of birth
TRICHOLOGY

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HUMAN HAIR ANIMAL HIAR

Fine thin Coarse and thick
Cortex thick (4-10 times as broad as medulla) Cortex thin
Cuticular scales are short, not continuous Cuticular scales are large, step like projections
Pigment more towards peripheri Pigment more towards medulla
Medulla thin and fragmented, sometimes absent Medulla broad, continuous and always present
Medullary index <0.3 >0.5
• Tattoo MarksFaint or disappeared tattoo marks can be made out on histological study of the regional
lymph nodes.
• In decomposed bodies, they are made visible by treating the area with 3%H2O2.
Methods to demonstrate old or faint tattoos visible;
• 1. infrared photography
• 2. UV lamp
• 3. Magnifying glass
• 4. high contrast photography
TESTS FOR BLOOD STAINS

To know the origin; Human or not? To identify blood stains
Serological tests Spectroscopy

Macrochemical tests
Microchemical tests
Immunological methods: Spectroscopy: Most reliable test for detecting blood in

- Gel diffusion recent and old stains
- Double diffusion in agar gel MICROCHEMICAL TESTS:
- Precipitation electrophoresis - Takayam Haemochromogen Crystal test: pink
- Hemagglutination feathery crystals of haemochromogen
- Precipitin test - Teichmann’s Hemin Crystal test: brown
- Latex test crystals of hemin chloride
MACROCHEMICAL TESTS: tests based on H2O2
- Benzidine test
- Toluidine blue test
- Leucomalachite green test
- Kastle-Meyer test or Phenolphthalein test

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SEMINAL STAIN EXAMINATION
Physical tests for seminal stains:

• Dried seminal stains on clothes can be examined by UV light.
• Fluorescence noted, which is non specific
Chemical Tests for seminal stains:

FLORENCE TEST: Formation of dark-brown rhombic crystals of choline iodide.
• Due to choline from seminal vesicle
BARBERIO’S TEST: Formation of yellow needle-shaped spermine picrate crystals.

• Due to the presence of spermine in semen
ACID PHOSPHATASE TEST: Undiluted semen has an acid phosphatase level of 340-360 Bodansky units/mL.
• A value of >100 Bodansky units with/without motile sperms indicate that ejaculation occurred within 12 hours of
examination.
• It is useful even in absence of sperm
Other tests are:

• Creatine Phosphokinase test (High in seminal fluid and can be detected even in 6 months old stains)
• Ammonium molybdate test (Detects phosphorous)
• Prostate specific antigen and Glycoprotein P30 test
IDENTIFICATION OF SPECIES ORIGIN:

• Precipitin test
• LDH isoenzyme pattern (human pattern is different from animal pattern)
• Detection of Y bodies in spermatozoa heads ( which is not seen in animals)
Q. Pre-auricular sulcus helps in detection of;

• A. Age
• B. Race
• C. Sex
• D. Height
• Q. Following a mass disaster, best way to identify bodies is;

• A. X-rays
• B. Dental
• C. Clothing
• D. None
• Q. A dead fetus is found in water canal & has a length of 25 cm. on post mortem examination, nails were
distinct. Light hairs were seen on head and ossification centre appears in calcaneum. What is the likely
gestational age of fetus?
• A. 2 months
• B. 5 months
• C. 7 months
• D. 9 months
• Q. Bundle of bones found were of a child around 12 years age. Which of the following bones would be the
most reliable for sex determination of the child for medico-legal purpose?
• A. Femur
• B. Skull
• C. Hip Bone
• D. Mandible

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Q. A piece of cloth was submitted by police obtained from a crime scene with some dried stains. On
microscopic examination after adding picric acid solution, yellow needle shaped crystals are seen. This
test is done to detect which of the following?
• A. CSF
• B. Semen
• C. Saliva
• D. Blood
Q. Study of lip prints is called as;

• A. Podography
• B. Dactylography
• C. Poroscopy
• D. Cheiloscopy
13. INDIAN LAWS and MEDICOLEGAL PROCEDURES
Legal Sections: Excerpts from Criminal Manual – By eastern book company – 26th edition
• INDIAN PENAL CODE (IPC) 1860:

• 44 IPC - Injury definition
• 46 IPC - Death definition
Criminal Responsibility:
Sec 82 IPC Criminal responsibility of person < 7 years = not liable.
- A child under the age of seven is incapable of committing an offence.
Sec 83 IPC Criminal responsibility of person 7-12 years = Liability depends on the mental maturity.
- Presumed to be capable of committing an offence if he has obtained sufficient maturity to understand
and judge the nature and consequences of his conduct.
Sec 84 IPC Criminal responsibility of insane person = not liable (MC Naughten rule - right or wrong test)
Sec 85 IPC Criminal responsibility of involuntary drunkenness =not liable (intoxicating substance is given without
the knowledge of the person)
Sec 86 IPC Criminal responsibility of voluntary drunkenness = liable (intoxicating substance is taken with intent)
Sec 87 IPC A person below 18 years of age cannot give valid consent to suffer any harm which can cause death or
grievous hurt. Eg; consent for wrestling
Sec 88 IPC Act not intended to cause death, but can cause death or grievous hurt, done by consent in good faith
and for the benefit of that person. Eg; death of a patient caused by surgery done by a surgeon.
Age for Consent:

• Definition of consent: Section 13 of Indian Contract Act.
Sec 88 IPC • Any act done in a good faith Should be done with consent of the
• Any act not intended to cause death person
Sec 89 IPC • Consent in case of child < 12 years/insane person obtained from guardian
• A person below 12 years and an insane person cannot give a valid consent to suffer any harm
Sec 90 IPC • Minimum age for consent of physical examination – 12 years
Consent given under insanity/intoxication/fear of injury – Invalid
In emergency situations, consent not required
Sec 92 IPC

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Treatment of Rape Victim:
Sec 166 B IPC Punishment for not treating a rape victim in Govt. or Private hospital is punishable – 1 year
imprisonment
Sec 228 A IPC Disclosing the identity of rape victim – 2 years
Summon:
Sec 172 IPC Punishment for avoiding summon -1 month imprisonment

Sec 174 IPC Non-attendance to summon
Sections Related to Police Intimation:
Sec 176 IPC Intentional omission to give information to a public servant by person legally bound to give (1
month imprisonment)
Sec 177 IPC Intentionally giving false information to a public servant (6 months imprisonment)
Sec 178 IPC Refusing to take oath – 6 months imprisonment & Fine
Perjury & Hostile Witness:
Sec 191 IPC Giving false evidence under oath (perjury definition)
Sec 192 IPC Fabricating false evidence

Sec 193 IPC Punishment for perjury (3-7 years)
Issuing False Medical Certificates:
Sec 197 IPC Issuing (attesting ) false medical certificates (7 years + fine)
Sec 198 IPC Punishment for using false certificates (7 years)
Sections Related to Preservation of Evidences and Police Intimation:
Sec 201 IPC Causing disappearance/destruction of evidence (up to 10 years)

Suspected articles of poison to be preserved (noncompliance-Sec 201 IPC)
Embalming in poisoning case before autopsy
Sec 202 IPC Intentional omission to give information regarding offence by person bound to give (6 months)
Sec 203 IPC Giving false information regarding the offence (2 years)
Sec 204 IPC Destruction of documentary evidence (2 years)
Transmission of Fatal infections:
Sec 269 IPC Negligent act likely to spread disease dangerous to life-punishment
Sec 270 IPC Willful act likely to spread disease dangerous to life-punishment

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Adulteration of Food and Drugs:
Sec 272 IPC Punishment for adulteration of food

Sec 274 IPC Punishment for adulteration of drug
Sec 275 IPC Punishment for sale of adulterated drug
Negligence in Handling Poisons:

Sec 284 IPC Negligent act in handling poisonous substances
Sec 328 IPC Giving stupefying drug with intent to cause hurt- 10 years
Offences on Human Body:

Sec 299 IPC Definition of culpable homicide not amounting to murder
Sec 300 IPC Definition of murder (culpable homicide amounting to murder)
Sec 302 IPC Punishment for Murder – Death or imprisonment for life
Sec 304 IPC Culpable homicide not amounting to murder. Imprisonment for life or 10 years, and also fine
Sec 304 A IPC Death caused by rash and negligent act-2 years
Sec 304 B IPC Dowry death- death of a female within 7 years of marriage
Sec 306 IPC Abetment of suicide – 10 years, also fine
Sec 307 IPC Attempt to murder – 10 years
Sec 308 IPC Attempt to commit culpable homicide – upto 10 years
Sec 319 IPC Definition of Hurt – bodily pain, disease or infirmity
Sec 320 IPC Grievous Hurt – Definition
Sec 323 IPC Punishment for voluntarily causing hurt -1 year, with fine
Sec 324 IPC Voluntarily causing hurt with dangerous weapon – 3 years also fine
Sec 325 IPC Voluntarily causing grievous hurt – 7 years, also fine
Sec 326 IPC Voluntarily causing grievous hurt by dangerous weapon – 10 years, also fine
Sec 326 A IPC Punishment for acid throwing (vitriolage) – life imprisonment
Sec 326 B IPC Attempt to acid throwing – 5 years
GRIEVOUS HURT
Emasculation
Permanent privation of sight of either eye
Permanent privation of hearing of either eye
Privation of any joint
Permanent disfiguration of head or face
Fracture or dislocation of a bone or tooth
Any hurt which endangers life or which causes the victim to be in severe bodily pain, or unable to follow his ordinary
pursuits for a period of 20 days.
Offences Against Woman:

Sec 354 A IPC Punishment for sexual harassment (1-3 years)
Sec 354 B IPC Use of criminal force on woman to disrobe (3 – 7 years)
Sec 354 C IPC Voyeurism
Sec 354 D IPC Stalking:
(1st offence: Cognizable & Bailable;
2nd offence: Cognizable & Non bailable)

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Sec 359 IPC Kidnapping Definition
Sec 362 IPC Abduction Definition
Sec 363 IPC Kidnapping – Punishment
Sec 364- 369 IPC Kidnapping under various circumstances
Torture:
Sec 330 IPC Torture (Voluntarily causing hurt to extort information/confession) 7

years
Sec 331 IPC Torture (Voluntarily causing grievous hurt to extort
information/confession) 10 years
Causing Harm on Provocation or Negligant Act:
Sec 334 IPC Voluntarily causing hurt on provocation -1 month imprisonment

Sec 335 IPC Voluntarily causing grievous hurt on provocation – 4 years imprisonment
Sec 337 IPC Causing hurt by doing rash or negligent act – 6 months imprisonment
Sec 338 IPC Causing grievous hurt by doing rash or negligent act – 2 years imprisonment
Sec 351 IPC Assault definition

Sec 352 IPC Punishment for assault
Sexual Perversions:
Sec 297 IPC Necrophagia/necrophilia (1 year)
Rape and Unnatural Offences:
Sec 375 IPC Rape – Definition

Sec 376 IPC Punishment for rape
Sec 376 A IPC Punishment for causing death or persistent vegetative state of victim due to rape 20 years/ life
imprisonment/death
Sec 376 AB IPC Rape of girl < 12 years (20 years to life/death)
Sec 376 B IPC Marital rape – 2 years
Sexual intercourse by husband upon his wife during separation
Sec 376 C IPC Sexual intercourse by person in authority
Sec 376 D IPC Gang rape –
Where a woman is raped by more than one persons constituting a group
Sec 376 DA IPC Gang rape of girl < 16 years (life/death)
Sec 376 DB IPC Gang rape of girl < 12 years (life/death)

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Sec 376 E IPC Punishment for repeated offenders – Life imprisonment or death
Sec 377 IPC Nonconsensual Unnatural sexual offences – 10 years
Adultery and Indecent Assault:
Sec 498 A IPC Subjecting a married woman to cruelty by husband or in laws

Sec 509 IPC Word, gesture or act intended to insult the modesty of a woman – 3 years
Drunkenness:
Sec 510 IPC Misconduct in public by a drunken person – simple imprisonment up to 2 hours
CRIMINAL PROCEDURE CODE (CrPC) 1973:

Offences:
Sec 2 (c) CrPC Cognizale offence

Sec 2 (g) CrPC Inquiry
Sec 2 (i) CrPC Non-cognizable offence
Sec 2 (w) CrPC Summons case
Sec 2 (x) CrPC Warrants case
Sec 39 CrPC Public to give information of certain offences – to police or magistrate
Abortion:
Legal provisions against miscarriage Jail term

312 IPC Punishment for causing miscarriage 3-7 years
313 IPC Punishment for causing miscarriage without the woman’s consent 10 years – life imprisonment
314 IPC Punishment for causing Death of the mother by act intended to 10 years – life imprisonment
cause miscarriage
315 IPC Punishment for doing any act preventing child birth or causing 10 years
death of child after birth
316 IPC Causing death of quick unborn child amounts to culpable homicide 10 years
317 IPC Punishment for abandonment of child under 12 years 7 years
318 IPC Punishment for concealment of birth by secret disposal of dead 2 years
body
Offences related to dowry death:

304-B IPC: Dowry death. 10 years of imprisonment which can extend to life.
Note: 304-A IPC is related to death caused by negligence
498-A: punishment for cruelty by husband or his relatives
Medicolegal Examination:
Sec 53 CrPC Medical examination of any accused, if requested by a police officer (not below SI).
Sec 53 (2) CrPC A female should be examined, only by or under the supervision of a female registered medical
practitioner
Sec 53 A CrPC Medical examination of rape accused, if requested by a police officer (not below SI)
Sec 54 CrPC Medical examination of an arrested person at his own request
+ 9 1 7 6 8 0 9 2 9 2 92
+ 9 1 8 13 6 9 32 6 6 6 + 91 8 97 7 9 41 7 2 3
+ 91-95600228-36/37/38 + 9 1 7 3 9 6 7 5 7 5 85
+ 9 1 96 3 3 79 9 5 04 + 91 8 9 77 9 4 2 72 3
: 0 4 0 2 3 5 1 52 5 2
[email protected]
186 | P a g e
FORENSIC MEDICINE
Inquest:
Sec 174 CrPC Police inquest

Sec 176 CrPC Magistrate inquest
Rape cases:
IN CAMERA TRIALS – Sec. 327 (2) CrPC
SEC. 416 CrPC
• Postponement of capital sentence on pregnant woman
• The high court shall order the death sentence of a pregnant to be postponed or commuted to life imprisonment
INDIAN EVIDENCE ACT (IEA) 1860:
Sec 32 IEA Dying declaration
Sec 45 IEA Expert witness
• Q. A physician punishable for medical negligence for infecting a normal healthy person with HIV +ve
needle under which IPC section?
• A. 269 IPC
• B. 202 IPC
• C. 203 IPC
• D. 166 B IPC
• Q. Which of the following is a penal code for death sentence?

• A. IPC 300
• B. IPC 302
• C. IPC 304
• D. IPC 320
• Q. A husband physically assaulting wife is punishable under;

• A. IPC 304 A
• B. IPC 304 B
• C. IPC 498 A
• D. IPC 84

+ 9 1 7 6 8 0 9 2 9 2 92
+ 9 1 8 13 6 9 32 6 6 6 + 91 8 97 7 9 41 7 2 3
+ 91-95600228-36/37/38 + 9 1 7 3 9 6 7 5 7 5 85
+ 9 1 96 3 3 79 9 5 04 + 91 8 9 77 9 4 2 72 3
: 0 4 0 2 3 5 1 52 5 2
[email protected]
187 | P a g e
ARISE - DELHI ARISE - HYDERABAD
Contact : Contact :
+ 91 9560022836 + 91 7680929292
+ 91 9560022837 + 91 7396757585
#: 2nd Floor, Above Indian Bank,
+ 91 9560022838 Opp. : Olive Hospital
K261, 2nd Floor Lane No.5, Kakatiya Nagar Colony,
Westend Marg, Saidulajab, Mehdipatnam, Hyderabad - 500 028
Saket, New Delhi, Delhi 110030 :[email protected]
:[email protected]
ARISE - KERALA ARISE - CHENNAI

Contact : Contact :
+ 91 8136932666 + 91 8977941723
+ 91 9633799504 + 91 8977942723
#: 2nd Floor, Kingdom Tower, #: No. A Super 20, Thiru.
Manna, Taliparamba, Vi Ka Industrial Estate,
Kannur, Kerala, India Guindy, Chennai-600032
:[email protected] :[email protected]
ARISE - JAIPUR
Contact :
+ 91 8977541723
+ 91 8977641723
+ 91 9929113115
+ 91 9929113116
Plot No-26, Krishna Vihar, Sector-5,
N ea r P u s h p E n c l a v e, P r a t a p n a g a r ,
Tonkroad, Sanganer, Jaipur-302033.
: a r i s em e d i c a l a c a d e m y j p r @ g m a i l . c o m
RISE WITH ARISE

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FORENSIC MEDICINE

CHAPTER PAGE NUMBER

3. MEDICAL LAW & ETHICS 27

7. ABORTION AND MTP (Medical

10. FORENSIC BALLISTICS 123

11. FORENSIC TOXICOLOGY 135

12. HUMAN IDENTIFICATION 161

13. Indian Laws 182

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TRANSPLANTATION OF HUMAN ORGAN ACT- THOA (Latest amendment 2014):

A Medical Board (BRAIN DEATH COMMITTEE) consists of;

• RMP, in charge of same hospital of patient

AUTHORIZATION GIVEN IN CASES OF ORGANS DONATED

Q. Which type of euthanasia is legally permitted in India?

• Euthanasia (Mercy Killing) : pentobarbital 2-10 g, death within 15-30 min

• Passive or Negative: withdrawing life supporting devices from a serious patient.

THANATOLOGY: study of death

Two types of death: Somatic and Molecular

SOMATIC DEATH: (SYSTEMIC DEATH/CLINICAL DEATH)

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Complete and Irreversible stoppage of;

Somatic death is associated with immediate signs:

CLINICAL CRITERIA to diagnose BRAIN DEATH:

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CLINICAL CRITERIA to diagnose BRAIN DEATH:

1. COMA 2. ABSENCE OF BRAINSTEM REFLEXES 3. SIGNS OF BRAIN STEM (LOWER)

All these tests are to be repeated, after minimum interval of 6 hours.

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Note: Certain conditions can cause reversible comatose situations.

First exclude such reversible causes like:

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MOLECULAR DEATH (CELLULAR DEATH):

EARLY SIGNS LATE SIGNS

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BEATING HEART CADAVER/BEATING HEART DONOR:

SUSPENDED ANIMATION (APPARENT DEATH)

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• In – Insanity / iatrogenic as in cardiopulmonary surgeries & anesthesia

Medicolegal Importance: Suspended animation should not be mistaken for death.

PRESUMPTION OF SURVIVORSHIP and PRESUMPTION OF DEATH:

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AUTOPSY: Postmortem Examination.

Q. Which of the following is against the rule of conducting a medicolegal autopsy?

RULES FOR MEDICOLEGAL AUTOPSY:

In suspicious, In natural/hospital deaths, - Usually Virtual autopsy All findings

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Police Consent from legal Done by Using imaging No definite

• Q. In medicolegal autopsy, which of the following is incorrect?

TYPES OF SKIN INCISION USED IN AUTOPSY:

• ‘I’ shaped incision: (chin to symphysis pubis) –

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IMPORTANT INDIVIDUAL ORGAN DISSECTION:

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SPINAL CORD DISSECTION

POSTERIOR APPROACH ANTERIOR APPROACH

STOMACH DISSECTION (Double Ligation Method):

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COLLECTION OF SAMPLES DURING AUTOPSY:

PRESERVATION OF DEAD BODY IN MORTURY;

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