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English Pages [297] Year 2022
'
,-
• ·._...,.;��---==--.. �:�r10;�;;:-.:�-�::;;.,:�j},���-:,fc, ""9T) Wlder& shallower
Large and oval
Small and triangular
Acetabulum
Large, directed laterally
Smal, directed anterolaterally
Ischial tuberosity
Inverted
Everted
JObturator foramen
Sacrum
Long
Uniform curvature Promontory more prominent
Pubis body
|Trlangular
Small
Upper half straight, lower half curved forward.
Promontory less prominent. Square
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33
Dr Pedagogy
Forensic Medicine Sex Determination from Theory LFeatures
|Architecture
Muscle markings &
Male
Female
Less obtuse angle
More obtuse angin
Square-shaped chin
V-shaped chin
Skull
Male
Rugged More pronounced
Female
Smooth
Less pronounced
bony ridges
(Glabella, supraorbi
tal ridges, occipital
protuberance, zygo matic arch, mastoid
process)
|4Frontal eminence 8
Small
Large
parietal eminence Orbits
Square with smooth margin
Forehead
Rounded with Sharp margin
Sloping &steeper Vertical U shaped
Smaller and parabola
Frontonasal
Distinct and
Smooth
junction
angulated
Palate
|Digastric groove
Mastoid process
Large, broader and
More deep
|Large and blunt
Less deep
Small and pointed Sloping forehead Prominent
Prorninent
VITAL INDICES FOR SEX DETERMINATION FROM BONES
supraorbital
Name of the
Acte fronto
index
nasal angle
Sclatic notch
Occiput
index Large
Washburn
mastoid
ischiopubic
Males Femle
Formulae
4-5
Width of notch Depth of notch
Width of notch Depth of notch
73-9491-15 100
index Verical forehead Smooth
CorporobasalBreadth of 1st sacral vertebra index of Breadth of base of sacrum
45
x 100
sacrum
46.2
frontonasal
angle
Sternal indexManubrial length
43
x 100
Body length
Ashley's Rule
Sex Determination from Mandible
" To determine the sex of the sternum
Features
Male
Female
Appearance
Large
Small
Chin
Angle of body with
Prominent muscle
Not prominent
markings Square shaped
muscle markings
Less obtuse 12s*
Roundeda
ramus
34
Angle of mandible
Everteda
Inverted
sternumlengt " It is also known as '149 rule' e female and >149 mm Male sternum length I is Is 0.59
human
In the scene of crime, bite marks on foodstuffs (apples, cheese a
Nature of Bite Marks
Pigment more towards the
Laiteatperiphery
mented, sometimes absent Medullary index c0.39
" "
Cortex thin
broad as medulla)
|Pigment more towards the
Sexual assault
Investigations Done Contd.
" Photographs from various angles
Swabbing of saliva
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Dr Pedagogy .
Inpression of bite mark: with Plastic substance (rubber or silicone based) or plaster of Paris.
skin carrying the bite is removed and
during autopsy.
preserved
in formalin
Human ldentification
LOCARD'S PRINCIPLE OF EXXCHANGE "
It states that "When two objects come into contact with each other, there is always transfer of some material between them: There will be a transfer of trace evidences between the accused, victim and the scene of crime.
Theory
" This is helpful in crime investigations, especially in sexual offences. TRANSFER OF EVIDENCES
Victim
Accused
Crime scene
DETERMINATION OF STATURE
iAnt
Stature can be determined from skeletal bones by formulae (Karl
Pearson's &Trotter and Glesser's) & multiplication factors
" Usually long bones are ideal for determining stature. "
Femur is the best bone used for stature estimation.
RECENT ADVANCES Newer methods of age estimation
Mehoda Rugesin Phcnle
From teeth: " Aspartic acid
racemization
Chemical method:
Estimation of nitrogen content of enamel (increases with age) PERCENTAGE OF STATURE CONTRIBUTED BY BONES
MULTIPLICATION FACTOR FOR STATURE DETERMINATION " Femur: 3.7
"Femur: 27%
" Tibia and fibula: (3.7+0.8)=4.5
Carbonate content (decreases with age) Radiocarbon dating of tooth enamel: Precise estimation of an individual's date of birth.
" Hurmerus: (4.5 +0.8)= 6.3
"Tibia 22% "Humerus 209%
Ulna: (5.3 + 0.8)= 6.1
Spinal column: 35%
"Radius: 6.5
-Shede Meken'
mahod
" Femur forms 27% of the entire stature of aperson.
Rau
Aopea,ane liament qrunles
Aien
Blasd- thik, higt 47
Lan vg hoir
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Resonirg-,TD
Dr Pedagogy a Glance
Forensic Medicine
F
Chapterat
Theory
IDENTIFICATION cOMPLETE INDENTIFICATION FINGERPRINTS DNA STUDY
PRESUMPTIVE IDENTIFICATION
LIP PRINT
PALATE PRINTS
RACE
FOOT PRINTS SCAR
AGE
SEX
STATURE
TATTOO SUPERIMPOSITION
STATURE rellable Is most Femur "Kart Pearson, Trotter
SEX DETERMINATION
Physlcal examination
RACE skull Cephallc lndex from
body
study (Barr . Sex chromatln In females) body Davidson nd and testes and "
and Glessers formulae used
AGE
Dental eruptlon
Ossificatlon of
epiphyses of long bones
biopsy of Gonadal Ovary (confimatory method) y Delection of SRY gene in chromosome
RELIABLE PELVIC BONE IS MOST
SEX
DETERMINATION FROM
BONES
MANDIBLE Male: Square chin, everted and less obtuse angle
MALE SKULL
fore head
MALE PELVIS
Heart-shaped pelvic inlet Funnel-shaped pelvic cavity Shallow pre auricular sulcCus
Acute sub publc angle notch Narrow greater sclatic
" Sloping "More pronounced glabella "Angulated fronto- nasal
Female: Rounded chin, inverted and more obtuse
lunctlon supra- orbital "Prominent
angle
rldgesmastoid process "Large
FEMALE PELVIS
Clrcularshaped pelvic inlet Bowl pelvicaiuricular ca sulcus Broad pre-au
Obtuse sub publc angle
Wider r
Everted isci
r sciatic notch
tuberosity
FEMALE SKULL "Large frontal eminence "Large parletal eminence "Rour
d orbits
Vertical forehead Smooth oth fronto-nasal junctlon
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Dr Pedagogy
Human ldentification
TEMPORARY DENTITION
Begins by 6 months Complete by 2 years
Theory
AGE ESTIMATION
20 In number
FROM DENTITION
In each jaw: 4 inclsors, 2 canines, 4 molars
BOYDE'S METHOD: INCREMENTAL LINES
STACK'S METHOD: WEIGHT OF THE TOOTH PEKMANENT DENTITION
METHODs OF CHARTING THE TEETH Universal
Begins by 6
.32 in number
in each jaw: 4 incisors, 2 canines. 4 premolars & 6 molars
.First permanent tooth to erupt is first molar.
SUCCESSIONAL TEETH
Teeth wthich don't have
.Teeth which replace the
deciduous predecessors All permanent molars
Secondary dentin
Haderup system FDI System (internationally
Root resorption
Transparency of root (most
reliable) Cementum apposition
SALIENT POINTS
From the age of 6-12 year the total| number of teeth in the jaw is 24,
deciduous teeth.
Period of mixed dentition": 6 and
"Incisors, canines and
premolars (20)
(12)
Paradentosis
Palmer notation
accepted) ·Modified FDI System
sUPERADDED TEETH
GUSTAFSON'S METHOD Attrition
12 years.
DEFINITIVE IDENTIFICATION
FINGER PRINTS
TYPES
DACTYLOGRAPHY 1st used in India by sir William Herschel first systematized by Sr Frands Galton first
fingeprit bureau of the world-
calcuta
16-20 pints of comparison are
accepled as proof of identity
Loops (most Common)
Whorls Arch
Composite
FINGERPRINTS
Most rellable
method of
identification "Different even it
jdentical twins " Not inheriled
PERMANENT
ALTERATION OF
POROSCOPY Study of pore structure between the fingerprint nridges.
s of sweat FINGERPRINTSPores are the openir od hy glands. Developed by Edmund
- Leprosy,
RUGAE:
electroculation, radiation and
ngraft
FOOTPRINTS: PODOGRAPHY LIP PRINTS: CHEILOSCOPY PALATE
The oores characteristics are
RUGOSCOPY
unique to each individual and
permanent
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ForensicMedicine
Theory
Dr Pedagogy ConceptsLast-Minute Tidbite
Freguently Asked
essence of crime. index, humerofemoral index. index, intermembral of offence or body the brachial index, crural Dolichocephalic index, Corpus delicti is is Cephalic index, nasal Cephalic index of Aryans Mesaticephalic.; Indices for Race: inn Mongoloids. scen are Indian skull is incisors and taurodontism motive. Cephalic index of an Shovel Caucasoids, cross-dressing with a cusp is seen in sex by real their " Carabelli's hide who bones. Concealed sex: Individuals accuracy in sexing from individual: Pelvis (95%). Diagnostic of Krogman's accuracy: accuracy about the sex shallow in females and nar maximum & wide pelvis; the in gives sex differentiate " Bone which most important feature to is 90% & long boncs - 80%. Greater sciatic notch is thedetermining skull sex from in The degree of accuracy by 10-12 years of age.
Pisiform gets ossificd years of age. Anterior fontanel closes by 1½ responsible. is not criminally years below7 person a IPC, years. Under 82 basiocciput around the age of 18-21 Basisphenoid unites the Sagittal. sutures, the most reliable is guardianship of the court is 21 years. under those For age estimation from skull for majority of the age of 18 years; Age Aperson becomes major at identification of sex, The last carpal bone,
Preauricular sulcus is useful for index. ischiopubic index and sciatic notch index, sternal more A female has compared to female is Corporobasal Index. male in more is which Index " (sternum) is related to Sex determination. " Ashley's rule of 149 is completed by 2 years. " Eruption of temporary teeth age of 6-7 years, First permanent molar appears at the incisor. erupt is Lower central The first deciduous tooth to to crupt is First molar The first permanent tooth
Period of mixed dentition is 6 to ll years. superadded teeth. All permanent molars are of age of adult over 21 years, Gustafson's method is used for estimation incremental lines. Boyde's method is based on counting leaves a trace. Locard's principle states that every contact personal identity is Dactylography. Most reliable method of determining fingerprint is; Loop. The most common pattern of fingerprint is: Composite. The least common pattern of patterns are different. In identical twins, fingerprint LOCARD, of sweat glands only. Invented by Poroscopy is the study of counting pores papillary ridges.
the edges of Edgeoscopy: Study of the characteristics formed byAnthropometry. using Bertillon systerm is method ofidentification
Cheiloscopy is the study of Lip prints.
palate. Rugoscopy (palatoprints) is study of rugae in Hard
In females, obturator foramen is triangle-shaped. to heel length. Rule of Haase is used for calculating age of the fetus from crown
among the long bones. For stature determination, femur is reliably used " Medullary index is used to determine sex of the individual.
If tattoo marks are destroyed, their presence can be inferred from presence of pigment in the regional lymph nodes.
" Feature which differentiates hunman hair when examined under microscope from animal hair is: Fragrment medulla.
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Dr Pedagogy
Human ldentification
IMAGE-BASED QUESTIONS L Cephalic Index of 80-85 is seen in which of the following race?
4. The minimum age of the given X-ray is:
Image-Based Questions
Head length
a. 12 years
b, 14 years
C. 16 years
d. 18 years
5. The minimum age of the given X-ray is: a. Mongols
b. Chinese
c European
d. Negroid
2. The minimum age of the given X-ray is:
a. 12 years
b. 15 years
C 6 years
d. 18 years
a. 12 years
b. 16 years
C. 18 years
d. 20 years
6. The minimumn age of the given X-ray is:
3. The minimum age of the given X-ray is:
a 12 years
b.
C 18 years
d. 20 years
14 years
a. 9 years C. l6 years
b. 6 years
d. 1l years
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51
Dr Pedagogy
Forensic Medicine
7. The minimum age of the given X-ray is:
Image-Based Questions
a. 9 years
b. 6 years
c.
d. 11 years
16 years
8. 8. AIl are thc featurcs present in male skull as compared to (PGI May 2018) female skull; except:
10. True statement about this skull is:
a. Prominent supraorbital ridges, prominent glabella, so chin, acute frontonasal angle-Male
b. Smooth frontonasal angle, round shaped orbit, promine frontal eminences-Male
son c. Prominent supraorbital ridges, prominent glabella, chin, acute frontonasal angle-Female d. Smooth frontonasal angle, round shaped orbit, promine frontal eminences-Female
11. Identify the sex of the displayed pelvis:
Sciatic notch
b. Larger foramen C. Larger frontal sinuses d. Larger parietal eminence 9. All of the following are the features of the displayed pelvis; a. Larger teeth
except:
a. Male
b. Female
associated with thi 12. Who among the following person is
study?
a Sub-pubic angle more obtuse 52
b. Pelvic inlet circular shaped c. Triangular obturator foramen
a. Francis Galton
b. Locard
d. Sacrum long and narrow
c. Krogman
d. Orfila
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Dr Pedagogy 3
The image shows which of the following method of identification?
Human ldentification
16. What is the name of the technique of studying the print given in the image?
Image-Based Questions
a. Blood stain pattern
b. Podography
c. Superimposition
d. Cheiloscopy
17. Name the technique of comparing the skull with the photograph. a. Dactylography
b. Poroscopy
d. Cheiloscopy c Rugoscopy 14, What is the name of the technique of studying the print given in the image?
a. Facial reconstruction b. Rugoscopy d. Cheiloscopy c. Superimposition 15. What is the name of the technique of studying the print given in the image?
a Facial reconstruction
b. Rugoscopy
G Superimposition
d Cheiloscopy
a.
c.
Facial reconstruction
Superimposition
b.
d.
Rugoscopy
Cheiloscopy
18. Which of the following techniques is used to these monozygotic twins?
1. DNA fngerprinting b. Dactylography c. Blood grouping typing d. None of these
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differentiate
53
Forensic Medicine
Dr Pedagogy
Image-Based Questions 19. The methods used to demonstrate old or faint tattoos are all; except:
21,
Features of the animal hair are all; exent
a. Scales are lange b Medulla thin &fragmented c. Medullary index >0.5
a Infrared photography c UV lamp
Magnifying lens d. Laser
d. Pigment more toward medulla 22. Features of the human hair are all; except:
20. One of the following statements is false regarding aging of Scar:
a. Cuticular scales are short & flattencd
a. Firm union occurs in from five to six days.
b. Medulla is thick &continuous
b. Reddish angry scar in five to six days
c Cortex is thick &medulla is one-thind of the shaft dur
c The scar becomes pale by second week
ten
d. It becomes tough and glistening in two weeks
d. Pigment in medulla is light &broken
23. Identify the naming system used for charting of teeth in the form given below:
a. Palmar notation
c Universal system
b. Haderup system
d. Diagram chart
24. Identify the naming system used for charting of teeth in the form given below:
13|| 12|| 11
4
a. FDI temporary teeth b. FDI permanent teeth
21222252272 c. Modified FDI temporary teeth
d. Modified FDI permanent teeth
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Dr Pedagogy 25. The highlighted part of pelvis is helpful in determining: (Recent Question 2016)
Human ldentification
28. Identify the sex of mandible:
Image-Based Questions
29. Which of these rules is associated with the hghlighted bonet a. Age C. Sex
b. Race d. Time since death
26. Age of this person is:
a. 6 years
C. 10 years e. 12 years 27. Identify the race:
a. Negroid race .
Caucasian race
b. 8 years
d. 17 years
a. Rule of Haase
b. Rule of half dozen
c. Rule of Ashley
d. Rule of Nysten
b. Mongoloid race d. All races
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Forensic Medicine
Questions
Dr Pedagogy
ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS 10, Ans, d. Smooth frontonasal angle, round-shabed prominent frontal eminences - Pemale
1. Ans, a. Mongols
DolichocephallcLong headed
lmage-Based MesaticephalicMedium
headed
Aryans,
70-74.9
Important Features of female skull
Europeans &
75-79.9
" Large Parietal eminence
Negroes Chinese
Brachycephallc
| Short headed
Mongoloids
" Large Frontal eminence
" Rounded orbits with Sharp margin 80-84.9
" Vertical Forehead
" Smooth Frontonasal junction
2. Ans. d. 18 years
" In the given X-ray, the centers for carpal bones appeared. to Ossification Center for lower end of radius & ulna appeared & fused. ExplanationsThe age for fusion of radius center is 18 years. The minimum age of the person must be 18 years.
11, Ans. b. Female
" Female pelvis shows characteristic wide & shallow gre sciatic notch
12, Ans, a. Prancis Galton
Francis Galton Dactylography
3. Ans. d. 20 years
" In the given X-ray, the last center, i.e., ischial tuberosity has appeared & fused.
with 4. Ans. d. 18 years Answers In the given X-ray
" Hence, the minimum age is 20 years.
" The ossification center for iliac crest & ischial tuberosity has
Locard
Poroscopy, Exchange principle
Krogman
Accuracy of Sex determination from bon
Orfila
Father of modern toxicologY, Father of forensic psychiatry
" Francis Galton systematized the fingerprint systems 13. Ans. b. Poroscopy
appeared.
The head of femur, great trochanter & lesser trochanter has fused with the shaft of femur.
" Iliac crest center has not fused. 5. Ans. a. 12 ycars In the given X-ray " The ossification center for lesser trochanter (12 vears) has
appeared. " Triradiate cartilage has not fused. (15 years) . Hence, the minimum age of the person is 12 years. 6. Ans. c. 16 years
14. Ans. d. Cheiloscopy 15. Ans. b. RugoscopyY
16. Ans. b. Podography 17. Ans. c. Superimposition
Dactylography Poroscopy
" In the given X-ray, all the ossification centers around the
elbow have appeared and fused. " Hence, the minimum age of the X-rayis 16 years. 7. Ans. d. 11 years
Rugoscopy
Chelloscopy
Podography
" In the given X-ray, the centers for head of radius, capitulum,
| Superimposition
Identification from fingerprints Identification from the arrangement of
Sweat pores in fingerprint ridges
ldentification from rugae In hard palate ldentificatlon from lip prints ldentification from footprints
Identification from skull & photograph
trochlea, olecranon process have appeared. The minimum age of the person must be 11 years.
Ans. d. Large parietal eminence
Important Features of female akull Prominent glabella, supraorbital rldges, prominent zygoma,
square-shaped orbit, square-shaped chin, prominent mental tubercle, Jess prominent frontal and parietal eminences. 9.
56
Ans. d. Sacrum long & narrow. " The displayed pelvis show circular pelvic inlet, sub-publc angle more than 90, sacrum short & wide, which ore Uggestive of female sex.
18. Ans. b. Dactylogruphy " Fingerprints will be different even in monozygotic twins
is 1 in 6 " Chances of two persons having jdentical prints billion 19. Ans d. Laser
" Laser is not used to demonstrate faint tattoos, 20. Ans. d, It becomes tough and glistenlng in two weeks Age of Scars:
" Flve to six days- reddish or bluish "'angry" scar.
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Dr Pedagogy . End of 14 days, the scar becomes pale! It is still soft and
sensitive; there is no further change up to the end of second month. In about two to six months, the scar becomes white and
glistening
21. Ans. b. Medulla thin &fragmented
.
not continuous
.Cortex thick (4-10 times as
Answers
with
Additional cusp in maxillary first molars
Present in Caucasjan race
Coarse and thick
Cuicular scales are short.
lateral inciwr have
" The image shows Carabelli cusp.
Animal hair
Fine and thin
" Permanent molar 1, central incior erupted.
27, Ans, c. Caucaslan race
continuous
Human hair "
26. Ans, b, 8 years
" Firt premolar has not erupted. " The minimum age of this peron must be years,
Afer this, there is no further change.
thick 22. Ans. b. Medulla is
Human ldentification
Explanations
28. Ans, Male mandible
Cuticular scales are large, step like projections Cortex thin
broad as medulla)
Pigment more toward the
"Pigment more toward the
medulla
to
Medulla broad, continuous
periphery
" Medulla thin and
Image-Based
and always present
fragmented, sometimes
"
Medullary index >0.5 " Precipitin test specific for
absent
Medullary index 22 years d. >25 years 7. First carpal bone to ossify:
a. Scaphoid
b. 93.59 cm
a. Dental
C. 42
approximate age is:
(INI-CET Nov 2020)
stat
According to FDI, the left lower canine is designated (Recent Questioa 2h a. 32
incisor
b. > 18 years
(AIMS
f
Following mass disasters, best way to identify bodi:i
6. X-ray showing fusion of sternal body segments and fusion of medial end of cdavicde. The a >15 years
130.095 cm
C. 143.00 cm
(EMGE June 2021) b. Upper central d. None
of eight
person will be:
16.
appear is:
prints
13. The skeletal remain in a building tol male, the length of humerus is 24.5wascm.suspected The
d. Mandible
a. Lower central incisor G. First molar
Height
(FINDER),
C. Ring finger
12-year
b. Hip
C. Femur
me
d. Litle finger
(FMGE Dec 2020)
a. Skull
d.
b. Middle finger
mal ridges
Epidermal ridge thickening
Fetal sex
c. Race
a. Thumb
Irreversible change in epider
b. 1-1, 2-1II, 3-IV, 4-I d. 1-I1, 2-, 3-1I, 4-1V
b.
are recorded excluding:
2-IV, 3-11, 4-11 (INI-CET Nov 2021)
Complete atrophy of epider mal ridges Partial atrophy of epidermal
body
(Recent Queslon
a. Fetal age 12. In a fingerprint reader
Ouesion
using the
ment
5. Heavy mandible
6,
(Recent
a. Theory of exchange b. Fingerprint study
bar vertebra
b. Breadth of fifth Jumbar vertebra X l00/breadth di sacral vertebra
C. Breadth of first sacral vertebra X 100/breadth of bas sacrum
d. Breadth of fifth lumbar vertebra X 100/breadth ot ba Sacrum
18. Sternal index is for: a. Age determination b. Sex determination
G. Species identification None of these
d
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(Recent Question 20
Dr Pedagogy
Human ldentification
ANSWERS WITH EXPLANATIONS 1. Ans bi,236
Ref The csentials of Forensic mnediine and taxicolog% Dr. KS Naryana Reddy, 33 ition, pg no: 80-82 Important Features of female skull
" Large Frontal eminence " Large Parietal eminence
Answers with
Sequence of eruption in Temporary teeth
Sequence of eruption in Permanent teeth
Lower central incisors
" First molar Second premolars
Upper central incisors
Upper lateral incisors "
Central incisors
Lower lateral incisors
Canine .
First molar
. Rounded orbits with Sharp margin
" Vertical Forehead " Smooth Frontonasal junction
Lateral incisors
Second molars
Canine
Explanations
Second molars
First premolars " Third molara
2 Ans a. 1-IV, 2-1, 3-I1, 4-1l[ The essentials of Forensic medicine and
Dr. KS Narayana Reddy, 33rd edition, pg.taricologs no:
80-82
Age estimation from skull
. Cosure of Posterior fontanel (Lambda): 3 months - 6
SEQUENCE OF TEMPORARY INCISORS ERUPTION
(UPPER CENTRAL INCISOR
UPPER LATERAL INCISOR
7 MONTHSs
8 MONTHS)
6 MONTHS
9 MONTHS
(LOWER CENTRAL INCISOR
LOWER LATERAL INCISOR
months
Cosure of Anterior fontanel (Bregma): 14-2 years
. Cosure of Metopic suture: 9 months- 2 vears
. Two halves of mandible fuse together: 1-2 years
" Basocciput and basisphenoid: 18-21 years Sagittal suture
Coronal suture
Posterior one
Upper half:
Upper half:
third: 30-40 years
40-50 years
S0-60 years
Anterior one
Lower half:
third:
50-60 years
Lower half: 60-70 years
Lambdoid suture
40-50 years
6. Ans. c> 22 years (refer to earlier discussion) Clavicle:
" The clavicle is the first bone to ossify in the body from two
Middle one third:
|50-60 years Body of Sternum & Sacrum ossification completes by 25
primary ossification centers in 6th week of intrauterine life. A secondary ossification center forms in the sternal end between 18-19 years and fuses by 21-22 years. 7. Ans. c. Capitate (refer to earlier
years.
3. Ans. b. 1-I, 2-III, 3-IV, 41 (refer to earlier discussion)
8. Ans. c. 75-80 (refer to earlier
discussion)
discussion)
4 Ans. b. Hip
9. Ans. b. 18-21 years (refer to earlier discussion)
Ref The Esentials of Forensic medicine and toxicology Dr. KS Narayana Reddy, 33 cdition, pg no: 65
" Pelvis is the best bone for sex determination before puberty. " The accuracy of sex determination from pelvis is 959% (Best bone) 5. Ans. a. lower central
incisor.
Ref. The Essentials of Forensic medicine and toxicolog, Dr. KS
Narayana Reddy, 33rd edition, pg. no: 68 " In the Permanent dentition, First Molar is the earliest to erupt.
" In the Temporary dentition, Lower central incisor is the
eariest to erupt.
10. Ans. a. Theory of exchange Ref The esentials of Forensic medicine and taxicology Dr. KS
Narayana Reddy; 33 edition, pg no: 86
Locard's Principle of Exchange: " It states that "When two objects come into contact with each
other, there is always transfer of some material between them."
This is helpful in crime investigations, especialy in sexual offences.
l1. Ans. a. Fetal age (as explained earlier)
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Dr Pedagogy
Forensic Medicine
Explanations Answers with 12. Ans. d. Little finger
15. Ans.
b. 33
Ref
Ref The essentials of Forensic medicine and tuxicolog
Forensic Anthropology
AM
Dr. KS KS Nannuna Reddy, 33rd cition, PR. no: 85
"Fingerprinting is the most specificmethod ofidentifcation.
Christenson, DÊ Barteli
Bassalacqua; lst Ed, Ch
" In the question, left lower canine is asked.
Galton's system describes about fingerprinting.
. In FDI
Fingerprint reader (FINDER) is a computerized automatic
" Canine is represented by second number '3
Method of dental charting. left lower quadran
represented by first number '3'
fingerprint reading system which can record each fingerprint data in half second.
" Prints of eight fingers are recorded excduding little finger,
16. Ans. b. In negroes, the cusps of molars are wid.
deep and shovel-shaped cusps in incisors. (refer to e discussion)
13. Ans. a. 130.095 cm
Ref The exsentials of Forensic medicine and toricolog, Dr. KS Narayana Reddy, 33rd edition, pg. na: 655
The multiplying factor for humerus in calculating stature in males is 5.31.
Caucasoid
Mongoloid
aped upper teal incisors
Carabelli Cusp
= 24.5 x 5.31 = 130,095 cm
two lingual cusp
Taurodontism
on mandibular
first premolars
upper Srd molars
are common
Males
Females
Humerus
S.31
S.31
Radius
6.78
Ulna
6.00
6.0
3.8
3.08
" IN MALES: >42 IN FEMALES: 2 mm -Ecchymosis
neoryASPHYXIA
Seen in eyelids, forehead, conjunctiva, visceral
pericardium, heart, lungs, scalp. etc.
Asphyxia literally means Pulselessnes9, Acondition caused by interference with the exchange of oxygen
ostoucu
Due to increased intracapillary pressure and endothelial damage, resulting in rupture of
and carbon dioxide in the body.
venules.
Visceral congestion
Classical Signs of Asphyxia (Asphyxia Triad)
capil aries
Congestion of the visceral organs, like liver, spleen, ete Occurs due to incrcased capillary permeability
ECHIAL
Rt. Ventricular enlargement
HEMORRHAGES
Postmortemn fluidity of the blood
(All the above S features are termed Quintet of asphyxia) IAttention: In all suspected asphyxial deaths, neck she ASPHYXIAL TRIAD CYANOSIs
be dissected at last.
Skull is opened first followed by dissection of the neck at los Drainage of blod from cavities gives bloodless dissectio
VISCERAL CONGESTION
of neck
artifacta. To avoid Prinsloo Gordon
Peripheral cyanosis
sa Sites: Tip of the nose, nail bed, car lobule, etc. Occurs when deoxy-hemoglobin is >5 gm% mgla
Prinsloo Gordon artifact
Form of hypostasis
Hemorrhage on the onterior aspect of the cervical spine. posterior to the trachea and esophagus
is If the patient is severely anemic, total amnount of Hb itself low. Thus, this sign is not seen in anemic patients.
Poses confusion in the interpretation of neck injuries
Petechial hemorrhages (Tardieu spots/Bayard's spots) Minute, pin-point shaped hemorrhages (2 mm in size)
MECHANICAL ASPHYXIA
|NECKCOMPRESSION
NECK COMPRESSION
SPENSION OF BODY NO SUSPENSION OF BODY WITH SUSPE HANGING
STRANGULATION
HANGING
LIGATURE STRANGULATION
uDICIAL
HANGING
LYNCHING
NO NECK COMPRESSION NO BODY SUSPENSION
sUFFOCATION ERING
SVING GAGGING
OVERLAYING
STRANGULATION BANSDOA
" TRAUMATIC ASPHYXIA
GARROTING MUGGING
" DROWNING
"POSITIONALASPHYXIA
HANGING
body by a ligature encircling the neck. " Hanging is a form of asphyxia caused by suspension of themethod uude m- phyi
t oe
The constricting force being the weight of the body rne
Types of Hanging HANGING
BASED ON DEGREE OF SUSPENSION BASED ON POSITION OF KNOT
TYPICAL HANGINGATYPICAL HANGING a cepu Knot o rthan 62
is placod centrally.
COMPLETE HANGING
http://t.me/dr_pedagogy on the occiput
Body ls fully suspended
"No body part touches the ground
Constricting lorce ls weight of the body.
PARTIAL HANGING
Any part of the body is touching the grouo For example, SItüng, kneeling. lying
position forc) Weight of the head is the constricting
Dr Pedagogy
Asphyxial Deaths
Fatal Perlod
" Death is immediate, if cervical vertebrae are fractured (as in
Theory judicial hanging) or if the heart is inhibited, rapid if cause is
asphyxia and least rapld if coma is responsible. " The fatal period is usually 3-5 minutes.
" Hanging is the most common method of committing suicide. Typical hanging Knot at occiput
Ligature Materlal
Atvpical hanging
Knot at side of neck and front of neck
" Material that is readily available (rope, metallic chain, electric
cord, cable, belt, scarf, dupatta, lungi, etc.)
If, found in situ, the ligature should be cut away fromknot and reconstructed by joining cut ends with tape or another cord and then examined Noose Fixed noose
Knot
. Simple slip knot
Complete Hanging
" Fixed knot, granny knot Incomplete
hanging
"
Running noose
" Soft ligature causes wide/faint ligature mark
" Narrow wire causes deep ligature mark (Cheese cutters method)
POSTMORTEM APPEARANCES IN A CASE OF HANGING
Carobd arlery
Splne (30 kg)
External Findings
Esophagus
Slgns on Face
Vagus
(5 kg)
Jugular vein
(2 kg) Trachea (15 kg)
Force of constriction for obstruction of
-2 kg (Cerebral venous
Jugular vein ml
Congestion)
-3405kg (cerebral anemia)| -15 kg (asphyxia)
6 Carotid arteries Trachea
-30 kg (cerebral anemia)
Vertebral arteries
Thyroid cartilage laminafracture-14.3 kg -18.8 kg " Cricoid cartilage Causes of death in hanging
" Tardieu's spots: Over the eyelids, under the conjunctiva and near the temple
" Swollen, cyanosed face (due to impaired venous return) " Subconjunctival hemorrhages and bleeding from noselears Protrusion of tongue due to pressure on floor
" Le facie sympathique® fu arseled (anhy veini angerteo)
" Dribbling of saliva9 ?aepae when bh eh lay ") Le Facle Sympathique (originally described by
Etlenne Martin (1950))
" Sign of antemortem hanging.
If the knot/ligature presses on cervical sympathetic chain, eyelid of that side remains open and the pupil is diloted.
" Asphyxio: Due to narrowing of laryngeal and tracheal lumina
" " " "
Venous congestion: Blockage of Jugular veins Combined asphyxio and venous congestion Cerebral anemia: Blockage of carotid artery Reflex vagal inhibiton resulting in sudden cardiac arrest.
" Fracture/dislocation of cervical vertebrae: Seen in judicial hanging
Asphyia is the cause of death in compete hanging, occlusion of
vessels (veins) in partial hanging
Dribbling of saliva:
Surest sign of antemortem hanging". " Excessive salivation due to pressure on submandibular glands Dribbling of sallva occurs from angle opposite to the side of knot.
(When the knot is on the nape of the neck, it occurs across the
middle of lower lip)
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Forenslc Medicine
Dr Pedagogy
TheorySlgns on Neck HANGING-LIGATURE MARK
Suspension
peak
Oblique suprathyroidal incomplete ligature mark
Ligature Mark (Suprathyroidal°, Oblique, Incomplete9)
Transverse ligature mark is seen in
Partial hanging
" Pressure abrasion (Sometimes patterned-Patterned abrasion9),
Low point of suspension
Above the thyroid cartilage (usually).
Slip knot with running noose
I runs obliqucly discontinuous, backward, upward and toward the point of suspension.
Mark is discontinuous because of a gap produced by the knot at the nape of neck. Skin at the site: Usually pale in color, but later becomes yellowish, le reproduced in the mark. Pattern of ligature material may be
dry and parchmentlike'ade
Signs on the Body
Postmortem staining in the lower part of upper limbs and
limbs: Glove and Stockings Fashion,ass
" Involuntary discharge of fecal matter and urine may be se In males, there may be penile erection and involuntary dide
ofsemen. ein dinae
Location of ligature mark Abovec tthe level of thyroid cartilage, between the larynx and the chin: 8e%B5.
Internal Findings
At the level of the cartilage: 15%
Neck
Below the cartilage: 5%, especially in partial suspension.
Subcutaneous tissue underneath the ligature mark is dry, â firm and glistening,
Knots: Fixed knot
"
It produces oblique ligature mark and incomplete ligature mark.
Hyoid Bone Fracture (15-20%) More commonly above the age of 40 years",
Slip knot running noose SlipcormnlS knot
It
The location is usually the great horns, at the junction of
encircles the neck and produces transverse and
two-thirds and outer one-third.
Amussat's sign9: Transverse carotid intimal tears seen in
complete ligature mark
drops (Judicial hanging"). Fracture of superior horn of the hyoid bone may be present
Patterned Ligature Marks with Different Ligature Material
of cases)
Fracture of vertebra "
vertebra | Most commnon fracture seen is of C2 cervical
CaHangman's fracture. Associated with hyperextension of neck. Greater horn
Lesser horn
66
Ardeshae
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Body
Hangmin kost
Dr Pedagogy
Asphyxial Deaths
Extra Edge
Theory
Fracture of Hyoid Bone in hanging:
Abduction frocture or Anterior Compression Fracture is seen.
Most common site: Junction of the inner two-thirds and outer-third of greater cornu.
LYNCHING " Lynching is a form of homicidal hangin.
Asuspect is overpowered and hung by several persons by means of a rope from a tree or somne similar object.
It was practiced by Captain William Lynch in North America,
where the blacks accused of rape, were hanged publicly without anyy trial.
Judicial hanging
Lynching - Homicidal hanging by mob
JUDICIAL HANGING In india, Knot is placed under the angle of jaw
Traumatic
Knot under the chin is more effective (sub-mental)
spondylolisthesis
" Length of rope from the point of suspension is equal to the
of axis
heighttof the individual
The ligature around the neck causes a forceful jerky impact on
the neck and results in Hangman's fracture.
Pars
Extra Edge Hangman's fracture:
interarticularis fraclure
Fracture of pedicles or pars interarticularis of the axis
vertebra (C2)./L Aiso Resulting in spondylolisthesis of C2 over C3. In judicial hangings, odontoid process is usually not
fractured. May also be seen in snorts. fall or road traffic accidents.
Hangman's fracture Contd...
67
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Forensic Medicine
Theory Extra Edge Simon's sign: A
Dr Pedagogy Suicidal hanging Hanging is a common method of committing suicide Ant long. lig
" Hemorhages seen oncor ventral surfoce of the intervertebral discsa beneath the anterior
V disc
Point of suspension should be approachable. Suicidal note° may be present.io th 3 " Fibers of the ligature material used, may be presen
-Simon's bleed
longitudinal ligament
hands. o s ea
in the lumbar spine.
Homicidal hanging
Due to overstretching
" Very rare.
of spine.
n At
" False positive: Putrefaction,
drowning &RTA
Suspension peak:
. The ligature mark of hanging is incomplete at the position of
3503-Srir
Difficult to hang an adult victim, unless he is intoricats uncon-scious.
Homicide should be suspected, when:
Signs of violence in the scene br Clothing of deceased deranged
Injuries present. abica d gahe met,d L
the knot.
" The gap resembles a triangle with the apex upwards. . Thissis called suspension peok. Indicates the position of the junction of the vertical part of rope and the noose. Mechanism: The junction of the noose and the vertical part of the rope is is pulled upwards and away from the skin and thus no mark
left there. Importance: t disinguishes hanging from ligature strangulotion.
Postmortem hanging
Person may be killed and then the body suspended to mimic suicide.
Signs of dragging to the place of suspension. " Branch of tree shows evidence of the rope having moved from below upwards
Absence of rope fibres in the hands of victim. Accidental hanging
Common in children, while 'playing hanging' or getting
suspended from play equipment.
Autoerotic hangingP in adults w d l e
Jlustratiue
Suspension peak
2015 Dimapur Mob Lynching A20-year-old college student was allegedly raped in Hotel
MANNER OF HANGING
Oriental Dream at Dimapur on 23 February 2015. Farid Kh the accused and his accomplice Nikavi, forcibly assaulted he
and intoxicated her. Then Farid Khan had allegedly raped he multiple times. Both were arrested on 25 February 2015
Jail. rape and assault, and were lodged in Dimapur Central The rape victim caimed that the accUsed was known
intoxicais her neighbor. She was lured into the car and was and shen times seyeral by him. She said that she was raped abour remain silent to accused been given Rs 5000 by the incident. During police interrogation, the accused Fario N sex. told that he had given her money and had consensual into the Dimu On 5 March, about 7000-8000 people broke Central Jal. maoe They dragged the accused out of the prison, stones. pelted him with and him naked, beat paraded away, by dragged the accused to a clock tower about 7 km publicy o was he mgtorcvcle and a a rope to his waist from
A 45year oid man was found hanging from a tree in the Outskirts of Delhi. The man was spotted alive the previous day around 10 pm. Relatives suspect foul play in his death. What Coud be the manner of Death (homicidal/suicidal/accidental)?
from the clock tower's ralings.
The police had fired blanks and tear gas at the croa was kille failed to disperse them. One member of the mob
52 police personnel were injured in the clashes.
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Dr Pedagogy
Asphyxial Deaths
STRANGULATION "
igature Strangulation (When Ligature Material is
used to Constrict Neck)
Signs of asphyxia more marked.
Face is congested, livid and marked with petechiae.
Neck Findings
Theory
Complete
intrathyroidal
transverse
Ligature strangulation ligature mark
Ligature Mark Ligature mark is transverse, completely encircling the neck,
below the thyroid cartilage (usually).
Transverse, horizontal
"
Base is reddish with ecchymosis.
below the thyroid cartilage
"
Iracture of thyrotd cartilage is more common', Involuntary d1scharge of feces and urine more common.
ligature mark in ligature strangulation
"
THROTTLING/MANUAL STRANGULATION
Multiple, disçoid
bruises (Due to fingertips)
Multiple crescentic
fingernail marks
" When hands are used to compress the neck, it is referred to as
manual strangulation/throttling. " Signs of asphyxia are more evident.
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Dr Pedagogy
Forensic Medicine
Adduction fractureof hyoid bone present. Throttling is almost always homicida|9 Suicidal throttling is impossible, because
Neck Findings
Theory
nail abrasions are seen
" Externally, crescentic or linear frger n compression by finger tips are Multiple discoid bruises, due to
seen. Aiplay bnw
musclesjs " Internally, extensive contusion ofneck subcutaneous "
in Intense extravasation of blood
unconsc
Throttling .Homicidal throttling" >> Accidental| throttling (
Seen
tissues under
impossible . Suicidal throttling
is the most signifhicant the external abrasions and bruises
internal sign
as
occurs, the hand will relax and pressure is relieved
Very rare
n nde tsp
Concept Alert
Manual strangulation-muitiple bruises &finger tip abrasions
Ligature strangulation
Hangingoblique
transverse ligature mark
ligature mark
one of the frequently asked areas in AlIMS exams. Notes: Friends, image-based question on throttling has been
MUGGING
BANSDOLA Constriction
of
neck
by
bamboo sticks9, one across the
Mugging
back of the neck and another across the front. Both the ends are tied with rope due to which the victim i
squeezed to death. "
Bruise is seen across the neck,
corresponding to the width of the object used.
"
Strangulation
assailant.
of neck by the benddof the elboPor
farearmd
The attack is usually from behind. and may leave no e 70
internal injury mark
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Dr Pedagogy GARROTING
Asphyxial Deaths
PALMAR STRANGULATION
tisa form of strangulation of neck by a ligature, in which a
Gnsle assailant can kill a healthy adult male.
warning. . The victim is attacked from behind without tightened, by neck and quickly over the is thrown Aligature results in which ruler, etc), stick, (rod, it with a lever twisting
" One palm is placed over both nostrils and the mouth and another Theory palm is placed perpendicular to the 1st palm.
" The base of second palm is compressing the neck.
pdden loss of consciousness and collapse',
Spanish Method Sogin. It was a method of judicial execution in
Soanish windlass-a device is used. It consists of iron collar placed around the neck and ghtened by screw for strangulation.
HYOID BONE FRACTURES Greater hom fracture with bruising
Abducbon or anteroposterior compression fracture
Adductonor
Inward compreseion fracture
Inward compression/ adduction fractures Seen in case of throttling Inward compression actúng on the hyoid bone.
Fractured segments disploced inwards
Periosteum Is torn on the outer side of the bone
Side to side
compression fracure
Anteroposterior compression"/ Avulsion fractures
Side to side compression
abduction fractures
fracture
" Seen in coses of hanging
" Outward compression acting on the hyold bone. " Fractured segments
displaced outwards
Due to muscular overactivity " Also known as bilateral
No direct injury to the hyoid bone.
"Tug" or "Troction" fractures.
fractures- seen in hanging One greater horn is
fractured outwards and the other inwards.
Periosteum ls torn on the
Inner side of the frocture
Attention
NoTE
Frcure of Hyoldd Bones: Hyoid diractures most common in Manual strangulotlon Monual stronqukotionA> Hanging > Ugature strangulabon
Ahyaid fracture shouid be diagnosed as antemortem in origin only if there Is recent hemorrhage and brulsing at the site.
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71
Forensic Medicine
Dr Pedagogy
TheoryLong Scarf Syndrome/Isodara Duncan Syndrome
strangulation. " It when ligoture a clothing around the victim's neck ('dupatta') becomes entangled, usually in. a moving mechanical device (e.. occidental It is occurs neck, resulting in strangulation death. clothing encircles and constricts the
motorbike wheel), and the
Deaths due to Commando Punch sudden cardiac arrest due to x of larynx with the edge of the hand, may result in Aforcible blow across the side of neck/front
inhibitory reflex.
Jlustratiue female was referred by On 5th October 2011, a dead body of a for autopsy. As College, Medical police to the mortuary, Madras police, a group to the husband by her per the statement given house in the midnight of 4 people broke the back door of their the woman resisted While point. at knife couple the and robbed robbers slashed to give the gold "Mangal sutra', one of the lost consciousness,
her neck and snatched it. As the woman of crime was the robbers fled the scene of crime. The scene
SUFFOCATION DEATHS Smothering® Choking Gagging
Traumatic asphyxia
Burking
Positional asphyxia
Overlaying Smothering Asphyxia caused by mechanical occlusion ofexternal air pas (nose and mouth) by hand, cloth, etc.
disturbed.
the During autopsy, one transverse cut injury was noted in
only rlght side of the neck. The wound was superficlal, cutting left side the skin and platysma. Multiple bruises noted on the of neck with underlying intense extravasation of blood. Hyoid fractured. bone ne wass Tound to be side of nree small scratch abraslons were seen on left were seen areas brulsed and adjacent laceratlons nose, two the lower lip, Owing to the superficlal nature of cut, it was
unlilkely to be the fatal injury. With the other findings, it was concluded as a case of smothering and throttling. The husband
arrested on the charge of murder and for faking it to be a
murder for robbery
Postmortem Findings Hraesa h i - p U r
Abrasibns and bruises around the mouth and nostrils
Injuries on the inside of the lips seen.
tu an
Bruising of gum and rupture of frenulum Smothering is usually homicida!?,
Choking pasa " Asphyxia caused by mechanical occlusion offinternal air by aforeign object, like coin, seeds, fish, etc. o brlu
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Dr Pedagogy
Asphyxial Deaths
Cause of Death
Asplhyxia Vagal inhibition
Theory
Laryngeal $spasm
ePresence of food items or foreign body in respiratory tract Choking is usually accidental? Common in children
Gagging Aform of asphyxia due to pushing a gag (rolled up cloth or
paper balls) into the mouth and blocking the pharynx.
Collections of saliva, excessive mucus with edema of pharynx and nasal mucosa causes complete obstruction. Almost always homicidal Victim is usually an infant or an elderly person.
Overlaying
eOverlaying results from compression of the chest, nose and mouth to prevent breathing
" Form of accidental smothering
hreuh
pha
. A nursing mother, sharing a bed with her child, may roll over
during sleep and occlude the air passages.
Postmortem Findings " Face, nose and chest of victim child may appear compressed and pale.
" Purely accidental in nature.
Burking " A combination of homicidal smothering and traumatic
asphyxia!.
sing mah crd
Method
Postmortem examination
Masque ecchymotique
Ahngon est
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
Victims were invited, made to drink alcohol and thrown on the
portion of body and the lower normal part.
ground. " Burke would kneel or sit on the chest and close the nose and
mouth with his hands, and Hare, his accomplice used to pull him around the room by the feet till he is dead.
Traumatic Asphyxia/Perthes Syndrome Asphyxia resulting from respiratory arrest due to mechanical Jxation of chest, so that the normal moements of chest wall are prevented,
Causes " Due to collapse of
" "
wall/house
Stampede by crowd, running in panic Run over by a vehicde
Rib and clavicle fractures are common; extremity and pelvic fractures may be seen. "
Mostly accidental in nature.
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73
Forensic Medicine
Theory
Dr Pedagogy Smothering
Burting Bruises over the inner surface of the lips
Positional/postural asphyxia: Positional asphyxia is due to abnormal body position that prevents adequate respiration/gas exchange Eramples: Death in inverted crucifirion, Jack knife's position
Café-Coronary
Jlustratiue
The name, cafe coronaró is amisnomer. " Acase of accidental chokingwherein, a bolus of food produces complete obstruction of the larynx.
Dead body of a 70-year-old male was brought for autopsy
23rd August 2010. The alleged history was that deceased az
Victim, who was apparently healthy, collapses suddenly dying
staying alone along with a caretaker at home. The person W
It mimics a heart attack and is usually seen in an intoxicated
The caretaker found him in an unconscious state in the be. the next morning. Postmortem examination revealed th
while eating.
restaurant patron.
apparently normal, the last night with no other relevant histo
small bruises and a laceration on the inner side of lower
Cause of Death
Frenulum of the upper lip was also slightly contused. Muiti
cardfac arrest Irom 'vagal inhibition' as a consequence of
stimulation of laryngeal nerve endings.
luganoe)diy
Petechial hemorrhage were noted under the scalp, Intet fissure of the
lungs-sub-pleurally.
Both lungs were congest No other injuries were present anje on the body. The cause of death was opined as death due smothering. The caretaker was taken into custody. Du and
edematous.
Interrogation he confessed that he had smothered the v
while sleeping and later wanted it to be disguised as natu death. 74
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Dr Pedagogy
Asphyxial Deaths
Extra Edge
Theory
Wedging
. This occurs when the face, neck or thorax is compressed between two firm structures. tis common In 3-6 months old children when they start to
nve to the corners of beds and cribs, but they cannot free themselves out of a wedged position. They become wedged between the mattress and either the wall or any structures.
Types of Drowning
DROWNING
Atypical drowning (no fluid entryintoalveoli)
Typlcal drowning (primarily
WHO Definition
tluid entry into alveoli)
Drowning is a process of respiratory impairment due to the or immersion in liquid. submersipn Mode-AGdedal
Wet drowning
Dry drowning
Secondary drowning (near
Hydrocution
drowning syndrome) Wet Orowning
Atypical Hydrocution
Pathophysiology depends upon the
Dry drowning
amount of water aspirated
HYDROCUTION
DRY DROWNING
FALL IN cOLD WATER
FALL IN WATER
(34 mUKgBW) ((MC) Enters alveoli and washes away surfactants
SUDDEN RUSH OF WATER
NERVE ENDINGS STIMULATION
INTO PHARYNX
Alveolar collapse
LARYNGEAL SPASM
Mismatch VP ratio
VAGAL INHIBITION
erla'
ASPHYXIA & DEATH CARDIAC ARREST
Cerebral hypoxemia
Diffuse end organ damage/death Wet Drowning
11 mL/kg (Pathophysiology depends upon the type of water) Salt water (hypertonic)
Fresh water (hypotonic) FRESHWATER DROWNING
SEAWATER DROWNING SALT WATER INHALATION
WATER INHALATION INTO LUNGS
INTO LUNGS
FLUID FROM LUNGS
ENTERS BLOOD
HAEMODILUTION
FLUID FROM
PULMONARY OEDEMA
BLOOD ENTERS LUNGS
HYPEROSMOTIC
SALT WATER IN LUNGS
(CARDIAc OVERLOAD &
VENTRICULAR
FIBRILLATION
HAEMOLYSIS
HAEMOCONCENTRATION
7 NaUTA,1
MASSIVE PULMONARY OEDEMA
HAEMOGLOBIN LEVELS
HYPERKALAEMIA
CARDIAC
INCREASE BY 30%
ARRHYTHMIA
aspirated is about 22 ml/kg oe tlectrolyte imbalance is noted when amount of water
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75
Forensic Medicine
Dr Pedagogy ApecheAM Postmortem Appearance
Wet Drowning (Primary or Typical Drowning) Theory
are wet. In this type, Water inhaled into the lungs and lungs NaCl) and sea water Two types Fresh water drowning (0.5-0.6%
External findings Livor mortis In stagnant water: face, upper part of chest In moving water: No appearance Washer woman's handa
drowning (3-4% NaCl).
Pathophysiology of Wet Drowning
owerer
atm
Cutis anserinea Froth in nostrils Cadaveric spasm
the alveoli The aspirated water commonly (3-4 mlkg) enters with the edema and destroys the surfactant inducing pulmonary
transudation of protein-rich fluid into the alveolar spaces.
This surfactant washout decreases the lung compliance and ventilation-perfusion mismatch resulting to hypoxemia and
Internal findings
Emphysemo oquosum Presence of sand particles in the airway
cerebral anoxia.
Presence of water in stomach and small intesine
If the aspirated volume is more:
Paltauf's hemorrhages . Temporal bone hemorrhages
Fresh Water Drowning (0.5-0.6% NaCl) " The aspirated water is rapidly absorbed from the alveoli, and in turn into the circulation leading to hemodilution and hemolysis.
Signs in a Drowning Case
" Circulatory overload, hyponatremia, hyperkalemia followed by
Cutis Anserina
ventricular fibrillation. te pd ySra
" (Goose skin/goose bumps/horripilation)
Sea Water Drowning (3-4% Salinity!
e
State of puckered and granular appearance of skin inte cold water
" The 2spiration of salt water results in shift of water from the
Due to contraction of erector pilorum muscles.
pulmonary circulation into the alveolar spaces due to osmosis,
Nonspecific for drowning. (Can aso occur in rigor mos
while at the sarne time electrolytes (sodium, chloride, magnesium
erector muscles).
from sez water) pass into the blood. There is hemoconcentration with crenation of RBCs, but not
Lungs Findings in
hemolysis and litle change in the sodium/potassium balance.
Drowningeb,Sorty
Secondary Drowning
" Lungs are voluminous, distended and show ballooning.
" Death occurs within half an hou to days after resuscitation.
Emphysema aquosum.wadls nyy aa,e
Distended lungs show rib markings.
" Death due to Cerebral anoxia-irreversible brain damage, heart
failure due to myocardial anoxia. Dry Drowning "
Froth in Drowning Afine, whit, lathery froth is seen at the mouth and noari
Waer does not enter the lungs.
"
Mechanisms for Cause of Death " Largngeal spasm and airway closure causing asphyxia " Refer cardiac arrest due to vasovagal stimulation.
HydrocutionNmmersion Syndrome/Submersion Inhibition "
Dezh results from sudden cardiac arres due to vagal
of heart?
"
. Intra-alveolar edema with thinning of interalveolar seta
aeba loephao o Copious frothy fluid exudes
inhibition
Itis one of the most
characteristic eternal signs of drow The froth may project as a balloon/mushroom-ike massfon mouth and nostrils.
f wiped away, it gradually reappears, on appling press! the chest.
Washerwomen's Hand Wrinkled, sbadeh, bleached appearance of skin. ¡di " Site: Palms,
palmar aspect of fingers and soles of feet in Occurs in drowning in cold waler, which stimulates the vagal plantar surface of toes. nerve endungs at surface of the body or water striking the " Nonspecific sign for or cold vter epigastrium entering the car passage. drowning. . It occurs due to imbibition of water its into outer layer Iime: First seen in the fingertips by 3-4 hours and whok
24 hours. Time sineAst can 'be nd
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Dr Pedagogy Codaveric Spasm
Cs gravel, sand, weeds or aquatic denched hands due to cadaveric spasn9,vegetation held firmly in Itis a proof of antemortem drowning,
OASDVxial Deaths
Middle Ear (Ueno's Sign) "
Presence of water and hemorrhage in middle ear is one of the positive proofs of antemorten drowning Theory
Sveshnikov's sign
Paltauf's Hemorrhage alee aillee daras of hemorrhage in lungs Mottled
"
Presence of water in the respiratory sinuses.
Emphysema
Edema aquosum
aquosum9
Rubture ofalveoli due to forced expiration.
Mostly seen in the lower lobes on anterior surface and margins
Lungs contains
lungs with the
froth
victim of
drowning
the person is
dead body is
unconscious
thrown into
at the time of
water
the conscious
.Presenceof sand, mud aquatic vegetations in the trachea and lower
hronchial tree are characteristic positive findings of antemortem drowning. Cue wehite froth mixed with sand in the lumen of trachea and
bronchi is highly suggestive of death from antemortem drowning.
Stomach and Small Intestines
Passive filing of lungs with
airless water and no formation of froth Occurs when
Occurs when
Airway
Hydrostatic lung
" Mere flooding of
both water and
of lungs.
0
struggles for Survival
water due to
hydrostatic pressure
Occurs when
drowning
IAttention:
Stamach (70% of cases) and small intestine (20%) contain water
Froth formation will not be seen in case of dry drowning
antemortetm drowning
and hydrocution.
Water in the small intestine-This is regarded as positiveevidence of death by drowning as it depends on peristaltic movement wwhich is antemortem.
because hyperventilation causes flushing out of CO,, which
. Sehrt's sign: Micro ruptures of the gastric wall due to the Swallowed flujd
" Wydler's sign:
The gastric content is taken into a beaker and allowed to settle for an bour.
Three layers are formed-foam in the uppermost, liquid in the
middle and sediment in the lowermost.
Hyperventilation before drowning causes rapid death,
is necessary for respiratory drive.
Laboratory Investigations Diatom Test " Diatoms are microscopic unicellular algae, which aecrete silica? skeletons called frustules.
" They are chemically inert and almost indestructible, being
resistant to strong acids ,dkal. yeistant to pute
Diatoms of size 60u enters the circulation.
DIATOM TEST PERSON FALLS IN WATER IF THE PERSON IS DEAD
IF THE PERSON IS ALIVE WATER ENTERS THE LUNGS ALONG WITH DIATOMS
DIATOMS PRESENT ONLY IN LUNGS
Vla Pulmonary Veins, Lymph Channels DIATOMS ENTERS
Diatoms circulated to
CIRCULATION
distant organs Bone marrow
Brain
Liver, pue
BEATING LEFT HEART
Kidneys
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Forensic Medicine
Theory
Dr Pedagogy
tissues like bone marrow Presence of diatoms in the distant antemortem
SEAWATER DROWNING
is the proof of of femur (best site for analysis)
dug ooning decomnposed bodies as diatoms in even Diatoms test is useful
drowning Poson ai
HAEMOCONCENTRATION
resist putrefaction
bodies thrown into water and in dry The test is negative in dead
CHLORIDE IN LEFT HEART INCREASES
drowning Gettler Test
LEFT HEART CHLORIDE RIGHT HEART CHLORIDE
chambers
content of blood in heart " Based on chloride of heart content of the right and left side " Normally, the chloride600 mg/100 mL. is nearly same, about antemortem or more, it is suggestive of " If the difference is 25 ng% ventricle drowning chloride reduces by 50% in left In freshwater drowning, 30-40% in left drowning, chloride increases by " In seawater
content of heart: No change in chloride inhibitinn Drowning due to laryngeal spasm or vagal Putrefaction
Patent foramen ovale
ventrice N wsel in dy dreg FRESHWATER DROWNING
Entertainer Great Cricketer,DROWNING Ms Dhoni -ANTEMORTEM
MNEMOA
and Finisher
SIGNS OF
M-Mud particles in airway marrow D-Diatoms positive in bone
HAEMODILUTION
C- Cadaveric spasm
CHLORIDE IN LEFT HEART DECREASES
G-Gettler's test positive E-Emphysema aquosum
F-Froth in mouth LEFT HEART CHLORIDE RIGHT HEART CHLORIDE
Forensic Riddle
clenched froth spilt unto his face, "Acold hand tightly the deceased part of the indicted, it is clear
wreathing on the under water, was breathing".
nm SEXUAL tASPHYXIA/AUTOEROTIC ASPHYXIA/HYPOXIPHILIA/ASPHYXIPHILIA/KOTZWARRISM
asphyxia. orgasm depend on self-induced and arousal sexual which a paraphilia in " Autoerotic asphyxia is AUTOEROTIC ASPHYXIA
PRESSURE OVER NECK COMPRESSION OF NECK
BLOCKAGE OF
CAROTID ARTERY
COMPRESSION LEADING
RELIEVED
TO DEATH
Accldental failure of
CEREBRAL ANEMA EROTIC HALLUCINATIONS
PERSISTENT NECK
NECK CcOMPRESsION
release mechanisms
PERSON RELEASES
THE PRESSURE
SEXUAL GRATIFICATION & ORGASM
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Dr Pedagogy
Asphyxial Deaths
Methods . Hanging: Most frequent method
"
Victims are usually young males
Electrical stimulation
. Gue sniffing
Thie condition is usually
associated
transvestism
with
Scene is usually the victim's own house, bedroom, bathroom Theory NO disturbance in the scene of crime Manner of death is accidental?
"
masochism
and "
NO suicidal note present.
RECENT ADVANCES New Markers of Antemortem Hanging
Along with the carotid intimal tears, intimal injury in
vein a emano
ir
P
hanging.
jugular
aroud aaventitial layer are renorted
Hemorrhages at the clavicular origin of the
sternocleldomastold muscles is a consistent autopsy finding in death by hanging.
.Bowel wall hemorrhage, especially in small intestine is recently suggested as a sign of death by hanging (after excluslon of othercharacteristic conditions leading to intra-abdominal congestion).
Petechlal hemorrhages
of the tympanic
membrane.
New Markers of Strangulation " Symmetrical bleeding of the vocal folds and laryngeal mucosa as a result of lateral laryngeal compression (strangulation) after exclusion of ubation artefacts. New markers of antemortem drowning
Elevated serum calcium and magnesium level is especially
useful for the diagnosis and differentiation of salt and
freshwater drowning.
Higher levels of serum strontium in left ventricle (>75 Hg/) than in the right is the best parameter for diagnosis of sea water drowning. " Higher levels of serum magnesium in left ventricle (>1.25 mg/L) than in the right is also used for the diagnosis of
seawater drowning
- ahe io not in
csndihon to exbesat
will
Lsng
- yat the ll d pat
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Forensic Medicine
CHAPTER AT A GLANCE
Theory
ASPHYXIA
Pelechial haemorrhages
(Pulselessness)
Visceral congestion
sUFFOCATION
ATION
STRANGULAn
HANGING
Neck compre No suspensk of body
Neck comp ssion with ncinn of hody suspension
.SMOTHERING CHOKING
JUDICIAL HANGING: (LIGATURE MARK:
Oblique, suprathryroidal incompleie
Glove & stocking distribution livor mortis
.GAGGING
THROTTLING
Hangman's fracture LYNCHING Homickdal hanging by mob
Culaneous abrasions & bruises
Adduction fracture hyoid Intense haemorrhage of soft tissUes of neck
" OVERLAYING
TRAUMATIC ASPHYXA .POSITIONAL ASPHYXIA
Abduction iraclure of
hyoid
SIGNS OF ANTEMORTEM
HANGIG dribbling
. Le facie symptahique
BANSDOLA
LIGATURE STRANGULATION
GARROTING
Ligature mark:
Transverse, below thyroid cartilage &complete Signs of asphyxia more intense
MUGGING
Thyroid cartilage fracture more common
SUFFOCATION
SMOTHERING Occlusion of extemal
CHOKING Occlusion of inlernal
air passages with foreign object Accidental
air passages
Homicidal
oVERLAYING Asphyxia due to chest
GAGGING Occlusion of intemal air
compression when obese
passages with a gag
mother shares bed with baby
TRAUMATIC ASPHYS Mechanical fuatrn
chest resulting in ash
DROWNING
WET DROWNING Water enters the lung
DRY DROWNING Water does not enter lungs
laryngeal spasm
HYDROCUTION Fall in cold water cardiac arrest
NEAR DROWNNK Dies in 6-12 hous after droWnin
due to vagal inhibition
Waler enlers
alveou &washes out surfactants
Aveolar collapse Mismalch VP ratio!
Cerebral bypoia Death
FRESH WATER DROWNING
|SEA WATER
Hemodiluion Hemolysis
Hemoconcantration "Crenation of RBCs
Hyperkalemia
"Pulmonary edema Resplralory failure
Ventricular flbrilaton
DROWNING
SPECIFIC SIGNS OF
|ANTEMORTEM DROWNING " Cadaveric spasm
Fine froth in Nostrils
"Emphysema aquosum
"Froth & sand In airway
"Pallauf hemorrhage
Waler in stomach &small
Intestine
Waler or hernorrhage in ear
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NON SPECIFIC SIGK Cutis anserine
Washerwoman a
Dr Pedagogy
Asphyxial Deaths
Frequently Asked Concepts-Last-Minute Tidbits tw asphyxial deaths, Cranium should be dissected first and neck at last (o avoid Prinsloo Gordon's artefact).
Theory
Partial hanging is common in Autoerotic asphyxia.
hangine Dribbling of saliva - surest sign of antemortem Le facie sympathique seen in antemortem hanging.
Carntid intimal tear (amussat sign) and Hangman's fracture are seen in judicial hanging. twdicial hanging is the method of execution of death sentence in India. It results in dislocation in 2nd and 3rd cervical vertebra (Hangman's fracture).
Spanish windlass technique is form of garroting.
Einger nail marks, fingertip bruises, hyoid bone fracture, extensive bruising of neck tisues diagnostic of throttling/Manual strangulation.
Adduction fracture of hyoid is seen in throttling. Abduction fracture of hyoid bone is seen in hanging.
Bansdola is constriction of neck by bamboo stick.
Mugging is constriction of neck by bend of elbow or fore arm,
Washer woman's hands and feet usually occur within 12-18 hours (non-specifíc sign).
Cutis anserina or goose skin is anonspecific sign in drowning.
Presence offine white leathery froth in mouth and nostrils is seen in drowning.
Hemoconcentration is seen in sea water drowning; hemodilution is seen in fresh water drowning. Io fresh water drowning. there inmay be hyperkalemia, hemolysis and ventricular fibrillation. wet
is seen " Emphysema aqueosum
wet drowning.
In sea water drowning, there is asteep rise in Na and Mg, Chloride, strontium. . The presence of fine white leathery froth in mouth indicates drowning.
.Diatoms test is negative in dry drowning and in dead bodies thrown in water.
In atypical case of drowning, diatoms are found in the brain and bone marrow. . Getler's test is to determine the chloride concentrations in the blood of heart chambers. " Convincing proof of burial alive is sand in trachea and bronchi.
. Smothering is a form of suffocation.
. Hydrostatic lung is seen when adead body is thrown in water. Emphysema aquosum is seen when a conscious person drowned in water. " Edema aquosum is seen when an unconscious person drowned in water.
" Hanging is usually suicidal, the most common method of suicide. Accidental hanging is seen in autoerotic asphyxia (sexual asphyxia/kotzwainism). Lynching is aforn of homicidal hanging.
Manual strangulation is almost always homicidal, suicidal throttling is impossible.
Choking is accidental. Smothering is usually homicidal
Masque ecchymotique is seen in traumatic asphyxia.
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Dr Pedagogy
Forensic Medicine
Image-Based Questions
IMAGE-BASED QUESTIONS
1. The most probable cause of death is:
4. ldentify the type of hanging:
1 Hanging
b. Throttling c Ligature strangulation d. Choking
2. The cause of death is:
b. Partial hanging
a. Complete hanging
d. Atypical hanging
c. Typical hanging 5. ldentify the type of hanging:
a. Manual strangulation b. Lynching c Ligature strangulation d. Smothering 3. The cause of death is:
6. The sign shown in the image is:
82
a. Mugging G. Smothering
b. Choking
Manual strangulation
a. Tardieu spots c. Vibices
b. Paltauff haemorrhage
d. Marbling
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Dr Pedagogy death is: 7. The cause of
Asphyxial Deaths
10. This sign is indicative of:
Image-Based Questions
Obstructlon
a. Wet drowning
b. Dry drowning
c. Postmortem immersion d. Hydrocution b. Smothering a. Gagging d. Choking c Mugging indicted for: is mancuver Heimlich 8.
11, The manner of death shown in the image is:
12
1 Near drowning c Choking
a. Accidental
b. Suicidal
c. Homicidal
d. Postmortem
This method of execution is termed:
b. Wet drowning d. Gagging
9. The fracture seen in X-ray is seen in:
a. Spanish windlass technique
b. Burking c. Bansdola
d. Pithing 13, This type of asphyxia is termed:
& Partial hanging
b. Manual throttling
c Judicial hanging
d. Bansdola
a. Smothering G. Choking
b. Garroting
d. Mugging
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83
Forensic Medicine
Dr Pedagogy 16. This sign is more suggestive of:
14. ldentify the condition: Image-Based Questions
a Antemortem drowning b. Postmortem drowning
a Environmental asphyia b. Traumatic asphyxia
c Non-specific d Hydrocution
c Postural asphyxia
is: 17. The type of asphyxia shown in the image
d Pathological asphyxia 15. The cause of death is:
smothering Combination of traumatic asphyxia and
choking
asphyxia and b. Combination of traumatic asphyxia and strangulation
c. Combination of traumatic asphyxia and throttling d. Combination of traumatic
a Strangulation b. Hanging c. Suffocation
d Traumatic asphyxia
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Dr Pedagogy
Asphyxial Deaths
ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS L. Ans, b. Throttling
" Itis termed as Hangmank fractureQ.
The photograph shows hyoid bone, with fractured greater
cornu displaced lnwards,-seen in throttlingQ 2. ANs. a. Manual strangulation
. The photograph shows multiple Crescentic nall marks In the neck, more suggestive of throttltne.
3. Ans. c. Smothering
Answers
" Itis associated with judicial hanging (hanging with along drop) 10. Ans. a. Wet drowning
" The photograph shows profusefroth over mouth and nostrils,with indicative of wet drowning
" Froth in drowning is an antemortenmQ feature of wet drowning. Explanations
" Froth is absent in hydrocution, dry drowning and post
. The plhotograph shows the presence of bruises over inner
aspects oflips and abrasions and over the perioral region, 4. Ans. c. Typical hanging
mortem drowning. 11. Ans. c. Homicidal
The photograph shows lynching
" Lynching is lhomicidal hanging, of an alleged suspect of rape or murder by a mob in a public place without any trial.
5. Ans. Partial hanging
.The image shows the knot is located at the occiput - Typical hanging.
Based on the position of knot:
" Over occiput- Typical hanging: Anywhere other than ociput - Atypical hanging
Based on the degree of suspension:
" Whole body suspended-Complete hanging: Any part of the body touching the ground - Partial hanging 6. Ans. b. Paltauff haemorrhage
" The photograph shows paltauffhemorrhage. " Paltauff's hemorrhage is asign of drowningQ.
to
12, Ans. a. Spanish windlass technique Image-Based " Spanish windlass technique is aform of garroting. 13. Ans. d. Mugging
" The image shows neck compression by the bend of elbow. " Mugging is constriction of neck by bend of clbow or bend of knee. 14. Ans. b. Traumatic asphyxia
Questions
" The photograph shows masque echymotic.
" Masque ecchymotic: Subconjunctival hemorrhage and
purple-blue discoloration of the face and neck that suggest traumatic asphyxia.
7. Ans, d. Choking
15. Ans. a. Combination of traumatic asphyxia and smothering
8. Ans, c. Choking
The image shows the obstruction at the level of larynx-choking " Smothering; Occlusion of external air passages by hand, pillow, plastic bag, etc.
. Choking, Occlusion of internal air passages by foreign
The image shows burking an asphyxia death produced by the
combination of traumatic asphyxia and smothering.
Was practiced by William Hare and William Burke, to kill 16 people and supply dead bodies to Dr. Robert Knox for
anatomy dissection.
body, food particles, etc.
Overlaying: Compression of chest, when mother shares bed with baby Gagging; Occlusion of internal air passages at pharyngeal level by agag Heimlich manoeuvre is a first aid procedure used to treat
16. Ans. c. Non specific " The photograph shows 'cutis anserina' " Cutis anserine or goose skin is the puckered and granular appearance of skin immersed in cold water " Cutis anserine is a nonspecificQ sign for drowning
choking or upper airway obstructions by foreign objects. 17. Ans, G. Suffocation
9. Ans, c. Judicial hanging
" The X-ray shows anterior dislocation of C2 over C3
(spondylolisthesis of C2)
" The photograph shows smothering " Smothering is a type of suffocation and is usually homicidal.
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Dr Pedagogy
Forensic Medicine
NEXT/CLINICAL CASE BASED QUESTIONS CBQ they fought for a Two friends consumed alcohol, after whichother onto the floor the pushes them common girlfriend. One of breathing while from him and covers his face/nose preventing
(INI-CET Nov 2021) as sitting on him/chest. This is known C Overlaying a. Smothering b.
5
casualty dead was brought to the ind the find cause of death. eters4 autopsy was performed to a mark on the chin On as sL eLamination only finding was
brought
A person
first picture. And on internal examination of fneck tthere wasfhe
Gnding on the anterior surface of neck as shown below possible diagnosis is:
(AIMS May 2017 Ny 217
d. Gagging
Burking
CBQ
2
Acase of hanging was brought for autopsy. On examination, ligature mark present in 1/3n of neck Right eye was open and the left eye closed. Salivary dribbling from the right side of eye? opening of right behind the cause mouth noted. What is
(INI-CET Nov 2021)
Sympathetic chain compression
a.
a Throttling b. Strangulation
b. Jugular vein injury c. Carotid artery injury d
C Mugging
d Hanging
Vagus nerve stimulation CB
6
CBQ
3
Postmortem shows nail scratches in A person was found dead. Hypostasis is
lip. the face, lip laceration in the inner side ofthethereason? be cannot following fixed. Which of the (FMGE Dec 2020)
room was unlocked. On ped Awoman died in her room. Her Subconjunctgl
dissection, there was contusion present. probable hemorrhage and froth in the mouth present. The
(IN-CET N¡v 212
condition is
a. Cause was throttling
b. Postmortem was done within 24 hrs c Due to asphyxia d. tis homicide
CBQ unlocked. Her blood Awoman died in her room. Her room was shown below. On neck alcohol levels were 350 m/mlL Image is (AIIMS Nov 2018) contusion present.
a. Traumatic asphyxia
b. Strangulation
G Hanging d. Drowning
dissection, there was
7
CE
A50-year-old chronic alcoholic while having dinner sudde
becomes aphonic and is brought to the casualty with complaint of respiratory distress, Immediate managemc should be:
a. Cricothyroidotomy 1 Throttling
c.
b. Bansdola
d Alcohol intoxication
Cafe coronary
b. Emergency tracheostomy c Humidified oxygen d. Heimlich maneuver
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Dr Pedagogy CBO A6-.vear-old male dead body was found in a hotel room.
llal indingsby the forensic team include glove and stocking
nnslasis, protrusion of the tongue, and dribbling of saliva.
The dribbling of sallva is suggestive of? Antemortem hanging
Amiddle-aged male body was found hanging from the Answers ceiling
On external examination, engorgement of penis and glove and
stocking distribution hypostasis noted. Which is true about the above mentioned signs?
Death due to sexual asphyxia
hanging NEXT/Clinical
ANSWERS TO NEXT/CLINICAL CASE-BASED QUESTIONS " Though alcohol intoxication is mentioned in the question,
Asnlhyxla due to sitting on the chest (traumatic asphyxia) and
it is not choking, as there is no obstruction noted in the
dosing the mouth and nostrils (smothering) is burking
|Smothering?
Occlusion of external air passages by hand, pillow, plastic tbag, etc.
Choking
to
b. Death dueeto hanging c. Death due eto strangulation and post-mortem d. None of the above
c Postmortem hanging d. Throttling
Burking I. Ans. b.
CBQ
a.
b. Strangulation
Asphyxial Deaths
tracheal lumen.
5, Ans. a. Throttling
The picture shows discoid bruises and brusing of the soft
Occlusion of internal air passages by forelgn body, food particles, etc.
Overlaying
Compression of chest, when mother
Gagging
shares bed with baby Occlusion of internal air passages at
Burking
Smothering and traumatic asphyxia
Case-Based
tissues of the neck - Suggestive of throttling 6. Ans. b. Strangulation
Questions
The picture shows discoid bruises and nail scratches in the
neck- Suggestive of throttling
pharyngeal level by a gag
7, Ans, d. Heimlich's maneuver
It is a case of choking.
Choking: Occlusion of internal air passages by foreign
2. Ans. a. Sympathetic chain compression.
body, food particles, etc. a. Heimlich's Maneuver
twas mentioned in the question that one eye is open and one
i can prevent choking and Cafe Coronary.
eye is closed.
ii. It's a first-aid procedure used to treat choking or upper airway obstructions by foreign objects.
This sign in hanging is la facie sympathique. Le facie sympathique: One of the surest sign of ante
iii. The term was coined after Dr. Henry Heimlich.
mortem hanging.
" Compression of sympathetic chain by the knot of rope.
Ans. a.
" Results in ipsilateral dilatation of the pupil and partial opening of the eyelids. 3. Ans, a. Cause was throttling
Presence of nail scratches in the face, lip laceration in the inner
side of the lip suggestive of death due to smothering.
4.
Antemortem hanging
Signs of antemortem hanging: 1. Salivary dribbling is seen on the opposite side of the knot. 2. Le facie sympathique 9.
Ans, d. None of the above
Hypostasis is fixed (Time since death is more than 6-8 hours) " Option A: Cause was throttling-false
" In this case, the presence of glove and stocking distribution
" Option B: Postmortem was done within 24hrs- True " Option C: Due to asphyxia- True " Option D: It is homicide- True (The findings suggestive of
and stocking hypostasis indicate the vertical position of the
homicidal smothering) Ans. a. Throttling8
body after death. Not a sign of death due to hanging.
Hypostasis is dependent on the position of body and non
specitic in hanging
" In males, there may be penile turgidity and involuntary
" The picture shows discoid bruises and brusing of the soft
tissues of the neck.
and engorgement of penis is due to the hypostasis, Glove
discharge of semen. " In both sexes, there may be an involuntary discharge of fecal matter and urine.
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Dr Pedagogy
Forensic Medicine
MULTIPLE CHOICE QUESTIONS
Multiple Choice Questions
(INI-CET Nov 2020)
1
Drowning True about Fresh Water b. Hypokalemia a Hemodilution
6. Hanging causes a large amount of injury to:
d. Arrhythmia
c Hyponatremia
features are seen in Sea water 2. Which of the following (INI-CET July 2021)
drowning ?
b. Hypokalemia
yponatremia
d. Hemodilution
c. Hypernatremia e Arrhthmia 1, a, b,d
7.
(Recent Question 26)
Lynching is:
a. Accidental hanging
b. Homicidal hanging
c. Accidental drowning d. Homnicidal drowning at: 8. The knot' in judicial hanging is placed
(AIIMS 2006, Recent Question h
2. a,e
3. The above phenomenon is due to
d. Esophagus
C. Trachea
4. b, c, d
3. C,e
(Recent Question 2h1
b. Carotidd artery
Vertebral artery
Behind the neck Below the chin
(Recent Question 2021)
b. Side of the neck d. Choice of hangman
commonly seen in? 9. Hyoid bone fracture is most
(Recent Question 201s
b. Gagging
a. Hanging Choking c. Throttling due to: (AIIMS 201 10. Death in jack-knife position is b. Positional asphyxia a. Burking c. Traumatic asphyxia
d. Wedging
11, Which of the following is not a type of suffocation:
(Recent Question 2016
a. Choking
b. Gagging
d. Throttling c. Smothering Question 2016 12. Immersion syndrome is called as (Recent b. Wet drowning a. Hydrocution d. Secondary drowning c. Dry drowning 13.
Feature of ante mortem drowning is:
(Recent Question 2016 a.
Cutis anserine
b. Rigor mortis & Case of torture in hot water
C. Washer woman's feet
b. Case of post-mortem hanging d
in water for 36 bours Case of tmfalanga Case of case
4. Partial hanging may resemble strangulation by
(FMGE June 2021)
d. Grass and weeds grasped in hand 14. Emphysema aquosumn is associated with? Dry drowning
C. Immersion syndrome
2 Knot mark
b. Situation below the thyroid cartilage
c. Dribbling of saliva
d. Transverse ligature mark
5. Judicial hanging is the method of execution ofa condemned
criminal in our country. The cause of death in such cases (FMGE June 2021) would be a. Vagal inhibition b. Fracture dislocation of cervical vertebrae c. Cerebra l hypoxia d. Asphyxia
15. Gettler test detects:
(Recent Question 2013, 5 b. Wet drowning Secondary drowning (Recent Question 2014
Diatoms in drowning
b. Chloride content of blood in drowning
c. Weight of lungs in drowning d. Magnesium content of blood in drowning 16. Most common form of drowning in India: (Recent Question 2014 a. Suicidal
c. Accidental
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b. Homicidal d. Infanticide
Dr Pedagogy
Asphyxial Deaths
ANSWERS WITH EXPLANATIONS llemodiltlon, c.
Hyponatremla, d. Arrhythmla
Internal FHndings: Explanations Answer with " Fracture lyold Bone: Abduction fracture " Amussat slgn: Carotld artery transverse intimal tear!
2. Ans, J.Ge water for 36 hours LAns, c lmmerslon in
(Ref The esentials of Forensic medlclne and toxicolog. Dr KS Nanyuna Redy: 33nl elition, pg no:369)
Signs of antenortem hanging Sallvary drlbbling? Le facie sympathlque? Features
Hypertonle
Hypotonle
Mechanism
Strangulatíon Constriction of neck
Constriction of neck
without suspension of body Homicidala
with suspension of
Fluld entering
Water Entering Into the blood
enters into alveoli
Resulting ln hemodilution
Pulmonary Edema
Hemolysis
body
Manner (usually) Sulcldal9 Signs of struggle Absent Ligature mark
Below thyroid cartilage
cartilaged Incompletea Obllque
falure
Complete
TransverseQ Subcutaneous
" Subcutaneous tissuesos under the
Here lt ls Hemo Concentration
Cardlac arythmia
Present
" Above thyroid
Respiratory
Hyperkalemla & Hyponatremla
tissues under the mark reveals
mark reveals pale,
ecchymosis.
white, glistening, Na',
Death
Ugature
Hanglng
Salt Water
Fresh water
hard skin
CIl ‘Mg4,‘ Strontium
in blood
4. Ans. d. transverse ligature mark
Hyold fracture
Common (>40 yeors)
Thyrold fracture
Uncommon
Uncommon
Common More marked
External signs ofLess marked asphyxia
5. Ans, b. fracture of cervical vertebra
(Ref The essentials of Forensic medicine and toxicology,
Dr. KS Narayana Reddy; 33rd edition, P8 no: 345) Transverse ligature mark in hanging seen in partial hanging, slip knot with running noose.
Face
Pale
Congested
Bleeding from
Less common
More common
Present
Absent
Less common
More common
At glans is more
Less common
nose and mouth Carotid intimal tear
Involuntary
discharge of
6. Ans, b, Carotid artery
Ref The essentials of Forensic medicine and toxicology Dr. KS
Narayana Reddy; 33rd edition, pg no: 345
urine and stools
Seminal fluid
common
Amussat sign:
" Carotid intimal transverse tear on the side of the knot
Associated with long drops. " It is due to combination of RADIAL FORCE (ligature materlal) and AXIAL TRACTION (weight of body due to Suspension)
POSTMORTEM FINDINGS IN HANGING
External finding:
7. Ans. b. Homicidal hanging [Ref The essentials of Forensic medicine and toxicology. Dr. KS Narayana Reddy; 33 edition, Pg. no: 346]
Lynching is aform of homicidal hanging. 8. Ans, b. Side of the neck
"cases) Ligature mark: Obilique, above the thyroid cartilage (80% and incomplete. Le facie symphathiqueQ: Unilateral opening of cyelid and
pupillary dilatation on the side of knot
" sign Driblng ofsalivafromthe angle of mouthº (most Important 8 of of ante mortem hanging) " Seminal emission is common,
(Ref The essentials of Forensic medicine and toxicology,
Dr. KS Narayana Reddy,; 33n edition, Pg. no:346]
Judiclal Hanging
" In India, the knot is placed near the side of the neck
" But the knot below the chin is highly effective.
" There is a sudden drop, resulting in hangman's fracture.
89
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Dr Pedagogy
Forensic Medicine
Explanations with Answers9. Ans. c. Throttling (as explained earlier)
1, Ans. d. Throttling
10. Ans. b. Positional asphyxia
12. Ans. a. Hydrocution
[Ref. Concise textbook of forensic medicine & toxicology by
Hydrocution/Immersion Syndrome/
Anil Aggrawal, P272.]
Submersion Inhibition
Jack knife position:
Death results from sudden cardiac
arrestQ inhibition of heart, " Occurs in drowning in cold water, which : nerve endings at surface of the body or
"A restraint position where the thighs and the knees are flexed against the chest.
due
to
vagl
stimulates the vagi water striking epigastrium or cold water entering the ear passage
" As a result, the body is subjected to indirect compression. attributed to the impaired movement of chest wall
. Death is
due to this position.
" Death is due to positional asphyxia 13. Ans. d.
Grass and weeds grasped in hand
High-Yield Info
Signs of antemortem drowning External findings
" Cadaveric spasm holding grass, gravel and sand in hand " Fine, white lathery froth in mouth and nose
Internal findings
Emphysema aquosum: Voluminous, ballooned and crepitant lungs
Presence of froth° mixed with sand particles in the trachea and bronchi Presence of water in stomach and Presence of water in middle ear
small intestine
Temporal bone haemorrhages ab tests:
Diatoms in the femur bone marrow Gettler's test
14. Ans. b. Wet
"
drowning [Ref. The essentials of Forensic medicine and toxicology, Dr. KS Narayana Reddy, 33rd edition, pg.
Emphyysema aquosum is a sign of wet drowning.
15. Ans.
b.Chloride content carlier)
16. Ans. c.
(Ref: The essentials of Forensic medicine and toxicolag
no:369]
of blood in drowning (as explained
Accidental
"
Dr. KS Narayana Reddy; 33rd edition, pg. no 32 is drowning accidental.
Most common manner of
(Ref The essentials of Forensic medicine and toxicology Dr. KS Narayana Reddy; 33rd edition, Pg. no:372]
90
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Dr Pedagogy
Forensi
Araumatology "Push Yaunoelf Because, Na'One Ese io Gaing a De t for Yau"
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Dr Pedagogy
Forensic Medicine
Theory
LEr's KNow THE TERMS FIRST Mechanical Injuries
Blunt force injuries (Ground, Sharp force: Light cuttng
Sharp force: Heavy cutting
weapon (Surgical blade)
weapon (Chopper, axe)
Sharp force: PoPointed
Abrasion (scratch)
Incised
Chop injury
Stab injurya
Contusion (bruise)
(cut injury)
stone, hammer)
Laceration (skin tear)
(Kitchen knife, crewe pencl)
wt
Fracture of bones
Injury (Sec. 44 IPC): Any harm, whatever illegally, caused to any person in: . Body Mind Reputation Property
Wound: A breach of natural continuity of skin or mucous membrane Open head injury: When the dura is torn Closed head injury: When the dura is intact Non-penetrating or closed abdominal injury: When the peritoneum is intact,
Penetrating or open abdominal injury: When the peritoneum is ruptured.
" Mass disaster: Death of more than 12 victims° in a single event, like fire, air crashes or floods. .............
ABRASION General Characters of Abrasion of the skin (epidermis) only Destruction of the skin, which usually involves the superficial layers
" Slight bleeding, heal rapidly and no scar formation,
ABRASION
Tangtial LATERAL RUBBING OF SKIN
COMPRESSION OF SKIN
WITH ROUGH SURFACE
GRAZE
SCRATCH
PRESSURE ABRASION
PATTERNED
ABRASION/
Pressure Graze
Scratch
inear abraslon caused by pointed or sharp object
" FingernaiP/Thorn/Pin
Friction with rough surface over wider area
ole uneven, longitudinal
Uel Hnes ost common
of abrasion Mo In road traffic Also called brush burn/sliding
dents
abraslon/rai
92
Pressure over the
skin with crushlng of
epithelium. Ligature marka
in hanging and strangulation.
c
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rt ar Patterned
eplthelium " Crushing of pattern
fthe weapo
Imprinted on the skin Ligature mark " Radlator grill mark Tread marks of tire
Dr Pedagogy Forensic Traumatology Differential diagnosis of abrasions
Theory
" Ant bite marks
SIte: Mucocutaneous junctions-around the eyelids, nose, mouth, axlla &groins
Appearance: GRAZE ABR
LINEAR
SCRATCH
UNEVEN LONG NGITUDINAL WWIDED AREA
PRESSURE
Irregular margins
ABRASION
Normal skin in between (Sand paper appearance")
LINES
" Vital reaction is absent. "
Extra Edge
Pressure sores
"Npppy rash
Nature of Injury: Ilualy abrasions are simple hurt (as they are superficial) except corneal abrasion,
Antemortem vs. Postmortem Abrasions
, Corneal abrasion is grievous hurt (Sec. 320 IPC) because
ahrasions over the cornea may cause corneal opacity and
permanent visual restriction.
Features Site
Medicolegal Significance of Abrasions
Antemortem
Postmortem
abrasions
abrasions
Anywhere on the
Bony prominences
body
Abrasions give an idea about the direction of force® Patterned abrasions are helpful to find out the causative weapon. Age of injury can be determined In open wounds, dirt or sand is usually present which is used to
Scab formation
Present
Absent
Color changes
Present
Absent, mostly
Manner of Injury
Vital reaction
yellowish without any change
connect to the scene of crime
Present9
Absent
Direction of force
Heaping of epithelium or epithelial tag:
. Surface epithelium is scrapped &deposited at the tail end
CONTUSION/BRUISE
Tal
of the obrasion
" Contusion is the extravasation of blood under the skin due to rupture of blood vessels, usually capllaries, as a result of blunt
Abrasion distribution and manner
. Crescentic finger nail abrasions over neck: Throttling
Abrasions around mouth &nose: Smothering Ua
dc
force injury. Present not only in the skin, but also in internal organs-lung, brain or muscle.
" Abrasions on breast, genitals & thigh: Sexual assaults
MNEMONIC
Blunt force
Time since injury from Abrasion
RRRBB8-R'g 1 A -Raw without scab (fresh) - 12 hours
Collection of blood (extravasation)
Abrasion heals from the periphery by growth of new
epithelial cels. After 7 days, Scab dries and falls off, leaving depigmented
area underneath
Swelling and discoloration of skin (contusion)
tgradually gets pigmented.
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Ho) whed uen
Forensic Medicine
Dr Pedagogy
Theory
Six penny bruise (as it
resembles six penny)-Hes
Discoid-shaped bruises
Due to pressure from fingertips Seen in neck of throttling cases & arms, forearm or wrist of child abuse cases
Butterfly brulse
lad
Due to skin pinching Moy be seen in child abuse cases.
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 Description
Type
Common type
Superficial/
Location: Subcutaneous tissue in fatty
subcutaneous
layer
bruise
Deep bruise
Below deep fascia. It may take
LOcat hours to 1-2 days to appear at the surface
Ankle contusion with bruise
(delayed brui Ect
Appearance of bruises ata site other than the site of injury, e.g., black eyes. Thus, site of bruise does not always
bruise
ti Patterned bruise
indicate the site of injury For example:Blackeye/spectacle hematomaQ Patterned bruise indicates the nature of the weapon
XDeep organ
n 2 eau
g
Aging or Dating of Bruise
Based on the color changes. destruction & removal dt As bruises heal, there is a gradual
extravasated blood
extends inwards tat Color change starts at the periphery and
center.
Contusion of the internal organs
hon
N
- uhnuorim
Oxyhaemoglobin (Red)
contusion
Deoxyhaemoglobin (Blue)
type-oH3 Railway line or tramline parallel, stick or a whip produce two Blows with a rod, linear haemorrhage.
Hemosiderin (Brown/violet)
Haematoidin bilyerdin (Green) Bilirubin (Yellow) 7-14 Fresh
Few hours
4-5 days
6-7 days
3 days
94
The intervening skin appears pale, The diameter of the pale area may indicate the diameter of the weapon.
OXY-H
DEOXY - Hb Hemosiderin
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Haematoidin/ Br Biliverdin
Dr Pedagogy Forensic Traumatology Prominent/easy bruisíng with
Extra Edge color changes Sites where are not contusion
" Multiple bruises of different ages in a same person isa
of seen-Subconjunctival hemorrhage (due to continuOus
feature of child abusea
phases) Postmortem lividity (in early .Artiicial bruise/Pseudo bruise Certain irritant substances and plant juices are applied on the
stin to mimic articial bruise. Trlomma)y Bruise R
Jluotrative A 28-year-old female was in a semiconscious state, brought to casualty by her newly-wed husband with history of giddiness and vomiting since 2 days. She was declared 'Dead on Arrival'. On autopsy, multiple areas of dark patches simulating birthmarks,
True bruise
Pseudo bruise
Blunt Trauma
Plant poisons like
were pale. Kidney showed acute tubular necrosis on microscopic
Semicarpus
examination. The cause of death was given as shock and
Cause
Calotropis
hemorrhage due to multiple soft tissue injuries sustained. Owing to the opinion, the husband was taken into custody. He confessed
PlumbagO Location
Theory
Males
were present all over the body. Extravasation of blood were noted on incising the patches, indicative of bruises. Multiple incisions were put on discolored areas all over the body. Numerous contused areas were noted (45 in no). Internal viscera
Pseudo/False Bruise Characteristics
e
obesity, leukemia, hemophilia, scurvy, bleeding diathesis, vitamin K& prothrombin deficiency
Contusion
Differences between True
" Females Conditions like cirrhosis,
exposure of air
Diferential Diagnosis of
Lesser/delayed brulsing
little force
Anywhere on the
bodya
Accessible parts of body
Like forearm, thighs, abdomen
Blisterfvesication
Not present
Presenta
Itching
Not present
Present
Color Changes
Characteristic of
Absent
changes as it heals) Blood
Chemical analysis
Negative
LACERATION A5 4e0) Tissues are torn as a result of application of blunt force. Tissues may be skin, mucous membrane, muscles or internal organs.
true bruise (color
Contents
to have tortured and beaten his wife with a stick covered by cloth.
Laceration is three-dimensional (length, breadth and depth)
las
Acrid serum
General Features of Laceration
Chemical/plant
" Irregular Shape®
juice detected
0tfvieN
Irregular and uneven Margins
MNEMONIC Substances producing pseudo bruise
" Contused edges Floor of laceration shows following features:
Tissue bridges (tissue, blood vessels and nerves bridging
Social Preventive Medicine Sermicarpus
across the gap of the wound)
Plumbago
Less hemorrhage because of crushed blood vessels.
Crushed? -Hse,ne, aix buls
Foreign particles like mud may be seen embedded in the
Madar (calotropis)
wound, which gives clue about the scene of crime
Factors Influencing Contusion Appearance Prominent/easy bruising with Lesser/delayed bruising
little force " Falr complexioned
skin
Dark complexioned skin?
Lax and vascular tissues,
Tissues with firm fibrous tissue or thick
eyelids
Dermis, such as abdomen,
such os foce, scrotum&
back, scalp, palms and soles
Children and elderly age
Good muscle tone
group
Contd..
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Forensic Medicine
Dr Pedagogy
Theory Iregular margins
Contused
Crushed hair bulbs
edges Tissue
bridges
Lacerated wound
Types of Laceration Split Skin is split .
Mechanism
Tissues are crushed between two hard surfaces, i.e, the weapon and the undertying bone
Incised likefincised looking
Tear
Stretch
Mechanism:
Localized pre[sure with pull
.
Tearing of skin and SC tissue due to localized impact with
hard irregular object
torce.
Overstretching of the skin
Avulslon/rinding Mechanism: Sheari delivered at an oblicy angle to skin. , Seen in Run overinr The rotating wheel riosl
causing laceration with
of skin and subcutanesg tissues from the under
flapping
Striae-like lacerations or
bone-FLAYINGO Direction of forceca
stretch mark-like lacerations
lacerotion
determined
MNEHO Extra Edge
bny Sites of incised looking lacerations:Fatal 8leeding
to ranges from skin flaps (minor) The severity of avulsion amputation of a finger or limb (moderate) and
& Sharp Knife Causes Slash Injury S- Scalp
(severe). skin over a force of a wheel tears off the " Flaying: The rotating frequenthy on the legs large area - flaying, and most where the large area of skin type severe Degloving injury: A rolled off a Iimb (like a glove) and subcutaneous tissue is and SC tissue is rolled off the Scalping: A large area of skin trapped hair is trapped and being scalp (especially when the in machineryl
K- Knee C-Chin
degloving
S-Shin 1-lliac crest F-Forehead
B-Brows eyebrows) lacerations are seen are Notes: Sites where incised looking PGMEE. commonty asked in various
INCISED WOUND (CUT/SLASH/SLICE) laceration Incised Uke/incised Looking incised wound. (A laceration will look like an This injury
looking like an incised wound)
ky eOu ney
tisa type of split laceration wounds, easily detectable on These are essentially lacerated lens.-ier eamination with a magnifying
Common sites:
the underlying bones, I.e., Scalp, " Wherever skin is dose tochin, Ilac crest, shin face, forehead, cheek,
24
N
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Dr Pedagogy Forensic Traumatology Regular Margins: Clean cut9,
HESITATIONAL CUTS |Tdetsa /Tadahe t /
dimensionQ . Length: It is the maximum
Depth/direction:
>b
debth)+o
Head end: deeper at the beginning of the wound Tail end: Shallow at the terminationQ Hemorrhage: More bleeding due to cutting of vessels
PROFUSE BLEEDING
CLEAN CUT MARGINS
IN THE FLOO
Indicates suicidal nature of the wound
Fees
toke
Theory
Multiple, small, superficial, parallel cuts noticed over the
accessible body parts Sites - Over throat, wrist, elbow, front of chest and abdomen. Multiple, small, superficial, parallel cuts noticed over th¹ accessible body parts
VESSEL NERVE
TalingY
" It is a feature of incised wOund
. Usually deeper at the beginning (head end) and toward termination, the cut becomes progressively shallow, known
as tailing of the wound.
Direction of the forcecan be determined
CHOP WOUND
Caused by a blow with the sharp-cutting heavy weapon.
Deep gaping wounds, Chusrito o h e U
Weapons used: Hatchet, axe or meat cleavers. Margins are sharp, and may show abrasion or bruising.
" Undermining occurs in the direction toward which the chop is
HEAD END
made. TAILING
DEEPER
Most of the injuries are homicidal
STAB WOUND (PUNCTURED WOUND) " Produced from penetration of weapons with pointed ends " Depth° is the maximum dimension of stab wound TAILING
" 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
4uTS
BEVELLING
through the other side, producing two wounds (Entry wound and Exit wound) Features
Undereut
Everted
Inverted
Margins Shelved
Exit wounds
Entry wounds
Smaller
Larger
Size
Characteristics Margins " Edges
(Bevel: Asurface having sloping edge)
Produced by oblique cuts ne blade of the weapon enters obliquely, tissues wll be MisiDie at one margin and other margin wll be undermined
Indicates homlcidal nature of the wouno
Direction of application of the weapon, and the relatGve
POSion of assallant and the vlctim can also be determined
Length
Bade Breadth
of the
Length Is slightly
"Roughly corresponds
WOund
less than
to the thickness of
are
the width
clean
of the
Cu
weapon
the blade
because
of stret
Depth Depth is the greatest dimension of a stab wound.
.
Depth corres ponds to the
Llength of
ching of
the blade of the weapon
the skin
entering the
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body
Dr Pedagogy
FOl
Tailing: wound " Seen in incised can be determined force Direction of "
Shape of Stab Wound Theory be triangular or wedge Single-edged weapon - Wound will will be sharp and the other shaped (one angle of the wound U rounded, blunt or squared off) elliptical or slit-like, and
Swallow tails: . Seen in laceration.
Small uneven tears at angles diverging trom the male laceration. Fish tailing:
Double-edged weapon - Wound will be
both angles will be sharp
" Seen in stab injury". wound . Small splits from the blunt end of the stab
acute angle. Sharp edge of knife produces angle. blunt produces Blunt edge of knife
.Produced during withdrawal of knife or the blunt end nt
DEFENSE/PROTECTIVE WOUNDS r It results from victim's spontaneous instinctive toward self-protection.
One angle is acute and other angle is blunt
Acute angles on both
sides-double edged
single edged knife
knife
and
Wedge shaped
Spindle/Oval shaped
"
bruises If the weapon is blunt, injuries will If the weapon is sharp, the cutting. attack, whether stabbing or
sare produced
abraend upon the ty
homicidal naun The presence of defense wounds indicate
'HILT MARK'INJURIES
the injuries.
abrasions/contusions produced by the hilt " Hilt marks are the body. guard of the knife during full penetration into the the location of by determined can be . Direction of the force
Active Defense Injuries tries to grasp the weapon They are seen when the victim flexor sides of the fingers and the
Location: palms, the between the interdigital spaces, more common in the web
hilt mark.
thumb and index finger. Passive Defense Injuries the hands or arms for These are seen when the victim raises
Hilt mark
protection. wrists, knuckles and the Location: Ulnar surfaces of forearms,
Hilt guard
back of the hands
Cut Injury in first web
LANGER'S LINE OR CLEAVAGE LINES " The pattern of collagen 6ber?
arrangements
are
the lines of cdeavage of the skin and their linear
representations are known as "Langer's%line li of cleavage.
Lines of Langer determine .
the Gapingof stab injury.
An íncised/stab wound at
Lright angles to the deavage lines- gaping wil be more. An incised/stab wound that runs parallel to these nes -
gaping will be less and slit
like shaped. 98
Defense wounds are absent if the victim is: Not me^
"
Attacked from behind
Unconsclous
" Under the influence of alcohol/drugs Taken by surprise
rabnled Wgunthrd by himsel,
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Dr Pedagogy Forensic Traumatology HARAKIRI (SEPPUKU)
It results in immediate death by sudden evisceration of the
internal organs and circulatory collapse.
is an unusual type of suicidal' stab injury and disembowel.
ment. A ined
warriors. .Practiced by Japanese Samurai sword Asingle large abdominal stab wound is inflicted by a short he left side, drawing the blade across to the right side and
Theory
Concealed punctured wounds:
" Punctured wounds on the concealed parts of body " Sltes: Nostrils, fontanels, inner canthus of eyes, axilla, vagina,
rectum and the nape of the neck. " Fatal penetrating injuries without leaving any visible external
then turning it upwards producing an L-shaped cut.
marks or bleeding.
REGIONAL INJURIES Types of Skull Fractures
Vault Fractures of Skull Types of fracture
Fissure Fracture
Causative force
Blows with an agent having a relatively broad striking surface
Description " Due to general deformation of skull
Most common fracture Thin linear cracks passing over the vertex or base without any displacement of the
fragments. " Difficult to detect, may not be seen on X-ray,
and can only be detected at autopsy. Depressed fracture
(fracture ala signature)
Heavy weapon with a small striking surface?
Example: Hammer, stone, chopper
Due to local deformation of skull.
Aportion of fractured bone is depressed inwards into the cranial cavity
The fractured segment resembles the pattern
of the striking surface of the weapon.
" It is also called fracture ala signature Comminuted fracture
It is oftena complication of fissured or depressed fracture.
(signature fracture) " There are two or more fracture lines
intersecting and dividing the bone into three of
more fragments.
duHQnert
When there is no displacement of fragments, it resembles a spider's web or mosaic.
Pond fracture
Obstetric forceps
(indented fracture)
Asimple dent in the skull without a 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
children due to pliability. elaah
o)
Also known as ping-pong fracture, as it looks similar to a dent in ping-pong ball.
Diastatic/sutural fracture
Blunt injury to skull of young adults
. Separotion of skull sutures Common in sagittal suture Occurring in the skull of children and young adults.
Gutter fracture
Oblque bullet wounds Cor'g hu'e
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.
Pertorating fracture
daggers, knives and axe Pointed sharp weapons like
Both the tables are involved
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Forensic Medicine
Dr Pedagogy
Theory
FISSURE
DEPRESSED
cOMMINUTED
DIASTATIC
GUTTER
POND
SkullBase Fractures " Fall from a height° landing on feet or
Ring or foramen Fracture
buttocks
Fall of heavy load on head " Heavy blow to chin
Hinge/transverse fracture
eI
" With heavy blowS or side impacts to head.
It is a type of fissure fracture that
encircles the base of skul around n
foramen magnum.
As a result, the skull gets separated from the spine.
" Linear fracture separating the skul
two halves, creating ahinge ('nod
foce' sign)., 9 doCrad
The fracture line extends from petry ridge on one side to the contralatera
(veccume Hes)
ype
petrous ridge through sella turcia. " It is also called 'motorcyclists froctur
FORAMEN MAGNUM
FRACTURE LINE
TRANSVERSE FRACTURE LINE
BATTLE'S SIGN 100
Bruising/ecchymosis over the mastoid proces in the line of posterlor auricular artery.
It is an indication of fracture of middle cranial fossa of the skul, and may suggest underlying brain trauma
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Dr Pedagogy Forensic Traumatology rOACRANIAL HEMORRHAGES Estradural hemorrhage
"
Subdural hemorrhage
.
Subarachnoid hemorrhage
Intracerebral hemorrhage Theory
Extraduril HemorthageSubdural Hemorhagesubarachnoid Hemorhagentracerebral Hemorthage
Between the skull & duraBetween dura &
Locatlon
Between arachnoid & pia
Within the brain parenchyma
arachnoldbd c
Middle meningeal
Mostcommon
Brldging veins*Arterial aneurysms
vesselaffectedarterva
Lenticulo-striate branch of MCA
AV malformations
ExtraduralHemorrhage
Site and Vessels Involved Blow impact over lateral convexity of head ’ fissure fracture
Causes
of squamous temporal bone ’ rupture of underlying middle meningeal artery.
unilateral Mostly traumatic in origin, and
SalientFeatures
Common Vessels Involved
It occurs usually on the side of the impact (coup injury).
Anterior branch of middle meningeal artery
Posterior branch of middle meningeal artery Age Group
" Middle meningeal veins
Common in adults between 20 and 40 years.
Bare in the elderly and children due to greater adherence of dura
Autuyladud, odsh
to the skull.
. Fracture (fissurc type) is present in most of the cases. DIRECT BLOW TO SIDE OF HEAD
FRACTURE OF THE THIN
TEMPORAL BONE RUPTURE OF MIDDLE
Scalp
MENINGEAL ARTERY
COMA AND DEATH
Skull
BLEEDING IN BETWEEN
cpidurdspte Fracture line
HEMIPARESIS AND PUPILLARY
DURA AND SKULL VAULT
CHANGES ON THE SAME
in skull
OF HEMATOMA |KERNOHAN'S NOTCH EFFECT
PM
(GRADUAL STRIPPING OF DURA AND HEMATOMA COLLECTION
Hematoma MIDLINE SHIFT Dura
HEMATOMA
RAISED INTRACRANIAL
COMPRESSING BRAIN
TENSION
Clinlcal Features
Medicolegal Aspects
Loss of consciousness due to concussion.
Dilation of pupil
the side of hemorrhage with conjugate
deviation of eyes to opposite side.
Lucid interval; It is a state of consciousness between two cpisodes of unconsciousness. CI Kn: Biconvex lentlcular-shaped° hemorrhage
Treatment
" Patient may be discharged from hospital during lucid interval
and may die at home; doctor may be charged with negligence. 304 A)
" Extradural hemorrhage may resemble drunkenness and patient
may die in police custody. Lucld Interval Definition: State of consciousness between the two periods of unconsciousness.
asurgical emergency, requiring emergency craniotomy.
Early diagnosis and intervention usually save the patient.
Etlology: Epldural hemorhage &insanity Slgnlficance: Legally responsible for criminal acts
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Can make a valid wil and can give valid evidence
10
Dr Pedagogy doyot conelese ? frding sty Forensic Mediçine
bdGnhee
-Se side
Theory
Jllustratiue
On a Sunday, Ramu, 18-year-old boy, was playing cricket with his friends in the ground. While fielding, he was hit with a cricket ball on right side of face around 1:30 pm. He was drowsy & fell immediately. His friends tried to wake him up by sprinkling
-Dura
After her repeated failed attempts, he was brought to casualty, where he was declared dead on arrival. During postmortem
Hematom
water. Ramu woke up in sometime and continued playing. By 2:30 pm, he returned home. His mother, returned home by 4:00 pm and found him sleeping & tried to wake him up.
examination, diffuse contusion with extravasation was noted
over right cheek &right pre- and postauricular region. Linear fissure fracture of size 7 cm was noted in right temporal bone.
On opening the skull vault, a large hematoma 450 g was seen in
the extradural space compressing the underlying brain. Midline
CT Scan: Concav0-convex or crescent-sh
shift to the opposite side noted. The cause of death was opined as effects of head injury due to blunt force.
in subdural space
Subdural Hemorrhage Bleeding is always from vein or capillary, not from artery. Cause "
It is usually traumatic, following an assault or fall (due to
acceleration- deceleration injury), sheng Age Group Children
Elderly
Shaken Baby Syndrome/Infantile
Follows a minor
whiplash Syndrome (most consistent
trauma
Feature)
ehd ba
t-shaped hyperdense col
According to the time of onset of symptoms after
divided into three types. Ae d b-b0te 3w Sub-acute sDH Chronic SDH Acute SDH
(immediately)
(several days to 2-3 weeks)
Rupture of
Occurs when
large bridging
bleeding is
vein, rupture of one of the cortical
from smaller
(pachymeningts
hemorrhagica intery
bridging veins
arteries or
injury
After about awe
chronic subdur
hemorrhage be
cerebral
to organize froms
lacerations
dural side. By 3-4 weeks,
nd
the hematoma
Vessels Involved
gets completely
encapsulated
" Rypture of bridging veins (Most common) The most
Mechanlsm of SDH: " Traumatic acceleration/deceleratton of the head causes differential movement of the brain relative to the skull.
" This differential movement results in stretching and tearing
of bridging veins. anu coto]
nyUh
common type of hemorrhage among boxers is suhde
hemorrhage. SDH 0s seen in child abuse (Shaken baby syndrome) When an infant or young child has an SDH, the diagnostic
prlority is to exclude shaking injury.
Dlagnosing Extradural &Subdural hematoma In CT scan
Extradural hematoma " Typically lentiforma (lens-shopebiroe " Do not cross
It presents usuah
3-6 weeks ater
sutures.Umiebha
5 LM
Subdural hematoma
Typically crescentic (crescent moon-shaped) More extensive than EDH
SDH crosses sutures.
Tatmnt
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Dr Pedagogy Forensic Traumatology subarachnoid Hemorrhage Causes
AA
Duration of boxing is more relevant than the severity of the blows.
himheean
Goontaneous (Atraumatic
Features
Traumatic
eto rupture of aneurysms in. Head trauma: Direct injury lCircle of Willis. AV nereeh Blow over jaw or side of of Rupture upper part of neck may age: Younger berry aneurysma cause rupture of vertebral of Elderly age: Rupture hypertensive aneurysms
artery with basal SAH.
Site: Mostlyinthee basal surface of brain (due to the location of the cirde of Willis)
Clinical Features Thunder clap headache., Sudden vomiting. ruha
Autopsy findings
Dementia
" Chronic SDH
Slurred speech
Theory
Degenerative changes in corpus
Parkinsonian-like facial
striatum NeUril lo
appearance TyemS
Enlargement of the ventricles
" Slow thought process, stiff limbs " Ataxia
Moed dstrbanw
alds
due to loss of white matter
(cortical atrophy) Perforation of the septum pellucidum
INJURIES OF SPINAL CORD
Whiplash Injury onset
of
severe headache with
. Features of raised intracranial pressure.
" Rocal neurological l deficits: hemiplegia, dysphasia. o stpbit Sudden loss of consciousness. 8e0 . In 40% of recovered patients, rebleeding occurs in 6-8 weeks which is commonly fatal.
ne mas lle
" Investigations: Lumbar puncture: Xanthochromia scen. (lo Aan (yE)
" In road traffic accidents, involving acceleration/deceleration trauma.
" Sustained by the occupant of a car?
" Sudden hyperextension and hyperflexion of neck "
Resulting in fatal contusion or laceration of spinal cord without
fracture of spine.
Extra Edge Commotio Cerebri: Concussion brain Commotio Cordisa: Concussion heart
Commotio Spine: Railway spine
-bdoss slig ienIllus trative Ms XX. a 16-year-old girl, was brought from a rural village to a
w . . . . . .
Histochenmical changes of antemortem wound In case ofa trauma to a living tissue, two zones are seen
Government Medical College Hospital casualty in unconscious
around the wound.
state with alleged history of snake bite. She had been to fetch
Central (superficial) zone:
water from the nearby well around 5 pm. She had not returned
after a long time &her parents went in search of her; found
her lying in semiconscious state near the well. They suspected
Azone of 0.2-0.5 mm close to the edge of the wound This zone has decreased enzyme activity Zone of negative vital reaction.
Snake bite as they noted a small bleeding scratch in her left
Peripheral zone:
leg. She was admitted as a case of snake bite & was treated with Antisnake venom and other measures. Despite antisnake
" Immediately beyond this layer, there is a 0.1-0.3 mm zone.
venom, her condition worsened & was referred to higher center
in Chennai city for further management.
She was re-admitted in the higher center as a case of snake bite, and was given the same line of management. Her condition
deteriorated and she died.
During postmortem examination, there was superficial healing scratch abrasion noted in left ankle. No fang marks detected. On opening the cranial cavity, thick layer of subarachnoid hemorrhage was noted in the base of braln. Multiple small saccular aneurysms found in the circle of Wllis.
This zone has increased enzyme concentraton during reparative process Zone of positive vital reaction
In postmortem wounds, positive vital reaction does not develop. It is demonstrable as a diminishing stainability and becomes visible in 1-4 hours after wounding. Enzyme histochemistry of antemortem wound Zone of negative vital reaction
Zone of positive vital reaction
Decreased enzymic activity
increased enzymic activity
One of the aneurysms in anterior communicating artery was in
ruptured state. The death was attributed to the ruptured berry
aneurysm.
Punch Drunk Syndromertraumatic Encephalopathy/Dementia Pugilistica Acondition occurring in old boxers, which may arise years
after the last injury. tis the cumulative result of recurrent non-fatal tiny hemorrhages in the brain.
103
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Dr Pedagogy
Forensic Medicine
TheoryExtra Edge
TRANSPORTATION INJURIES
Enzyme Histochemlstry Enryme hlstochemistry
Injuries due to road 1 destrian 2
trathe acidents are ot three tvs
Motor cyclist
33 Orupant of the vehicle
10 8
Injuries to Pedestrian Usual sequence of the impacts with vehicle: " First, the vehicle hits the person (hrst impact with v After the first innpact, the victim is scoo Opt oft the falls on the vehicle (seond impact with vehicle) Then the victim is thrown on the ground.
injuries
Secondary impact injuries
injuries caused by
Injuries caused by
Primary impact
DEnzyme Histochemistry
vehlcle when It irst
second Impact of
struck the person
victim and vehicle
PRIMARY IMPACT INJURIES
SECONDARY IMPAGT INJURIES
SECONDARY INJURIESI
TERTIARY IMPACT INJU
ES
Transportation inurres
PRIMARY MPACT INJURIES
1ST SITE OF IMPACT WITH THE VEHICLE
Phe irnst o
bufnper o radiator Burmoer iniunee preert
104
Patternsd iniurast
SECONDARY IMPACT INJURIES
SECONDARY INJURIES
2ND IMPACT OF VICTIM
VICTIM FALLS
WITH THE SAME VEHICLE Same side of prnnnary inpact injuriee Seyere head inuriss
ON GROUND
.Oppote ande io primary inpact inures
Head inËury with brain Jamag t more comon Mesns, bruises
4aCrstohs
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Secondary injunes
impactnne Injuries susta by a
victm e
talls on the g
Dr Pedagogy Bumperlnjuries
Sparrow foot marks; Multiple small facial lacerations produced by
rimaryimpact injur)Q Injuries on skin, sot fracture)
Forensic Traumatology
tissues and fracture of bone (bumper
The level of bumper injuries varies with the height of bumper in Ailerent vehicles., Ligo
shattered glass of windscreen of a car. Dicing injuries: Theory " Supericial cuts of the skin produced by the shattered glass of the
side and the back windows of a car.
" Right angled or V-shaped laceration seen over face, forehead and arm.
Dashboard fracture:
BumperFracture
Posterior dislocation of hip joint with fracture of posterior rim of acetabulum Duc to impact of knee against dashboard
Ihaally in tibia° (sometimes in fibula)
wedge shaped . Triangleor
se of triangle is vehicle. the site of impact &the apex of triangle
points the direction of
Patellar fracture and Posterior cruciate ligament injury associated
Front passenger
Driver
Face:
Face: rmu lhplecut
Impact against windscreen’ sparrow foot marks
Impact against
eO wd windscreen’
sparrow foot marks
Bumper fracture
Splne: Whiplash injuryK
Spine: Whiplash injury Leg
Leg
Impact against clutch, brakes ’ Abrasion, bruise & laceration over
foot, fracture ankle.
Impact against dashboard’
Fracture femur, posterior dislocation of hip
Abdomen & chest
Impact against steering wheel’ Fracture sternum & ribs, cardiac contusion, Rupture of liver, spleen
l on o How to Interpret bumper injuries? the striking Vehicle leg: back of " Bumper injuries at the victim from behind Person was Bumper injuries at same level on both legs:
standing at the time of impact. on both legs: Person was " Bumper injuries at different levels impact. of the time walking or running at
Extra Edge Tail gating& under-running: back of the heavy " The motorcyclist/car driver hits into the vehicle. " This may be due to unexpected stoppage of the heavy
vehicle.
Head and shoulder injuries, sometimes decapitation.
Injury to Occupants of a Vehicle Neck: hyperextension and hyperfiaxion
Hea
against
indshield
Sleering
Wheel impact
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Dr Pedagogy
ihue Forensiç Medicinen, Subwtaneas Theory Extra
External Features
Edge
"
Ladder rung tears:
Patches of pink discoloration are seen over the large joints (usually on knees, elbows
extensot
Multiple transverse intimal tear in aorta, adjacent to the
sor outside of the " Pink postmortem staining°ub oeis
main rupture.
Internal Features
Seen in aortagin deceleration Injurles.
"
Blood: Bright red in color.
" Stomach: Wischnewsky spots may be seen.
Extra Edge Paradoxical undressing: " This may occur in severe hypothermia, the
Rupture site
partially or fully undressed. Noked Anina
Ladder-ung' tears
" During terminal hypothermia, the victim becomes
disoriented and confused, and may undress himself
" In such case, there may be suspicion of sexual offenta
" The manner of death is usually accidenta Terminal burrowing or Hide and Die Syndrome:
" Seen in severe hypothermia.
Due to terminal hallucinations.
Victim is often found under bed or bench, behind Wardrk. on a shelf.
This may also lead to the assumption of a homicide cide or ro
THERMAL INJURIES
Trench Foot and Immersion Foot " Result of prolonged exposure to severe cold (5°-8°C)
Heat injuries General heat
Local heat
|Heatc n i e
Burns (due to dry heat)-nes Scald (due to moist heat)
" Heat syncope/ehaun
hot l i ,seam
" Heat stroke
Cold injuries General cold
|Hypothermia
" Typically seen in soldiers during winter warfare, especil trenches and in persons exposed to prolonged immersion t The extremities are affected in those conditions,
Frost Bite "
Result of exposure to dry cold (-2.5°C)
" Infarction of the peripheral digits with edema, rednes and'a necrosis of the tissue. p anaye
Local cold
ath
Frost bite (due to dry cold)
Stages
Trench foot (due to molst
Itching &pain followed by numboes First degree (rTOsl
cold)-denws
" Second degree (
frosthite Painless blisters
" Third and fourth degrees (deep frost bite): Necrosis &garg
Hypothermia loh d, ellas LRRH¾, LQP
formation; sometimes autoamputation
Body core temperature less than 35°C.
Treatment -Protetn body pats
Common in elderly alcoholics and newborns.
" Moist cold is more lethal than dry cold.
Rewarming
General Hyperthermla Mental status
Pathogenesis
Heat cramps/MIner's cramps/
Molst and cool Electrolyte disturbances due to dehydration,‘ wahn
Normal
Cardiovascular collapse & syncope due to Intense
Sweating
Normal
Dry &hot skin In
Impaired
FIreman's cramps 4us e Heat exhaustlon/heat syncope/
prostration Heat stroka
Triad of cerebral dysfunctlon with 106
Skin
Disorder
Impaired consciousness, Increosed body
core temperoture (rectal) more than 40.5'C ond hlstory of heot exposure)
Cerebral dystuncton
isd
ehn classical heat stroke conscousness |Dlaphoresls In
exertional heat
stroke rhdm
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Other features
|" Constricted pual
Tachycardia Tachypnea calorieih0-vo Postmortem
Dr Pedagogy Forensic Traumatology RURNS (DUE TO DRY HEAT)
Theory
Classificationn of Burns Dupyutren's
Characteristics
Hebra's
Wilson's
Modern
Painful,
1
Superhcial
No scar
1 s0Epidermal
Reddening
Vesication/Blistering skin Destruction of superficial
Characters
2
Superficial
(epidermis)
2*
(Dermis) 4 Destruction of whole skin Muscles5 Destruction of deep fascia, nervei 6 Complete charing (vesses,
fastn
Scarring S Heals in 3 weeks e a
Dermo-epidermal
Painless°. N 3
bone)
Deep Burns
e
Heals in 3-6 days-, danta Painful
3
ad
aria
Deep
t
Scarring
May take months/may
need grafting- s
Etimation of affected body surface area:
Lund and Browder Method
" For infants, head is 18% of TBSA and each leg is 13.5% of TBSA.
Trunk & upper limb is the sarme
(For each year above 1year-old, add 0.5% to each leg and reduce 1.0% to the head until adult values are reached)
Rule of palms:
Back 18%
For estimating smal burns The surface area of a patient's palm (incduding fingers) 1%
Front 18
1%
" For burms in oduts: "Rule of Walloce' or 'Rule of nine' us
se
For burns in children: lund & Browder chart
" For patchy burns: Rule of palm'
causes of Death Immediate
Delayed
Rermote
complications Primary or
neurogenic shock Area
%of skin burns Rule of Nine adult
Lund &Browder chart children
Head y k
rnk -Front Brurlk -Bad
GeniLoertal aieb -L ower Limb-&
Accidents and
18
|09 09
18 18
01
Infection
Renal failure 1Curtling ulcer Toxemia
Jaundice
injuries
Vagal inhibition 09
Pper lmb -
Ugper mb -R
AsphyiaN
Secondary
hypovolemic shock
Inflammatory complications
Autopsy Findings
09
sdrs
Specific findings of antemortem buns
18 01
18 -
13
18
13
100
100
Soot in respirotory trocta Carbaryhernoglobi in blood
Nonspecific findings {can be present in postmortem burns also) "Pugilistic attitude Heat rupture
Line of redness
Heat hematoma?
Alburnin& chloride in vesicles Healing granulation tissue
Heat fracture
Infection
hement of 1/34of body surfce area (30-50%) s usually
Curting ukcer
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107
Dr Pedagogy
Forensic Medicine
Postmortem bli. How to differentiate Antemortem from
MNEMONIc
Theory Signs of antermortem burns: F-Fluid in blisters (‘
proteins &chloride) |-Inflammatory reaction/ Ireaction, infection/signs
Content: Serous fluid containing
fire' was alive at the time of
albumin & chlorides and red with The base is inflamed
A 'CS are seen
Carbon/soot deposition in airway 2 iN
vital t of healing lgranulation tissue)
Postmortem vesice Content: Ga_
Antemortem vesicles
Findings that indicate "Person
The base is dry, har and yellow.
ordere erythemotous bord
co elevated (>10 mg %)-%
R-Line of Redness
" Cyanide levels elevated
E- Elevated enzymes
"
SCALDS
Curling's Ulcer in stomach
Injury caused by moist heat;
.
Heat Artefacts Nonspecific for ante-mortem burns. and, therefore, not much Present in postmortem burns also
liquids above 60C
Abbe donEL Iniury at and below the site of contact. commencement Maximum damage at the point of point of contact Restricted to exposed body parts or
or " No charring, carbonization
hair singeing in scalds.
present. " Evidence of splashing bleachedQ,
medicolegally significant.
Skin sodden &
Pugillstic attitude
"
proteins.ehat Mechanism: Coagulation of muscle
ELECTROCUTION INJURIES
attitude/heat Also known as (boxing, fencing or defense stiffening) 5 t
Blisters over the burnt area.
et ays
Jes
Attitude: "
knees, the arms are The legs are flexed at the hips and in front of the body and flexed at the elbows and held out
the Pattern of Factors that Determine
(like a boxer) the fingers are hooked like claws
Heat rupture/split
burning9. Skinsplits occurring due to severe
Electrocution Injuries Kind of current:
surfaces and joints. Sites: Fleshy areas, extensorcentimeters)
except in lightning. DC injuries are uncommon,
(several " Multiple and Large
Large (several centimeters)
"
tetanoid spasms Amperage is more dangerous, as it causes 5 mA
Mechanism: boiling blood. venous sinuses due to " Rupture of extrodural hematomoa " Resembles Comb gppearance Appearance: dark brown, HoneySite: Parieto-temporal region
"
Haby Due to exXcessive
ndran
Newk u " Street &Avenue frocture
e
in wet skin is only 200-300
Duration of current: "
No vital reaction or brul_ing
eneaa4 at the marginsI s
Crocodile burns: Loose contact with High voltage cu
t
Current pearls:
conductor into Deposition of molten meal from the
108
tissues
ldentiñed by scanningelectron microscopy.
Vital reaction/brulsing present at the margins
Presence of intact nerves &
Nerves & vessels Cut or
vessels in the floor
crushed
Irreguiar margins
Varlable
PM b with low voltage current
" Spark burn/lash burn: Loose contact with air gap D
Presence of blee ding
Absence of bleeding
duration of current Severity is directly proportional to the
Efects of Electrocution
Incised/lacerated wound Heat rupture
progorko
The principal bodily barrier is the skin. (1000-1500 ohms), but resisti" Dry skin offers high resistance ohms > nMot
" Joule burns: Firm'contact
which exert shrinkage of the muscles,
Rreat pull on bones.
40 mA - ventricular arrhythmia >50 mA - instantly fatal.
Resistance:"
o bne i e e dmig oMwechrak 1t fracture Heat ‘itreLYaNesm Skull fractures on either side above the temples.bheqe
ding
numbness, pain.
muscles of hand and forear 10-15 mnA - tetany within the flexor
Heat hematoma space due to heat "Hematoma in extradural
" Usually stellate vcþid Long bone fracture
Awith hd be
Current: d.tu Pohr
lacerated wounds2, Resembles incised or
" Usually seen
Injung
times more dangerous tha Alternating current (AC) is 4-5 direct current (DDC).
dehudr
Zenker's degeneration in skeletal muscle "
Bone pcarls: Heat generated by the current may melt the
phosphate in bone.
Radiographically seen as rarefactive foci in X-ray lim
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Dr Pedagogy Forensic Traumatology Grocodile Burn
ole Burn
.Endgenous burn
hecmsqldbin he
Multiple punched out
as ebuns a'so known electcobuns which is
Theory
spark lesions over the exposed parts of the body
specific and diagnostic of
On June 12, 2015, 20 people died and 30 suffered burn injuries due to fall of live high voltage electric wire on a bus at Tonk
due to arcing of high
district in Rajasthan. 60 people were travelling in the bus and all of them were going to attend a wedding party in a nearby village.
tension current
electric burns
Jlluotratiue
the point ofentr
at " found LOW Votage Current
The loose wire got entangled in the wheel of the bus. In fear and anxiety, people tried to get down from bus and got electrocuted.
Morphology ofJoule Burns
In such incidents, where the live wire touches the bus, the
Bard shaßos pale central crater, with a raised border around.
The cater ioor is lined by pale fiattened skin.
rubber tire of the vehicle provides insulation and there is no flow of current and chances for electrocution is minimal. When
ret burn is commonly found on palmar aspects of hands.
the passenger tries to get down, there is contact with bus and
the ground simultaneously. This completes the circuit allowing the flow of current and passengers got electrocuted.
NoTE nebumis endogenous bun, while flash burn is exogenous? bun
CaSe of Death Iiar fbrilation (low votage current)-most common
The omse of death depends on the path of current. .Whr onganis present in the path of current that organ will fected becaise of the current.
Emples
When the current flow is from ight arm to left arm, cardiac rimia develops due to the involvement of heart. . When the current flow is from head to foot, victim will die of
ioryfaiure due to the invoBvement of brainstem. Joule burns
Medicolegal Aspects " Dezts are usualy accidental.
" Jaz dectrocution: Death penalty is carried out using the dectic chair in some States in the US.
Extra Edge Aao-reaction test:
" efor detection of metals at the site of entry of electric urent
LIGHTNING INJURIES ay inlan indiidun by direct strike,asidelash or conduction deat-ctLdd Fng or magnetization of metallic articles seen.
trough another object.
Filigree burns
Arborescent
ara Lchtenberg'sBurns/Filigree Flowers/ Burns"l Uirphi " Ldenberg Bowers: are pathognomonic of lightning strike,
Pracil thin irregular tortuous markings on skin resembling
brancbes a atree.
oes not coTesoond to vascular
Fond ova shoulders or fanks channels Nt asociated vith
burning
EXPLOSION INJURIES: INJURIES PRODUCED BY BOMB EXPLOSION "
A bomb is a container filled with an explosive mixture and
missiles, which is fired either bya detonator or a fuse.
" When a bomb explodes, the explosive material produces a large
volume of gas; and releases alarge amount of energy.
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109
Dr Pedagogy
Forensic Medicine
TheoryMechanisms of Injurles by Explosion Victim Displacement
Blast Wave
An explosion produces a 'shock wave
which spreads
"
concentrically from the site of explosion,
When the blast wave passes through the body, the organs containing air fluid interface get afected. Examples: Ear, lung, GIT.
.
When a bomb
explodes, the victim is
structure resulting in skeletal injuries.thrown
away againt a
Building Collapse/Burns ialirCh Due to explosion, structural collapse may occur, Ieuh traumatic asphyxia, crush injuries or ire
producing fah
Flying Missiles &Projectiles
Terrorists often implant screws, nails and Ishrapnel in the bomb.
Radiation, Chemical, Bacteria
On explosion, such things fly as projectiles and inflict injuries.
.
" Such flying objects may strike any part of the body resulting in penetrating trauma.
Hyper-inflammatory state due to exposure to the contami
of explosive blasts (dirty bombs).
including, bacteria, chemicals and
Blast Injuries are of Five Types PRIMARY BLAST INJURY - BLAST WAVE
SECONDARY BLAST INJURY- FLYING OBJECTS
TERTIARY BLAST INJURY
VICTIM DISPLACEMENT
QUATERNARY BLAST INJURY- BURNS-MislowA
Primary blast injuries
Secondary blast injuries Tertiary blast Injuries
Blast wove
Flying projectiles Victim displacement
High-Yield Info " Most common blast injury: Secondary blast injury
Most common fatal blast injury: Secondary blast injury
Most common organ involved in primary blast injury: Ear
Second most common organ involved in primary blast
Quaternary blast injurles
Structural collapse/fire
injury: Lung Most common organ involved in underwater blast with he
Quinary blast injuries
Hyperinflammotory state due
above water: GIT? Most common organ involved in underwater blast with h
to chemical/rodiation
under water: Ear
Most common organ involved in secondary blast wave: s Most common fatal injury primary blast injury: Blast luns Most common injury In solid blast- Skeletal injuries
110
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Dr Pedagogy Forensic Traumatology EXPLOSION INJURIES Theory PRIMARY INJURIES Due lo tblast wave
SECONDARY INJURIES Due to lying
Air blast: .Organ involvement: Ear >Lung GIT
Tympanic perforation COmman
m
9projectiles
TERTIARY INJURIES Due to victim thrown away
Triad of abrasions,
QUARTENARY INJURIES
Due to victin thrown away
Skeletal injuries
bnuises & puncture lacerations are
Flash burns, crush
injuries, traumatic ijuries & respiratory injuries
diagnostic- Marshal's trlad.
Blast lung (fatal)
Incendiary bombs:
Contains phosphorus &magnesium
TORTURE METHODS
Malotov cocktail:
burns " Primarily produces
" The participation of physician in torture or abetment of torture is
Simple incendiary weapon. It is also known as a petrol bomb. ne illed with petrol &gasoline. " The bomb is
" Section 330 IPC: Voluntarily causing hurt to extort confession, or to compel restoration of property
Wick is lighted &thrown at the target.
Order of organ involvement in primary blast injuries: In Air: Tyrmpanic membrane, Iung &GIT
prohibited by the guidelines in 'Declaration of Tokyo' Jtaob p t ) " Section 331 IPC: Voluntarily causing grievous hurt to extort confession, or to compel restoration of property.
Underwater (head above water level): GIT, Lung&Ear
Underwater (head under water level): Ear,GIT &Lung. Methods of Torture Falanga bastinado)
Canes or rods used to beat on the soles
Telefono Wet submarine Dry subrmarine?
Repeated slapping on the side of head over ears 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
Forced immersion of head in watercontaminated with urine or feces
Cattle prod
Electric shock, especially over the genitals
Chepuwa
The legs and thighs are tied very tightly with bamboo sticks to induce severe pain
Ghotna
Rolling a wooden log over the thighs up and down, while the log is weighed by one or two policemen standing on it
Sham execution
Victim is blindfolded and asked to stand before a wall and then threatened that a vehicle is going to hit him
Dunking Back slave La bandera
Mercelago
d planton
Saw horse Hog tyin
He hears the sound of a vehicle very near to him, causing fear and shock Victim is irmmersed into water, taken out after some time and given a chance to confess
Heated metal skewer inserted into the anus Suspension by wrist
Suspension by ankles Prolonged standing Forced straddling of a bar Tying the wrist & ankle of a person in a prone position
11
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Forensic Medicine
Dr Pedagogy
Theory
Parrot perch Telefono
Falanga
Dry subrnarine
Wet submarine
Saw horse
LA Bandera
Mercelago
EL planton
FORENSIC BALLISTICS
LET's KNow THE TERMS FiRST
ammunition and their effects. deals with the study of firearms, " Forensic ballstics: Science that
Proxdmal (intenal)
Intenediate
(externn)
Teminal balistics
ballistic
112
Ghotna
Internal or proximal balllstics: Study of the projectile within the gun. air. External or Intermedlate balilstlcs: Study of the passage of the projectile through the Wound or Terminal ballstics: Study of the effects of projectile on the tissues.
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Dr Pedagogy Rasic Structure of a
Forensic Traumatology
Firearm Bolt
Barrel
Breech end
Muzzle
Muzzle end
Theory
Taper
Bullet Chamber
Butt Percussion
Trigger guard
pin/
Rim of cart
Bore-inS dis
P. Cap
Chamber Taper
Bore
main parts: Any firearm has three
.
Butt/handle
.
Barre!
Action - Bolt, percussion pin, hammer, spring and trigger.
Tágger
Grooves
Land
Barrel T. Guard
. tisa long hollow metal cylinder. . The lumen of barrel is known as bore.
Riflings
. The end where cartridge is inserted - Breech end.
"
. The front end where bullet exits - Muzzle end It has three parts: Chamber, taper & bore.
The interior of barrel, ie,, bore has 4-6 grooves running parallel
to each other from breech end to muzzle end. " They are twisted spirally from breech to muzzle end (which gives
1 Chamber - To lodge the cartridge
Taper -Connects the chamber to the bore. Bore- Long tube lies between the chamber &muzzle end
the spinning motion to the bullet)
" The elevated areas are called lands and depressed areas called grooves,
Classification of Firearm
Firearms can be broadly dassified into Rifled frearms &Smooth bore firearms. Smooth bore gun/shotgun/pepper gun
Rifled gun Any gun hoving grooves (rifling) in the bore is called rifled gun.
The bore is uniformly smooth without any grooves in shot gun.
RIFLED BARREL
'Riles: 0.22, single shot, lever action, bolt-action, LoD0
.Revovers Single shot5340 pistols Auto-loading pistols4syd
Men
d
RPM
Typical shotgun barel E.g.
" Depending on loading: Muzle loading or breech loading
" Submachine guns
Depending on barrel: Single barrel, double barrel bee
Machine guns
" Depending on choking: Unchoked or cylinder bore Quarter choked . Half choked Fully choked
Projectiles used in rifed gun: BULLET rode
To
" Projectiles used in smooth bore gun: Lead shots/Lead pellets
|Smooth bore guns are caled shot guns5, ,as lead shots are used in projectiles)
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Forensic Medicine
Dr Pedagogy
Theory
Choking: In shotgun, the distal 10 cn of barre
Spiral grooves in the bore of rifled gun. 1 G
It can be oft diterert grades.
Unchok6d
otages of choking in shot gun: Advantages Advantages of rifling: Imparts Spinning moton to the bullet.^
Straight trajectory rar
. Increases the velocty of the pellets.
Maximum pellet dispersion-’ Unchoked (Cyfinder P
Prevents wobbling of bullets.
" Increoses accuracy & range
Reduces the pellets dispersion Increases the erploive forces of the
shotgun.
.
Least pellet dispersion -’ Full choked shngun.
BORE/CALIBRE/GAUGE:
Itis measured by the internal dimension of the barel RIFLED GUN CALIBRE
FOR LARGE BORES:
SMOOTH BORE GUN CALIBER
Indirect method: 1POUND (454 grarns) OF LEAD TAKEN
It is the diameter of the dor of interior of the t harrel of a
LEAD BALLS ARE MODE.
FOR SMALL BORES: rifled
SIZE OF THE LEAD BALL=SIZE OF THE BARREL
Direct method:
The internal diameter of the barrel
.Measured between
nally oppos
lands
Epressed in inche
meters, e.g. 22, 32
38
The number of equally sized lead bals- o% made from 1 pound of lead = Gauge Bore = Number of spherical lead balls taken
to fill the barrel.
For example, 12 bore gun -12 lead bals are ma
from 1 pound lead 24 bore gun-24 lead bals are
made from 1 pound lead 14
Structure of Ammunition
Projectile in rifled gun - Bullet
Projectile in shot gun- Cartridge with lead shots. Constituents of shotgun cartridge (from base to top)
Constituents of rifled gun-bullet (from base to top)
(Detonator cap) Percussion cap containing primer mixture
(Detonator cap) Percussion cap containing primer matue
Gunpowder
Gunpowder
Thick fet-wad Lead shots
Bullet
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Dr Pedagogy Constituentsofishotgun ortrldgë (trom base to top)
Forensic Traumatology
Constituents of iled gun-bullet (from base to top)
Theory Case Bullet
Lead
Shot
Bullet case
Wad e Gunpowder Power
charge Brass head
Primer
Primer p Rsson Chamber/Primer Cup/Detonator Cap
Cartridge The Brain of the . Rcoatains the priming mixture-Kahyilatble
The strike of firing pin on the primer cup ignites the priming
misture and burns ns it.
The fre flashes through the flash hole/vent and ignites the
Percussion cup
Smokeless gun powder
Single base: Nitrocellulose " Double base: Nitrocellulose + Nitroglycerine " Triple base: Nitrocellulose + Nitroglycerine + Nitroguanidine Explosive power: Most effective explosive with minimal smoke
"
Each grain produces 800-900 cc of gas.
gunpowder.
. The priming mixture contains lead peroxide, lead styphnate, tetrazene, barium nitrate, antimony sulhde and potassium
Semi- Smokeless gunpowder: 80% black and 20% smokeless gun powder.
chlorate, etc
MNEHONIC Primer constituents
Wad " Made up of soft material, like felt, cardboard, plastic, cork or straw.
It separates the gunpowder and lead shots.
LAST
-Barium nitrate
Functions of wad:
S-fLead) Styphnate I-Tetrazene?
" Acts like a piston " Seals the gas in the bore effectively (Obturation) and thereby allows optimum pressure to develop
A-Antimony
" Helps in lubrication
-lead peraride
" Prevents the escape of gas from the breech end
Gunpowder FFFFa
Black gun powder
Potassiun nitrate(75%) K
Working Mechanism of Firearm PULLING THE TRIGGER
harcoal (15%)
PROPULSION OF
"Sutfur (10%)S
" More smoke produced ‘ hre Lias
BULLETSHOTS
HAMMER RELEASE
" Desoibed as FG, FFG, FFFG, FFFFG depending on the fineness of the grain.
Ihe fner grains have more number of 'F
PERCUSSION PIN HITS
GAS
PERCUSSION CUP
PRODUCTION
Erplosive power: tach grarm of black gun powder produces 3000- 4000 cc of
gas
Each grain produces 200-250 cc of gas.
IGNITION OF
PRIMER MIXTURE
FLAME
EXPLOSION OF
PRODUCTION
GUN POWDER
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Forensic Medicine
Dr Pedagogy Due to the deposition of lubricants, gun oll or lead
Theory Abrasion Collar/Ring
bullet.
surrounding Arim of reddish-brown zone ofabraded epidermis,
the entrance wound.
"
In rifled gun entrance wounds. collar. If contusion also present, contusion Abrasion collar Quls Absent abrasion collar: Entry wound on palms and soles Ricochet bullet.
Dirt collar/G, QDA0 Wla Bullot entry hole
-Abrasi on col Dit coler -Bullel entry
Abrasion collar surrounds the dirt collar,
Mechanlsm to the spinning The skin around the entry wound is abraded due action of bullet.
.
Dirt collar rim is more prominent in clothing- "bullet wi Abrasion and dirt collars are proof of an entry wound
Effects of Discharges ofa Gun
Importance
Round Abrasion collar: If the bullet hits at right angle to the skin surface.
Oval abrasion collar: If the bullet hits at oblique angle to the
skin surface
gives the Diameter of the entry wound + abrasion collar
approximate diameter of the bullet.
Fire/Flame-’ Burning at entrance wound along with
burning or singeing of hairs.Jehuss Smoke -’ Blackening effect or smudging e kwiped b
Hot gases -’ Scorching effect Unburnt gun powder-> Tattoolng effect, peppering or
stippling effect Felt wad-’
Grease Collar (Bullet Wipe) the entrance wound. A black/grey colored ring is seen lining
Minor abraslon and bruise.
Metallcfoulíng
Blackening
Tattooing
soot or smoke solling/smudging)
Due to embedding of unburnt or partially burnt powder particles in the skin. a Tattoolng cannot be wiped away with
Iwith abrasion collar.
. Bullet/Pellet - Puncture woung
Deposition of smoke produced by
expelled by " Due to fragmnents of metal
combustion of gunpowder. It can be easily removed with a wet
the discharge. Cannot be wiped off from the skin,
cotton.
wet cotton.
Antemortem phenomenon and alive. indicates that the indivldual was
Shotgun
cm
15 cm
Flame/singeing
30-em
45um
Blackening/smoke
|Tattooing/unburnt powder
Revolver/Plstoll
60-90 cm
30 cm
60-90 cm
Rifle
15 cmS
30 cm 60-90 cm
2m Card
2m
Wad
WOUND BALLISTICS
Rifled Gun lnjuries
tight contact with skin. Contact shot: Muzzle end of the gun is in Close shot: Victim lies within the range of flame
of flame but within the Near shot: Victim lies outside the range
range of gunpowder Distant shot: Outside the range of gunpowder.
Specific appearances of contact shot Muzzle/recoll imprint mark: power of the Patterned abrasion caused by the expansive muzzle. gases lifting the skin forclbly up against the This is a slgn of a contact shot. Back spatter: in the barrel may sun " In a contact shot, negative pressure blood, hair, tissue fragments back Into the barrel.
Blowback phenomenon or blast effect: especlaly" Cruclate, stellate or ragged laceration is seen, there isa bone under the skin (skull)
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Dr PedagogyForensic Traumatology Appearanceof
Woundof Rifled Firearm in Different Ranges
cONTACT(Pointblack)
CLOSE SHOr
NEAR RANGE
(ränge of tlame)
(range of gunpowder)
"
I, Muzzleimpression
wound
Present
margins blackening & Burns, powder tattooing seen
" Burning/blackening
Blackening- Present
ofthe
Tattooing. Present
Abrasion collar-Present
than the " Circular wound smaller diameter of the bullet
" Burning, blackening, tattooing Absent
Absent
" Tattooing-Present
along the track in skin wound (not seen
LONG RANGE
" Circular entrance
Burns &Singeing
, Stellate"orcruciate
l
Circular entrance wound
Theory (beyond the range of gunpowder)
" Abrasion collar - Present
Abrasion collar Present
|externally
cONTACT SHOT TON nta
CLOSE SHOT
Stellate/iregular shaped
"Bullet hole, Abrasion collar
"Buns, Blackening
"Bums, Blackening, tatlooing inside the track of the wound
Tattooing
Tattooing / Abrasion collar
NEAR SHOT "Bullet hole "Abrasion collar
DISTANT SHOT
"Bullet hole
"Abrasion collar
"Tattooing
Burns
Blackening Bullet hole
Appearonce of Wound of Shotgun Firearm in
Important points to remember:
Different Ranges
.
Wound is cruciate/stellate in contact shot.
In shot gun, there is dispersion of lead shots.
" Burns, blackening and tattooing around entrance wound till 90
ln contact shot, cruciate or stellate appearance is noted due to blast efect. Efects of flame, smoke, tattooing are noted within 1 m. (beyond
" Between I and 2 m, lead shots are about to disperse (but has not
cm approx.1 m).
As the distance increases, the dispersion increases.
Im, only lead shot injuries seen) Beginning of lead shots dispersion is seen at 2 n
begun to disperse) making the wound rat - hole appearance. . All the lead shots enter the skin as single mass till 2 m. " After 2m, lead shots begin to disperse and individual pellet holes
can be found in addition to central big hole. " At 4 m, there is complete dispersion of lead shots and only
" Complete dispersion is seen at 4 m
individual pellet holes are seen.
Deinitlon of ranges in shot gun:
Contact range: Muzle end of gun is in tight contact with skin.
Close range: Less than 1 m Near range: 1-2 m
Intermediate range: 2-4 m
Distant ange: More than 4 m
Appearance of Wound of Shot Gun in Different Ranges
Contact Shot
Close range (slm)
Single entrance wound Stellate or cruciate WOund
Burms/ ckenialong ng/ tattooingblaseen the track of
wound
Muzie impression
present
Near range
Intermediate range
Distant range
(1-2 m)
(2-4 m)
(>4 m) " Individual
Single circular
SIngle entrance
entrance wound
wOund
Central hole due to shot mass surrounded
by individual pellet hole
Present
Irregular margins -
Blackening
Rot hole
increases from
appearance/
2-4 m, the slze of
Cookie cutter
central hole decreases
Burns/singeing Present
Tattooing- Present
appearance
" As the distance
and the pellet
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pellet holes due to complete
dispersion
117
Dr Pedagogy
Forensic Medicine
DISTANT
INTERMEDIATE
Theory
cONTACT
CLOSE
NEAR
2 m
Extra Edge Thumb Rule Determination of range:
The extent of dispersion wll approximately indicate the range of firing.
Unchoked Gun: Range in yards is given by 2/3 x spread in inches.
" Fully choked gun: Range in yards is given by 4/3 xspread in inches.
" Half choked gun: Range in yards is given by the spread in inches.
" For example, a pellet spread of 6 Inches in a wound.
Range in Unchoked/cylinder bore gun= 6x2/3= 4 yards (range is 4 yards) " Range In fully choked gun = 4/3 x6 = 8 yards (range is 8 yards) " Range in half choked gun =6 yards (range is 6 yards) The plastic cup wad may contain lead shots; the wad may open between 30-60 cm in the form of petals.
(30 to 60 cm)
>90 cm
The four petals stick out, and a circular entrance wound is produced with a
The air resistance folds back the petals and a single hole of entrance will be produced.
Maltese cross pattern of abrasion encircling it Abrasion
Cross-ke abrasion
Entry Wound vs Exit Wounds Character
Entry wound | Smaller than the dlameter of the bullet
Size
Edges
Inverted
Abrasion collar &grease collar PJrr Scorching, smudging &tattoolng Bleeding 118
Fat extrusion
Cherry red color
Present May be present Less
Absent
May be present
Exit wound
Larger
Everted
Absent Absent More
|May be present
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Dr Pedagogy Forensic Traumatology Shoredexitwound
Souvenir Bullets
Iftheskinat the exitt wound is supported by firm objects or tight garments, c,g. belt, waist band, bra or tie, or body is leaning
" Retained bullet inside the body for a long time. Dense fibrous tissue surrounds the bullet.
gainsrta wall, the exit wound |skin gets crushed as the bullet is resistance. coming out with
Due to absorption of lead from the bullet into the body fluids,
chronic lead poisoning may occur. Plubihm
eeit wound is surrounded by a margin of abrasion resembling
an entry wound.
Frangible Bullet /fded loet
ATYPICAL BULLETS bllouch
Dum -Dum Bullet iAlraded bule n The nose oftheebullet is not covered by jacket and exposed.
" These bullets are designed to fragment and disintegrate on
impact. Usually made up of powdered copper, iron or lead.
Incendiary Bullets
" Incendiary bullets contain phosphorus®, -4olade on imta
ernands or mushrooms on striking the target, producing a large hole and more damage.
" Type of army bullet used to cause fire in the target.
Tandem Bullet (Piggyback Bullet) Cause: Old unused gun or faulty ammunition.:
When an unused gun is fhired, the fhrst bullet gets struck in the barrel.
Tracer Bullet
" It leaves a víaible mark or trace while in flight, so that the
path of bullet can be seen. n sdo in the ar in dayk
When it is fired again, the second bullet carries the first bullet
and comes out.
Two bullets come out of the muzzle end.
Efects of flame, smoke and gun powder are absent and the wound appears as long-range fire. First bullet gets stuck in the barrel
Frst firnng
Theory
Plastic Bullets or Baton Round It is made up of polyvinyl chloride. "
Can be fatal, if hit from near distance.
Poisoned Bullets They are usually 0.177 caliber bullets containing curare, ricin or aflatoxin.
Second fiing
Second bullet comes out with the first bullet
Non-toxic or Green Bullet
" Lead-free bullet. Duplex Bullet or Cartridge Some military rifles contain two bullets.
Ricochet Bullet " Aricochet bullet is one which before striking the victim, strikes
some intervening object first, and then after ricocheting, hits
Both the bullets enter the target at different points, when it is fired.
the victim.
" Base of the first bullet is notched, where the second bullets fts.
" The path of aricochet is completely unexpected. Yawming Bullet Abullet traveling in an irregular fashion instead of travelling nose onis called ayawning bulle.
May cause key hole entry wound., - t oolise
Tumbling Bullet Abullet that rotates end-onend during its nnotion
" 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 absent, as the bullet loses its spinning motion.
Yawning bullet
"
Burning, blackening and tattooing are also not seen.
" Depending on the surface hit, paint may be found adhering to the bullet.
Kennedy Phenomenon Tunbing bullet
Aht
Mutk wound
Iatrogenic surgical alteration of the entrance wound.
. The evaluation of whether the wound is entrance or exit becomes
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Dr Pedagogy
Forensic Medicine
How to find out whether the recovered
ATYPICAL APPEARANCES IN SHOTGUN Theory
been fired from the alleged firearm?
WOUNDS
Primary Marking/Class Characteristics
Billiard Ball Ricochet Effect they strike each At cose range. while the lead shots are bunched., through the pass as they pattern other, and soroad out in a wide
"
As the bullet passes throughthe barrel, the rifling
suggest a Such arperance of wide dispersion of lead shots may ire) Jong rang fire (even though actually it is close range Intermediate
grooves pr
" Primary markings are used to identifythe make and guns invohed.
model ofs,
Secondary Markings or lndividuallAccidental
Skin
Characteristics "
Erratic
BAard bal ricochet
Every gun model has speciic rifling pattern.
markings on the buller (macroscopic).
hxty.
object
bullet ha
Each gun has some imperfections in the barrel which a. unique to that gun.
dispersion
" Imperfections may be produced accidentally durina. manufacturing process or may be due to sticking of lead na to the bore when shots are fired (Metallic Fouling).
Markings produced on bullet surface by such imperfection
called secondary markings (bullet fingerprint).
" They are useful in identifying the specific gun which was fired
Balling or Welding of Shot
PRIMARY MARKINGs: Macroscopic Rifling grooves of the
" Ballingof shotgun pellets results in the conversion of some lead
SECONDARY MARKINGS: Microscopic striations/
barrel.
shots into acompact mass. Remaining lead shots alone disperse.
Imperfetions of the barrel
" Itresults in asingle wound (due to balled shots) aFd surrounding ho The technique of study of markings on crime fingerorinins bullet and test dispersion (remaining dispersed lead shots)
or more lib Cause: Faulty manufacture, old ammunition
microscope - Bullet but builet under comparison
or melting of shots due to excessive heat
" anBecause of effect, the actual distance shot wound may look like intermediate range wound or may be 2 firearms are used.
Gunshot ResidueTests -Lubitaken fan hond o hanlk Dermal Nitrate test or
Paraffin test Harrison and Gilroy test
analysis
" Qualitative chemical test.
soil, glass pieces, paints. AAS is useful
Atomic absorption
spectroscopy (AAS) and Flameless atomic
absorption spectro
Detects nitrates and nitrites
elements in GSR, hair, nails,
NA
To analyze the holes in clothing and tissues. To find whether or not a
photometry (FAAS)
person has fired a gun.
Scannlng electron
Most sophisticated tool
microscope-energy
Minute traces of GSR can be
dispersive
found.
kray spectrometry |(SEM-EDX) nt
rifled.
" Helixometer: Instrument to examine the interior of the barrel
Bullet slap/graze: When the bullet strikes at an angle, it
from the suspect's hand.
Also to identify traces of
Neutron activation
Extra Edge Paradox guns: If the barrel is partly smooth bored and party
cannot penetrate the skin but elliptical or triangular abrasion is produced. Kronlein shot:
" Rare type of skull injury due to high velocity bullet. loe
" Bursting of skull and laceration of dura with complete e evisceration of brain. A Cyt won
Rayalaseema phenomenon: "
It is an artifact.
. Abullet is implanted in a stab injury to fake a firearm injury
It is done to mislead the investigations.
Such cases were reported at Rayalaseema district in Andhrd Pradesh.
Bullet emboli/Wandering bullet: Vascular embolization of bullet.
" Associated with small caliber, low velocity bullet . Usually involves the arterial system.
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Dr PedagogyForensic Traumatology Puppes Rule
Gunshot Wounds on Skull
Eor skull injuries due to multiple impacts°. (gunshotu/blunt inpact)
impacts ccan be established. stquence of the.
The
Principle
Theory
Skull has outer table and inner table.
When the bullet enters the skull, bevelling occurs in the second
layer.
not ede
" In entry wound, the beveling is present in inner table of skull In exit wound, the beveling is present in the outer table of skull Entrance wound
Skull outer table Skull inner table
Outer table
Exit wound
Clean cut hole
Bevelled opening
Bevelled opening
Clean cut hole
Inner table
Inner table Outer table
-Bevelled
.When there are two tracture lines in the skull, the second fracture
vil always be stopped by the preexisting fracture line.
margins/
Bevelled
margins
Cotey
Potnkcat'sn-fH
1211
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Dr Pedagogy
Forensic Medicine
Theory
Chapter at a Glance BLUNT INJURIES
ABRASION
SHARP INJURIEs
cONTUSION
LACERATION
Destruction of layers ofBlood accumulation skin
Fothelial tag at tall end
Dd: Ant bite m
Margins irregular and
under skin Skin normal
Graze-most common Ks
pressure sores
INCISED Maro ins and
bruised
Tissue bridges+
Extravasation of blood+
crushed
raltway ine he "Ectopic bruise: black
Bleeding less
eye
"Dd: postmortem stalning
PoiDepthntedmoteweaprs
CUt
Single-edged r. wedge-shaen ole edge
vessels cut
Bleeding more
Do
Tailing+
knife
Split type-incised
- oval-shaped
Flaying present in
Penetrating only entry
Avulsion type
HESITATION AL CUTS:
Perforating -entry and ert
HARAKIRI:
DEFENSE INJURY: HOMICIDAL
SUICIDAL STAB INJURY
CIDAL
regular
Halr bulbs,
Hair bulbs, vessels
" Irregular margins
STAR
BULLETS USED
RIFLED GUN INJURIES
RIFLING IN BARREL
SPINNING OF BULLET CLOSE
cONTACT
NEAR
(Range of flame) Muzzle impression+ " Stellate margins+
Burns, blackening and track ot
aiong the
wOund
DISTANT
(Outside flame.
(Outside gun
within gunpowder)
Circular entrance wound
-Circular entrance
Burns and Singeing+
woUnd
-Blackening+
Tattooing+ Abrasion collar+
Tattooing Abrasion collar
powder)
Circular entrance Abraslon collar+
CALIBER: DISTANCE BETWEEN OPPOSITE
- Smoke: Blackening
LANI
" Flame: Burns and Singeing
SunpOWder: Tattooing
rasion collar and Bullet hole
SHOT GUN INJURIES)
" in shot gun, there Is dispersion of lead shots . The more the distance, more the
dispersion
CONTACT
CLOSE
NEAR
(2m)
(>4m)
Single entrance
entrance wound
Central hole due
WOund
Burns/singeing
Irreqular marglns -
to shot mass
Pretent ening present Tattooing present
Rat hole appearance
DISTANT
Burrounded by
Individual pellet hole.
Individual pellet holes due to Complete
dispersion
PHERICAL BALLS FROM CALIBER: NO. DF SPHER
POUND OF
EAD
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Dr PedagogyForensic Traumatology Frequently Asked
Concepts-Last-Minute Tidbits
abrasionsare usually simple hurt except corneal All most common type of fabrasion is Graze (brush abrasion. . The abrasion). e noted in tail end of abrasion. are tags Epithelial In contusion, thesskin is normal, whereas the underlying vessels ruptured. etavasation of blood noted in contusion
Theory
line bruise anddttire marks are the examples of patterned bruise ArtibcialI contusion producedlby the juice of Semecarpus
Toceration: Margins irregular, hair bulbs &vessels crushed
anacardium (Marking nut).
bridges: Present in laceration; absent in incised wound
more in incised wound Hemorrhage Less in laceration; laceration avulsion of feature Eaving is ike laceration/Split laceration appear like an incised wound at scalp, elbow, shin, etc. Tailingis noted in incisedI wound, swallow tails in lacerated wound, fish tailing in stab wound. Beeling of incised wound is homicidal in nature
Cenitalia incised wound is homicidal in nature Lesitational/intentional/ tentative cuts are suicidal in nature
Chop wounds overhead are homicidal, wide gaping, bevelled. Harakiri/seppuku is suicidal stab injury abdomen. Sed fracture skull is called signature fracture, as the pattern of the weapon can be determined.
Dctatic fractures involve sutures and are common in sagittal suture.
Ponds fracture are common in obstetric forceps delivery and among children.
Gutter fracture skull is due oblique bullet injury .ing fracture is fracture line around foramen magnum and due fall from height
Hinge fracture is also called motorcyclist fracture. Fracture line noted in MCF Contrecoup impact lesion is present at a site opposite to impact, common in mobile head. Ertradural hemorrhage commonly occurs from rupture of Middle meningeal artery.
. Subdural hemorrhage is due to the rupture of bridging veins. Lucid interval seen in EDH.
Whiplash is due to Hyperflexion and Hyperextension, seen in occupants of the car. " Paradoxical hypothermia is seen in hypothermia. Frostbite (dry cold injury) is very common in Nose; Trench foot is due to moist cold injury.
" Joule burn is an endogenous burn/due to contact with low voltage current " Arborescent burns/Lichtenberg burns/Filigree burn/Ferning is due to lightning. Tire marks and avulsion laceration are characteristics of run n over accident.
" " " "
Rifling is done in rifled gun and choking is done in smooth bored gun. Presence of spiral grooves in the barrel of agun is rifling; terminal constriction of barrel in smooth bored gun is choking Paradox gurm is basically ashotgun, in which the muzle end is rifled. Wad is present in shotgun cartridge; Wad acts like apiston and helps in lubrication in shot gun.
" Max dispersion is seen in unchoked gun and least dispersion of pellets is seen in fl choked shot gun. o Caliber is the distance between two opposite lands in rifed gun. " Abrasion collar (due to gyroscopic action of bullet) and Grease collar (due to deposition of dirt/grease) are associated with riled Firearm injury:.
Grease collar is also known as bullet wipe.
nagunshot injury, burns are due to the flame; Blackening seen is due to Smoke.
latooBng is due to the deposition of unburnt gun powder. Puppes Rule is related with determination of Sequence of bullets. Kennedy phenomenon is iatrogenic alteration of gunshot wounds. "
mary marking is due to rifling pattern on the gun, secondary marking is due to irregularities.
Secondary narkings are moree specific and individualistic. SEM-EDX is the specifc test for detection of Gunshot residue.
Injuries caused by the blast wave: Primary blast injury. Injuries caused by the fving obiects: Secondary blast injury
,uies caused by the wind/victim displacement: Tertiary blast injury
Injuries ccaused by theemiscellaneous factors: Quaternary blast injury.
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123
DrIMAGE-BASED Pedagogy QUESTIONS
Forensic Medicine
Imáge-Based Questions
(Recent Question 2021)
4. Identify the sign.
1. ldentify the injury.
a. Battle sign
a. Incised looking laceration
b. Raccoon sign
b. Incision
G. Ring fracture
d.
d. Anterior cranial fossa fracture
c. Laceration looking incision Laceration
image. 2. Identify the skull fracture as shown in the
5. What is the cause of injury in this person?
(INI-CET N
(INI-CET 2020)
a. Comminuted
b. Depressed
c. Ring
d. Sutural
e.
(Recenl uei
Linear fissured
3. ldentify the postmortem finding. (EMGE Dec 2021)
a. Electrocution
b. Lightning
c. Hot liquid injury d. Mechanical injury
6. Identify the phenomenon.
a. Tattooing
24
b. Abrasion collar
a. Left lung missing
c.
Cardiac tamponade
b. Fat necrosis d. Pulmonary embolism
c. Electrical injury d. Shot gun wound
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(INI-CET Nor X
Dr PedagogyForensic Traumatology 7.
Identify the injury shown in
image.
(INI-CET 2020)
10. Comment on the range of the shotgun entry wound.
Image-Based Questions
a Contact wound
b. Close range wound c. Near range wound 1 Incised wound
b. Lacerated wound
c Abrasion
d. Contusion
& ldentify the image.
d. Distant range wound 11. The injury shown in the figure is:
(AIIMS Nov 2018)
a. Stab wound
b. Wound of firearm entry c. Wound of firearm exit a Abrasion
b. Laceration
c Imprint
d. Graze
9. ldentify the fracture.
d. Penetrating wound 12. ldentify the type of skull fracture.
(AIIMS Nov 2018)
a. Fissure fracture
b. Diastatic fracture L Hinge fracture
C Depressed fracture
b. Ring fracture d. Comminuted fracture
c Depressed fracture d. Comminuted fracture
125
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Forensic Medicine
Dr Pedagogy
13. True statement about this injury is: Questions Image-Based
16. The source of bleeding in this hemorrhae.
a. Bridging veins a. Blood is present in vessel and can be washed away easily b. Extravasation of blood occurs
c. Produced by pointed object
b.
Aneurysms
c. Middle meningeal artery d.
Diploic veins
17. True about this firearmn injury:
d. Postmortem pooling of blood in venules 14. The type of injury shown in image is:
a. Scratch abrasion
a. Entry wound due to bullet entering the skin perpent
b. Patterned abrasion
larly b. Entry wound due to bullet entering the skin oblique
Graze abrasion d
15.
Pressure abrasion
True about stab wounds:
Rifled firearm exit wound d. Shotgun exit wound
18. Comment on the range of the entry wound.
a. Depth is greater than breadth b. Breadth is greater than depth
c. Length is greater than breadth d. t has wound of entry and exit
a.
Contact wound
C. Near range wound
126
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b. Close range wound
d. Distant range wound
Dr Pedagogy type 19. The
offlaceration
shown a in the
image is:
Forensic Traumatology
22. The skull fracture seen in the picture is caused by:
Image-Based Questions FORAMEN MAGNUM -FRACTURE
LINE
a. Strike by harnmer
a Stretch laceration c Split laceration
b. Avulsion laceration d. Cut laceration
20. The following injury is:
b. Strike by bullet
C. Fall from height landing on feet d. Strike by iron rod in neck 23. Tissue bridges are seen in the image:
a Primary impact injury
b. Secondary impact injury G Tertiary impact injury
B
d Secondary injury
21. The critical impact angle in external ricocheting is:
& 30-degree C 60-degree
b. 45-degree
d. 90-degree
a. Injury A
b. Injury B
c. Both Injury A &B
d. Neither A nor B
24. Identify the injury in scalp.
a. Incised injury c. Laceration
b. Stab injury d. Chop injury
127
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Forensic Medicine
Dr Pedagogy
25. The range of this rifled firearm injury in the chest is: Image-Based Questions
a.
Contact shot
b. Close shot
c.
Near shot
d. Distant shot
28. Identify the type of injury.
26. This type of fracture is produced by: a. Whiplash injury
h
Punch drunk svnd;
c. Secondary injury d. Coup injury 29. Pick out the correct pair:
A
a Heavy weapon with small striking surface
b. Heavy weapon with large striking surface
a. Entry wound-A; Exit wound - B
c Light weapon with small striking surface
b. Entry wound- B; Exit wound- A c. Entry wound - A & B
d. Light weapon with large striking surface 27. Identify the injury.
d. Exit wound - A & B
30. The injuries produced by blast wave are: Blast Wave
a Penetrating injury c. Chop injury
a. Primary blast injury b. Secondary blast injury
b. Perforating injury
c.
d. Defense injury
d.
Tertiary blast injury Miscellaneous blast injury
128
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Dr PedagogyForensic Traumatology 1. True regarding
these lines jis:
34.
ldentify this method
of
torture:
Image-Based Questions
a Picana
b. Parrot's perch
.These are the pattern of dermal collagen and elastic fibers.
c Chepuwa
h They do not correspond to the creases of the body surface
d. Saw horse
Astab wound with long axis at right angles to the cleavage
lines of Langer, will gape lesser A. Astab that runs parallel to these lines will gape more
e. Bastinado
35. The most common intracranial hemorrhage associated in this scenario is:
12 The injury seen in the RTA victim is due to:
a Extradural hemorrhage b. Subdural hemorrhage
a Whiplash Injury
c. Subarachnoid hemorrhage
b. Windshjeld C Acceleration -deceleration
d Intracerebral hemorrhage
d. Seat belt 33.
Identify this torture method:
&Chepuwa c Parrot perch
b. Bastinado d. Saw horse
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129
Forensic Medicine
Questions
Dr Pedagogy
ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS
1. Ans. a. incised looking laceration The photograph shows incised looking laceration in the scalp.
" Incised looking laceration is a type of split laceration.
Image-Based
Commonly seen in bony prominences
on the skull vault
. The image
3. Ans. c. Cardiac tamponade to The photograph shows blood in the pericardial Hemopericardium (cardiac tamponade). Explanations
cavity
Cardiac tamponade
This results in compression of
with
cardiac chambers.
Answers
" Most common type 9. Ans. a. Hinge fracture
"Most common type of skull fracture
pressure.
photograph shows graze abrasion Graze/Brusk
gravel rash.
shows thin, linear fissure fracture line is seen
Rapid accumulation offluid or blood in the pericardial space causing increase in the intrapericardial
8. Ans. d. Graze
. The
2. Ans. e. Linear fissure fracture
The photo
" Profuse hemorrhage is seen
" Length >Breadth >Depth of the wound
shows the fracture line in the middle cr fossa extending from one side to the other - Hinge fr or motor cyclist fracture.
10. Ans. d. Distant range wound
The photograph s
Beck's triad
Hypotension
Muffled heart sounds Raised jugular venous pressure
Decreased venous return
individual pellet injuries.
" Complete dispersion of lead shots is seen in distant re (4 m).
11. Ans. b. Wound of firearm entry
The photograph shows beveling of inner table of skull
" In entry wound, the beveling is present in inner tahle skull
" In exít wound, the beveling is present in the outer table df skull
Decreased cardiac output " Most common cause is trauma
12. Ans. d. Comminuted fracture . Ans, a. Battle sign
" Two or more fracture lines intersecting and dividing th
bone into three or more fragments. Mastoid ecchymosis
Battle
sign
Middle cranial fossa #
13. Ans. b. Extravasation of blood occurs
" The injury displayed is contusion.
" Extravasation in blood is the characteristic feature Contusion.
Raccoon
Periorbital
sign
ecchymosis
14. Ans. d. Pressure abrasion
Basal skull #
" The picture shows ligature mark, which is an example d pressure abrasion.
It cannot be patterned abrasion, as the pattern of the ligatur is not reflected in this mark.
15. Ans. a. Depth is greater than breadth " In stabinjury, depth is the maximum dimension
5. Ans. b. Lightning
Filigree burn/Lichtenberg flowers - Lightning.
Lichtenberg flowers are pathognomonic of lightning strike. Superficial thin irregular tortuous markings on sl
resembling
branches of a tree. Found over shoulders or flanks.
6. Ans, d. Shotgun wound
" The photograph shows multiple pellet wound suggestive of shotgun wound. 7. Ans. a. Incised wound The photograph shows incised wound in the fingers. Features: " Margins are clean, cut & regular
130 A
" Structures at the floor of the wound [vessels, nerves, hair bulb, eic.J
" In incised wound, length is the maximum dimension. 16. Ans. c. Middle meningeal artery " The photograph shows the hematoma above the dura mat - extradural hematoma.
. EDH is due to rupture of middle meningeal artery. 17. Ans. a. Entry wound due to bullet entering the skin
perpendicularly " The photograph shows the bullet wound with circu abrasion collar.
When the bullet enters the skin perpendicularly, abrasio
collar is circular.
" When the bullet enters the skin obliquely, abrasion co is oval.
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Dr Pedagogy Forensic Traumatology T
Ans. C. Near
range wound
.The photograph shows s circular wound along with tattooing
it.
around of gunpowderrifled entrance injuries
Appearance of Cuciate or Stellate wound- Contact range Circular bullet ywOund with singeing, blackening &tattooing "
nd the wound - Close range (within the range of flame)
" Circular bullet hole around the wound
with abrasion collar
& tattooing
- Near range (within the range of
gunpowder.
" Circular bullet hole with abrasion collar - Distant range
(outside the range of gunpowder) laceration 19. Ans C. Split
The photograph shows incised looking laceration in the scalp.
Incdised looking laceration is a type of split laceration.
. Avulsion laceration shows flaying,.
injury 20. Ans. a. Primary impact . Bumper injury is a primary impact injury. . Primary impact injury
Due to 1" impact of vehicle on the
yictim.
. Secondary impact injury - Due to 2nd impact of same vehicle on the victim.
. Secondary injury - Due to victim thrown on the ground.
26. Ans. a. Heavy Weapon with small striking surface " The
photograph shows depressed fracture in the skull.
Answers
by heavy weapon with " Depressed fracture is smaller striking surface like hammer. " It reflects the pattern of the weapon and termed signature fracture.
with
27. Ans. a. Penetrating injury
Penetrating wounds: The weapon enters into the body/cavities without producing any wound of eexit.
Explanations
Perforating wounds: When the weapon enters the body
through a cavity and exits, thus producing two surface wounds (Entry wound and Exit wound). 28. Ans. a. Whiplash injury
" Whiplash injury is seen in occupant of car. " It results from hyperflexion and hyperextension movements
29. Ans. a. Entry wound- A: Exit wound-B The photograph shows abrasion collar in the wound A
to
Image-Based
suggestive of entry wound and everted wound with more
bleeding in woundB suggestive of exit wound.
30. Ans. a. Primary blast injury
"Primary blast injury-Blast wave Secondary blast wave - Flying projectiles Tertiary blast injury - Victim displacement
Questions
" Quaternary blast injury - Burns, building collapse
21. Ans. a. 30 degrees
"Critical angle of external ricocheting of bullet is 30 degrees. . The bullet before striking the victim, strikes some
intervening object first, and then after ricocheting, hits the victim.
31. Ans. a. These are the patterns of dermal collagen and elastic fibers
" The patterns of collagen fiber arrangement are the lines of cleavage of the skin and their linear representations on the
" The bullet may be deformed. 22. Ans, c. Fall from height landing on feet Ring fracture in the base of skull seen in fall from height
landing on feet or buttocks 23. Ans. a Injury " Injury Ais laceration, while injury B is incised wound.
skin are known as "Langer's line of cleavage" " A stab wound with long axis at right angles to the cleavage
es of Langer, will 8P
" A stab injury that runs paral
tohese lines will gape less.
32. Ans. b. Windshield
" The picture shows sparrow foot marks, which is due to broken windshield.
T
" Tissue bridges are characteristic of laceration.
33. Ans. d. Saw horse
4 Ans, c.Laceration
" Photograph shows incised looking laceration.
34. Ans. b. Parrot's perch
Common in scalp, forehead, shin, iliac crest, etc. 35. Ans, b. Subdural hemorrhage
25. Ans, d. Distant shot
ne Photograph shows bullet hole with abrasion collar and
Dence of blackening, tattooing and burns
" The photograph shows shaken baby syndrome. " The most common intracranial haemorrhage associated with shaking is sub dural haemorrhage.
131
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Dr Pedagogy
Forensic Medicine
NEXT/CLINICAL CASE-BASED QUESTIONS
NEXT/CIinical Case-Based Questions
7
CBQ
A-49-year-old male is brought to
inverted margins, AGunshot bullet wound showing tattooing, (FMGE Dec 2020) The range is:
no signs of burns/charring. Contact
c.
Near
d. Close
emergency& bomb explosion. He has multiple abrasions injuries at right side chest & abdomen.
lacera
Which following is responsible for proximity of these injuries:
Distant
(INI-CET Nov n
a. Explosion burns
CBQ
2
A Cricket player was hit in the head & becomes unconscious. After sometimes, he becomes conscious. After the match, he lost his consciousness & was taken to the hospital. The
diagnosis could be:
af
b. C.
d. Building collapse 8
(FMGE Dec 2020)
Extradural hemorhage
Flying missiles Blast etfect
A 28-year-old man was involved in a bomb blast exolos
Subdural hemorrhage Subarachnoid hemorrhage
Which of the following is not true?
d. Intracerebral hemorrhage
CBQ Apatient presented to OPD, with burns of soddened skin, with
dear line of demarcation, lines of vesicles running down the
(IN-CET Nov 2021)
body. The probable cause is due to: a
Chemical burn
c.
Burn due to dry heat
d.
Burn due to mnoist heat
a.
Lightening
b. Force of explosion decrease rapidly
Injuries due to burns or air blast Force of explosion is directional
Abrasion, bruise and fracture are triad of explosion
CBÌ
4
Aperson is brought to emergency department, with laceration on the forehead and back ofhead. Mechanism of such laceration (INI-CET Nov 2021) on forehead is by: a Skin crushed between 2 hard objects
9
CE
A 25-year-old victim has been brought for autopsy. Multige
abrasions were present over right upper limbs & right le
Fracture was present in the both the bones of right leg. :
b. Shearing force
examination of the abrasion, the age of this abrasion is:
c. Semi sharp objects d.
Overstretching
CBQ
5
A person under police custody is made to lie on a prone
position and his ankle and wrist are tied behind. What is the
(INI-CET July 2021)
name of this torture method? a.
Choke
b.
Falaka
C.
Hog tying
d.
Bansdola
CBQ
6
A man was working in field, collapsed in a hot summer afernoon. Which of the following symptoms is least likely to (Recent Question 2021)
be seen?
Bradycardia Hot skin
132
d
Hypotension
Temperature 105.2°F
b.
12-24 hours
c. 4-5 days
2-3 days
d.
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5-7 days
Dr PedagogyForensic Traumatology CBQ
10 of fall from bike has come to 15-pearoldwith alleged history noted in his left forearm. The type of A OPD. Abrasion
T sustained is: sbrasion
CBQ
14
A 35-year-old married woman had arrivedNEXT/Clinical at the police by her husband. The of abuse complaining domestic station
investigating medical officer noticed bruises on the forearm,
shoulder and back on examination, She also had blackening with swelling and puffiness around her left eye, which made it
difficult for her to open her eye. The blackening around the eyes is caused by: a. b.
G. Penny bruise Questions d Ectopic bruise Case-Based
Friction abrasion Patterned abrasion
CBQ During autopsy of a 35-year-old man found dead in his house, approximately a wound over the right parietal area that waswas found. The circular sbaped and 5 x5 cm by dimension 15
C. Contact d. Imprint
Seratch
h Graze
CBÌ
a hammer forensic expert safely assumed the weapon to befound in the fracture of be the type would probably. What
most
skull?
ale dead body has brought for autopsy. The injuries are as
Rem in thbe image. The manner of injury shown in the image
c. Ring fracture
Gutter fracture
d. Sutural separation
b. Depressed fracture
CBQ
16
revealed Examination of the victim of the road traffic accident
multiple shallow, punctate wounds that had a bizarre pattern these
on the face and
findings as Sparrow
The forensic doctor documents
tmarks. What could most probably be
the cause of such an injury?
Motor cyclist's fracture b. Under-running or tail gating G. Steering wheel impact
d. Windscreen impact C.
& Accidental b Suicidal
Four members of the same family were burnt to death when their
hut had caught fire, allegedly from embers that had been blown around from the bonfire they had lit earlier that evening to warm CBQ
12
Arular bullet wound, erythema seen around the margin,
bbdtening &tattooing present. What is(Recent the range? Question 2019) 4 Contact shot entry b. Qose shot entry wound wound Cose shot exit wound
& Near shot
CBQ
17
Homicidal
d None of the above
themselves. The bodies were seen with their hips flexed at the hip
and lnees. Their hands were held in a defensive pose and with
denched fists. This posture in burn victims is because of:
Coagulation of proteins and present in ante-mortem burn b. Coagulation of proteins and present in post-mortem burn C. Coagulation of proteins and present in both ante-mortem and post-mortem burn
d.
None of the above
entry wound
13
CBQ
lame burn over face, both Tvogarlisbs,-ol4 froatchildof sstained abdomen and chest. Percentage of burns
hed
(AIIMS 2016) b. 54% d. 40%
CBQ 18 A30-year-old pedestrian is hit by a car and sustained injuries. He is noted to have tiblal fracture on the left leg and contusion
over the scalp on the right side. The tibial fracture in this patient isa result of:
a. Primary impact injury
b. Secondary impact injury
G Tertiaryy impact injury d. Quaternary impact injury
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133
Forensic Medicine
Questions
Dr Pedagogy
ANSWERS TO NEXT/CLINICAL CASE-BASED QUESTIONS 11. Ans. c. Homicidal
1. Ans. b. Near shot
The injuries on the victim are defense homicide.
The wound showing absence of burning (out of the range of flame) and presence of tattooing Case-Based gunpowder) indicates the near shot.
(inside the range of
2. Ans. a Extradural hemorrhage The period of consciousness between two unconsciousness
is called lucid interval. It is primarily seen in extradural hemorrhage.
12. Ans. b. Close shot entry wound The circular wound with erythema seen around the
blackening &tattooing is suggestive ot close shot entry
13. Ans. b. 54%
NEXT/Clinical 3. Ans. c. Burns due to moist heat
According to Rule of nine: Face = 18%
The burns showing soddened skin, with clear line of
Both upper limbs =9+9%
demarcation, lines of vesicles running down the body indicate scalds. Typical features of scalds " No charring &No singeing of hair
Front of chest =9%
" Soddening of the skin to " Signs of splashing Answers" Lines of blisters
Front of abdomen = 9% Total surface area of burns: 54 % 14.
Ans. d. Ectopic bruise
Blackening with swelling and puffiness around her lef o following a trauma indicates black eye, a type of ectopic br
" Clothes are wet & intact
4. Ans. a Skin crushed between two hard objects
injuries,
15. Ans. b. Depressed fracture. " Depressed fracture is due to local deformation of skull
The laceration in the forehead &back of head is split laceration.
. The fractured segment resembles the pattern of the strikt
Split laceration is produced by skin crushing between bone &
surface of the weapon
" It is also called 'fracture ala signature (signature fractur)
Weapon.
5. Ans. cHogtying It is the torture method, where the victim's ankle & wrist are
tied in a prone position. 6. Ans. &. Bradycardia In heat stroke, tachycardia is seen (not bradycardia)
7. Ans. b. Flying missiles
16
Ans, d. Windscreen impact
The description of the injury suggests sparrow foot markx T
sparrow foot marks are due to broken windshield.
17. Ans. c. Coagulation of proteins and present in both unt
mortem and post-mnortem burm
The posture is suggestive of pugilistic attitude or defos attitude.
The pugilistic attitude is due to coagulation of muscle ptes
explosion 8. Ans. dAbrasion, bruise and fracture are triad of multiple abrasions In a bomb blast victim, the presence of & abdomen are & lacerations injuries at right side chest
to flying missiles) suggestive of secondary blast injuries (due Laceration are scen & Marshal's triad = Abrasion, Contusion on sarne side of the body (due to flying missiles).
9. Ans. b. 2-3 days
It is a nonspecific sign, seen in ante-mortem burns postmortem burns also.
18. Ans. a. Primary impact injury The tibial fracture on the left leg of a RTA victim is de
the bumper impact tof the vehicde.
The injury due to the first impact with vehicle (bun impact) is known as primary impact injury
10. Ans. b. Graze
The image showing reddish brown scabbed abraslon, Indicating 2-3 days.
134
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Dr Pedagogy Forensic Traumatology MULTIPLE CHOICE QUESTIONS I.
with correct palr (INI-CET Nov 2020) Match the following Injury
Weapon 1,
Incised wound
a
Lathl
Chop wound
Road traffic accident
3, 4, Surglcal blade
d
Graze abraslon
3(d), 4 (c) &. I (6), 2 (a), 3(b), 4 (c) 4 (a)
(FMGE June 2021)
Sharpobject
b. Blunt object
d. IJV ante-Imortem death due to burns: of sign conclusive 11. Most
(AIIMS 2016)
(AIIMS Nov 2019)
term is 3. Bullet wipe
Gutter fracture of skull b. Blackening d. Dirt from barrel c. Tattooing can be determined by the spread of shot AAsertion: Range
of pellets Reason: Shotgun cartridge contains pellets
(AIIMS May 2019) true and the 2 Both assertion and reasons are independently assertion the reason is the correct explanation for the assertion and reason are independently true but Both b. assertion reason is not the correct explanation of the reason is inde c. Assertion in independently true but the
pendently false
the reason is inde d. Assertion in independently a false but pendently true
e. Both assertion and reasons are independently false
occurs due to 5. Paradoxical undressing cause of death
(AIIMS May 2019)
2 Immersion syndrome b. Hypothermia d. All of the above c Dhatura poisoning Question 2016) 6. Scalp laceration may resemble? (Recent 1 Incised wound
b. Abrasion
. Gunshot wound
d.
Contusion
7. 7.In an incised wound. all of the following are true, excep
(Recent Question 2014, 15)
a t has
cdean-cut margins D. Bleeding is generally les than in lacerations C Tailing is often present Length of injury docs not correspond with length of blade
(Recent Question 2016) (AIIMS 2014) & Subbing heart b. Cutting the genitalia . Shooting in Stabbing in abdomen d. mouth Frimary lmpact iniury ls commonly scen in:
Hara kiri mean:
(Recent Question 2015)
c Pedestraininjury Injury
a. Heat hyperemia b.
Heat fracture
c. Presence of carboxyhemoglobin
b. Motor cycle injury d. Burns
(Recent Question 2015)
Antemortem burn
b. Postmortem burn
C. Asphyxia d. Carbon mono oxide poisoning
antemortem and post 13. Not a differentiating feature of (Recent Question 2015) mortem burn?
d. Bullet
c Fall from height used for:
Gun shot
Questions Multiple Choice
b. SVC
C. Descending aorta
a.
d. 1(c), 2 (a), 3(d), associated with , Cutter fracture of skull is
L
Carotid arteries
d. Absence of line of redness 12. Soot in trachea is a sign of:
3(d), c. I(b), 2 (c), 4 (b)
8.
(Recent Question 2015)
Ladder tears seen in:
Tram tack brulse
2. Axe
b. 1(d), 2 (a),
10,
a. Laceration on medial aspect of thigh b. Cheery red muscle
C. Soot in respiratory passage d. Cyanide in the blood
(Recent Question 2016)
14. Molst burn refers to: a. Simple burns
b. Scalds
C. Electric burns
d.
Thermal burns
of: 15. Bone pearl's or wax drippings is pathogonomic a. Burns
c. Lightening
b. Scalds d.
Electrocution
(AIIMS Nov 2018)
16. Bullet fingerprinting is: a. Human fingerprints on bullet
b. Primary marking c. Secondary marking
d.
Distorted bullet
produce maximum 17. Which type of chocking in short gun (Recent Question 2016) dispersion of pellets? a. Fully chocked C. Quarter
b. Half d.
Unchoked
18, Smokeless gunpowder contains:
(Recent Question 2016)
a. Nitrocellulose
b. Charcoal
c.
d. Sulphur
Potassium
by: 19. Gunpowder remnant can be visualized (Recent Question 2016) UV rays c. Infrared rays
a.
b. X-rays d. CT scan
is called: 20. Bullet which is left inside the body for long a. Souvenir bullet
c. Tracer bullet 21. Tandem bullet is:
b. Tumbling bullet
d.
Tandem bullet
a. Bullet which left for long in the body b. Bullet not released on first fire but comes out with second bullet on secondd shot
C. Bullet that leaves a visible mark in path that a person can d. Bullet deviated from is path
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135
Forensic Medicine
Dr Pedagogy
Answers with Explanations
ANSWERS WITH EXPLANATIONS
1. Ans. c.l (b), 2 (c), 3(d),4 (a)
6.
(Ref Review of Forensic Medicine
Ans, a. Incised wound
Taxicology:
IRef Revicw of Forensic Medicine
Gautam Biswvas; 2nd etition; P- 196]
" Tram line Bruise (aka Railway line bruise)
longitudinal weapon like stick, cane, lathi can
oroduce t sbruise
This bruise looks like Tram-line/Railway-line.
2. Ans. d. Bullet (refer to earlier discussion)
bullet/glancing bullet, tangentially
Essentials of Forensic Medicine & Toxicology,
33rd Ed, P 230]
Grease Collar (Bullet Wipe) " Ablack/grey colored ring is seen lining the entrance wound. " Due to the deposition of lubricants, gun oil or lead from the bullet.
" Abrasion collar surrounds the dirt collar. " Dirt collar rim is more prominent in dothing- 'bullet wipe. " Abrasion and dirt collars are proof of an entry wound. 4. Ans. b. Both
assertion and reason are independently true but the reason is not the correct explanation of the assertion.
(Ref: Review of Forensic Medicine + Toxicology, Gautam Biswas, 3rd edition, P 212]
" Shotgun cartridge contains lead pellets. Range of shot gun can be determined by the spread of
(margjns
differentiated from incised wound by examination with magnifying lens.
7. Ans. b. Bleeding is generally less than laceration
pellets.
Incised wound/cut/slash/slice
Gaping present &eversion of margins
Points to Remember:
Characters
Laceration
Incised wound
Margins
Irregular, edges
Clean cut, regular
contused Tissue bridges
Present
Tailing
Absent
Present
Bleeding
Less (due to
More (due to
The extent of dispersion will approximately indicate the range of firing. " Unchoked gun: Range in yards = 2/3 spread in inches. " Fully choked gun: Range in yards =4/3 in inches. " Half choked gun: Range in yards = spread in inches. 5. Ans. b. Hypothermia (Ref: Review of Forensic Medicine & Taxicolog, Gautam Biswas,
3rd edition, P 264)
Paradorical undressing:
LACERATION
" In such case, there may be suspicion of sexual offence.
" The manner of death is usually accidental.,
Terminal burrowing or Hide and Die Syndrome:
Seen in severe
Absent
crushing of vessels)cutting of vessel INCISED WOUND
" This may occur in severe hypothermia; the body is found partially or fully undressed. " During termínal hypothermia, the victim becomes himself. disoriented &confused, and may undress u
i
2nd cdition, Pg- 1
" Tailing is present, suggesting the direction. " Bevelling is seen if the blade cuts obliquely.
Determination of range:
byptions.
"Due to terminal
"Victim is often found under bed or bench, behind wardrobe, on a shelf.
" This may also lead to the assurmption of a homicide or
robbery.
Toxicology: Gautam
" Margins clean cut ®ular . Blood vessels are clean cut, profuse bleeding presere
Thumb Rule
136
2nd edithon, P-i
Laceration looking like an incised wound to be regular &clean cut) ag Sites: Shin9, scalp", eyebrows, cheek bones, iliac creut & perineum.
IRef Review of Forensic Medicine
3. Ans. d. Dirt from Barrel
[Ref KSN Reddy,
"
Can be
Gutter fracture:
" Caused by oblique travelling to the skull
Incised looking laceration:
Toxicology, Ga tam
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Dr Pedagogy Forensic Traumatology abdomen 8. Ans. d. Stabbing in IRef Review of Forensic Medicine c Toxicology; Gautam Biswas: 2nd edition; Pg- 199)
. Hara-kiri (seppuku) is a form of Japanese ritual suicide by disembowelment. . Stab injury in the abdomen, causing instantaneous
evisceration of bowel loops. . It results in circulatory collapse and death Suicldal manner Hesitational cuts
14. Ans. b. Scalds
(Ref Parikh 6th/e p. 4I151) Local effects of heat & cold:
" Dry heat: Flame burns
Explanations Answers with
" Moist cold: Immersion
" Moist heat: Scalds
foot
" Dry cold: Frost bite
15. Ans. d. Electrocution (Ref: Review of Forensic Medicine & Toxicology; Gautam Biswas; 2nd edition; Pg- 275)
"
Hara-kiri@
Joule burn
Homicidal manner
Defense injuries
flash or spark burn
Chop injury over head Stab Injuries over back
Incised wounds on
SKIN
edile fash crocodile
Bevelling injuries
0enitolio
burn
arc eye bun
9. Ans. c. Pedestrian injury Ref Reddys 29thle p. 249-52; Parikh 6th/e p. 4.132-4.135;
MUSCLE
ELECTRIC INJURIES
Zenker's degeneration Bone pearls
BONE
Forensic Medicine by Guharaj 2nd/e p. 166, 167, 168;
Micro fractures
(Zig Zag fracture)
Rao (1999)/ep. 207, 208, 209)
Pedestrian injuries: " Primary impact injuries: Injuries caused due to the first
impact of the vehicle with the victim. " Secondary impact injuries: Injuries caused due to the second impact of the vehicle with the victim, .Secondary injuries: Injuries caused due to victim falling on
the ground. Ref Essentials of Forensic Medicine d Toxicology, KSN Reddy, 33rd Ed., P 280
282)
" Ladder tears: Multiple parallel horizontal tears of the
aortic intima that occur in deceleration injuries.
Aorta injury in Road traffic injuries: " In sudden deceleration forces, complete or partial transection of aorta results. descend " The most comnon site of complete transection is the arteriosum. ligarnentum of attachment to the aortadistal ing
tears
" Io partial transection, multiple, semicircular ¶llel tears. occur in the intima of aorta known as ladder-rung
11. Ans. c. Presence of carboxyhemoglobin
Primary Marking/Class Characteristics: " Produced by rifling grooves Primary markings are used to identify the make and model of the guns i Secondary markings or individual/accidental characteristics
" Produced by imperfections of barrel are called secondary markings.
" They are useful in identifying the specific gun which was
fired- Bullet finger printing 17. Ans, d. Unchoked 18. Ans. a. Nitrocellulose
Ref Review of Forensic Medicineó Toxicology: Gautam Biswas; 2nd edition; Pg - 215)
BLACK unpowder: Potassium nitrate (75%), Charcoal (15%) &Sulfur (10%)
" SMOKELESS gunpowder:
SEMISMOKELESS gunpowder: 80% black &20% smokeless
12. Ans, a Antemortem burn
gunpowder.
13, Ans, a. Laceration on medial aspect of thig
(Ref.: Parikh 6the p. 4.I52-4.156) Soot particles In airway
Carboxyhaemoglobin In blood
Blisters wilh alburnin
ANTEMORTEM BURNS
LNON-SPECIFIC SIGNS
(Ref Reddy 31stle p. 217: Parikh 6th/e p. 437-39, Apurwa Nandy 2ndlep. 48]
involved.
10, Ans. c. Descending aorta
SPECIFIC SIGNS OF
16. Ans. c. Secondary marking
chlorlde
Line of redness Heallng slgns
19. Ans. c. Infrared rays (refer discussion) 20. Ans, a. Souvenir bullet
21. Ans, b. Bullet not released on first fire but comes out with second bullet on second shot
(Ref KSN Reddy, Bsentials of Forensic Medicine + Taxicolog. 33rd Ed, P 230]
Infectlon
Souvenir Bullets:
Pugillstlc attude
" Retained buller inslde the body for along time.
Heal haemalorma Hesl fracture Heat rupture
4. I52-4.156] 6th/e p.33d (Ref Parikh R KSN Raddy, Essertials of fForensic Medicine &Toxicology. Ed PJ25)
Dense fAbrous tissue surrounds the bullet.
" Due to absorption of lead from the bullet into the body
fluids, chronic lead poisontng may occur. Tandem bullet (Plggyback bullet): . Two bullets come out of the muzzle end.
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137
http://t.me/dr_pedagogy Nolke -Tim
Kad"
y
Work Doesn't
Salent
When Jalent
Beato
work "Havd
Forensic
Dr Pedagogy
Dr Pedagogy
Forensic Medicine
Theory CLASSIFICATION OF POISONS Let's Know the Basics
cORROsIVES CALKAL!
INORGANIC ACID ULPHURIC ACID
NaOH KOH
.SUL
ORGANI C ACIDS CARBOLIC OXALIC
.NITE
TRIC ACID
HCL
IRRITANT
POISON
ACETIC
NEURAL ORGANICS
SOMNIFEROUs (SLEEP des N INDUCING): G): OPIODS
DELIRIANTS STIMULANT (CNS NTS): DATURA COCAINE, CANNABIS INEBRIANTS
SPINAL
NUX VOMICA
ABRUS PERIPHERAL NERVE SEMICARPUS CROTON POISON
CONIUM "CURARE
(UNTOXICANTS): ALCOHOL AR 99-enbri
ARSENNC "MERC
ANIMALS
.COPPER
"SNAKE
. 1RON
SCORPION
ONVETALLY. ..2CPNHOSPHP HLORNE
ACONITE
CARDIAC
1.CANORGANE, METALL
RICINUS
" IODINE
IGITALIS Sear NERIUM CERBERA THEVETIA NICOTINE
.CCAPR YANIDE
ASPHYXIANTS
HYOON MONOXIDE
OGEN SULPHIDE
" CARBON DIOXIDE
AGRIGULTURR
-b
ldeal homicidal poison . Cheap and Easily
Colorless, odorless,available and tasteless
Can be mixed with food easily
Symptoms should resemble notural diseasea
No antidote
NoOpostmortem changes
Should not
be by chemical tests detected and must be rapidly body, e.g,destroyed Fluorine,from
vthallium) Arsenic, aconite (commonly
MISCELLANEOUS INSECTICIDES "FOOD POISONING
RolkncUeleAneeo
ldeal suicidal poison Cheap and easily available
Police intimation
Pleasant taste
39 Cr.P.C
Ea_ily taken with food
should be done by a
Not informing the
doctor under
police is
Giving false information is punishable under 176 IPC punishable under 177 IPC If there is any suspected of food, article should be stomach wash by to preservepreserved the doctor. Intentional omission
Highly toxic
Painless deoth
Highly toxic
used)
-
VGyonide fideal)
Others are Opium, barbiturates OPC and endrin (commonly used)
amounts to destruction of evidence and punishable under 201 IPC Intentional omission to inform police about the
offence s Dunishable under 202 IPC Intentionally giving false information about the offence s
punishable under 203 IPC Negllgent conduct with respect to poison is
under 284 IPC "
punishable
Causing hurt by means of potson, with offence is punishable under 328 IPC intent to commita
140
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Dr Pedagogy Forensic Toxicology GENERAL LINES OF TREATMENT ncantamination:
Emesis. Gastric lavage,
INORGANIC ÁCIDS Catharsis, Activated
Whole bowel| irrigation
huras!
eectivee avageis very
within 1hour of poison ingestion. Gastric sitting position or position Oin lefA lateral Boustube,
for gastric
Rylestube
lavage: Lavacualor (Best), Ewald's tube,
Theory
Nitricacid
Brown to black streak from
GastricLavage
TubesusedI
Sulfurlcacid
ISObacion: "Xanthoproteic
angle of mouth
Yellow discoloration
Black tongue Aaolen
of tissues (picric acid formation 47tooo
Chalky white teeth"dermi lack stomach wall or black charred stomacha Blotting paper stomach
Yellow teeth Brown stomach mucosa
Vitriolage (Throwing Acid Over Face -Adadork to Disfigure) carbolicacid, caustic " Sulfuricacid (most common9), Nitric acid, or calotropis. nut juice soda, caustic potash, iodine, marking A IPC? " Voluntarily causing grievous hurt by acids - Sec. 326
32c rc (10 years/life imprisonment) " Attempt of vitriolage-Sec. 326 BIPC (5-7 years)
1
ExtraE d g e Na. .a rale Costraindications: Comatose patients, corrosive (except
henol), esophageal varices, volatile poisons, convulsant poisons.
Activated Charcoal Mechanical antidote Contains small, low volume pores for adsorption of poisons
Magenstrasse (Street of the Stomach)
" The pathway corrosive agents follow in food-filled stomach
" It is along the lesser curvature (Location of greatest damage) half " In case of empty stomach, damage is seen in lower
(fundus spared)
Acivated charcoal does not adsorb: Corrosives
Heavy metals/Hydrocarbons
"Iron
" Pesticides Solvents
(Magenstrasse)
Maemonic: CHIPS)
CORROSIVES Arid
Alkalis
USes coagulative necrosisCauses Liquefactiveenecrosis ne Alkalis
Acids
noranic acid | Primarily shows
ocal acton only as there
hno Systemic
Absorption
Organic acid It has systemic Eg. 1. NaOH absorption 2. Potasslum Hence, shows Local action +systemic action hydroxide
" Carbolic acid (Phenol)
2HNO.
"
3. HCL
" Acetic acid
"hyloaoicacid causes
Oxalic acid
Boric acid
a
3. Sodium carbonate Potassium
carbonate 5. Ammonla
Hydrofluoric Acid AUardtoh. N lee
tmei
It is a unique acid as it can cause both Coagulative necrosis (by ions) &Liquefactive necrosis (by Fluoride ions)
Mechanlsm of Toxicity Liquefactive necrosis Decalcification +intense destruction of the bone
When it comes in contlact with calcium/magnesium, it forms
Laekkrtinsoluble salts, Thus, results in hypocalcemia &hypomagnesemia. liquefactive necrosis.-
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141
Dr Pedagogy
ForensicMedicine
Systemiceffects
Phenolic Polsoning
of entry, Irrespective of the route are:seen systemic effects following Hypocalcemica
Local exposure/effects
heory
Skin
Causes deep burns
severe excruciative pain
[predominantly]
primarily in subungual
Hypomagnesemla " Hyperkalemia Cardlac arrhythmias
h hale 1mahsn co
Cs) ys - Hya h,fcale pua (7 1. Carbolisma 2. Carboluria (green color urine)
Constriction of pupils -Mi 3.4. Corneal deposition 5. Cartilage deposition
(PCT) 6. Convoluted tubule damage
." Metabolic acidosis
7. CNS depresslon", Lony lusws
Treattent
ifavailable calcium gluconate, 2.5% apply of 10% calcium Topically burns SC injection
Acute Poisoning (Carbolism) Miosis
and numbness due to Skin: Burning skin. white eschar on
deep/large In cases of gluconate is given Correct Electrolyte imbalance
nerve
PCT necrosis, hemoglobinuria.
oxidation of Green color urine due to the
IVCalcium gluconate
endings de
metabolites
at
Chronic Poisoning (Phenolic Marasmus)
ORGANIC ACIDS
and systemic effects systemic absorption - both local
have (They present)tdiahue-
weight loss " Anorexia, Progressive pigmentationnof skin and sclera Dark urine, and
Cesl,Rer'h
(ochrosa
Other Features
Carbolic Acid (Phenol)
White/brown leathery stomach is seen Gastric lavage can be done (Gastric lavage contraindi other corrosives)
as an antiseptic or disinfectant. " Phenol is usedHisoy odoY dokne
Didr Metabolism
Putrefaction is delayed
and pyrocatecho " Phenol gets converted into hydroquinone metabolites on further oxidation
Land excreted in the urine the- carboluriaQ, produces green color urine
sof Phen ol, Properesoa,Phead
odtcauses tingling
Ak., ligaments (Ochronosis°)
tat
Oxalic acid is used in ink remover solution (used to e
Used in calico printing and as bleaching agent.
Spinach and cabbage I Attentlon
When ina question of a case of poisoning, history of ink remover solution is given, Oxalic acid should be considered.
LvshgReay muwsa
OXALIC ACID (ABSORBED INTO BLOODSTREAM
TETANY HYPOCALCEMIA
cOMBINES WITH)
(CHVOSTEKWEISS SIGN) (ACCOUCHEUR'S
HANDITROUSSEAU's SIGN)
CALCIUM IN
BLOODSTREAM
CALCIUM OXALATE CRYSTALS
OXALURIA: EXCRETION OXAL ATON OF CALCIUM
E CRYSTAL s IN URINE
TUBULAR NECROSIS AND
142
e
writing in attempts at forgery)isn tain omoe
" It danmages the sensory nerve endings (initially sensation, later numbness and fnally anesthesia) in cornea, cartilage and " Phenol and metabolites get deposited
Mechanism of Toxicity
sugas salt d
Oxalic Acid Aud
RENAL FAILURE (UREMIA)
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Dr Pedagogy Forensic Toxicology
al'sen) groundvomitus" is seen
Coñee Theatment:Calkiumgluconalee(antidote). parathyroid stomachisseen in postnlortem
.Blackcolor
CAed Himdialys.
Exta
RoledLobsterSyndrome t there Inboricacidpoisoning,
MNEMONIC
extract
aree massive areas of erythema,
and exfoliation (loOking like aboilled lobster) desquamation, seencommonly on tthe palms, soles and buttocks.
Theory METAL M-Minamata disease,Mernbranous colitis", S - S Membranous glomerulonephritis E -Erethism" (Mad hatter")
T-Tremor" (Hatters shakes) Glassblowers' shakes
A -Acrodynla
L -Lentis (Mercurla lentis)
rashesare
The
MINAMATA DISEASE
" Disease due to organic mercury"
Chronlc organic mercury intoxication caused by eating
contaminated fish and shellfish
coordination, gait " Symptoms include disturbances in hand
and speech, tremors, rigidity, selzures.
ERETHISM " Mad hatter syndrome
Neuropsychiotric symptoms
Personality change da
nid
Irritability, shyness, dementia, insomnla
industry workers " Common among gloss industry and hat Intention Tremors (Danbury Tremors/Shaking Palsy)
Predisposed Occupation: Workers of hat industries (hatter's shakes)
IRRITANTS:METALS
shakes") and glass blowing industries (glass blower's
Type of tremors: Coarse tremors Site: First in the hands’ lips’ tongue’ arms and legs. Features: Worsening of handwriting (early feature)’ Slurring of speech’ ataxia ’ concussion mercurialis (most severe
Mercury (Quick Silver) Todc Forms of Mercury Elemental mercury
form of tremors).
toxic Not absorbed in the GIT & Inhaled vapors are toxic.
Organic mercury
Acrodynia (Pink Disease)/Swift-Feer disease/Calomel's disease
o
Incudes Methyl mercury, Ethyl mercury, etc.
Inorganic mercury mercurous " Indudes 2 types of salts. They are mercuric salts &
ldiosyncrotic hypersensitlvity teaction Due to mercurous chloride (calomel) Age group: Children Features
salts
Mercuric chloride (most toxic salt)
Mercurous chloride (calomel) Mercuric sulfide
Mercuric cyanide onicity: Organic mercury >Mercuric salts >mercurous salts)
HdiSm ares of Chronic Mercury Poisoning Sate grey mucosa in stomach1 Excessive salivation, gingivitis, loosening of teeth, blue lines on 6ums
Minamata disease
hatter syndrone) Erethism- -Neuropsychiatric features ((Mad(Danberry tremors/
Tremorshakes/Glass s- Coarse blowers shakes") Hatters intentional tremors
Acrodyni a (pink disease) Lens
deposition- Mercuria lentis -
1 Hunter--Russell syndrome
Pink discoloration in the hands and feet Pink Puffy
Painful
Paresthetic Peripheries Assoclated with Dental fillings, teething powders
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143
Forensic Medicine
Dr Pedagogy
Iheory Mercurialentis Toxicity: Exposure to mercury vapor Mechanism: Brownish deposition of mercury in anterior lens
copsule Site: Anterior lens capsule, Bilateral
Slit lamp examination: Malt brown reflex Visual acuity: Normal (No effect on visual acuity)
THE
Hunter Russell Syndrome
INHERITOR'S
Due to the toxicity of Methyl-mercury visd dak sped sdf
POWDER
" Classically, patients present with paresthesia, dysarthria, sensory
ATale ef
deficits, deafnes, cerebellar ataxia, and progressive constriction
ARSENIC
of visual felds
A
Jlustvative
On April 21, 1956, a 5-year-old girl was examined at the Chisso Corporation's Factory Hospital in Minamata city, Japan. The
doctors were surprised by her symptoms: unable to walk, speak and convulsions. Two days later, her younger sister also began to exhibit the same symptoms and she was also hospitalized. The
girls' mother informed doctors that her neighbor's daughter was also experiencing similar problems. On May 1, it was reported as "epidemic of an unknown disease of the central
nervous system", marking the official discovery of Minamata
falade100-2Sng Clinical Features Acute Poisoning
" Causes hemorrhagic gastritis Gastroenteritis like cholera In postmortem, pink velvety stomach mucosa or strawba stomach seen.
d
disease.
Chronic Pojsoning
Researchers found that the victims, were often members of the same family, clustering in fishing hamlets along the
. Metallic taste, excessive salivation, and garlic odor of breat
shore of Minamata Bay. Cats also began exhibiting bizarre
movements and strange walking that the people said the cats were "dancing". It was even noted that some cats fell
and sweat. ka
Alopecia,l
Aseics as
Skin.
into sea and drowned, which the residents referred to as cat
Arash resembling fading measles rash
suicides'.
Rain drop pigmentation
It was shocking to find that large quantities of methyl mercury
were detected in fish, shellfish, and sludge from the bay. The
Brown pigmentation over skin flexures, temples, shoulders, palm, eyelids and neck
Leucomelanosis: Ncp\es
SCHCC
Chisso factory was identified as the source of contamination as Mercury contaminated waste water from Chisso factory spilled into the bay. The Organic Mercury travelled from microorganisms inhabiting the bay, and then up the food chain to fish and shellfish, and then finaly to the cats or humans
" Hyperkeratosis of the palms and soles bilaterally.
which ate the fish and shellfish.
Black Foot Disease"
" Macular areas of depigmentation (earliest sign") Aldrich Mees line: White bands of opacity in the nalls of fingers and toes.
Chronic exposure also causes vasospasm and peripheral vascular insufficiency ' h b i a 40N WN
Arsenic (Metalloid)
. Dry gangrene and spontaneous amputations of affected
Toxic Compounds of Arsenic
extremities
The toxicity of arsenic compounds can vary greatly. In general,
Peripheral Neuropathy
arsenic compounds can be ranked from highest to lowest toxicity:
"Peripheral mixed neuropathy with tÉngling, numbness of
" Arsine gas (Most 1oxic form)
" Inorganic arsenic (e.g. Arsenic trioxide - most toxic salt) inheritance powder Organic arsenic Elemental arsenic.
144
MURDER
hands and feet (glove and stocking distribution")
Hematological Signs
" Bone marrow suppression, mlcrocytic hypochromic anemia, thrombocytopenia and leukemia. anyshe
Noes- Poyantheitate halygkn pai tting
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Dr Pedagogy
ANs
(ls
ol)
CDTA
kof Arsenic Toxicity
Jllustrative
L9. Blood samplea polsoning: than te sarmpleis moreereliable the blood sample.
Mrs Vidya, 32-year-old, thin-bult staff nurse, had come Theory with
Uninay
detailed examination, she was found to be having raindrop
DMS
Oagnoss
Urine arsenic levels of >50 arsenie
ug/244 hours
is an
history of repeated infections and generalised weakness. On
indication
eposureto (Dimethvl lor like DMA e
Forensic Toxicology
Arsenic Acid), MMA Acld] noted. Arsenic Methyl BoneQ Hair, Nall and nnk posoning: are taken, as arsenlc has the tiseuee nail samples
plgmentation, palmar hyperkeratosis, and hypertension and
Metabolites
Guillain-Barré lke peripheral neuropathy. Blood tests revealed
neutropenia, microcytic hypochromic anemia. She raised the susplcion of belng poisoned for property affairs by her husband,
who is a blochemistry lecturer. On further questloning, she had
depositng in keratin noerty of morereliableesample than the Scalp halr, as scalp blc hairis chancessof. external contamination with the
also glven the history of intermittent episodes of diarrhea.
The arsenic concentrations in blood and urlne were found too
hasnmore irhas
hlgh, beyond normal level, Her husband was arrested and he
enionment
confessed of adding small doses of arsenic salt to her food
Tests:
every day.
test Reinsch° test Morsh AOmic absorphon spectroscopy -AAS
Dlsadvantages of Arsenlc Usage asHomlcidal Poison
t
It delays putrefaction
be detected in completely decomposed bodies, keldeaesa Can Can be found in bones, hairs and nails for several years
MNEHONIC
S - a s dei nnoyhas Car
ASenic Poisoning
iynewsethy
BonaparteARSEN
Senember Napoleon Bonaparte died of arsenic) -
Back foot disease
Lead poisoning is the most common chronic heavy metal
poisoning.
-Neoplastic(Skin, lung, Bladder)NAA
" Most common route of occupational exposure is inhalational'
- wmleh
-Alopecia
Lead "
toxic) 0-Oude (arsenic trioxide most
be detected in charred bones or ashes
p
Toxle Salts of Lead
Anemia
P-Peripheral neuropathy
A-Atrich Mees' line, Asophg -Raindrop pigmentation Rgor mortis longer
(tlele
Lead tetroxide (Vermillion)
teyt,R
Retards Putrefacton , Rin
-Teratogen
-Enugtions on skin (hyperkeratosis) Enteritis (cholera)
Lead acetate ugar of lead
| Lead acetate
Lead sulphlde Used es ume
ety
Most common source of lead
poisoning |Used as Sindoor mot
Ay.
Tetraethyl lead
Antiknock in petrol
Lead sulfide
Least toxic form
Lead carbonate
Palnts
Tetraethyl lead
Lead encephalopothy Ai o
Lead tetroxlde
Load carbonata
Commonly ueed ae vemilllon/sindoor
used in paints
qf-muge akeswyis 145
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Dr Pedagogy
Forensic Medicine Taxic Actions Theory
group and interferes with Lead combines with sulthvdrd
"
tohondrial oxidative Inhibit heme synthesisphosphre mito
ALA
ayprporphringn axidase, Frnhelatas)
MNEHO
Plumbism Features ABCDEFGHI
delydratase,
A-Anemia
8-Burtonian line/Basophilic stippling, Bone lines C-Colic, Constipation (dry belly ache)
sheaths and causes lead CNS atfets nerve cells and myelin
encephalopathy in children JUric acid excretion- f Blood urates - Saturnine gout
D- Drop (wrist/foot drop)-Lead palsy
d
m
E-Encephalopathy
F-Facial pallor (earliest sign) r
Plumbism (Saturnism)
sis
G-Gout (saturnine gout)
" Chronic lead poisoning is called Plumbism (saturnism) " Lead is a cumulative poison. In chronic exposure, lead deposits
H-Hypertension |-impotence
in Aones (904, liver and kidneys.
DiarsiA
ALA
Anemia - Microcytic Hypochromic anemia
Mechanism: Inhibition of ALA dehydratase, coproporphyrin oxidase and Ferrochelotase
Elevated levels of ALA, Coproporphyrins, free erythrocyte protoporphyrin Punctate Basophilia/Basophilic Stippling in RBCS
Lead
Pyrimidine 5 nucleotidase Ribasomes aggregate as dark blue spots in RBC cytoplasm?
|Colic(saturnine colic)
Burtonian line
" Nocturnal
Blue line along
Late synptom
gums
Opposite to caries tooth Deposition of leod
sutfide (lead +H,S
Lead enCephalopathy
Lead palsy " Late symptom Common in adults
Spasmodic
abdominal pain
Degeneration of nerves and
lasting for few
muscular atrophy
minutesm bhae
by bacteria)
Pain relieved by
1 week of exposure
pressure
Lead osteopathy/lead ine
Present in all cases
" Among children!
of plumbism Due to tetraethyl
. Deposition of lead
lead
Wrist drop and foot drop
in growing ends of
bones
In children Irritability, laasra
Radiopaque bands along metophysi
restlessness,
of long bones and iliac crest morgins.
hyperkinetic, delirium, hallu
" Width of lines
cinations and coma
implies the durotiot
Brain damage is
of exposure
Irreversible and
" Minimum 4 week
permanent Green color vomitus
"
Blood picture Bloodd picture in plumbism Polycythemia
Microcytic hypochromic anemia
Anisocytosis , Poikilocytosis j Cabot's ring Ring shaped inclusion bodies seen RBC
Basophilic stippling
"
copper chemical compounds may cause green hair
discolorat
Extra Edge
Thallum Poisoning -Rkatde
YMees' lines presentin to
Copper Polsoning- Vital Points "
disease Chronic contact with swimming pool water containing a
iNdeal homicidal poison features (poisoner's poison)
Copper 146
In postmortem, bluish green stomach mucosa present.
" Copper deposits in tissues-chalcosis l " Chronic inhalation of Copper Sulfate- Vinevard sprayers
Pseudomotor neuropathyA-pRh huNud r
Features resemble Guillain Barré syndrome
Metalic taste
Ptyalism (increased salivation) in chronic poisoning
het
. Triad of alopecio with madarosis, neuropathy ond dioi
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d
Dr PedagogyForensic Toxicology Phosphorus Poisoning 4P MNEMONIC Chronic (Phossy Jaw/Glass Jaw/Lucifer's Jaw)
ThalliumPoisoning - AND Anemghhiecs: ,Aopeca
weekness changespanc so-petheic
Phstlmnea Theory
Nail
Neuropathy& damne
.Oarrhea a
ExtraEdge
******
Poisoning
rotoxicity
Golden-yellowstaining of
Neph
teethRstula
Ouch Diseasea
disease") disease= "it hurts-it hurts and water by mining effluents with food of Contamin ation admiuminJapan. cadmium poisoning are bone pain ands maineffects of The ritlebones.Bre weaken resulting in multiple Osteomalac cia - Bones athological bone fractures
Waddlinggait
Due to inhalation of fumes over years. - v o b o the jaw, loosen Toothache (earliest symptom9), swelling of Sequestration of jaw, lower of Necrosis ing of the teeth,
NON-METALLIC IRRITANTS
bone in the mandible, multiple sinuses discharging foul-smelling
pus. Ostnyts d a d b e , t e s
Fhosphorus PAe nhosphorus (yellow phosphorus)
Red phosphorus
Diwali Poisons
Nontoxic
uminous in dark
(phosphorescence)
Phosphorus and Mercury
Nonluminous
aricodor rfanmable (unstable, should be kept
Odorless
Noninflammable
ORGANIC IRRITANTS
No smoke
Plant Irritants
der water) fnis smpke
Accidental poisoning cases with fire crackers (Diwali poison) sdrat killers.
Todturtps patçerohd
Dear friends, please Note:
" In general, plant irritants on ingestion cause burning pain from the mouth to stomach, salivation, vomiting, purging and bloody
stools, followed by circulatory collapse and death.
Sgns and Symptoms Gurlicky odor Laminous vomit and stoolPbecause of the presence ofphosphorus
Fumes emanate from the stools (smoking or smoky stool
mdrome). A b a
Atle poisoning causes liver cell necrosis, fatty liver and acute
relow atrophy
On injection into skin, inflammation, edema and necrosis at puncture site.
On contact with skin, burning, redness and vesication " Plant irritants do not have antidotes, except Abrin
(antiabrin-antidote)
" Symptomatic management only
lame of poison
Major active principle and toxicity
Special points
ds comnunis (Castor)
Active Principle: Rlcin,Rini Quo
(category B) inhh
Entire plant is poisonous
Ricin is a Biological warfare agent
Rilhone
Castor oil nonpoisonous
ns Precatorius unchi Ratb/rosary beadl
óan iquorice)
Unbroken seeds are not poisonous when a se Swallowed or cooked.
Active Principle: Abrin mpo Abraline
Others: Abrine, abric acid and
Entire plant is poisonous spot at Seeds are bright scarlet red with a black one pole
Similar to VIper snake venom
Used asSUl needles? Amew ion,ak si
Anti abrin° (antidote)
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Contd..
147
Dr Pedagogy
Forensic Medicine
Major active principle and toxlcity
Name of poison Theory
Special polnts
Active Principle: Crotin
Croton tiglium
Others: crotonic acid &crotonoside Entire plant is polsonous
Tamel Gte,Jama bisn,Ctn Kes
Seeds resemble castor
Active Principle: Semecarpol and Bhilawanol " Seeds are black heart-shaped with a rough
Semlcarpus anacordium
(Marking Nut)-bla
projection at the base.
Irritant Julce is brownish and acrid, but turn
black on exposure to air.
Calotroplssgliganteo
p
edoAk3
Applied to the skin. i
irritation, itching andla painful serum and eruptions of the with aer The lesion resembles a bruise.surrounding h
blister
Uscharin, calotoxin and calotropin lachin, Skin: Bister oycd- G17 irg tab'n Whoeplerd Giqenha
Eye: Conjunctivitis and blindness
Ingestion: Vomiting and diarrhea
Calotropis root - highly poisonous to cobras and other poisonous snakes.
Copsicum onnum
L
Hulan's hand; Contact dermatitis to chill
Capsicin &capsalcin
Medicolegal Importance ~wi- A deitak obytort Ricinus communis
Croton
Semecarpus anacardium Abrus precatorius
Accidental poisoning
Accidental poisoning
To produce artificial
Accidental poisoning
Abortifacient
Biological warfare
Abortifacient.
Juice may be introduced
ldeal cattle poison?
Infanticide (mixed win
brulse/conjunctivitis
Into the vagina, as a
weapon
Arrow poison
Calotropis
milk)
punishment for infidelity. For criminal abortion,
Powdered seeds -
juice is applied to the
conjunctivitis.
Cattle poison by ming with fodder or insertrg
cervix by means of
a cloth smeared with t
abortion stick.
juice inside the rectum of the animal
Seeds-abortifacient and
To produce artificial
arrow polson
bruise
A-1se2d
Arrow poison
Sui Needles " Powdered abrus seeds mixed with dhatura and opium are made
into paste with spirit and water. Small sharp needles are made from this paste and dried under Sun.
The needles are inserted into wooden logs and cattle are struck
with great force which drives the needle into the flesh (s0 as to
resemble snakebite). " Painful swelling develops at the site of injection, with inlammation and necrosis, sepsis and death.
Abrus is thus commonly used as cattle poison in Indian villages and is called ldeal cattle poison
Ricinus communis
" The poisoning resembles viperine snake bite, Toxalbumin " Proteins that inhibit protein synthesis
" Agglutination of RBCs and Hemolysis of RBCs 48
Phytotoxn (Plant toxalbumin) L. Ricin 2. Crotin
Anlmal toxalbumin 1.
Snale venom
2.
Scorpion venom
3.
Abrln
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Abrus seeds
Dr Pedagogy
Forensic Toxicology
Extra Edge Hunan Hand 5yndrome
Theory
Paintul contact dermatitis to capsaicin (the active principle ot
capsicum)
Hrequently presents in cooks and chili pepper workers after
preparing or handling chili peppers.
Contact with other body parts gives ri_e - "Hunan nose"
"Hunan eye", and "Chili Willie".
Capsaicin binds with pain receptors causing the sensation of
intense heat or burning.
ANIMAL IRRITANTS: SNAKES Appearance
Venomous snakes
Non-venomous
snakes
Croton seeds Habit Head scales
Nocturnal
Not specific
Usually smalla
Usually large
3 exceptions
(Poisonous snakes with large head scales) "
Cobra
"
Krait
Cobra: 3rd labial largest,
touches eye and nasal shields
Kralt: 4 infralabials scales
below mouth and 4th being largest
Semecarpus anacardium seeds
Belly scales Tal
Fangs
Mouth Bite mark
Large and cover the entire
Small
breadth of bellyA
Compresseda Flatinse aky Not compressed Long and canalized, like Short or small hypodermic needle
grooved teeth
Two fang marks
Small teeth
Calotropis plant
marks
149
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Dr Pedagogy
Forensic Medicine
Theory Snout f
Elliptical pupil
-Round pupil
Fangs Teeth
Anal plate scales Venomous
Non-venomous
Head scales
Venomous
Belly scales
Nonvenomous
SNAKES IN INDIA
Smal head scales scales
Large head scales
" Large belly
Singie row of anal scale
Compressed tait " Long fangs.
FAMILY: ELAPIDAE King cobra Common cobra Krait
NEUROTOXIC VENOM
POISONOUS SNAKES WITH
LARGE HEAD SCALES
POISONOUsNON-POISONOUS
bely
sCascale
Uncompressed tal Small teeth
FAMILY: VIPERIDAE
FAMILY: HYDROPHIDAE
"Saw scaled viper Munge
MYOT DTOXIC VENOM
"Russell's viper
Shake
"Pit viper
VASCULOTOXIC (HEMOTOXIC) VENOM
Fatal dose
Sra Brd Supralabial Scale largest
COBRA
Common cobra- 15 mg
King cobra- 12 mg 5g Krait -2.5-6 mg
PiA inhd 4th Infralabial
KRAIT
scale largest
"Russell's viper -40 mg " Saw scaled viper- 8 mg
Ophiology: Study of snakes; Ophitoxemia Circulation of
snake venom in blood. hroke bik
haa
Four venomous snake species are responsible for most of the human snake bite cases in India. They are referred to as the blg four.
1. Indian cobra, Naja naja? 2. Common krait, Bungarus caeruleu 3. Rusell's viper, Dabola russeliQ russ
.
Cobra
Krait
" Russell's viper
" Saw scaled viper
" Elapidae envenomation: Neuroparalytic manifestaton " Vlperidae anvenomatlon: Bleeding tendencies
The big four:
150
Indlan Antisnake venom is effective agalnstb
Sea snake envenomatlon: Rhabdomyolyss and renal fallure
"Mamba snake: Cardiotoxlcity
Saw-Bcaled viper, Echis carinatus
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Dr Pedagogy S in
Ah
ofensícToxicology
Clinical Features
pan
Snake bite
whyhnia
Fright (M.c) Non venomous bite
(70%)
Venoumous bite (30%)
Dry brte
(no symptorns) 20%
Envenomation (ophitoxenia) Progressive paintul
Neuroparalytic
Swelling
Viperb
Cobra kraitz
Local necrosis Ecchymosis
"Diplopia
Dysarthria
" Painful swelling
Dysphonia Dyspnea
Compartment
A
syndrome
Russell's viper
Flat tailed
saw scale viper
Plosis
"Blistening
Myotoxic
Vasculotoxíc
sea snake
"Bleeding-saras- Muscle ache ran),ule2rras " DIC
"Muscle swelling
" Shock Acute
" Involuntary contractions
of muscles
kidney injury
Dysphagia
Compartment
r3Ave Paralysis
syndrome
Neurotoxic features (seen in elapid bites)
localsymptoms
!no loal Syn-kra " Ptosis, followed by descending paralysis resulting in respiratory necrosis. Pin,Swelling, blisters, Bleedingfronbiite site is the most important feature, as it indicates sioers bite &is an important sign to start ASV immediately. Resional lymphadenopathy: It is also an important sign for
rting ASV Lehn ragine
paralysis.
Vasculotoxic/Hemotoxic features (seen in viper bites) " Disseminated Intravascular Coagulation is the most important
complication of viper bites.
(ordistiShk Haboein,nyn
Extra Edge Dry bite
no venom is released. Adry bite is a bite by a venomous snake in which
The rate of dry bite differs between snake species.
MMinute Whole Blood Clotting Test (20 WBCT) B d e eyt The most reliable test of venom-induced defibrinogenationand kept aside for 20 minutes. blood is put in a clean test tube Afew millliters of venous tis then tilted to see if it has clotted or not.
hcoagulability indicates systemic envenomation by Vipers.
Whole blood clotting test (WBCT) Draw 2ml of venous blood and transfer Dectly into a clean and dry glass tube.
e t upright, open undisturbed for 20
d/or 30 minutes
at
test indicates normal coagulation.
indicates a coagulopathy.
room temp.
Snale VWenom Ophthalmla From spitting cobra. tthe venom exposed to
douing
breaks down quickly upon inversion After exactly 20 minutes, pick up the tube If clot the of the tube or fails to coagulate, the test and invert it. If a solid clot is retained,
of vision and
burning, stinging pain, eyes, intense
temporary
wateringBof the eyes with congested conjunctivae, followed by profuse
blindness.
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151
Forensic Medicine
Dr Pedagogy
Theory
Jluotratiue
A5-year-old boy, who was sleeping along with his parents,
It is not done in viper bites, due to thee
risk of
syndrome. Antisnake venom:
(compartmen
developed sudden abdominal pain, weakness of his hands and mild difficulty in breathing. The chlld was reported to the
" It is effective against Common cobra, Krait, Russell's scaled viper (big 4) asair kig
hospital and on examination, he was drowsy with bilateral ptosis, complete ophthalmoplegia and paresis of the limbs. I
Source of ASV is hyper-immunized horse serum.
seemed like a rapid progression to descending paralysis and shallow respiration. The boy was immediately intubated and mechanically ventilated. An erythematous papule (3 mm by 2
No need of test dose. IV Route of administration (1-2 ml/min)
mm) was noted on his right forearm.
Adetailed history revealed that the family was residing in a village near Kanchipuram, Tamil Nadu and that they were sleeping on the floor that night. The boy was completely well till 2:00 AM and suddenly developed the symptoms in the early hours of the morning. He denied history of any food consumption outside, which could have caused botullsm, NeurotOxlc envenomation due to snake bite was suspected
as an important possibility and anti-snake venom was
vipet,
Can be given only when signs of envenomation preset Itis available in the form of frozen, dried powder; whjch d.. be mixed with diluent.
" Time: Very effective, if we start ASV within 4-6 hrs
" Dosé: 10 vials [irrespective of age &sex]
In case of neuroparalytic envenomation, ASV should be rene till the clinical improvement occurs.
In case of vasculotoxic venom, ASV should be continued nil
clotting becomes normal (repeat the 20 min clotting test. nil becomes normal)]
administered.
Respiratory failure was completely reversed after 36 hours
MNEHONI
of administration of ASV and he was extubated. No residual
neurological deficit was detected and he was discharged after 7
days of hospital stay.
The cardinal symptom of krait bite, which is abdominal pain,
can precede neurological symptoms by several hours and the
paucity of local tissue reaction is a typical feature of Krait bites I wish to reiterate that rapldly progressing descending paralysis in the absence of local tissue reaction could be an early feature of krait bite. They are commonly reported in the early A morning and those sleeping on the floor are at a greater risk. of administration high index of suspicion is reguired, as timely
ASV is effective against Cool Shah Rukh Khan (0r) . C-Common Cobra
CSK Rocks C-Common Cobra
" S-Saw scaled viper
S-Saw scaled viper
" R-Russell's viper
K-Kraít
K- Krait
. R-Russel's viper
Interesting Facts about Krait-the 'KILLER'
ASV is critical for a favorable outcome.
Management of Snake Bite Specific treatment
First aid approach CARRY NO RIGHT
Carry - Carry the pt'
No= No ligation/tourniquet/
Indian Polyvalent Ant snake venom
suction/Cautery/electric shock/Neostigmine +atropine coffee/alcohol/'euS R- Reassurance
-Immobilization (pressure Immobilization) GH- Get to the Hospital
(to reverse the neuroparalysis in cobra
bite) Neostigmine is not so effective In kralt bite
immediately -Tell the doctor, systemicC
signs of envenomaton Pressure Immobillzation:
" Apply crepe bandage/Sutherlands wrap &immobilize the entire limb
Objective: To occlude the lymphatics. For upper limb, pressure up to 40-70 mm Hg For lower limb, pressure up to 55-70 mm Hg
Belongs to Elapidae and thus, neurotoxic. . More dangerous than Cobra
. Nocturnal (comes out only during night time)
the bite site; Krait bite is dangerous as there ls no paln at
the victim is unaware of the bite
" Kralt is neurotoxlc. " Venom Is loaded with presynaptic toxins and is 16 times
more powerful than cobra " Causes Immediate paralysis of muscles. " Ineffectve treatment and No response to anticholinesterases.
" Fatality is 70-80%
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Dr Pedagogy AnForensicToxiçology
Alho hogey Cantharides(Spanish Fiy)/ utiveprinciple:CantharidinQ
" This is followed by depression of vital centers of medulla
1y
-o,2 r
producing coma and death.
" Three stages of alcoholism: Stage of influence, stage of Theory
150-)5EgOrdination and stage of coma725ea 5b-159 " Pupils are dilated in the initial two stages, constricted in
Tnordoth
comatose state.
Macewen Sign .
Seen in alcoholic coma,
" Pupils are contracted, but on stimulation of the person, e.g., by Lcalapplicationonskin: Vesicle orbblister formation
pinching or slapping pupils dilate with slow return o Lota " This diferentiates alcohotic comafromcoma due to other cause-phie
Opingestion:
Aloodstained vomiting and diarrhea.
in painand nephrotoxicity ( ail) urine Frank blood in Prapism,^ido (elndsia)
Extra Edge
abat..50
Statutory limit for driving in India: 30 mg%° (Sec. 185 of
MVA Motor Vehicles Act)
dAlh0
si
Widmark's formula: a =prc(blood); a =3/4 prq (urine)
CNS DEPRESSANTS NEURAL
Public nuisance under the influence of alcohol is punishable
Te GRIANTS
Alcohol clearance rate: 15-20 mg/hr
under Sec. 510 1PC
Alcohol Taridty: Isopropyl alcohol >Methyl alcohol>Ethyl alcohol
Abrupt excess or stoppage of alcohol can cause delirium
tremens (Mania a Potu)-Coh'ndain Any crime committed by a person suffering from delirium tremens, is not punishable under 84 IPC.
Absolute
Rectified
alcohol
spirit
99.95%
90-95% ethanol +
alcohol
5-10%
Methylated spirit
Surgical'spirít
99% alcohol
90-95% ethanol + 5-10% methanol
+5% wood naphtha
methanol traces of castor oil
Samples used to estimate alcohol levels in the body
Bloodsample - NaF +(k oxalate esevhe Note: While withdrawing the blood, never use rectified spirit for disinfection; as it may give false positives Urine sample Naf
Alveolar air(breath analyzer) Al conde-based sn eN
Vitreous humor
%of alcohol
Beverage Beer
4-86o7
|Wine, champagne
t0-15-2ol
" Itis specifically useful during autopsy of decomposed bodies. Ratio of blood alcohol with different body.fiuids
Blood: Urine =1:1.33 Bloso tohol
Port, shery
20
Blood: Exhaled air (breath) =1:2300
Whisky, gin, brandy em, liquor
40-4505D7.
Blood: Saliva = 1:12.
50-604
Vodka
60-65-50-60%
Action lead
Blood: CSF = 1:1.17 Blood: vitreous = 1:1.2
Methods to find blood and urne alcohol levels
" Kozelka and Hine test
iially ethanol acts as a depressant of cortical centers for ngconduct and judgment with release of inhibitory tone,
lma
stth
Gas chromatography (most speciic) Qonat " Cavett test uolahe
unrestrained behavior.
l04 MVA
Lab test (an be
dsne in Hosta
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153
Forensic Medicine
Dr Pedagogy
Methanol (Wood Alcohol) Theory Formaldehyde 33 times more toxic than methonol, ic Acid 6 times more toxic than methanol
METHANOL
Formic
ALCOHOL
Treatment:
Ethanol- Competitive inhibitor for Alcohol
DEHYDROGENASE
SEVERE METABOLIC
dehydrogenase
FORMALDEHYDE
sBicarbonate -for corecting metabolic
Foneioe
ACIDOSIS
Due to accumuiation o
formic acid in body
acidosis 4-Methyl pyrazole-Competitive inhibitor
for Alcohol dehydrogenase
Folinic acid- formic acid elimination
ALDEHYDE DEHYDROGENASE
"Hemodialysis- Treatment of cholce in severe poisoning
BLINDNESS Retinal damage
FORMIC ACID
Toxic metabolites:
Optic nenve damage Biurred vision Scotoma
Formic acid, Formaldehyde
Papiloedema
SNMNICROUS
Marquis test: To detect opLore lora sn Rihi
Opium/Afim/Chandu/Madak Opium is derived from the juice of Papaver somiferum capsule.
Antidote: Nalaxone sodium Na
Treatment for morphine withdrawal:
Methadone
to be nrer Along with routine viscera, brain, blood and bile
Mobrire os Heroin (Di-acetylmorphine) din bood Brown sugar/junk/smack/dope
" Semisynthetic derivative of opium
Routes of Administration of Heroin It can be taken by snorting, smoking or intravenocs (mainlining) and subcutaneously (skin popping).
Toic part: Uaripe fruit capsule, latex juice.
It is dried to " The juice is obtained by cutting the unripe capsule.
abrown residue. ()', ~\I(. ~ Ahl> I OJ210 difYS)
~units/mL - ~1C/~, ~ ~- f.-2...,~ \._ A,alut of >100 ~aasky umts _wi~hlwithoui motile sperms , ~rthalejaculationoccurrcdw1thin 12hoursoftxaminalion. (t¥ds II' not related to sperm co1111t : : Id is useful even in the absence of sperm
,..Jloef/llOSPholdna" Test
1
CPl is .high in seminal fluid,.and can be dnectcd even in 6-!llldh·old stains.
>,"otC~-..
• ~ )I\
"1 t\"~itM I
•
~" \t -..II() ,.. 11
Guys do rtmember that: • During fetal autopsy. abdominal cavity should be opened first. ½
.., I,() 1 \j / .,,. L
,_,,.,,,, Molybdate Tat
~,~v~"""~ I.
,.,_Sptd6cAntigen or Glymprottin PJO Test ISAJound in seminal plasma, male wine and blood, and has not Im 6JWMI ill any female body tissue. • plO CIA be detected in dried and old stains
Chest
1
~:.b~tb~~ -~y~t'°' \.,,~, ~5-\tb
IIIIS~ 11: HIGHLY RELIABLE FOR SEMEN ~~~~Ji ,;~ft(j ~I.. 0$~ ~\.\l~I)-.) 1' -IUIIWUOn of Species Origin
•fllcipiin~I
I
~ iloenzyme
pal1ern (Human pattern is dilfmnt from
t\)~ iri'-
llillalpcma) I..'\- - ~~OI"" A.\?llv~ ~ U)~ Dilution of Y ~ spermatozoa ~ (wblch is not seen
il..:-L)
-
· \} b~Qie.L"" -~ l
~.,,,.,_
"
u
~MrNc-QJ l ~ ~,ll4.
• I.I I...L.
._;: ~ spemia retain full
• le
mollllty In ¥lplll h nd 12boura. tallll rema1n motile In the uterine cavity for 3-7 daya. of IBOlile apen1111o1oa from ¥1p111 II a lip or
'"'°'U- ~~~"iQq- ~"~1 •,. \ "'1.)
i~ U.~
hlr4:." C,,~~o. ",~l"'t
:l..i J; a;~ ,) ~~ ....
Examination of Live Born Baby
~W'l\ ,~rq.;~1. .\.-,',,...,l"(\qn
IJtl«ISlbephosphorus.
~
• Viable child
I
u-'"
¼~~ ~
J.1 1. it < 1wt d"- ( ~•,I.Or tl1J,: ! '),,.,. ma1ur11y at which I f, I ' ·II bl y I CXlstcnceafterblrlh c us a c 10 lead a Jepatalc ,,:,, • Asperl h . ..; ., ~ /,~JI .,.. -1..,.r,.:t -/ •·. • V . aw, ac lld Ii viable In 21 odays (7 months) • ~.I../ 1 1 ag1t115 u1e · . R , .,,_,.. -'d b nnus. csplratson (cry) of the feius while In the wom after the rupture of membranes !. Vagltui vaglnaJbQ· R · , ' ' i.~. . 1t . . . 1l •• ,,~~ti?~'w"i ' the head u In 1he vagina
-\1..¾\.\~
~~ l'°to (r~m scmil:lal vesicle. ~10 diO
:t
'
11nt ,IJjgOI Iodine test To dltecl vaginal
J )
• Sign: Semen in genilalia of animal • Groond for divorce
l
__j
' • • • •
INCEST Seit Within blood 191aliona Not an ol'lence lo India Eleclnl complex Phareoh complex Oedipus comp!ex
~ l cal•
B\JCCAl COO\JS (Sin of Gomorroh) • Oral coitus • Sign: Semen In lhe oral cavily • Ground for divorce LESBIANISM (Trlb1dlam) • Female homoseXU8lily • ~ (active) or Femme (J>8$$ive) • Ground for cfrvorce
------------;=~:;=========--===-=-------------~ f SE.XUAL PARAPHIL.IAS
l I
I
ACHIEVING SEXUAL GRATIFICATION BY ACTS OTtlER THAN INTERCOURSE
l
J. ! 'Infliction of pain or physical cruelty on lhe partner: Sadism • Having sex wtth the dead body: Necrophill• • Ealing the dead body: Necrophagla Receiving painful sllmulu1 from lhe partner tor 11xual pleasure: Masochism • Wearing the dress of opposite sex: 1 Transvestism • Exposure of genllalia In a public pface to obtain iexual pleasure: Exhibitionism • Sexual arousal resulting from objects: ~
· I
I
Fetishism
' Rubbing lhe private parts of a woman in a public CfOWded place: Frotteurlsm
--
• Observing unsuspecting people undress or na~ed, laking bath: Voyeurism/Peeping tom • Sell-stlmUlation whlch eflects sexual arousal: Masturbation • Female amputates penis of her male pa,tner. Bobbit syndrome • Inducing hi& wife lo have sexual lntercoU11e with another man and by observing the same: Troilism • Sight of others engaged In sexual lntercourw: Mlxoscopla • Sexual actMly involving enemas: Kllsmaphllla • sexual arousal by u~g Obscene languege over phone: Telephone S~lologia
----
/
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Dr Pedagogy ,~ ;------------------------------------------------------------Forensic Medicine
t1
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>-
~
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CV
INFANT DEATH S enUclde· killing lnf•nt• -
,--- -- - '' LIVE BORN
f
I
t DEAD BOR N Penod o1 vralnllty· 210 d• y• • Rl{I PI mor111 ' - - - - - - - ••• Mocornllon • Mummmcallon
.C
I-
Jf
l•
• Viable child (>210 day•) • Wea expanded lungs • Inflammatory redon In umbllcal cord • Pr11Mnce of m ilk In •tomach
TESTS OF LIVE BIRTH
,---:-:====;;-:;=----. X-RAY SIGNS OF MACERATION Spaldlng sing • Ovarl11pptng of cranial bones Robert's sign: • Appooranc• of 9,u shadow" In heart • HyfM!r1lexlon ot spine • Crowding of lhe ribs
MACERATION (Aseptic autolysls) , Oeed child lnsldo ulerue for about 3,4 days • Llqor emlnll No air Earll.,.1 sign: skin sllppage Jolnta aro hypermoblla sweetish dlaagreeable odor
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....
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STILLBIRTH • Born nner 28 we~k•. or progn•ney. and bnby dfa not breothe or 1t,a w 11ny •lgn, of llfa Boby dlod during lobor -
MUMMIFICATION 1, lnloct membrane, 2 Scanty liquor emnll 3. ,'lbsenl blood supply • Fetui dlea In 2 weeks
SIGNS OF LIVE BIRTH
• Hydrostatic; Respired lungs will float In -!er • Foder•••: Weight of lung• double■ • Plocquelrs: Rallo of lung weight l o body weight (from 1/70 to 1/35) • Wredln's: Presence of a ir In middle ear I• Bn19lsu's a■c:ond Ille: P,e■ence of swallowed air In stomach
-...._.... ..... .....
r .------------~
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Frequ~• ·~·' · ·-··- - --· "' JJu;-Last-Minute Tidbits 3
]led dcfloration.
,r•I"''l),is ' n tc~r ln sclClla11nlcrcoune Ia po&tcrolatcral (•·• 0,c1o,,.,. - 7 0-o,,"~ ~U>c-4. f-1-· • ·-• -
j
..
"0!1 . ....
tMIMllo!u
~··.
.
.,
.,_, notii:r': List of offences which ore considered as . . . .ainduct. llllmmgO: Notice of toution by SMC to a doctor guilty of Info• J!!l"I ~ not to npeat the offence.
PROFESSIONAL MISCONDUCT/INFAMOUS ~DUCT - ...,~+k; ;,p \ :
a\l
~ llnd dishonorable act by the doctors. by 0 1ficrtloc.ton4 ofgood rrpuu .
'-ming Notice • '•tberu,
1
'llit11ot1a o/11e.b ""-ldi are considaed infamaw conducts. bicom,Pletc, updated by SMC periodically.
•
B
C
Bribery Covering
A:Multery A: Abortion (criminal) A: Alcohol A: Advertisement A: Association A: Addiction
t - l, \¼ ('"o}:jci - ,...,, , ); .• \.,.\,\,
,A•!)'"'°'·""'M~
• Simple Negligent act of the doctor, causing damage to the patient. • Damage Is such, which can be compensated b)I poylng ll'IOM)'
Types of Negligence • • • • • •
Civil negligence Criminal negligence Contrib utory negligence Corporate n~ligen ce Ethical negligence Compo sile negligence
L's\·,,- ..-~ 4~~y~ ':>'!;b WL :. , .- '- \> TT "-rrt c,·idcn~
; -.:.t.._h ,-.. '-" '''W"°'
.
u 'l\ot nttded
as
Calculated Risk Doctrine •
An important drft nu to an,, doclor.
• •
'!be docirinc Is th11t. injury may occur. even though reasonable care has been taken. \:.,~.., 1 ~ -' \ l°'N)\-\- ~ ~ \. 6.wry ac«pled method of lrtalmmt has cert11in percentage of
•
lf the Froduct deficiency ll proved, thr 11111111,fatturtr btcomti rr,tpo•~•iblt'l for r/,c i11J11r')' or de111l1.
•
11,c bunlcrr of proof about the safety lits with the m11nuf11cturcrO.
Doctrine of Respondent Superior/ Vicarious Liability ':.->~~ ~~-~; bl.L t..... r,,..'..~~ L.4. I:, • 'Let the master answer°' V' 1
lnjury ordtolh ohhepatien1 is due to unlnlrntlonal/11111d,·ute111 act by doctor4. Misadvenrutt is ,nisd1anct, acddcrrt or disaster. • Hypmensitivity ~~ctions caused by penicillin, tetr.tcydinc or aspirin. • Trawmtic- rupiutt of rtctum or chemical peritonitis during barium enema. • Thyroid cancer with 1-131 therapy. • Fatal compliations from hemolytic reactions with blood
rvenlng N t .i
•
The chlcf doctor b.comes responsible for any neg\Jgence of his assistants When two doctors practice as partners, cnch is liable for ncgligtnce or the other
•
A hospital, as an employer, is responsible for negligence or Its employees who are acting under its supervision and control A physician.is responsible for the acts of the interns and residents, cnrried out under his dlrect supervision and control
\i'-liv...
ows Actus lnterveniens = Unrelated Action 0
Circumstances
•
transfusion. \)a~ ',, f'I-J...,_
•
t\..t ~~-"i~4l
An ramlattd or unaptdtd inle,.,.tning ,wt which breaks the be said to be an e,;pected complication. Doctor is responsible for the negligent act of leaving of swabs in the abdomen In accidents and assault cases. cominuity of events and cannot
~.,\+-, ,..:'>.,'lq+tJ. ½'-~ ~ -, ~ -,dw-\ Res Judlcata ('the Things have been Decided')
Wbrn the case is completed between two parties in the court, it cannot be tried again bdWffll the same parties. • EDmplc: If a patient sues a hospital for any negligentt and the lhlnp m dccided,Jic cannot subsequently sue the doctor again separately Cur the 11111e negligence.
•
'Borrowed Servant Doctrine;.,_ •
Umltcrclon Period
The nurse unploycd by a hospttal to assist in surgeries willbe th~ ~ " L 'borrowed servant' of the operating surgeon during the surgery. and the servant of the hospital for all other purposes.
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 loquitu~ ,o Doctrine of common knowledge
•
'Ihe Ptlient lhould fik die aut against the doctor within
/rOfrl dietlote ofalltgu M~grnu.
2 years0
~,
~\"~ iii ~~~;lk wi ~(\~~~ O\u ct Mu'(C.h-,
Burden of proof I ies on patient
Res lndicata
o°
An employd~ is rcsporulbl~ not only for his own negligent act, but also for t.he ncgllgmr net of 1,1$ cmployus If three conditions are satis:fied: • There must be an employer-employee rdatlonshlp • The employee's conduct must occur within the scope of his employment • Incident must occur while on the job.
• •
• Enmplrs:
•
•
l
1).-:,~""
~~ ~~ ~ Therapeutic Misadventure •
•
1t is leg•rding mnuers of
•common knowledgt.
unavoidablt risks.
The injuryorrfo,ul, of rlrt p,1tlr11t during m,atmcnt Is due to the d~fin,nr or f1111tty physiwl 11gmtut y diw:hu sed 1CCOrdlng 10 prev hge na. t :). I.. ~ ~ ixg y P,111ten1 w» gwlty o ( con trib utor '-. ~ "- • =-.,. ~ ,.>, '),"° < '."» 1 Thm1~" 11C m1UM/w nt11,t'J.
0 •'~ )
fJn • u(1udgmm1° the pall ffll l ofu tl'M d curu cnt fur tlw a.ct from ·.\> -~ ~ , -~ l, U# .,~ Ila Jud lUU "~- ,;,.. "'re,¼N'1 (rum tJw dak of allcg,td Lun kali oa: C - 6kd wr Z JN
Mslop-nc,c.
• (-.r :.~ • ~ ,
... ) . \ ••
C.. .,.M ar1 1 oiot• IIIGNI mitconduct II d1ff«111t. • Pfd eu• orll , m l ~ , """""1w IO IIW t-• Fo, a CNI.. of pr o/f lf•.. "' proft,ulonol molp,am ,,,_ ,,, 11 ,.., nw nfto l, wh ,n, In lh■ ,0,, n of CN ll-n uJ dlM p, tlomof, IO llw pan lnJuty, ,-n , dub tllty Of . . .,, II mhrociduct II 1aun • T h e ~ Ktl On nery acllOn ... .. , died -.u ndl, whet■n the dl1tlpl1
ffliltlr-•
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far,,.,
br ._ ,tN -. for,-or 1d1natn,... .w1 1i .., .e.
Fea wre
Pro fess iona l mis con duc t
Pro fess ioul
Nat ure
Violatio n o f codl!! of medic.ii ethlcs'I
Ab se~ ofl ' T -
Dut yof care
Nee d not be pres ent
Should ~ pr~
O.m ace to the pat ten t
Nee d not be pre sen t
Should ~ ~
Tri.I by
Slate m~ lul council°
~
skill & are~
Waminc", Tem por a,v
Pun ishm ent
eruure or ~,, .• •rasut\'
Appe.aon befl led1 n
ToN MC
C1v,I or cnm>Ni CW-:-
-
lmposorvnen< or ~ To h11&hef coum:
CONSENT •
Cun1r..t A,t, Ill~! l~h r,al by ~- ll ul t1w lnJ wi ~ ~~ wiJ to .:onwnt wu ur mu, ,
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Emergency Conditions (Sec. 92 IPC)
•
~~Q.rJ-
Doctrine of Informed Refusal
Invalid Consent
•
u.- 0\
In un emergency inmMng children. when their parents or guudlJJIS ore not ovaibbk constnl am II0 ~ ~~,\.- · h L-... • What Is the punishment for not oblfginc SLA'nmon? 1)- '"'I 7 • A Summon must be obeyed. . • If the witness falls to attend the court w1:hout any valid Justification, then: ,._ot,' c.Q wQ).N~ r .,,,_'Mt,}/ i~h, I , In Civil cases: Liable to pay domog"l!s. \" -~ , In Criminal casM: Court may l.ssue arrest wurant'I. • Olsobeditnct to attend the court on receiving the summon Is punishable up 10 silt months' impr,sonment (ll4 IPCJ. a. What If summons from two courts are received for lht ""'•
I
~
~d.w\. ~\(
Assistant sessions judge
10 )'1tars0
Unllmlted0
Chief Judicial Mag,strate
7years0
Unllmlted0
I Cln s Judicial Moglstrote
3 years0
10000 rupees
II Class Judic;i;il Miglnrate
l year"
SOOO rupees
\._
I
HNEHDNIC " - " of crimilNI court: Numericals: 1, J, 1, 10 • Subsbtute this numencals from the lowest court. I • , 2.,. class M"&l5trate court, 1st class mag,rtrate, Chief Judicial maa1strate & ~ nt~ns • 2"" class mag,~tt-1 )'1tar • l" clan mas,.trate - 3 yHrs • Chief judlcial ma111trate- 7 vears • Assistant sess1o"s coun -10 years
SpKlal Courts
I
day? ),.,:•"'
One crimrnal court and Attend criminal court'I other civil court 1-0:::,:ne::::..low:::..:e:..:r::,o:.:u_rt:__ &_o_th :--e-r- -t:A:-:tt-:-e-n-:d--::h-;-lg--::h-e-,-co-u-rt'l-;:-- - l
!lo.J- -:,:i,.;
•
...,, Conduct Money (0 et •
Punishments In lnd;a, the cap"al punWunffll or death ~a1ty is by hanging'! by neck till death (Sec. 354(5) CrPCJ
•
5«416Crl'C
•
oney
\¼I.It
It Is the money/fee offered to a witnuslW11°-"'
Med ical Law and Ethics
.
g questions In direct examinarfon and re-exominarfon, leadin ore not ollow td. Bur If the witness Is declared hostile by the Judge, leading onon and qutsfio ns are even permi tted In direct exomin n. re-11xominono
Red Cross Emb lem
Fubn s ol_. ...m iNtl on r. • Examination of a witness by the opposite party lawye • Def.me lawyer in cases of criminal cases. • Leaclinf quntlanl - allowecf'I (Sec. 143 IEA). • Ctoss-euminallon has no time llmlt'I.
,_.., ,.. ol lle-txaftlnatlon llla-DINct Enmlnatlonl
• E.umlnltlon of a witness subsequent to the aoss• eaminatlon by the lawyer or the party wflo called him. • UOtfltlfl quatlons ar, nat allow d'I.
a..-a11tbJtlleJudte
Stale of • AJudp mi, ult llff't question to the wltntss at any s. lhe t,lalG to dear doubt • Ste. 165 IEAG
RECENT ADVANCES ,.......Rtfora«apllfltglftlhffl ...... ... CDIII ,.,.... ment for • M a• ~IIClllfled 1111 quantum of punish l flam fldllty tmtl or cash C,lfts, doctan 1a11pt1111 bribe . . . . C'Offlpll .....
• Gifts word! 1DINHCIOO: warn1111
Who can use 7 (As specified by the Geneva Connntions} • • • •
ln1mia11onal Red Cross Organizations ers l'acilitlts for rhe care or injured and sick armed forcts memb Armed forces mrdical pcrsonnd and cquipmcnl lM Misuu It puni.shable with a fine of 500 and forfci!Utt of goodJ or vehid a 011 which lht tmblr m has bc-rn laud
l • Gifts worth 5000-10000: Su~s lon from State Mediu Council for 3 months al • Gifts wonh 10000-soooo: Su~s lon from State Med.c Counclf for 6 months il • Gifts wonh >50000: Suspension from State Medlail Counc forl ,-
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.1
I
Dr Pedagogy NCE RECORDING OF EVIDE
~--- -----r ---
OATH (51 IPCJ
-~
• 12 years: Physkal e•amlnatfon (Sec. 19 IPC) • lnsanlly or inlo•icaled pe150n: Invalid consent (Sec, 90 IPC) • No consenl In emergency (Sec. 92 IPC)
I I
• Patient waives.
•Al delalla should be given aboUl his condition and
t
- -,- - - - - - - -,
be told
be Informed • Pallent& right lo refuse
• Oonatron of sperm • Any procedure hampers sexual act1Y1ty '--------~
CONSENT NOT REQUIRED IN
• Medlcolegal autopsy • Mass Immunization
ax--« lo be Informed
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------------------------····>.\.i····----------------------t~~~a,1' Qr\.,t \1,Q\ d~lt. L.,1\~ >..h,~, c1·,0311~;t> ~ ;;,,._: ..\.. .._.. ..,,,, Mh cl,,,-.d:\11I 1"'-\ -'n\4 LET\ KNOW THE TERMS FIRST
-
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,11, \; • Fofensk P1VChl1try: It duls with the appllcollon or knowled8C or psychlo1ry In tho odmlnlw1t1on or )Jsllco, Iii rei menial • Mentally Ill person: Any person who Is In need of treatment by ronson of any mcn1ol disorder othar Ihon 4'd1tt1>11, • Dellrlum1Lick of orientation In tarms of Uma, plnco o~d parson, • Delusion: Persistent false belief • HaUudnat1on: False perception or stimulus, which Is not prosant. \. 11 ,/\b°'\&..o. .l ,,., .w,-H~ fv, " ) • Illusion:False Interpretation of stimulus, which Is present. object. or stimulus particular of• fear Irrational or Elltesslw • Phobia: • 1mpul11: Sudden Irresistible force compaUlns e parson to the conscious performance of on action without monve or lore lhD(,Cft • Lud d Interval! Period of sanity between two periods of Insanity. • Mens rt1: Criminal mind or Criminal thou8ht. h....MlA,, • Adus m :Crlmlnal act. • Holo1raphk wlll: Awlll which Is written by the testator.In his/her own handwrftfn8, • ~cept!on ord•r: The order Issued by the court for admission and detention or n mentally III person In a psychiatric hosp/1:ar
.
~- ~~
• COmpos mentfs: Sound mind
• Somnanlbullsm: Sleep w1lkl11g • Somnollntll (Sltep,,drunanness): State or confusion when the person Is aroused from deep sleep. During this st.11e. h, 111~ commit some crime. • Somnlloquy (S1Np-t1lkln1): Patient talks during this state, but does not remember about It In the morning on awakening,
• ~I.ii-
,._··~;'~ {-~~ ·:li''~o-ji·_;;······,t~·~"~ ;:J''~'i.'" '~---\t,.i;.;;;.···0·;·.,~~ .. x.;;·;:,;:;;~~:f•~,,,.
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•
Individual diould be kepi under observation for 10 day,0 , which an be extended up to a mulmum of 30 days "1th the pcrmwlon ol nag!stratc. Cvtifica:e should be Issued after a minimum of 3 namlnatlona.
Motive
~rspos1111 facton
. ".
5lcnsand ' symptOms
Manag1mMt ofProp1rty and Affairs •
Absent
Consent givtn by an lruane person b 1 01 a valid consci110.\u. \ ~-. Contract: Any contract signed by an insane person Is no1 nJld Contract algned by an Insane person during the pmodo/lllCil lntcnal lava1lcl. ll\'l~ ~ Vt.'J>O.- d..., Marrlog1 ~.,,,.,..,i ,,,,,,! when ht is (,,, ~ Ifany of the couple Is proved 10 be Insane;t tlie time ofIIWlilf. obserwcj(l then U1e murl1ge can be declared os Null and Vold0 Frequently If any one of the parme.rs becomes inruie after.\ marriqr. lh.,1 '..!IN;/1 J, ';1 , .u r t ~ u .o....: .~ ~ - . ..f\'\V"I ta , > J' .. r \ 11 .)• 1 ,, ,.,. • · r, '>,. ,. ·~ ·· , '-"' !JI('\ ~11 } .,' ''\~UF Pedagogy . Q.I\ qt:"~ ... Dr ~ N \,v ~~ N ' u"' i:u ,--J ,,, , vi , t ct rd 6t ya docto r. uJdb eO I ' "-._, forc.e. undue Influenc
~ . , JI shO .should b( 'fh tlt
r m Jrcprc1cn .
no
¥b0n1lblllty "''" 1nt1ne CAN Defend
, (tllOD of facts.
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1, ;
sane Person ,responslblllty of an In
•
I: lrr uln 1ble Impulse
~I
• C· Currtn'srut,
fl Ruf,
10 tt,. ,c, ~) 0/ -U l I ' ~ ~ ga t res g wron n Is dealt b bU1ty of Insane perso ns1 po rt.s l ina y im Cr ia, , r.nd
~r
te ~I I At American Law Institu lt ru 's ten gh • N; M'Ha • 0; Dtrrham'srult I
, Ill . n14 JpCO
nslbillty of a person. ~ & rht crunlnal rtSJ>O lble If II Is proved t criminally re.iponJ , , r, ,caiscd ptrson is no ng the crime he wu suffc . ,ro lul nng nomt , •411 1tht timt of comm d' did he t tha , rom uc uc of mind , pdt I citied of reason o~ ing do u w he t tha t ac ality of i,oW (be na111re and qu
,
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...,,,U 11 ~. ,1)- a " Gt,n1t1 M'Nillh d ...~ had suf ck the blc k of IW l O"I ed, plstol, whlCh wuOfd ~luSIOfl1 and w u 1CQ1i ,t1 ~ on 1~ fir ten lfr Na M' . lhGt Ille secretary M ~ n fm h on onwn.tv in t.red from pl( III
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of=~ e-:~..~.,,,r:,,,,r,.,,..~......... ....
hit'(bltshtd chit M'N,thtffl wt
e~
lhe House
tlfY
6,.d UOM J ,w.~
i ... ~, ht .). Jr .., \ V .). .."
w uhroom, ht 1 ' " talking, '" ' ro,wty. WIien "- wow up to vi e !h t _,_ -" . wl!llffl ht 11111111 p« ~ ..~ . )'L , -~
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•
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• bo ut t"- - . _ _ __ _. • r1c,1 q~mon, __ ,. ,.. _, L iv.. = ,, .... ,, • series of hypotht ol L- QIW, .,. i.. i,.. al , »4 ..tao _.. ., u ... , ,.., ,... ..... ..,, ..._ tl u es " ,,. ... , _ . . lnel ,-sponslb11ity ,,... 111 cled S days laoft«LoItnffwas .~ -'- > ud v" framed tor a lm ._ j, . , ~
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H,podJondrlacal D1lu1ion°
1
'111/dJ~C.~0,y,.
• Pmisknt fw or bdlef of having • s~ium/1 (like cancer)
based on the patient's own unrralistic Interpretations of phr,siCi31 , sigmand~ptoms. ~12 \.e.. "'4i --~ ~ ~-1- · Iii... ..,,, 'fl'.11:~ "
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. Forensic Medicine
Dr Pedagogy
-- - - -- - - -- - - - - - - -- - - - - • - - • •
r
------------------- --- --- --- - - --- --- ....
Erotomoniao (dt Clirom boult's Syndrom,) ~,,,, ""
Nihilistic Dtlusion
PerSon holds a delusional bd,ef thlll a11otl1c, Ptr lug/,tr socwl s111111 s. rs"' love w,rl, l1imlhefl.. • ~4l~ Cf~ • The erotomanic tncs to get close 10 the ~rso n throU calls, e-moll~. Jctrcrs, gifts and vlsils. gh ltlcpi.~ • It is more commo11 in ,.-om w than in men. • It is seen during psychosis. t.~ ~N '- di., c.n ~w •~
io~..,
•
Snlman Kh Lo•·c wllbmr • •
The p3tknt d~ not bdie,·e 111 his crls1cnce or the exls1encc of earthly m~ll m. -~\ ii Commonly seen in dep~sslon L \\
e~ ~
-~ ~...,... l,.v ~
Dtlusion of Mis1dtntification
•
~
r-- :,\'~
Copgral' ,s a rart syndrome in which 1he patient believ es that a friend, parcn~ spouse or any family member has been replaced by an idcnt,cal looking impostor.
Jf£U6f;,/,alitJi. ✓.:; Eroto m1ni1
Frtgo/1SyndrorM •
F"fo m sy,,drorn~O is a disorder in which a person holds a dehuional belief that dl1feren1 people are In fact a single person who changes his or her appearance or is In disgu ise.
lT
Ms V, a 23•year-old woman was brought by the pol,ce alt!I being arrested for uespassing on Mr J's house . Ms V stated that she was simply entering her husband's home and was adamantly declarlng that Mr J was her husband. She described that it was a love marriage and also gave detai ls about tio-they met and how the marriage happened . On inveSligation. it was found that Mr J was her boss, a few years ago. tie had fired her because of her inappropriate romantic advances.~ V was unmarried and was staying in Chennai then. She denied these allexations, staring th~t peop le around her were plo!Mi against and cheating her. She was also in a false belief that sill may get killed by some unknown persons. Ms Vwas diagnol'O with delusional disorder, erotomanic type and persecution ai,d was started on risperidone. Othello syndrome A 29-yeu-male patient, Mr K was forcefully brou&ht by his siblings, with complaints of Insomnia and persis ' "',ifOIi tent aruie, . further quutlonlng, he said that his wile was havin& an a a, with his neigh bor, which was very dlstres.slng to him and du~ which ht used to rema in anxious the whole day. TheY clan to him that she was not havln11 an affair with their nei&hbO'· Despite eiq,lllnln&, his belief was persistent. He was st,irted Ofl \ Tab. Rlsperldont.
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---- ------------
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I
1,;011
lli,eltl 1100 • t!l1'pel0~
,i
Vi&oal halluO Nlllon
pcrup uon° without nny exter,ra/ ob•1crr or I5 false
d .,.,,,iO.•o.sa"""'' and in cond.ihons, like high fev•r • , rug
. 1 ~,··
c,d' ;o 1 and drug withdrawal. · • ,1t:.1Uo--" -
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--::::::::;;;;;;::::;;;;:=,:;;;r;;;;;.__=- -,
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l",...i hallucination : False percc'f>1ion of sense of sight , usually : l,,Jitorf ba))udnation: False perce ption of sound
,.;us. /Tll.ing IJl!adO,Y balludnatlon : False perce ption primarily inv~v smdforodors-
1
False perce ption involv ing taste. l>-c..U' Tlfa pdrtl~11l,1r obJ«
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Dr Pedagogy
Forensic Medicine
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Postmort•rn Ap p,a ran\ c,d-.. 1,,.,J.... .,qJP~ ~ \ cf\, €. q~11 ~.,, _ t wn nirnphy, cmp/y cl111111hr11• bro ull, Sm : rl • fica • f11111 ca: Streu frnc111ra• •
Oulll,hulJ cr: 1)1Ar enclcd
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& ■dlola
.
fypes:
symptom) • Olfac:IOfy • PaycllomoCor
• Tactile (Magnan•s
• Visual • Ouatatory
• Audltlxy
• Contract: Invalid • Marriage: N ull & void ~ : lnvalld
CIVtL : : : J
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1
• lnHnity: Nol responsible (Sec. 114 IPC ) • Involuntary dNnkenne n: N ot responsibl e (Sec . 85 IPC ) • Voluntary dNnkenne ss : Refip onslble ( Sec. 86 IPC)
1
C RIM INAL
1
RESPONS IBILITIES Of AN INSANE PERS ON
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• Calmd Clalualon: One II• died • ~delu 9iona: Belief a l being followed , cheated , 11a11 irwd o, ca,....,e,ed against • ttwi,ocna,ldnacal delu9ion: BelW al having Nrious dise• Oalu■iDn of lntldelil,tO hlllo sylldrome: Belief Iha! the ■peaJN .. unfallhful
• DalualanClf,.,__, Eve,ytt,ing refenlny u,. penoon
-e,...,... ,.:,.,_ •thelalac l..,nlslnl ovewUh lhem
per90 n bellevea they ere much ~ - - they nlllllypder,l 1s 11rm1y convinced 1t1at • person ha
• Dllmlon d glWldllur. The
• Daaiand oannl: ....,_ bm contrvlll ng-'s ltloughla
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lanol ■ fac:t
•Dlaardel 'clthought ....... belief In eomelhillQwhk:11
• Stimulus llbMnt • F■IM perception
8YIIPTOI IS OF MENTAL ILLNE.SS
S omnambu lism: N ol re spons,ble Automatis m : N ot responsib le
-
• Kleptoman ia: S leaUng sman value things • Pyroman ia: Setting fire • Oniomanla : Compulsi ve buying • Dipsoman ia • M utilomania
fypes:
• No mollve or Intent
• Consciou s acts
• Sudden Irresistible force
IMPULSE
,{.lo.nu .
Claustrop hobia Fea.- of he ights: Acrophobia • Fear of dal1uiess: Nyctopho bia • Fear o f dl tt: Mysophob la0 • Fea, of w a ter: Hydropho bia
• Fear of dosed spaces:
• Fear of o pen sp a ces: Agorapho bia
fypes:
• Irrational fear of a particular situation
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